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Global Nutrition Transition and the Pandemic of Obesity in Developing Countries
Abstract
Decades ago, discussion of an impending global pandemic of obesity was thought of as heresy. But in the 1970s, diets began to shift towards increased reliance upon processed foods, increased away-from-home food intake, and increased use of edible oils and sugar-sweetened beverages. Reductions in physical activity and increases in sedentary behavior began to be seen as well. The negative effects of these changes began to be recognized in the early 1990s, primarily in low- and middle-income populations, but they did not become clearly acknowledged until diabetes, hypertension, and obesity began to dominate the globe. Now, rapid increases in the rates of obesity and overweight are widely documented, from urban and rural areas in the poorest countries of sub-Saharan Africa and South Asia to populations in countries with higher income levels. Concurrent rapid shifts in diet and activity are well documented as well. An array of large-scale programmatic and policy measures are being explored in a few countries; however, few countries are engaged in serious efforts to prevent the serious dietary challenges being faced.
Supplementary resource (1)
... Obesity is perhaps one of the greatest health concerns in LDCs because of the high proportion of mortality attributed to weight-related non-communicable diseases (NCDs) such as cardiovascular disease, diabetes and certain cancers, the prevalence of which is also rising rapidly (Aydin, 2019;Godbharle et al., 2024). There is a strong correlation between these chronic diseases and obesity (Jobe et al., 2024;Popkin et al., 2012). According to the WHO (2016), these chronic diseases can no longer be considered as just a problem for high-income countries. ...
... According to the WHO (2016), these chronic diseases can no longer be considered as just a problem for high-income countries. Importantly, Popkin et al. (2012) indicate that the burden of rising obesity on health, quality of life, productivity, and individual health cost is more severe for sub-Saharan Africa (SSA) countries. ...
... Other countries in SSA including Kenya, Tanzania, Rwanda, Namibia, Botswana, Namibia, and Zambia are also considering the SSB taxation policy (Thow et al., 2021). The increasing obesity level is a worrying trend for SSA because the region faces a dual burden of undernutrition and overnutrition (Popkin et al., 2012). In addition, health infrastructure and facilities in most SSA countries are limited and the prevalence of infectious diseases like malaria puts incessant pressure on the inadequate health facilities. ...
Obesity (overweight) is a widespread concern not only in high-income nations but also in low-income countries across sub-Saharan Africa (SSA). Although many studies attribute this trend to economic development triggering a shift in nutrition patterns within SSA, they tend overlook a critical factor: the level at which these determinants are measured. Assessing them nationally while drawing comparisons with individual-level obesity data introduces a statistical challenge known as the ecological fallacy. To address this, we utilize local-level night light data as a proxy for local economic development. Analyzing demographic and health surveys from 44 SSA countries spanning the period 1992-2019, we find that local development is associated with a 0.002% increase in the body mass index of women. In addition, we find that night light intensity is associated with 0.2%-0.3% increases in probabilities of a woman being overweight and obese. Our results remain robust when
... The global pandemic of obesity has become a severe threat to social security in developed and developing countries (Popkin, Adair, & Ng, 2012;James, 2004;Swinburn, et al., 2011;WHO Consultation on Obesity (1999: Geneva & Organization, 2000 . The prevalence of obesity has tripled since the 1970s worldwide, and in 2016 the total number of overweight and obese people was estimated to reach about 1.9 billion, compared to 1.5 billion in 2008 (Popkin, Adair, & Ng, 2012) According to the World Health Organization (WHO), the total number of obese adults increased more than three-fold since 1995 and was 650 million in 2016. ...
... The global pandemic of obesity has become a severe threat to social security in developed and developing countries (Popkin, Adair, & Ng, 2012;James, 2004;Swinburn, et al., 2011;WHO Consultation on Obesity (1999: Geneva & Organization, 2000 . The prevalence of obesity has tripled since the 1970s worldwide, and in 2016 the total number of overweight and obese people was estimated to reach about 1.9 billion, compared to 1.5 billion in 2008 (Popkin, Adair, & Ng, 2012) According to the World Health Organization (WHO), the total number of obese adults increased more than three-fold since 1995 and was 650 million in 2016. WHO claims that most of the world's population live in countries where overweight and obesity are responsible for a higher share of mortality than underweight. ...
