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Eyeberu A, Dessie Y, Assefa N. Burden of overweight and obesity among adolescents in Ethiopia: a systematic review and meta-analysis. Int Health 2024:ihae041. [PMID: 38850065 DOI: 10.1093/inthealth/ihae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Overweight and obesity continue to escalate, despite the regulations and interventions that have been put in place. To support further policy directions, it is necessary to have pooled data that illustrate the burden of overweight and obesity among adolescents nowadays. Thus, this systematic review and meta-analysis aimed to determine the burden of overweight and obesity among Ethiopian adolescents. METHODS Embase, Science Direct, Medline, PubMed, Google Scholar and Web of Science were the databases used in the search for publications that ran from inception until 25 October 2023. STATA version 18 was used to analyze data on overweight and obesity in adolescents. Using the random effect model, the pooled estimates with 95% CIs were calculated. Using the Galbraith plot, I2 statistics and Cochrane Q statistics, heterogeneity was investigated. RESULTS In total, 20145 adolescents aged 10-19 years were included in this meta-analysis study. The pooled prevalence of overweight and obesity among adolescents in Ethiopia was 10% (95% CI 9 to 12%; I2=94.03%). There was a substantial correlation between being female (OR=1.81, 95% CI 1.47 to 2.15), attending private schools (OR=1.78, 95% CI 1.31 to 2.26), having a family size of ≥4 (OR=1.86, 95% CI 1.14 to 2.58) and being of middle economic status (OR=1.62, 95% CI 1.14 to 2.10). CONCLUSIONS In Ethiopia, one in 10 adolescents is overweight/obese. The study's findings clearly show that a large number of adolescents are dealing with this emerging public health issue. Moreover, characteristics related to physical activity, nutrition and sociodemographics were discovered to be associated with overweight and obesity. To lessen the burden of overweight and obesity, the government and other parties should work together to support gender-specific nutritional interventions, encourage healthy lifestyle choices among teenagers and facilitate these efforts.
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Affiliation(s)
- Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Nega Assefa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Jima BR, Sisay BG, Feyesa I, Hassen HY. Performance of mid-upper arm circumference to identify adolescents with obesity and metabolic syndrome: NHANES 2011-2018 analysis. Pediatr Obes 2024; 19:e13107. [PMID: 38318985 DOI: 10.1111/ijpo.13107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Mid-upper arm circumference (MUAC) was recommended for screening of adolescents with obesity, although its diagnostic performance with respect to high-precision assessment of body composition remains unknown. OBJECTIVE To evaluate the diagnostic performance of MUAC in identifying obesity and metabolic syndrome in U.S. adolescents. METHODS A cross-sectional study was conducted using National Health and Nutrition Examination Survey (NHANES) data (2011-2018) of adolescents aged 12-19. We calculated the area under the receiver operating characteristic curve, sensitivity, specificity, positive and negative predictive values and likelihood ratios of MUAC in identifying obesity and metabolic syndrome. RESULTS In our study, data of 5496 adolescents, including 2665 females, were analysed. The prevalence of obesity was higher in boys (14%) than girls (10%), whilst metabolic syndrome was more common in males (2.6%) than females (1.7%). The area under the curve (AUC) of MUAC in identifying obesity was 0.69 in boys and 0.86 in girls, whilst the AUC of MUAC in identifying metabolic syndrome was 0.91 in boys and 0.87 in girls. The optimal MUAC cut-off for identifying adolescents with obesity was 28.3 cm in boys (sensitivity: 64.8%, specificity: 85.5%) and 30.8 cm in girls (sensitivity: 67.9%, specificity: 90.1%). CONCLUSIONS MUAC was a good indicator of both obesity and metabolic syndrome, with higher accuracy in girls.
