Correlates of the double burden of malnutrition among women: an analysis of cross sectional survey data from sub-Saharan Africa.
ABSTRACT: OBJECTIVE:To investigate the correlates of the double burden of malnutrition (DBM) among women in five sub-Saharan African countries. DESIGN:Secondary analysis of Demographic and Health Surveys (DHS). The outcome variable was body mass index (BMI), a measure of DBM. The BMI was classified into underweight (BMI <18.50 kg/m2), normal weight (18.50-24.99 kg/m2), overweight (25.0-29.9 kg/m2) and obesity (≥30.0 kg/m2). SETTINGS:Ghana, Nigeria, Kenya, Mozambique and Democratic Republic of Congo (DRC). SUBJECTS:Women aged 15-49 years (n=64698). RESULTS:Compared with normal weight women, number of years of formal education was associated with the likelihood of being overweight and obese in Ghana, Mozambique and Nigeria, while associated with the likelihood of being underweight in Kenya and Nigeria. Older age was associated with the likelihood of being underweight, overweight and obese in all countries. Positive associations were also observed between living in better-off households and overweight and obesity, while a negative association was observed for underweight. Breastfeeding was associated with less likelihood of underweight in DRC and Nigeria, obesity in DRC and Ghana, overweight in Kenya and overweight and obesity in Mozambique and Nigeria relative to normal weight. CONCLUSIONS:Our analysis reveals that in all the countries, women who are breastfeeding are less likely to be underweight, overweight and obese. Education, age and household wealth index tend to associate with a higher likelihood of DBM among women. Interventions to address DBM should take into account the variations in the effects of these correlates.
Project description:This study examined the socio-demographic factors associated with normal linear growth among pre-school children living in better-off households, using survey data from Ghana, Kenya, Nigeria, Mozambique and Democratic Republic of Congo (DRC). The primary outcome variable was child height-for-age z-scores (HAZ), categorised into HAZ?-2SD (normal growth/not stunted) and HAZ<-2 (stunted). Using logistic regression, we estimated adjusted odds ratios (aORs) of the factors associated with normal growth. Higher maternal weight (measured by body mass index) was associated with increased odds of normal growth in Mozambique, DRC, Kenya and Nigeria. A unit increase in maternal years of education was associated with increased odds in normal growth in DRC (aOR = 1.06, 95% CI = 1.03, 1.09), Ghana (aOR = 1.08, 95% CI = 1.04, 1.12), Mozambique (aOR = 1.08, 95% CI = 1.05, 1.11) and Nigeria (aOR = 1.07, 95% CI = 1.06, 1.08). A year increase in maternal age was positively associated with normal growth in all the five countries. Breastfeeding was associated with increased odds of normal growth in Nigeria (aOR = 1.30, 95% CI = 1.16, 1.46) and Kenya (aOR = 1.37, 95% CI = 1.05, 1.79). Children of working mothers had 25% (aOR = 0.75, 95% CI = 0.60, 0.93) reduced odds of normal growth in DRC. A unit change in maternal parity was associated with 10% (aOR = 0.90, 95% CI = 0.84, 0.97), 23% (aOR = 0.77, 95% CI = 0.63, 0.93), 25% (aOR = 0.75, 95% CI = 0.69, 0.82), 6% (aOR = 0.94, 95% CI = 0.89, 0.99) and 5% (aOR = 0.95, 95% CI = 0.92, 0.99) reduced odds of normal growth in DRC, Ghana, Kenya, Mozambique and Nigeria, respectively. A child being a male was associated with 18% (aOR = 0.82, 95% CI = 0.68, 0.98), 40% (aOR = 0.60, 95% CI = 0.40, 0.89), 37% (aOR = 0.63, 95% CI = 0.51, 0.77) and 21% (aOR = 0.79, 95% CI = 0.71, 0.87) reduced odds of normal child growth in DRC, Ghana, Kenya and Nigeria, respectively. In conclusion, maternal education, weight, age, breastfeeding and antenatal care are positively associated with normal child growth. In contrast, maternal parity, employment, and child sex and age are associated negatively with normal growth. Interventions to improve child growth should take into account these differential effects.
