Mapping child growth failure across low- and middle-income countries

Child growth failure (CGF), manifested as stunting, wasting, and underweight, is associated with high 5 mortality and increased risks of cognitive, physical, and metabolic impairments. Children in low- and middle-income countries (LMICs) face the highest levels of CGF globally. Here we illustrate national and subnational variation of under-5 CGF indicators across LMICs, providing 2000–2017 annual estimates mapped at a high spatial resolution and aggregated to policy-relevant administrative units and national levels. Despite remarkable declines over the study period, many LMICs remain far from the World Health 10 Organization’s ambitious Global Nutrition Targets to reduce stunting by 40% and wasting to less than 5% by 2025. Large disparities in prevalence and rates of progress exist across regions, countries, and within countries; our maps identify areas where high prevalence persists even within nations otherwise succeeding in reducing overall CGF prevalence. By highlighting where subnational disparities exist and the highest-need populations reside, these geospatial estimates can support policy-makers in planning locally 15 tailored interventions and efficient directing of resources to accelerate progress in reducing CGF and its health implications

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

Forouzanfar MH, Afshin A, Alexander LT, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. LANCET. 2016;388(10053):1659-1724.Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57.8% (95% CI 56.6-58.8) of global deaths and 41.2% (39.8-42.8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211.8 million [192.7 million to 231.1 million] global DALYs), smoking (148.6 million [134.2 million to 163.1 million]), high fasting plasma glucose (143.1 million [125.1 million to 163.5 million]), high BMI (120.1 million [83.8 million to 158.4 million]), childhood undernutrition (113.3 million [103.9 million to 123.4 million]), ambient particulate matter (103.1 million [90.8 million to 115.1 million]), high total cholesterol (88.7 million [74.6 million to 105.7 million]), household air pollution (85.6 million [66.7 million to 106.1 million]), alcohol use (85.0 million [77.2 million to 93.0 million]), and diets high in sodium (83.0 million [49.3 million to 127.5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Copyright (C) The Author(s). Published by Elsevier Ltd

Malnutrition and obesity: Mexico’s double burden

Tema del mesEn México, al igual que varios países del mundo, nos enfrentamos a un grave problema de mala nutrición. Por un lado, todavía más de un millón de niños tienen retardo en crecimiento y, por el otro, el sobrepeso y la obesidad aquejan a millones de personas en el país, situación que sin duda conlleva a la aparición más frecuente de enfermedades crónicas como la diabetes y la hipertensión. Los patrones de consumo de nuestro país se caracterizan por un alto consumo de alimentos y bebidas densas en energía, bajas en fibra, vitaminas y minerales, que contribuyen a la epidemia del sobrepeso y la obesidad. Al respecto, es importante rescatar y orientar a la población a la preferencia de alimentos tradicionales como el frijol, quelites, maíz y amaranto, entre otros, así como de frutas y verduras naturales, además de desincentivar el consumo de alimentos procesados y bebidas azucaradas.In Mexico, like in other world countries, we face a serious malnutrition problem: By one side more than a million of children have growth delay and -in the other hand- overweight and obesity affect millions of people throughout the country, this undoubtedly carry out an increase in the frequency of Diabetes and Hypertension. Feeding patterns in our country are characterized by a high consumption of dense-energy foods and beverages, poor in fiber, vitamins and minerals, this contributes to the overweight and obesity epidemics. Taking this into account it would be important to rescue and aim the population feeding patterns to traditional foods like beans, quelites, maize, amaranth among others as well as natural fruits and vegetables, and at the same time to discourage the processed food and sweetened beverages consumption