... In urban areas of lower income countries consumption of fast-food and street food raises concerns about obesity (Popkin B. M., Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases, 2006). Several studies report micro-and macronutrient deficiencies in urban areas as a consequence of nutrition transition and as a reason of increases in obesity (Ameye, Urbanization and the two tails of malnutrition in Tanzania, 2017; Kearney, 2010;Maruapula, et al., 2011;Popkin, Adair, & Ng, 2012). ...
Hey, that's a belated upload of my master's thesis which was written in 2021. Feel free to read it out. It's about obesity, based on a dietary survey of a large sample of individuals in Russia, and it uses a multiple mediation model (which is like SEM model).
Very insightful to see the progress of obesity influenced by diet quality in emerging economies. This work has not yet been published. Any information from this work should be cited referring to the credentials mentioned here. Thank you
... The impact of multinational food corporations in emerging economies on the nutrition transition [1,2], has been a long-standing public health concern [3]. Multinational food corporations such as fast-food restaurants, manufacturing and processing corporations and retailers increasingly dominate global trade and investment and are progressively penetrating markets in low-income countries [4,5]. ...
... Considerable research efforts have been dedicated to elucidating the unfavourable health outcomes linked to the increasing availability and accessibility of highly processed food and beverages in low-income countries [2]. The causal association between the consumption of highly processed foods and non-communicable diseases (NCDs), such as type 2 diabetes, obesity, and coronary heart disease, has been well-established. ...
... Prior research on the consumer acceptance of multinational corporations' food products in low-income countries has predominantly suggested that these products are valued for their symbolic and status-enhancing properties, as well as their perceived foreignness or nonlocalness, which are considered prestigious and cosmopolitan, implying a social signalling effect [18]. However, at the time of these studies, research on nutrition and consumption patterns in low-income countries was primarily concerned not only with the malnutrition of lowincome groups, but also with the slightly aspirational middle class, with their purchasing power and their purported aspiration for a Western lifestyle [2]. In the meantime, the middle class in Sub-Saharan African countries has gradually increased, and due to economic growth, improved living standards, urbanization, and progressive cultural globalization [12], it can be assumed that, in addition to the global appeal of multinational corporations' food products, other drivers for their consumption have become increasingly important. ...
Introduction
The fundamental transformation of food systems and retail environments in low-income countries is influencing consumers' food choices and dietary habits in unfavourable directions through the consumption of highly processed, energy-dense foods, predominantly manufactured by multinational food corporations. This study aims to identify the principal factors driving consumers' preference for multinational foods over local foods in the urban Accra region of Ghana.
Method
This cross-sectional survey involving a random sample of 200 consumers conducted in March/April 2023 using interviewer-administered questionnaires employed a maximum difference scaling approach to investigate the drivers of urban Ghanaian consumer food choices for multinational food corporations' products over local foods. The maximum difference scaling modelling analysis utilized in this study identifies the primary drivers of multinational food corporations' product preferences and the associated trade-offs.
Result
The study discovered that food quality and safe packaging, perceived healthiness, taste and flavour, and nutritional value were the most significant factors driving consumer preference for multinational food corporations' products over local foods in Ghana. The criterion food quality and safe packaging had the significantly highest utility than all other attributes in terms of consumer preference for products/meals from multinational food corporations over local foods.
Conclusion
The results of this study provide significant contributions to the existing body of research, as previous studies have not identified these factors as primary drivers of multinational food products. Public health authorities and nutritionists can use the study's findings to implement targeted quality assurance measures in local markets and to address the drivers in health education campaigns.
... Major behavioural shifts and changes in food systems contributing to high BMI include greater availability of shelf-stable and high-calorie products; limited financial and proximal access to healthy food options; increased consumption of ultra-processed foods 44 and fat, sugar, and animal products; and reductions in physical activity related to global work and transportation trends. 45 Particularly in low-income and middle-income populations, the shift away from a traditional diet to an industrialised one has been abrupt and is associated with considerable increases in nutrition-related noncommunicable diseases such as type 2 diabetes. 46 In some instances, high type 2 diabetes prevalence rates might also be partly associated with a population-specific genetic disposition to developing diabetes. ...