Project description:High early morbidity and mortality following antiretroviral therapy (ART) initiation has been a distinguishing feature of ART programmes in resource limited settings (RLS) compared to high-income countries. This study assessed how well body mass index (BMI: kg/m2) correlated with survival among HIV infected patients with and without TB co-infection.We retrospectively evaluated clinical data from 1000 HIV infected patients, among whom 389 were also co-infected with TB, between January 2008 and December 2010, in KwaZulu-Natal, South Africa.Among 948 patients eligible for analysis, 15.7% (149/948) were underweight (<?18.50), 55.9% (530/948) had normal BMI (?18.50-24.90), 18.7% (177/948) were overweight (25.00-29.00) and 9.7% (92/948) were obese (?30.00). Irrespective of TB status, underweight patients, had significantly higher risk of death compared to those with normal BMI at baseline (aHR?=?2.9; 95% CI: 1.5-5.7; P?=?0.002).Irrespective of TB co-infection, low BMI correlated with mortality in HIV infected patients.UKZN Biomedical Research Ethics Committee Reference number E 248/05, 23 September 2005.
Project description:The double burden of malnutrition (DBM) is characterized by the coexistence of underweight and overweight individuals in a population. The objective of this study was to assess the level of DBM, as well as its main determinants, in women in South and Southeast Asia. We searched scientific literature databases, including PubMed, EMBASE, CINAHL, and Google Scholar; gray literature; and reference lists from primary research published between 1969 and September 30, 2017. In total, 128 studies met our inclusion criteria, representing data of ?5 million women >15 y of age from South and Southeast Asia. The findings show that prevalence rates of underweight and overweight varied by study from 7.0% to 61.0% and 1.0% to 64.0%, respectively. For the total study period, the pooled prevalence of underweight and overweight was 28% (95% CI: 25%, 31%) and 17% (95% CI: 15%, 19%) in South Asia, respectively, and 20% (95% CI: 15%, 26%) and 20% (95% CI: 15%, 24%) in Southeast Asia, respectively. In both regions, underweight was more prevalent in rural areas, among women of the youngest age group (15-19 y), and among those in the poorest wealth quintile. In contrast, overweight was higher in urban areas, among women of older age, and among those in the wealthiest households. This study also found that prevalence of overweight has recently exceeded that for underweight in this population.
Project description:BACKGROUND/OBJECTIVES:Urbanization and lifestyle changes have resulted in nutrition transition. Over-nutrition causes obesity increase, although malnutrition still exists. This phenomenon is called a double burden of malnutrition (DBM). This study was conducted to confirm the existence of DBM and to investigate the dietary factors related to DBM in Indonesian adults. SUBJECTS/METHODS:Data for the subjects (51 men and 89 women) who are the adults resided in Malang, Indonesia were collected between July 17 and August 14, 2017, by using questionnaire. Height, weight, waist and hip circumference, blood pressure, blood glucose, total cholesterol, and hemoglobin were also measured for the subjects. RESULTS:The average age of the subjects was 47.2 years. The average height, weight, and body mass index for men were 160.08 cm, 62.6 kg and 25.45 kg/m2, respectively, and those for women were 148.74 cm, 58.09 kg, and 26.21 kg/m2, respectively. Of the subjects, 3.6% were underweight, 24.3% were normal or healthy weight, while 72.2% were overweight and obese. Analysis of the dietary intakes revealed high for cereal (7.73 points), but very low for milk (0.25 points) and fruits (0.51 points). Dietary diversity was very few overall (< 5). The occurrence of both anemia (23.6%) and chronic diseases such as hypertension (57.1%), diabetes (12.1%), and hypercholesterolemia (3.6%) was considerably high. The existence of DBM was confirmed by 16.4% of the subjects. DBM was observed significantly higher in women than in men. Dietary diversity and DBM occurrence were inversely correlated. On average, the number of chronic diseases was 1.08 in men and 1.79 in women. Dietary diversity inversely affected systolic blood pressure. CONCLUSIONS:DBM existed in adults in Malang, Indonesia due to inadequate dietary intakes, and a high rate of chronic diseases.
Project description:Data on the allele and genotype frequencies of the five single nucleotide polymorphisms (SNPs) 5 genes - rs1514175 TNNI3K, rs713586 RBJ, rs887912 FANCL, rs2241423 MAP2K5, rs12444979 GPRC5B in Russian women are presented. Several genome-wide association studies identified these SNPs could be significant genetic markers associated with body mass index (BMI). Standard methods were used for collecting of the anthropometric characteristics (height and weight). We calculated the frequencies of alleles and genotypes of five SNPs in 5 groups: all samples, underweight (BMI<18.50), normal weight (18.50-24.99), overweight (25.00-29.99), obese (>30.00).