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Affiliation(s)
- Beshada Rago Jima
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Binyam Girma Sisay
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ilili Feyesa
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hamid Yimam Hassen
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Martino F, Niglio T, Barillà F, Martino E, Paravati V, Bassareo PP. The Association between Mid-Upper Arm Circumference and Blood Pressure in an Italian Population of School-Aged Children and Adolescents with Lipid Disorders. J Clin Med 2024; 13:663. [PMID: 38337357 PMCID: PMC10856649 DOI: 10.3390/jcm13030663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Many anthropometric measurements have been investigated concerning their association with blood pressure (BP) in paediatric age groups. This study aims to find a relationship between mid-upper arm circumference (MUAC) and BP in a population of children and adolescents aged 1-18 years. Methods: 5853 subjects (2977 females and 2876 males) were studied. MUAC, body mass index (BMI), and BP were measured. The individuals in the study were subdivided and grouped by gender and type of school attended in Italy: 1-5 years (pre-school), 6-10 years (primary school), 11-13 years (secondary school), 14-18 years (high school). Results: In the age range of 6-13 years, all the subjects with MUAC > 50th percentile had systolic and diastolic BP significantly higher than children with MUAC below 50th percentile (p < 0.0001). In the age range 14-18 years, the relationship persisted only in females (p < 0.001 and p < 0.05 for diastolic and systolic BP, respectively). A linear relationship was found between MUAC and BMI. Conclusions: In Italian children of both genders aged 6-13, arm distribution of body fat is strongly associated with increased systolic and diastolic BP. As such, a simple anthropometric measurement like MUAC might represent a tool to identify young subjects who are at risk for HTN.
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Affiliation(s)
- Francesco Martino
- Department of Internal Medicine, Anaesthesiology, and Cardiovascular Science, La Sapienza University, 00161 Rome, Italy; (E.M.); (V.P.)
| | | | - Francesco Barillà
- Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy;
| | - Eliana Martino
- Department of Internal Medicine, Anaesthesiology, and Cardiovascular Science, La Sapienza University, 00161 Rome, Italy; (E.M.); (V.P.)
| | - Vincenzo Paravati
- Department of Internal Medicine, Anaesthesiology, and Cardiovascular Science, La Sapienza University, 00161 Rome, Italy; (E.M.); (V.P.)
| | - Pier Paolo Bassareo
- School of Medicine, University College of Dublin, DO4 W6F6 Dublin, Ireland;
- Department of Cardiology, Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland
- Children’s Health Ireland at Crumlin, D12 N512 Dublin, Ireland
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Kowatari R, Sasaki H, Murata K, Sato K, Sagawa K, Kudo M, Minakawa M. Establishment of prediction equations for subcutaneous tissue thickness in two representative intramuscular deltoid injections. Vaccine X 2023; 14:100316. [PMID: 37275271 PMCID: PMC10239006 DOI: 10.1016/j.jvacx.2023.100316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/07/2023] Open
Abstract
This study clarifies the predicted subcutaneous shoulder depth and investigates the safety of the conventional (three-finger breadth method) and new (axillary method) intramuscular injection methods. The anatomical features of 245 volunteers who received the COVID-19 vaccination via the conventional method were investigated at the injection site (T point) and the hypothetical injection site using the new method (A point) via ultrasonography. The body mass index (BMI) and subcutaneous thickness at the T point (men: r = 0.75; women: r = 0.45) and the A point (men: r = 0.81; women: r = 0.55) were positively correlated. The upper arm circumference and subcutaneous thickness at the T point (r = 0.51) and the A point (r = 0.58) were correlated in women. Formulas to predict subcutaneous thickness using BMI and upper arm circumference were established: predicted subcutaneous thickness at the A point = 0.62 × BMI - 7.7 mm (R2 = 0.66) in men and 0.658 × BMI - 5.5 mm (R2 = 0.31) in women. This study demonstrates safe intramuscular injection sites and their depth.
