Childhood Dual Burden of Under- and Overnutrition in Low- and Middle-inCome Countries: A Critical Review

In low- and middle income countries, the distribution of childhood nutritional diseases is shifting from a predominance of undernutrition to a dual burden of under- and overnutrition. This novel and complex problem challenges governments and health organizations to tackle opposite ends of the malnutrition spectrum. The dual burden may manifest within a community, household, or individual, but these different levels have not been addressed collectively

Prevalence and trends in the childhood dual burden of malnutrition in low- and middle-income countries, 1990–2012

Abstract Objective To describe trends in country- and individual-level dual burden of malnutrition in children <5 years, and age-stratified (<2 years, ≥2 years) country-level trends, in thirty-six low- and middle-income countries (LMIC). Design Using repeated cross-sectional nationally representative data, we calculated the prevalence of malnutrition (stunting, wasting, overweight) at each survey wave, annualized rates of prevalence change for each country over time, and trends before and after 2000, for all children <5 years and separately for those </≥2 years. We examined country- (ratio of stunting to overweight) and individual-level (coexistence of stunting and overweight) dual burden in children <5 years. Setting Demographic and Health Surveys from thirty-six LMIC between 1990 and 2012. Subjects Children <5 years. Results Overall malnutrition prevalence decreased in children <5 years, driven by stunting decreases. Stunting rates decreased in 78 % of countries, wasting rates decreased in 58 % of countries and overweight rates increased in 36 % of countries. Rates of change differed for children </≥2 years, with children <2 years experiencing decreases in stunting in fewer countries yet increases in overweight in more countries. Countries with nearly equal prevalences of stunting and overweight in children <5 years increased from 2000 to the final year. Within a country, 0·3–10·9 % of children <5 years were stunted and overweight, and 0·6–37·8 % of stunted children <5 years were overweight. Conclusions The dual burden exists in children <5 years on both country and individual levels, indicating a shift is needed in policies and programmes to address both sides of malnutrition. Children <2 years should be identified as a high-risk demographic

Quantifying the urban environment: A scale measure of urbanicity outperforms the urban–rural dichotomy

The rapid urbanization of the developing world has important consequences for human health. Although several authorities have called for better research on the relationships between urbanicity and health, most researchers still use a poor measurement of urbanicity, the urban-rural dichotomy. Our goal was to construct a scale of urbanicity using community level data from the Cebu Longitudinal Health and Nutrition Survey. We used established scale development methods to validate the new measure and tested its performance against the dichotomy. The new scale illustrated misclassification by the urban-rural dichotomy, and was able to detect differences in urbanicity, both between communities and across time, that were not apparent before. Furthermore, using a continuous measure of urbanicity allowed for better illustrations of the relationships between urbanicity and health. The new scale is a better measure of urbanicity than the traditionally used urban-rural dichotomy

Maturational timing and overweight prevalence in US adolescent girls

OBJECTIVES: This study examined the relation of age at menarche to overweight in US adolescent girls. METHODS: Effects of age at menarche and race/ethnicity on overweight were estimated via logistic regression, after adjustment for sociodemographic characteristics, in a sample of 6507 Hispanic, Black, White, and Asian American girls who participated in wave 2 of the National Longitudinal Study of Adolescent Health. RESULTS: Overweight prevalence rates were significantly higher in early maturing adolescents of all racial/ethnic groups but highest (57.5%) among early maturing Black girls. Early maturation nearly doubled the odds of being overweight (body mass index at or above the 85th percentile). CONCLUSIONS: Greater public health attention should be focused on the high prevalence of overweight, particularly among minority female adolescents

Screen time and physical activity during adolescence: longitudinal effects on obesity in young adulthood