... 50 Although obesity is theoretically reversible 28,51,52 and addressing it could provide the biggest opportunity to limit the advance of diabetes, current trends suggest that obesity rates are likely to continue to climb. 45 Various interventions and policies to address obesity have been developed and studied, [53][54][55][56] but no programme to date has shown long-term, sustained, population-level reductions in obesity. 57 This is probably because no strategy has attempted to deal with the multiple factors that potentially contribute to obesity. ...
Background
Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050.
Methods
Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively.
Findings
In 2021, there were 529 million (95% uncertainty interval [UI] 500–564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8–6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7–9·9]) and, at the regional level, in Oceania (12·3% [11·5–13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1% (73·1–79·5) in individuals aged 75–79 years. Total diabetes prevalence—especially among older adults—primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1–96·8) of diabetes cases and 95·4% (94·9–95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5–71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5–30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22–1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1–17·6) in north Africa and the Middle East and 11·3% (10·8–11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%.
Interpretation
Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers.
... The Asian FE is characterized by rapidly transitioning diets and food habits and calls for timely development and updating of FE assessment tools and methodologies. For instance, the COVID-19 pandemic led to a sustained increase in consumption of take-out, ultra-processed, and outof-home foods in Asia, 77,86 which requires complementing or altering existing traditional FE measures/tools to better capture these dietary transitions. [77][78][79] ...
... For instance, the COVID-19 pandemic led to a sustained increase in consumption of take-out, ultra-processed, and outof-home foods in Asia, 77,86 which requires complementing or altering existing traditional FE measures/tools to better capture these dietary transitions. [77][78][79] ...
Food environment (FE), an interface where people interact with a broader food system, is critical to health. Understanding the Asian FE may help to tackle the “triple burden of malnutrition” through informed research and policy. This review identifies FE domains assessed in the Asian context and collates the tools/measures used in these evaluations. We further synthesized the reported associations of FE with diet and health outcomes and identified knowledge gaps. Forty-two articles were reviewed (East Asia, n = 25, 60%; South Asia, n = 8, 19%; and Southeast Asia, n = 9, 21%). The results showed that FE was frequently examined in children, adolescents, or adults, but data were scarce in older adults. Food availability ( n = 30) and accessibility ( n = 19) were popularly studied domains. Furthermore, FE was measured using geographic information systems ( n = 18), market ( n = 7), or stakeholder ( n = 21) surveys. Twenty-eight (67%) articles assessed associations of FE exposures with diet ( n = 12) and health ( n = 21). Increased food availability and accessibility were associated with poorer dietary and health outcomes despite nonexisting validity and reliability reporting in 62% of articles. Limited high-quality studies emphasize the need for harmonized definitions, better study designs, and validated FE measures/tools in Asia. Improving the quality of FE research is critical to designing effective interventions to improve public health nutrition in Asia.
... This is the coexistence of undernutrition (underweight, wasting, and stunting) alongside overnutrition (overweight or obesity) within a population [2]. The prevalence of DBM has been reported in many Obesities 2024, 4 10 developing countries and has been linked to nutrition and economic transitions [2][3][4]. DBM is an increasing nutritional problem in all population groups [5,6]. In a South African study, the prevalence of underweight, overweight and obesity was 2%, 27% and 42%, respectively [6]. ...
... To date, no national evidence of a double-malnutrition burden has been reported. A study conducted in Sub-Saharan African countries including Zimbabwe showed a downward trend in the prevalence of underweight [9], whereas several studies have shown an increase in the prevalence of overweight children and adolescents in Zimbabwe [2,3]. Despite the differences in prevalence, the coexistence of undernutrition and overnutrition is a paradox that shows the need to investigate factors that are associated with underweight and overweight separately, and it is of paramount importance to find the factors which that overlap. ...