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Affiliation(s)
- Ryosuke Kowatari
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Japan
| | - Hanae Sasaki
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Japan
| | - Kenyu Murata
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Japan
| | - Ken Sato
- Hirosaki University Health Administration Center, Japan
| | - Koichi Sagawa
- Hirosaki University Graduate School of Science and Technology, Japan
| | - Masako Kudo
- Hirosaki University Hospital Nursing Department, Japan
| | - Masahito Minakawa
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Japan
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Dereje R, Girma A, Molla A, Simieneh A. Mid upper arm circumference as screening tool of overweight or obesity among adult employees of Mizan Tepi University, Southwest Ethiopia. Heliyon 2022; 8:e10793. [PMID: 36211995 PMCID: PMC9535271 DOI: 10.1016/j.heliyon.2022.e10793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/14/2022] [Accepted: 09/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background Overweight or obesity is an excessive fat accumulation that impairs the health and wellbeing of the adult population throughout the world. Recently Mid upper arm circumference (MUAC) was suggested as a screening index for overweight or obesity among adolescents, but its utilization for the assessment of overweight or obesity in the adult population is not clear yet. In addition, little is known about the screening ability of MUAC for overweight or obesity in the adult population of Ethiopia. Therefore, this study aimed to evaluate the utility of MUAC for screening overweight or obesity among adult employees of Mizan Tepi University, Southwest Ethiopia. Method A Facility -based cross-sectional study was carried out from February 21 to March 20, 2020, at Mizan Tepi University. About 585 study participants were selected by gender-based stratified sampling technique. Anthropometric data like weight, height, and MUAC were collected. Pearson's correlation between MUAC, body mass index (BMI), and age was calculated to see a relationship between them. The Receiver operating characteristics (ROC) curve was calculated to identify the screening ability of MUAC for overweight or obesity. The appropriate MUAC cutoff point for both men and women established using the Youden index. Additionally, sensitivity, specificity, positive, and negative predictive values were calculated. Result The prevalence of overweight and obesity among the study participants was 18.1% and 4.8%, respectively. MUAC had a strong positive correlation with BMI, r = 0.65 (95% CI; 0.56-0.69). According to ROC analysis, MUAC is an excellent screening tool for male and female employees with excellent accuracy (AUC = 0.9 with 91.4% sensitivity and 76.4% specificity) and good accuracy (AUC = 0.83 with 67.2% sensitivity and 83.5% specificity), respectively. Based on the youden index, the cutoff point of MUAC to screen overweight or obesity among male and female employees was 26.91cm. Conclusion Mid-upper arm circumference (MUAC) has an equal ability with BMI to screen overweight or obesity among adults. Therefore, MUAC can be utilized as an alternative index to screen overweight and obesity in resource-limited setups.
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Affiliation(s)
- Rahel Dereje
- School of Public Health, College of Health Science, Mizan-Tepi University, Ethiopia
| | - Abel Girma
- School of Public Health, College of Health Science, Mizan-Tepi University, Ethiopia
| | - Abebaw Molla
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Ethiopia
| | - Asnake Simieneh
- Department of Medical Laboratory Science, College of Health Science, Mizan Tepi University, Ethiopia
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Nainggolan O, Hapsari D, Titaley CR, Indrawati L, Dharmayanti I, Kristanto AY. The relationship of body mass index and mid-upper arm circumference with anemia in non-pregnant women aged 19-49 years in Indonesia: Analysis of 2018 Basic Health Research data. PLoS One 2022; 17:e0264685. [PMID: 35239719 PMCID: PMC8893704 DOI: 10.1371/journal.pone.0264685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background and objectives Anemia remains a major public health problem worldwide. This study examined the relationship between anemia and the nutritional status of non-pregnant women aged 19–49 years in Indonesia. Methods and study design The data were derived from the 2018 Basic Health Research Data of Indonesia. We used information from 11,471 non-pregnant women aged 19–49 years. The dependent variable was anemia (hemoglobin level <12 g/dL). The independent variable was women’s nutritional status, a combined indicator of body mass index (BMI) and mid-upper arm circumference (MUAC). Our analysis controlled for women’s age, education, physical activity, fruit and vegetable consumption, and the presence of communicable or non-communicable diseases. We performed logistic regression analyses. Results The prevalence of anemia in non-pregnant women aged 19–49 years was 22.3% (95% confidence interval [CI]: 21.4–23.3). Women with overweight and obesity were less likely to develop anemia than those with a normal BMI, regardless of their MUAC score. The highest odds for developing anemia were observed in underweight women with low MUAC scores (adjusted odds ratio [aOR] = 2.83, 95%CI: 2.19–3.68). Higher odds ratios were also observed in women with insufficient physical activity, despite their sufficient consumption of fruits or vegetables (aOR = 1.87, 95%CI: 1.06–3.28). However, women who had been diagnosed with a non-communicable disease had a reduced likelihood of developing anemia (aOR = 0.75, 95%CI: 0.67–0.83). Conclusions Strengthening health promotion activities to improve nutritional status and healthy behaviors, particularly a healthy diet, remains important for women in Indonesia to reduce the prevalence of anemia and improve their overall health status.