<p>Abstract</p> <p>Background</p> <p>The joint impact of sedentary behavior and physical activity on obesity has not been assessed in a large cohort followed from adolescence to adulthood.</p> <p>Methods</p> <p>Nationally representative longitudinal data from Waves II (1995; mean age: 15.9) and III (2001; mean age: 21.4) of the National Longitudinal Study of Adolescent Health (n = 9,155) were collected. Sex-stratified multivariate logistic regression analysis assessed the odds of obesity associated with Wave II MVPA and screen time, controlling for sociodemographic characteristics and change in MVPA and screen time from Wave II to III. Obesity was defined using body mass index (BMI, kg/m²) International Obesity Task Force cut-points at Wave II and adult cut-points at Wave III (BMI ≥ 30).</p> <p>Results</p> <p>In males, adjusted odds of prevalent obesity was strongly predicted by MVPA bouts [OR (95% CI): OR_{6 vs. 1 MVPA bouts}= 0.50 (0.40, 0.62); OR_{4 vs. 40 hrs screen time}= 0.83 (0.69, 1.00)]. In females, greater MVPA bouts and lower screen time correlated with lower prevalent obesity [OR (95% CI): OR_{6 vs. 1 MVPA bouts}= 0.67 (0.49, 0.91); OR_{4 vs. 40 hrs screen time}= 0.67 (0.53, 0.85)]. Longitudinally, adolescent screen time hours had a stronger influence on incident obesity in females [OR (95% CI): OR_{4 vs. 40 hrs}= 0.58 (0.43, 0.80)] than males [OR (95% CI): OR_{4 vs. 40 hrs}= 0.78 (0.61, 0.99)]. Longitudinal activity patterns were not predictive of incident obesity.</p> <p>Conclusion</p> <p>Reducing screen time during adolescence and into adulthood may be a promising strategy for reducing obesity incidence, especially in females.</p

Screen time and physical activity during adolescence: longitudinal effects on obesity in young adulthood

<p>Abstract</p> <p>Background</p> <p>The joint impact of sedentary behavior and physical activity on obesity has not been assessed in a large cohort followed from adolescence to adulthood.</p> <p>Methods</p> <p>Nationally representative longitudinal data from Waves II (1995; mean age: 15.9) and III (2001; mean age: 21.4) of the National Longitudinal Study of Adolescent Health (n = 9,155) were collected. Sex-stratified multivariate logistic regression analysis assessed the odds of obesity associated with Wave II MVPA and screen time, controlling for sociodemographic characteristics and change in MVPA and screen time from Wave II to III. Obesity was defined using body mass index (BMI, kg/m²) International Obesity Task Force cut-points at Wave II and adult cut-points at Wave III (BMI ≥ 30).</p> <p>Results</p> <p>In males, adjusted odds of prevalent obesity was strongly predicted by MVPA bouts [OR (95% CI): OR_{6 vs. 1 MVPA bouts}= 0.50 (0.40, 0.62); OR_{4 vs. 40 hrs screen time}= 0.83 (0.69, 1.00)]. In females, greater MVPA bouts and lower screen time correlated with lower prevalent obesity [OR (95% CI): OR_{6 vs. 1 MVPA bouts}= 0.67 (0.49, 0.91); OR_{4 vs. 40 hrs screen time}= 0.67 (0.53, 0.85)]. Longitudinally, adolescent screen time hours had a stronger influence on incident obesity in females [OR (95% CI): OR_{4 vs. 40 hrs}= 0.58 (0.43, 0.80)] than males [OR (95% CI): OR_{4 vs. 40 hrs}= 0.78 (0.61, 0.99)]. Longitudinal activity patterns were not predictive of incident obesity.</p> <p>Conclusion</p> <p>Reducing screen time during adolescence and into adulthood may be a promising strategy for reducing obesity incidence, especially in females.</p

Impact of lipid-based nutrient supplementation (LNS) on children\u27s diet adequacy in Western Uganda

Lipid-based nutrient supplements (LNS) can help treat undernutrition; however, the dietary adequacy of children supplemented with LNS, and household utilisation patterns are not well understood. We assessed diet adequacy and the quality of complementary foods by conducting a diet assessment of 128 Ugandan children, ages 6-59 months, who participated in a 10-week programme for children with moderate acute malnutrition (MAM, defined as weight-for-age z-score \u3c -2). Caregivers were given a weekly ration of 650 kcal day (-1) (126 g day(-1)) of a peanut/ soy LNS. Two 24-h dietary recalls were administered per child. LNS was offered to 86% of targeted children at least once. Among non-breastfed children, over 90% met their estimated average requirement (EAR) cut-points for all examined nutrients. Over 90% of breastfed children met EAR cut-points for nutrient density for most nutrients, except for zinc where 11.7% met cut-points. A lower proportion of both breastfed and non-breastfed children met adjusted EARs for the specific nutritional needs of MAM. Fewer than 20% of breastfed children met EAR nutrient-density guidelines for MAM for zinc, vitamin C, vitamin A and folate. Underweight status, the presence of a father in the child\u27s home, and higher programme attendance were all associated with greater odds of feeding LNS to targeted children. Children in this community-based supplemental feeding programme who received a locally produced LNS exhibited substantial micronutrient deficiencies given the special dietary needs of this population. These results can help inform programme strategies to improve LNS targeting, and highlight potential nutrient inadequacies for consumers of LNS in community-based settings