(1) Background: The double burden of malnutrition (DBM) is an emerging public health concern among children and adolescents in developing countries. This study investigated the prevalence and factors associated with being underweight and overweight among adolescents. (2) Methods: This cross-sectional study was conducted among 423 adolescents across 10 high schools in Harare. A questionnaire was used to collect data and weight for height-z-scores were used to compute body mass index. Pearson’s Chi-Square and multinomial logistic regression were used to test for associations and explore factors associated with being underweight or overweight at (p < 0.05). (3) Results: The median and IQR range for the participants was 16 (14–19) years. There were more girls 53.2%, than boys 46.8% (p = 0.002), and more 14–16-year-olds 54.1%, than 17–19-year-olds (p = 0.070). More boys 10% than girls 9.1% were underweight, whereas more girls 21.8% than boys 9.3% were overweight and obese (p = 0.002). By age, more 14–16-year -olds were underweight 12.7% than 17–19-year-olds 5.9%, whereas more 17–19-year-olds 16.2% were overweight than 14–16-year-olds (p = 0.070). Significant factors associated with being underweight were inadequate balanced nutrition knowledge [OR = 1.49 (0.139–0.997), p = 0.049], being in the 14–16 years age group [OR = 2.56 (1.137–5.779), p = 0.023], having formally employed [OR = 2.34 (1.008–5.428), p = 0.048] and unemployed [OR = 5.17 (1.263–21.116), p = 0.022] household heads. Significant factors associated with overweight were being a girl [OR = 0.32 (0.168–2.561), p < 0.001, and having formally employed household heads [OR = 2.00 (1.044–1.206), p = 0.037]. The employment status of the household head (being formally employed) was the only factor which associated with both underweight and overweight statuses. (4) Conclusions: Although underweight and overweight statuses co-exist, among adolescents, those who are overweight appear to be more than those who are underweight. Significant factors associated with being underweight were inadequate nutrition knowledge, being 14–16 years old, and having formally employed or unemployed parents. While being a girl and having formally employed parents were significant determinants of the overweight status. This paper calls for more awareness of DBM and context-specific interventions targeting obesity in a country where undernutrition has been traditionally prioritized at policy and program levels.
... On the other hand, the results by size of locality suggest that individuals residing in urban areas have a nonnegligible higher probability of suffering from diabetes compared to people living in rural locations. This is in line with the phenomenon of "nutritional transition", which initially occurred in high-income countries and later in low-income countries, first in urban areas and then in rural areas [56,57]. For Mexico, [58] despite the prevalence of diabetes presents heterogeneous patterns, this condition is strongly greater in urban areas compared with rural areas. ...
Background
Demographic and epidemiological dynamics characterized by lower fertility rates and longer life expectancy, as well as higher prevalence of non-communicable diseases such as diabetes, represent important challenges for policy makers around the World. We investigate the risk factors that influence the diagnosis of diabetes in the Mexican population aged 50 years and over, including childhood poverty.
Results
This work employs a probabilistic regression model with information from the Mexican Health and Aging Study (MHAS) of 2012 and 2018. Our results are consistent with the existing literature and should raise strong concerns. The findings suggest that risk factors that favor the diagnosis of diabetes in adulthood are: age, family antecedents of diabetes, obesity, and socioeconomic conditions during both adulthood and childhood.
Conclusions
Poverty conditions before the age 10, with inter-temporal poverty implications, are associated with a higher probability of being diagnosed with diabetes when older and pose extraordinary policy challenges.
... Energy intake of more than the energy requirement is a well-known risk factor for obesity in review studies (Hruby & Hu 2015;Hruby et al. 2016). Particularly noteworthy is the fact that most energy intake from food did not yet come from energy dense-nutrientpoor-low-fiber-fried fast foods and sugar-sweetened beverages as is often documented among other groups, such as in reviews by Saklayen (2018) and Popkin et al. (2012), but mostly from large portion sizes of the daily staples of beans, matooke and posho, that made up the women's main meals. ...