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Affiliation(s)
- Olwin Nainggolan
- Centre for Research and Development of Public Health Efforts, National Institute Health Research and Development, Ministry of Health Republic of Indonesia, DKI Jakarta, Indonesia
| | - Dwi Hapsari
- Centre for Research and Development of Public Health Efforts, National Institute Health Research and Development, Ministry of Health Republic of Indonesia, DKI Jakarta, Indonesia
| | | | - Lely Indrawati
- Centre for Research and Development of Public Health Efforts, National Institute Health Research and Development, Ministry of Health Republic of Indonesia, DKI Jakarta, Indonesia
| | - Ika Dharmayanti
- Centre for Research and Development of Public Health Efforts, National Institute Health Research and Development, Ministry of Health Republic of Indonesia, DKI Jakarta, Indonesia
| | - Antonius Yudi Kristanto
- Centre for Research and Development of Public Health Efforts, National Institute Health Research and Development, Ministry of Health Republic of Indonesia, DKI Jakarta, Indonesia
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The performance of mid-upper arm circumference for identifying children and adolescents with overweight and obesity: a systematic review and meta-analysis. Public Health Nutr 2022; 25:607-616. [PMID: 35034665 PMCID: PMC9991645 DOI: 10.1017/s1368980022000143] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study aimed to synthesise the existing evidence on the performance of mid-upper arm circumference (MUAC) to identify children and adolescents with overweight and obesity. DESIGN Systematic review and meta-analysis. SETTING We searched PubMed, EMBASE, SCOPUS, Cochrane Library, Web of Science, CINAHL and Google scholar databases from their inception to December 10, 2021, for relevant studies. There were no restrictions regarding the language of publication. Studies reporting measures for the diagnostic performance of MUAC compared with a reference standard for diagnosing overweight and obesity in children and adolescents aged 2-19 years were included. PARTICIPANTS A total of 54 381 children and adolescents from twenty-one studies were reviewed; ten studies contributed to meta-analyses. RESULTS In boys, MUAC showed a pooled AUC of 0·92 (95 % CI 0·89, 0·94), sensitivity of 84·4 (95 % CI 84·6, 90·8) and a specificity of 86·0 (95 % CI 79·2, 90·8), when compared against BMI z-score, defined overweight and obesity. As for girls, MUAC showed a pooled AUC of 0·93 (95 % CI 0·90, 0·95), sensitivity of 86·4 (95 % CI 79·8, 91·0), specificity of 86·6 (95 % CI 82·2, 90·1) when compared against overweight and obesity defined using BMI z-scores. CONCLUSION In comparison with BMI, MUAC has an excellent performance to identify overweight and obesity in children and adolescents. However, no sufficient evidence on the performance of MUAC compared with gold standard measures of adiposity. Future research should compare performance of MUAC to the 'golden standard' measure of excess adiposity.