Adiposity and Chronic Inflammation in Young Women Predict Inflammation during Normal Pregnancy in the Philippines

Background: Rates of overweight and obesity are on the rise globally, and excess adipose tissue may contribute to elevations in inflammation during pregnancy, leading to pregnancy complications and adverse birth outcomes

Longitudinal, cross-cohort comparison of physical activity patterns in Chinese mothers and children

BACKGROUND: There is limited evidence comparing adult and child physical activity (PA) trends and examining parent–child PA associations within a newly industrialized country setting. PA research within a newly industrialized country setting is particularly important given the negative effects of rapid urbanization, socioeconomic growth, and technological advances on PA behaviors. The purpose of our study was to examine trends and associations in PA behaviors in Chinese mother-child pairs and to investigate relationships between PA behaviors and socioeconomic variables in this dyad. METHODS: We studied PA behaviors in 2 separate cohorts of mother-child pairs (n = 353) followed over a 2–4 year time period using longitudinal data from the China Health and Nutrition Survey (2000 Cohort: 2000–2004; 2004 Cohort: 2004–2006). Comparable mother-child PA behaviors included total metabolic equivalent hours per week (MET-hrs/wk) from active commuting, leisure-time sports, and sedentary behaviors. Logistic regression models were used to examine associations between mother and child PA and relationships between PA behaviors and socioeconomic variables. RESULTS: Children experienced increases in active commuting and leisure-time sports activities with increasing child age, whereas mothers experienced temporal declines in active commuting and minimal change in leisure-time sports activity. Sedentary behavior was high for children and mothers over time. Mother-child associations were positive for active commuting and leisure-time sports activities and negative for sedentary behavior (P < 0.05). Maternal education was associated with a greater likelihood of high leisure-time sports activity and high sedentary behavior in mothers but not in children (P < 0.05). CONCLUSION: Efforts to reduce sedentary behavior in Chinese mothers and children are imperative. While increased leisure-time and active commuting activities in children is encouraging, continued PA promotion in children and more intensive efforts to promote leisure-time sports and active commuting in mothers is needed

Longitudinal Trends in Obesity in the United States From Adolescence to the Third Decade of Life

No longitudinal analyses using national data have evaluated the increase in obesity from adolescence into early adulthood. We examined obesity incidence, persistence, and reversal in a nationally representative cohort of US teens followed into their early 30’s, using measured height and weight data, in individuals enrolled in wave II (1996; 12–21 years), wave III (2001; 17–26 years), and wave IV (2008 early release data; 24–32 years) of the National Longitudinal Study of Adolescent Health [N=8,675]. Obesity was defined as a BMI≥95th percentile of the 2000 CDC/NCHS growth charts for adolescents or ≥30 kg/m2for individuals ≤20 years and ≥30 kg/m2 in individuals>20 years. In 1996, 13.3% of adolescents were obese. By 2008, obesity prevalence increased to 36.1%, and was highest among non-Hispanic black females (54.8%). Ninety percent of the obese adolescents remained obese in 2008. While annual obesity incidence did not decline in the total sample across the 2 study intervals (2.3% per year 1996–2001 vs. 2.2% per year 2001–2008), rates among white females declined (2.7% to 1.9% per year) and were highest among non-Hispanic black and Hispanic females (3.8% and 2.7% per year, 1996–2001 vs. 3.0% and 2.6% per year, respectively, 2002–2008). Obesity prevalence doubled from adolescence to the early 20’s, and doubled again from the early to late 20’s or early 30’s, with strong tracking from adolescence into adulthood. This trend is likely to continue owing to high rates of pediatric obesity. Effective preventive and treatment efforts are critically needed