The last national demographic and health survey in Uganda found that nearly two of every 10 women living in Kampala capital city and the surrounding urban areas in Mukono and Wakiso districts were obese. This study aimed to clarify how food consumption practices are indicated in the obesity of women in urban Uganda. Measurement of weight and height, interviews and intensive 7-day observation of 14 women in August and September of 2018 was complemented by interview data collected between February 2016 and September 2017 among 540 women. Results showed that the number of eating occasions was limited, the timing was later in the day, and both were irregular. This was associated with the difficulties in acquiring food, the time required to prepare a meal, and the chores women needed to accomplish. Daily energy intake varied from one day to the next, but the net average was high-2,430 kcal (SD = 694) and exceeded the daily energy requirements. Most of the energy came from the second main eating occasion and from large portions of the main staple foods and sauces. Perceptions of ideal food consumption practices, and of the drivers of food consumption practices, were influenced by long-standing habits in the individual homes and communities where they were brought up, and by the women's past and present experiences of instability in food availability and access. Efforts to foster stability in food security across the life course could therefore be instrumental in neutralizing the sociocultural risk factors for obesity among women in urban Uganda.
... Aside from the low nutritional density, UPF are often subjected to degradation of the food matrix, chemical modification of food substances, presence of food additives, loss of micronutrients, and exposure to packaging materials [8,10]. Due to their pervasive accessibility and affordability, these high-energy-density options may not just account for the majority of consumers' daily caloric intake [49,50], but potentially reduce their consumption of health promoting foods such as whole grains, fruits, and vegetables [51]. This shift in dietary habits could, in turn, heighten the risk of adverse health outcomes [9,50,52]. ...
Purpose
We aimed to examine the association between dietary patterns and type 2 diabetes mellitus (T2DM) while considering the potential effect modification by metabolic phenotypes (metabotypes). Additionally, we aimed to explore the association between dietary scores and prediabetes.
Methods
A total of 1460 participants (11.8% with T2DM) from the cross-sectional population-based KORA FF4 study were included. Participants, classified into three metabotype subgroups, had both their FSAm-NPS dietary index (underpinning the Nutri-Score) and ultra-processed foods (UPF) intake (using NOVA classification) calculated. Glucose tolerance status was assessed via oral glucose tolerance tests (OGTT) in non-diabetic participants and was classified according to the American Diabetes Association criteria. Logistic regression models were used for both the overall and metabotype-stratified analyses of dietary scores’ association with T2DM, and multinomial probit models for their association with prediabetes.
Results
Participants who had a diet with a higher FSAm-NPS dietary index (i.e., a lower diet quality) or a greater percentage of UPF consumption showed a positive association with T2DM. Stratified analyses demonstrated a strengthened association between UPF consumption and T2DM specifically in the metabolically most unfavorable metabotype (Odds Ratio, OR 1.92; 95% Confidence Interval, CI 1.35, 2.73). A diet with a higher FSAm-NPS dietary index was also positively associated with prediabetes (OR 1.19; 95% CI 1.04, 1.35).
Conclusion
Our study suggests different associations between poorer diet quality and T2DM across individuals exhibiting diverse metabotypes, pointing to the option for stratified dietary interventions in diabetes prevention.
... On the other hand, the nutritional transition and the westernisation of consumption patterns also carry health costs. In recent decades, there has been an increase in noncommunicable diseases such as obesity, diabetes, and other cardiovascular diseases in middle-low and low-income countries (Popkin, Adair and Ng, 2017). ...
The nutritional transition, together with the demographic and epidemiological transitions, stands as one of the most crucial phenomena shaping societies in the 20th century. A prominent characteristic of the nutritional transition is the increased consumption of animal-origin protein, particularly meat. Within this context, the present article utilises Spain as a case study to provide a close examination of the nutritional transition during the latter half of the 20th century. Spain’s significance lies in its late but rapid development of this transition. In the 1960s, meat consumption was relatively low compared to other European countries; however, within just two decades, it surpassed that of many developed nations. On one hand, the article offers a detailed insight into how budget constraints were eased to foster meat consumption among various consumer groups. On the other hand, the study aims to quantify the influence of income, prices, and preferences in driving this process
... 11 Over the past 50 years, dietary habits in these countries have shifted towards increased consumption of fats, sugar, and animal-source foods. 36 Furthermore, economic progress has led to the development of sedentary jobs, resulting in reduced physical activity and subsequently higher rates of overweight and obesity, which are two major risk factors for CRC. 37 According to our findings, the incidence rate of CRC in both sexes significantly increases with the aging of the population, reaching a peak in the 80-84 age group (total ASR = 122.34). ...