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Wang J, He L, Yang N, Li Z, Xu L, Li W, Ping F, Zhang H, Li Y. Large mid-upper arm circumference is associated with reduced insulin resistance independent of BMI and waist circumference: A cross-sectional study in the Chinese population. Front Endocrinol (Lausanne) 2022; 13:1054671. [PMID: 36619554 PMCID: PMC9816137 DOI: 10.3389/fendo.2022.1054671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Body mass index (BMI) is a common indicator in clinical practice, but it is not sufficient to predict insulin resistance (IR). Other anthropometric methods supplement BMI in the assessment of body composition, which can be predicted more accurately. This cross-sectional study aimed to evaluate the association between mid-upper arm circumference (MUAC), triceps skinfold (TSF) thickness, mid-arm muscle circumference (MAMC) and IR in Chinese adults. METHODS This cross-sectional study analyzed data from the 2009 China Health and Nutrition Survey database. The study population was divided into four groups according to the MUAC quartiles, and the homeostasis mode assessment was used to evaluate the degree of IR. Logistic regression analysis was performed to calculate odds ratios (ORs) with 95% confidence intervals (CIs), with adjustments for multiple covariates. Subgroup analyses stratified by age, sex, BMI, waist circumference (WC), smoking status, and alcohol consumption were performed. RESULTS In total, 8,070 participants were included in the analysis. As MUAC increased, BMI, TSF thickness, MAMC, and the proportion of IR tended to increase. However, we found that there was a significant negative association between MUAC and MAMC and IR in the logistic regression analysis, independent of BMI and WC, the ORs for the highest quartiles compared with the lowest quartiles were 0.662 (95%CI: 0.540-0.811) and 0.723 (95%CI: 0.609-0.860), respectively. There was no significant association was observed between the TSF thickness and IR (OR=1.035 [95%CI: 0.870-1.231]). The inverse associations were more pronounced among participants with lower BMI and WC. No significant age-specific differences were observed (P-heterogeneity > 0.05). CONCLUSIONS After adjusting for BMI and WC, MUAC was negatively associated with IR in Chinese adults, and the association between MUAC and IR was derived from arm muscle instead of subcutaneous fat. MUAC could be an additional predictor of IR besides BMI and WC in clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yuxiu Li
- *Correspondence: Huabing Zhang, ; Yuxiu Li,
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Shifraw T, Selling K, Worku A, Berhane HY, Ekström EC, Berhane Y. Mid-upper arm circumference for identifying adult overweight in large-scale population-based surveys: empirical evaluation using data of the EAT Addis study, Ethiopia. BMJ Open 2021; 11:e049602. [PMID: 34857561 PMCID: PMC8640627 DOI: 10.1136/bmjopen-2021-049602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The present study evaluates body circumferences as a nutrition screening tool for women of reproductive age with children less than 5 years of age to improve the detection of overweight and obesity in a community setting. DESIGN This study draws data from a community-based cross-sectional study conducted between July-August 2017 and January-February 2018 to account for seasonality in Addis Ababa, Ethiopia. SETTING One hundred and sixteen districts were included in Addis Ababa, Ethiopia. PARTICIPANTS A total of 4914 women of reproductive age with children less than 5 years of age were participated in this study. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measures included anthropometric indices. There were no secondary outcomes. RESULTS The optimal cut-off points to identify overweight women of reproductive age were >87.5 cm for waist circumference (WC), >31.7 cm for neck circumference (NC) and >28.0 cm for mid-upper arm circumference (MUAC) based on the highest corresponding Youden index. The area under the receiver operating characteristics curve was 0.92 (95% CI: 0.91 to 0.93) for WC, 0.83 (95% CI: 0.82 to 0.84) for NC and 0.91 (95% CI: 0.89 to 0.92) for MUAC. CONCLUSIONS Our result shows that WC and MUAC are alternative tools to body mass index. Both WC and MUAC are effective in identifying overweight women. We recommend using MUAC in large-scale population-based assessments to identify overweight and obesity in low-income settings as it is logistically simpler and operationally feasible.