Project description:BACKGROUND:Maternal stature and body mass indices (BMI) of non-pregnant women (NPW) of child bearing age are relevant to maternal and offspring health. The objective was to compare anthropometric indices of NPW in four rural communities in low- to low-middle income countries (LMIC). METHODS:Anthropometry and maternal characteristics/household wealth questionnaires were obtained for NPW enrolled in the Women First Preconception Maternal Nutrition Trial. Body mass index (BMI, kg/m2) was calculated. Z-scores were determined using WHO reference data. RESULTS:A total of 7268 NPW participated in Equateur, DRC (n = 1741); Chimaltenango, Guatemala (n = 1695); North Karnataka, India (n = 1823); and Thatta, Sindh, Pakistan (n = 2009). Mean age was 23 y and mean parity 1.5. Median (P25-P75) height (cm) ranged from 145.5 (142.2-148.9) in Guatemala to 156.0 (152.0-160.0) in DRC. Median weight (kg) ranged from 44.7 (39.9-50.3) in India to 52.7 (46.9-59.8) in Guatemala. Median BMI ranged from 19.4 (17.6-21.9) in India to 24.9 (22.3-28.0) in Guatemala. Percent stunted (<-2SD height for age z-score) ranged from 13.9% in DRC to 80.5% in Guatemala; % underweight (BMI <18.5) ranged from 1.2% in Guatemala to 37.1% in India; % overweight/obese (OW, BMI ?25.0) ranged from 5.7% in DRC to 49.3% in Guatemala. For all sites, indicators for higher SES and higher age were associated with BMI. Lower SES women were underweight more frequently and higher SES women were OW more frequently at all sites. Younger women tended to be underweight, while older women tended to be OW. CONCLUSIONS:Anthropometric data for NPW varied widely among low-income rural populations in four countries located on three different continents. Global comparisons of anthropometric measurements across sites using standard reference data serve to highlight major differences among populations of low-income rural NPW and assist in evaluating the rationale for and the design of optimal intervention trials. TRIAL REGISTRATION:ClinicalTrials.gov # NCT01883193 (18 June 2013, retrospectively registered).
Project description:BACKGROUND:Obesity is a risk factor for breast cancer (BC) development, recurrence, and death. In view of this, we aimed to investigate the clinical value of obesity in BC patients treated with anti-HER2 therapies in the NeoALTTO trial, which randomized 455 patients to neo-adjuvant lapatinib, trastuzumab, or their combination plus paclitaxel. METHODS:Patients were classified according to their basal body mass index (BMI) into underweight (<?18.5?kg/m2), normal (??18.5; <?25?kg/m2), overweight (??25; <?30?kg/m2), and obese (??30?kg/m2) WHO categories. Univariate and multivariate logistic regression analyses were performed using BMI as a categorical variable. Pathological complete response (pCR) and event-free survival (EFS) were the NeoALTTO primary and secondary outcomes, respectively. RESULTS:Among 454 patients analyzed, 14 (3%), 220 (48%), 137 (30%), and 83 (18%) were classified as underweight, normal weight, overweight, and obese, respectively; 231 (51%) and 223 (49%) had hormone receptor (HR)-positive and HR-negative primary tumors; 160 (35%) achieved pCR. In the overall patient population, no association was found between BMI groups and pCR, as we reported pCR rates of 57.1%, 35%, 30.7%, and 39.8% in underweight, normal weight, overweight, and obese cases, respectively. In contrast, in HR-positive tumors, overweight or obesity was generally associated with decreased likelihood of achieving a pCR independently of other clinical variables, including planned surgery, nodal status, and tumor size (odds ratio [OR]?=?0.55, 95%CI 0.30-1.01, as compared to normal or underweight; p =?0.053); notably, no differential effect of BMI with respect to pCR was observed in HR-negative cases (odds ratio [OR]?=?1.30, 95%CI 0.76-2.23, as compared to normal or underweight; p =?0.331), resulting in a statistically significant interaction between BMI and HR status (p =?0.036). There was no association between BMI and EFS neither in the overall nor in the HR-positive population, but this analysis was under-powered. CONCLUSIONS:NeoALTTO patients overweight or obese at baseline and with HR-positive primary BC appeared less likely to achieve pCR after neo-adjuvant anti-HER2 therapies. This finding paves the way to future research in targeting the interplay between HER2/HR signaling and metabolism.