Background: While there has been extensive research on colorectal cancer (CRC) incidence and its associated factors in Iran, a significant gap exists in studies predicting its future trends. Our study aimed to thoroughly report CRC incidence across Iran from 2014 to 2017, by sex, age, and geographical regions, and provide a projection for 2025.
Methods: This retrospective study utilized data from the Iranian National Population-based Cancer Registry (INPCR). Patients with the International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3) codes C18 to C21 were included. The age-standardized incidence rate (ASR), was calculated per 100000 individuals annually, and crude incidence rates were retrieved for various demographic groups and years.
Results: Between 2014 and 2017, a total of 43580 new CRC cases (55.96% males) were registered. Men exhibited an ASR of 134.45, while women’s ASR was 94.85. The highest ASRs were observed in Tehran, Qom, and Ilam (18.99, 18.26, and 18.06, respectively). Incidence rates surpassed 20 after age 50 for both genders, reaching their peak within the 80–84 age group. Adenocarcinoma was the most frequent histological type of CRC in nearly all provinces. Case numbers and ASRs are projected to continuously rise until 2025, with a predominance of male cases.
Conclusion: The anticipated increase in CRC incidence in Iran emphasizes the need for additional studies to better identify risk factors. Furthermore, implementing screening programs is recommended for individuals at a higher risk of CRC, including men, the elderly population, and those residing in regions with a notable prevalence of CRC.
Keywords: Colorectal cancer, Incidence, Iran, Projection
... Obesity is predominantly attributed to unbalanced nutritional metabolism, especially for energy intake or expenditure imbalance [3]. Fatty acids (FAs) are major components of lipids, which provide an important energy source as nutrients. ...
Background
Childhood overweight and obesity is becoming an emerging face of malnutrition. The aims of this study were to develop fatty acid (FAs) related dietary patterns and explored the associations of FAs related dietary patterns with overweight and obesity among Chinese children.
Methods
An observational study was conducted on 435 children aged 4 to 7 years old in South Central China. Erythrocyte FAs composition was analyzed by gas chromatography-mass spectrometry. Diet was collected by food frequency questionnaires and dietary patterns were evaluated by reduced rank regression. The logistic regression analysis was used to exploring the association of dietary patterns with overweight and obesity.
Results
The prevalence of overweight, obesity, and overweight or obesity were 6.52, 4.59, and 11.11% in Chinese children, respectively. Twenty five types of FAs were detected in erythrocyte of children and four FAs related dietary patterns were identified. The dietary pattern positively correlated with n-3 PUFAs, but negatively with SFAs,was characterized by high intake of fish, shrimp, crab and shellfish, leaf-off vegetable, nuts, and tubers, which have a significantly decreased overweight risk (OR = 0.580, 95%CI: 0.375 ∼ 0.895, P = 0.014).The pattern positively strong associated with n-6 PUFAs, but negatively strong with n-3 PUFAs, had high intake of snacks, leaf-off vegetable, fresh beans, and coarse cereals, which have a significantly decreased obesity risk (OR = 0.518, 95%CI: 0.325 ∼ 0.827, P = 0.006).
Conclusion
Four FAs related dietary patterns were identified. The dietary pattern with high intake of fish, shrimp, crab and shellfish decreased overweight risk by increasing n-3 PUFAs, and decreasing SFAs. The dietary pattern with high intake of plant food, decreased obesity risk by providing an balanced n-6/n-3 PUFAs ratio.
... This result is congruent with a study in India and Myanmar showing that non-working women have higher odds of developing co-occurrence of overweight/obesity and anemia than workers [63]. The possible justification might be a reduction in the level of physical activity that induces sedentary life and progression to the development of OWOB and anemia, in contrast with the earlier lifestyle [64]. ...