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Affiliation(s)
- Tigest Shifraw
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Katarina Selling
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Alemayehu Worku
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- School of Public Health, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hanna Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Eva-Charlotte Ekström
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
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High Prevalence of Overweight and Its Association with Mid-Upper Arm Circumference among Female and Male Farmers in Tanzania and Mozambique. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179128. [PMID: 34501716 PMCID: PMC8431514 DOI: 10.3390/ijerph18179128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 11/17/2022]
Abstract
The increasing prevalence of overweight/obesity may already have reached the farmers in Tanzania and Mozambique. Here, the measurement of the mid-upper-arm-circumference (MUAC) could become a simple and sensitive tool for early detection of at-risk groups of overweight as well as underweight. Body Mass Index (BMI) and MUAC of female and male farmers (n = 2106) from different regions of Tanzania and the Zambézia province, Mozambique, were analyzed by region, sex, age, and correlates. MUAC cut-offs, calculated via BMI cut-offs (<18.5, ≥25, and ≥30 kg/m2), and multiple linear regression (MLR), compared to those selected by highest Youden’s index (YI) value, were assessed. The study showed an overall higher prevalence of overweight (19%) than underweight (10%) due to the high number of overweight female farmers (up to 35%) in southern Tanzania. BMI, which was mainly and positively predicted by MUAC, was higher in Tanzania and among female farmers, and decreased significantly from the age of ≥65 years. MUAC cut-offs of <24 cm and ≥30.5 cm, calculated by MLR, detected 55% of farmers being underweight and 74% being overweight, with a specificity of 96%; the higher cut-off <25 cm and lower cut-off ≥29 cm, each selected according to YI, consequently detected more underweight (80%) and overweight farmers (91%), but on the basis of a lower specificity (87–88%). Overweight was evident among female farmers in East Africa. MUAC cut-offs, whether defined via linear regression or Youden’s Index, could prove to be easy-to-use tools for large-scale screenings of both underweight and overweight.
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Nitika. Discriminatory performance of mid-upper arm circumference for identifying thin and severely thin adolescents: a secondary data analysis using Comprehensive National Nutrition Survey. Nepal J Epidemiol 2021; 11:1023-1033. [PMID: 34290892 PMCID: PMC8266405 DOI: 10.3126/nje.v11i2.33926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background Timely identification of adolescents with undernutrition is of utmost importance, and recently, mid-upper circumference (MUAC) had been considered as an alternative to body mass index (BMI) and BMI for age z-score (BAZ) for its screening. However, little is known about the MUAC cut-offs, specific to age and sex. The study was planned to assess the discriminatory performance of MUAC in identifying thin and severely thin adolescents and estimating age specific MUAC cut-offs, separately for males and females, against BAZ as the gold standard. Methods The Comprehensive National Nutrition Survey (CNNS), India data was used for this analysis. The Receiver Operating Characteristic curve (ROC), area under curve (AUC), and Youden Index were used to estimate MUAC cut-off values for thin (BAZ < -2) and severely thin (BAZ < -3) adolescents. The current analysis was done on 31471 adolescents. Results The MUAC cut-offs for identifying thin adolescents were: for 10-14 years - 19.2/19.4 cm, for 15-19 years - 22.9/21.7 cm for males and females respectively; and for severe thinness were: for 10-14 years - 18.4/18.3 cm, for 15-19 years - 21.9/20.2 cm for males/females. For thinness, the cut-off varied between 17.4-24.5 cm (for 10-19 years) among males, and for females, it varied between 17.5-20.9 cm (for 10-19 years). For severe thinness, MUAC cut-off ranged between 16.4-23.7 cm (for 10-19 years) among males, and for females, between 17.3-20.7 cm (for 10-19 years). Conclusion MUAC, a easy to use measure demonstrated an equivalent diagnostic performance for the identification of thinness and severe thinness against BAZ. Thus, age- and sex-specific cut-offs could be considered for screening thin and severely thin adolescents.