Project description:Background:Despite increasing research on the double burden of malnutrition (DBM; i.e., coexisting over- and undernutrition), there is no global consensus on DBM definitions. Objectives:To identify published operational DBM definitions, measure their frequency of use, and discuss implications for future assessment. Methods:Following a structured search of peer-reviewed articles with terms describing "overnutrition" [e.g., overweight/obesity (OW/OB)] and "undernutrition" (e.g., stunting, micronutrient deficiency), we screened 1920 abstracts, reviewed 500 full texts, and extracted 623 operational definitions from 239 eligible articles. Results:We organized three identified DBM dimensions (level of assessment, target population, and forms of malnutrition) into a framework for building operational DBM definitions. Frequently occurring definitions included coexisting: 1) OW/OB and thinness, wasting, or underweight (n = 289 occurrences); 2) OW/OB and stunting (n = 161); 3) OW/OB and anemia (n = 74); and 4) OW/OB and micronutrient deficiency (n = 73). Conclusions:Existing DBM definitions vary widely. Putting structure to possible definitions may facilitate selection of fit-for-purpose indicators to meet public health priorities.
Project description:The prognostic implications of very low body mass index (BMI) values remain unclear in patients with acute decompensated heart failure (ADHF). This study aimed to investigate the prognostic impact of BMI classification based on the World Health Organization criteria in patients with ADHF. Among 3509 patients with ADHF and available BMI data at discharge in 19 participating hospitals in Japan between October 2014 and March 2016, the study population was divided into five groups; (1) Severely underweight: BMI?<?16 kg/m2, (2) Underweight: BMI???16 kg/m2 and?<?18.5 kg/m2, (3) Normal weight: BMI???18.5 kg/m2 and?<?25 kg/m2, (4) Overweight: BMI???25 kg/m2 and?<?30 kg/m2 (5) Obese: BMI???30 kg/m2. The primary outcome measure was all-cause death. The median follow-up duration was 471 days, with 96.4% follow up at 1-year. The cumulative 1-year incidence of all-cause death was higher in underweight groups, and lower in overweight groups (Severely underweight: 36.3%, Underweight: 23.9%, Normal weight: 14.4%, Overweight: 7.9%, and Obese: 9.0%, P?<?0.001). After adjusting confounders, the excess mortality risk remained significant in the severely underweight group (HR, 2.32; 95%CI, 1.83–2.94; P?<?0.001), and in the underweight group (HR, 1.31; 95%CI, 1.08–1.59; P?=?0.005) relative to the normal weight group, while the lower mortality risk was no longer significant in the overweight group (HR, 0.82; 95%CI, 0.62–1.10; P?=?0.18) and in the obese group (HR, 1.09; 95%CI, 0.65–1.85; P?=?0.74). Very low BMI was associated with a higher risk for one-year mortality after discharge in patients with ADHF.
Project description:BACKGROUND:To determine the association between malnutrition and early childhood caries (ECC) in children resident in sub-urban, Nigeria. METHODS:This study was a subset of a larger cross-sectional study the data of which was generated through a household survey conducted in Ile-Ife, Nigeria. The study's explanatory variable was malnutrition (underweight, overweight, wasting and stunting) and the outcome variable was ECC. Poisson regression analysis was used to determine the association between ECC and malnutrition. Variables (sex, frequency of sugar consumption, maternal knowledge of oral hygiene, oral hygiene status) associated with ECC in the primary study were adjusted for to obtain the adjusted prevalence ratio (APR). RESULTS:Of the 370 children, 20 (5.41%) were underweight, 20 (5.41%) were overweight, 67 (18.11%) were wasting, 120 (32.43%) were stunted and 18 (4.86%) had ECC. Factors associated with ECC were being stunted, underweight, overweight and fair oral hygiene. The prevalence of ECC was lower in children who were stunted (APR: 0.14; 95% CI: 0.03-0.69; p?=?0.02), almost seven times higher in children who were overweight (APR: 6.88; 95% CI: 1.83-25.85; p?<?0.001), and predictively absent in children who were underweight (APR: 0; 95% CI: 0-0; p?<?0.001) when compared with children who had normal weight. Non-significant risk indicators for ECC included consuming sugar between meals three times a day or more, having low socioeconomic status and being female. CONCLUSIONS:For this study population, the indicators of malnutrition - being stunted, underweight, overweight - and fair oral hygiene were risk indicators for ECC. The frequency of sugar consumption was not a significant risk indicator when malnutrition was included as an explanatory variable for ECC in the study population.