Background
Overweight/obesity is one of the major public health problems that affect both developed and developing nations. The co-occurrence of overweight/obesity and anemia is thought to be largely preventable if detected early. To date, no spatial analyses have been performed to identify areas of hotspots for the co-occurrence of overweight/obesity and anemia among reproductive women in sub-Saharan Africa. Therefore, this study aimed to assess the spatial distribution and associated factors of the co-occurrence of overweight/obesity and anemia among women of reproductive age.
Methods
Data for the study were drawn from the Demographic and Health Survey, a nationally representative cross-sectional survey conducted in the era of Sustainable Development Goals, in which the World Health Assembly decided and planned to cease all forms of malnutrition by 2030. Seventeen sub-Saharan African countries and a total weighted sample of 108,161 reproductive women (15–49 years) were included in our study. The data extraction, recoding and analysis were done using STATA V.17. For the spatial analysis (autocorrelation, hot-spot and interpolation), ArcGIS version 10.7 software, and for the SaTScan analysis, SaTScan version 10.1 software was used. Descriptive statistics were presented using frequency tables and percentages. We employed multilevel logistic regression to investigate associated factors. In the multivariable analysis, variables with a p-value of ≤0.05 are considered as a significant factor associated with co-occurrence of overweight/obesity and anemia among women aged 15–49 years.
Results
The overall co-occurrence of overweight/obesity and anemia among women in sub-Saharan Africa was 12% (95%CI: 9–14%). The spatial analysis revealed that the co-occurrence of overweight/obesity and anemia among women significantly varied across sub-Saharan Africa. (Global Moran’s I = 0.583163, p<0.001). In the spatial window, the primary-cluster was located in Liberia, Guinea, Gambia, Sira Leon, Mauritania, Mali, Cameron and Nigeria with a Log-Likelihood Ratio (LRR) of 1687.30, and Relative Risk (RR) of 2.58 at a p-value < 0.001. In multilevel analysis, women aged 25–34 years (AOR = 1.91, 95%CI: 1.78, 2.04), women aged 35–49 years (AOR = 2.96, 95% CI: 2.76, 3.17), married (AOR = 1.36, 95% CI: 1.27, 1.46), widowed (AOR = 1.22, 95%CI: 1.06, 1.40), divorced (AOR = 1.36, 95% CI: 1.23, 1.50), media exposure (AOR = 1.31, 95%CI: 1.23, 1.39), middle income (AOR = 1.19, 95%CI: 1.11, 1.28), high income/rich (AOR = 1.36, 95%CI: 1.26, 1.46), not working (AOR = 1.13, 95% CI:1.07, 1.19), traditional contraceptive utilization (AOR = 1.39, 95%CI: 1.23, 1.58) and no contraceptive use (AOR = 1.27, 95%CI: 1.20, 1.56), and no health insurance coverage (AOR = 1.36, 95%CI: 1.25, 1.49), were individual level significant variables. From community-level variables urban residence (AOR = 1.61, 95%CI: 1.50, 1.73), lower middle-income country (AOR = 2.50, 95%CI: 2.34, 2.66) and upper middle-income country (AOR = 2.87, 95%CI: 2.47, 3.34), were significantly associated with higher odds of co-occurrence of overweight/ obesity and anemia.
Conclusion and recommendations
The spatial distribution of the co-occurrence of overweight/obesity and anemia was significantly varied across the sub-Saharan African country. Both individual and community-level factors were significantly associated with the co-occurrence of overweight/obesity and anemia. Therefore, public health programmers and other stalk holders who are involved in maternal healthcare should work together and give priority to hotspot areas of co-occurrence in sub-Saharan Africa.
... The first is that greater income may result in worse cardiovascular-related behaviors and outcomes, consistent with other evidence from South Africa (37,38). In recent years, many low-and middle-income countries have experienced rapid economic growth, resulting in an increase in dietary consumption of sugar, lipids, and processed carbohydrates (39). Additional pension income may promote expenditure on high-calorie foods leading to an increase in the probability of hypertension (40)(41)(42). ...