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Affiliation(s)
- Nitika
- Independent Public Health Consultant, India
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12
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Khadilkar AV, Khadilkar VV, Gondhalekar KM, Kajale NA, Karkera PH, Prasad M, Trehan A, Barr RD, Ladas EJ. Reference centile curves for mid-upper arm circumference for assessment of under- and overnutrition in school-aged Indian children and adolescents. Nutrition 2021; 91-92:111401. [PMID: 34364267 DOI: 10.1016/j.nut.2021.111401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/09/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Malnutrition is common in developing countries and is not restricted to young children. It has been suggested that measuring mid-upper arm circumference (MUAC) is an easy, accurate, and low-cost method of identifying malnutrition in the early stages. The aims of this study were to construct age- and sex-specific MUAC reference centiles, and to define and validate cutoffs for assessment of under- and overnutrition in Indian children 5 to 17 y of age. METHODS This was a cross-sectional, multicentric, observational study conducted in seven schools in seven states from June 2018 to November 2019. The study included 6680 healthy 5- to17-y-old children. MUAC was measured using non-stretch tapes (UNICEF). Sex-specific MUAC percentiles were computed for age and height. Cutoffs for MUAC z-scores for thinness and overnutrition were defined and validated for healthy school children (n = 726) and children with cancer (n = 500). RESULTS Reference centiles for MUAC for age (and height) for boys and girls are presented. Cutoffs defined for thinness and for obesity were -0.7 and +1.5 z-score, respectively (corresponding to 25th and 95th percentiles of the MUAC for age/height). For ease of use, rounded cutoffs for thinness were 16 and 18.5 cm from 5 to 9 and 10 to 14 y of age, respectively, in both sexes, and a cutoff of 22 cm in boys and 20 cm in girl from 15 to 17 y of age. For obesity, 20 and 25.5 cm from 5 to 9 and 10 to 14 y of age, respectively, in both girls and boys and a rounded cutoff of 29 cm in boys and 27 cm in girls from 15 to17 y are proposed. CONCLUSIONS We presented MUAC percentiles and cutoffs for screening for thinness and overnutrition in Indian children from 5 to 17 y of age. These data may also be used in children with cancer and other chronic disorders with growth failure.
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Affiliation(s)
- Anuradha V Khadilkar
- Paediatric Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital. Pune University, Pune, India.
| | - Vaman V Khadilkar
- Paediatric Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital. Pune University, Pune, India
| | - Ketan M Gondhalekar
- Paediatric Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital. Pune University, Pune, India
| | - Neha A Kajale
- Paediatric Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital. Pune University, Pune, India
| | - Priya H Karkera
- Fitterfly Health Technologies, Mumbai, India; Department of Nutrition, Surya Children's Hospital, Mumbai, India
| | - Maya Prasad
- Paediatric Oncology, Tata Memorial Hospital, Mumbai, India
| | - Amita Trehan
- Paediatric Haematology Oncology Unit, Advanced Pediatric Center, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ronald D Barr
- Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Elena J Ladas
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Irving Medical Center, New York, New York, USA
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Obesity and Metabolic Care of Children of South Asian Ethnicity in Western Society. CHILDREN-BASEL 2021; 8:children8060447. [PMID: 34070381 PMCID: PMC8228459 DOI: 10.3390/children8060447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/13/2021] [Accepted: 05/22/2021] [Indexed: 11/17/2022]
Abstract
South Asians constitute one-fourth of the world’s population and are distributed significantly in western countries. With exponentially growing numbers, childhood obesity is of global concern. Children of South Asian ancestry have a higher likelihood of developing obesity and associated metabolic risks. The validity of commonly used measures for quantifying adiposity and its impact on metabolic outcomes differ by race and ethnicity. In this review we aim to discuss the validity of body mass index (BMI) and other tools in screening for adiposity in South Asian children. We also discuss the prevalence of overweight and obesity amongst South Asian children in western countries and the differences in body fat percentage, adiposity distribution, and metabolic risks specific to these children compared to Caucasian children. South Asian children have a characteristic phenotype: lower lean mass and higher body fat percentage favoring central fat accumulation. Hence, BMI is a less reliable predictor of metabolic status in these children than it is for Caucasian children. Furthermore, the relatively lower birth weight and rapid growth acceleration in early childhood of South Asian children increase the risk of their developing cardiometabolic disorders at a younger age than that of Caucasians. We emphasize the need to use modified tools for assessment of adiposity, which take into consideration the ethnic differences and provide early and appropriate intervention to prevent obesity and its complications.
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