Consumo de alimentos en América Latina y el Caribe

El cambio en el patrón alimentario en los países de América latina y en los estilos de vida de la población, se han visto afectados durante las últimas décadas debido a los procesos de globalización y por el urbanismo. Según datos del 2009 de FAOSTAT, muestran que en 29 países de América Latina y el Caribe (Suriname carece de información), el trigo, el arroz, el maíz y el azúcar sin refinar son los productos básicos de mayor disponibilidad. El suministro per cápita en todos los países de la región de energía total, muestra que existe un mayor suministro de kilocalorías provenientes de productos de origen vegetal que de productos de origen animal; países como Barbados, Brasil, Cuba, Dominicana, México y Venezuela tienen un suministro de kilocalorías per cápita mayor o igual a las 3000 kilocalorías al día. Haití es el único país con un suministro menor a 2000 kilocalorías/día.El suministro de proteína per cápita en total muestra que Antigua y Barbuda, Argentina, Bahamas, Barbados, Brasil, Chile, Cuba, Dominica, México y Venezuela tienen un suministro per cápita de proteína mayor a los 80 gramos al día, mientras que Ecuador, Haití, República Dominicana y Suriname tienen un suministro menor a los 60 g/d. El suministro de grasa per cápita en total, muestra que Argentina, Brasil y Barbados superan el suministro de 100 gramos de grasa al día per cápita, en contraste a Perú y Haití que presentan el suministro más bajo rebasando apenas los 40 g/d.Feeding and lifestyle patterns in Latin America have being affected during the last decades due to globalization and urbanization processes. According to FAOSTAT data from 2009, 29 Latin America and Caribbean countries (Surinam has no data) wheat, rice, corn and unrefined sugar are the basic products with greater availability. Per-capita energy availability in all the region countries shows that a higher amount of kilocalories comes from vegetal products than those of animal ones; countries like Barbados, Brazil, Cuba, Dominican Republic, Mexico and Venezuela have daily Per-capita energy availability above 3000 kcal. Haiti is the only country with under the 2000 kcal/day. Protein availability per-capita shows ciphers above 80g/day for Antigua & Barbuda, Argentina, Bahamas, Barbados, Brazil, Chile, Cuba, Dominica, Mexico and Venezuela , whereas countries like Ecuador, Haiti, Dominican Republic and Suriname are under 60g/day.Fat per-capita availability shows that Argentina, Brazil and Barbados are above 100g/day in contrast with Peru and Haiti both with the lowest availability barely above 40g/day

Maternal Characteristics Determine Stunting in Children of Less than Five Years of Age Results from a National Probabilistic Survey

Background Maternal nutrition and some variables are the main determining factors of birthweight and delayed intrauterine growth of children. Objective To explore the association between the mothers’ biological and sociodemographic characteristics, and the anthropometry status in children under five years of age. Design The population consisted of a sub-sample of 1,047 mother-and-child selected pairs from the probabilistic National Nutrition Survey, carried out in Mexico. Mother-and-child pairs included mothers aged 12 to 49 years, with children under five years of age. Data on sociodemographic characteristics, obstetric history, 24-hour recall dietary intake, and the women and children's anthropometry were collected. The association between maternal characteristics and children's anthropometry status was assessed using multiple logistic regression models. Result Nearly 16.7% of the children 2y). The height/age of the children was severely affected by maternal height and birth order. In addition, the interaction between socioeconomic level and maternal schooling had a marginal effect (p = 0.09) in the ≤2y group. On the other hand, whether the family received social services and the interaction between maternal height and a dichotomy urbanism variable were significant (p = 0.05) and (p 2y group. Conclusion Some biological and socioeconomic characteristics among mothers have a negative effect on their children's attained size, especially in the period between 2 and 5 years of age

Association between High Waist-to-Height Ratio and Cardiovascular Risk among Adults Sampled by the 2016 Half-Way National Health and Nutrition Survey in Mexico (ENSANUT MC 2016)

Little evidence exists regarding the association between waist-to-height ratio (WHtR) and cardiovascular risk (CVR) factors in Mexican adults. Our study pursued a twofold objective: To describe the association between a high WHtR and CVR indicators among Mexican adults canvassed by the 2016 Half-Way National Health and Nutrition Survey, and to examine the interaction of sex and age on this association. We analyzed data from the adult sample (≥20 years old) and classified in two groups using WHtRs ≥0.5 considered high and low otherwise. The following CVR factors were analyzed: High-total-cholesterol (≥200 mg/dL), low high-density-lipoprotein-cholesterol (HDL-c < 40 mg/dL), high low-density-lipoprotein-cholesterol (LDL-c ≥ 130 mg/dL), high triglycerides (≥150 mg/dL), insulin resistance (IR) (HOMA-IR) (≥2.6), and hypertension (HBP) (≥140/≥90 mmHg). We estimated prevalence ratios (PR) to analyze the association between high WHtRs and CVR indicators. Over 90% of participants had high WHtRs and were at greater risk for dyslipidemias, HBP, and IR compared to those that had low WHtRs. PR for men with high WHtRs were between 1.3 to 2.3 for dyslipidemias, 3.4 for HBP and 7.6 for IR; among women were between 1.8 to 2.4 for dyslipidemias and HBP and 5.9 for IR (p < 0.05). A high WHtR is associated with CVR factors in Mexican adults