Supplementary Material for: Africa in Transition: Growth Trends in Children and Implications for Nutrition

The aims of this paper were to: (1) review the literature and examine contemporary child growth in terms of stunting prevalence across Africa; (2) discuss child stunting within the context of economic growth and adult obesity, and (3) elucidate the implications for child nutrition. It is evident that stunting in under-5-year-old children still plagues Africa and has not decreased as expected in line with the concomitant improvement in economic development over the past decade. Persisting and possibly widening inequality ensures that not all segments of the population, in particular the most vulnerable, benefit equally from economic growth. Of concern is the association between the increasing economic progress across Africa and the rising adult obesity, especially amongst females. More and more African countries are now afflicted with a double burden of malnutrition. The implication for child nutrition is that African countries need not only apply a multisectoral approach to accelerate the reduction in stunting levels, but also to arrest and prevent obesity

Insulin resistance is associated with lower acetylcholine-induced microvascular reactivity in nondiabetic women.

The association between insulin resistance and microvascular dysfunction is well established in obese individuals with type 2 diabetes. It is unclear whether this relationship is dependent on obesity and body fat in insulin-resistant persons. This study investigated acetylcholine (ACh)-induced microvascular reactivity in apparently healthy women (n=37, 20-45 years), with and without insulin resistance

Silhouette showcards confirm altered obesity-associated body image perception in international cohort study of African-origin populations.

Given the increasing prevalence of obesity and need for effective interventions, there is a growing interest in understanding how an individual's body image can inform obesity prevention and management. This study's objective was to examine the use of silhouette showcards to measure body size perception compared with measured body mass index, and assess body size dissatisfaction, in three different African-origin populations spanning the epidemiological transition. An ancillary objective was to investigate associations between body size perception and dissatisfaction with diabetes and hypertension. Research visits were completed in local research clinics in respective countries. Seven hundred and fifty-one African-origin participants from the USA and the Republic of Seychelles (both high-income countries), and Ghana (low/middle-income country). Silhouette showcards were used to measure perceived body size and body size dissatisfaction. Objectively measured body size was measured using a scale and stadiometer. Diabetes was defined as fasting blood glucose ≥126 mg/dL and hypertension was defined as ≥130 mm Hg/80 mm Hg. Most women and men from the USA and Seychelles had 'Perceived minus Actual weight status Discrepancy' scores less than 0, meaning they underestimated their actual body size. Similarly, most overweight or obese men and women also underestimated their body size, while normal weight men and women were accurately able to estimate their body size. Finally, participants with diabetes were able to accurately estimate their body size and similarly desired a smaller body size. This study highlights that overweight and obese women and men from countries spanning the epidemiological transition were unable to accurately perceive their actual body size. Understanding people's perception of their body size is critical to implementing successful obesity prevention programmes across the epidemiological transition