Background and Objectives
Hypertension is a major modifiable contributor to disease burden in sub-Saharan Africa. We exploited an expansion to age eligibility for men in South Africa’s noncontributory public pension to assess the impact of pension eligibility on hypertension in a rural, low-income South African setting.
Research Design and Methods
Data were from 1 247 men aged ≥60 in the population-representative Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa in 2014/2015. We identified cohorts of men from 0 (controls, aged ≥65 at pension expansion) through 5 years of additional pension eligibility based on their birth year. Using the modified Framingham Heart Study hypertension risk prediction model, and the Wand et al. model modified for the South African population, we estimated the difference in the probabilities of hypertension for men who benefitted from the pension expansion relative to the control. We conducted a negative control analysis among older women, who were not eligible for pension expansion, to assess the robustness of our findings.
Results
Older men with 5 additional years of pension eligibility had a 6.9–8.1 percentage point greater probability of hypertension than expected without the pension expansion eligibility. After accounting for birth cohort effects through a negative control analysis involving older women reduced estimates to a 3.0–5.2 percentage point greater probability of hypertension than expected. We observed a mean 0.2 percentage point increase in the probability of hypertension per additional year of pension eligibility, but this trend was not statistically significant.
Discussion and Implications
Although the Older Person’s Grant is important for improving the financial circumstances of older adults and their families in South Africa, expanded pension eligibility may have a small, negative short-term effect on hypertension among older men in this rural, South African setting.
... Globally, obesity is progressively taking on the characteristics of an epidemic, and Nigeria is not exempted from this trend. [2][3][4] The current obesity epidemic has been linked to Nigeria's socioeconomic and epidemiological shift from a lowerincome to a middle-income nation, which has changed eating habits and lifestyle choices. Because of this, a large number of Nigerians have sedentary lifestyles and consume diets high in calories, resulting in excessive energy intake and poor energy expenditure in the majority of adult Nigerians. ...
... The reformulation of the basic food basket emerges in a global context marked by concerning shifts in dietary consumption patterns, characterized by a decrease in the intake of nutritious foods -such as fruits, vegetables, and grains -and an increase in the consumption of oils, sugary beverages, and ultra-processed products 5 . In Latin America, this trend is evidenced by the consumption of sugary foods and beverages at quantities up to three times higher than recommended by the World Health Organization (WHO) 6 , a pattern contributing to a significant rise in the consumption of salt, refined carbohydrates, and snacks, alongside a consequent decrease in the intake of fruits, vegetables, and legumes 7 . ...
Decree 11.936/2024 initiates a significant transformation in the Brazilian basic food basket, focusing on encouraging healthier and more sustainable eating habits. By prioritizing whole foods and restricting ultra-processed foods, it aligns with nutritional policy guidelines and tax reform, demonstrating a commitment to public health and food sustainability. The document reconciles with the recommendations set forth by the Dietary Guidelines for the Brazilian Population, which emphasizes seasonality, family farming, local and regional traditions, biodiversity, and environmental respect essential elements for food and nutritional security that offer direct benefits to public health. Through this approach, it seeks to guide the population towards balanced eating practices, ensuring access to nutritionally adequate and sustainable food, especially for the most vulnerable segments of society.
... Additionally, nutrition is important for understanding the prevalence of various diseases. According to Popkin et al. [4], global dietary shifts are associated with changes in disease patterns. This shift highlights the value of nutrition in addressing global health concerns like obesity, diabetes, and heart disease [5]. ...
In industry 4.0, where the automation and digitalization of entities and processes are fundamental, artificial intelligence (AI) is increasingly becoming a pivotal tool offering innovative solutions in various domains. In this context, nutrition, a critical aspect of public health, is no exception to the fields influenced by the integration of AI technology. This study aims to comprehensively investigate the current landscape of AI in nutrition, providing a deep understanding of the potential of AI, machine learning (ML), and deep learning (DL) in nutrition sciences and highlighting eventual challenges and futuristic directions. A hybrid approach from the systematic literature review (SLR) guidelines and the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was adopted to systematically analyze the scientific literature from a search of major databases on artificial intelligence in nutrition sciences. A rigorous study selection was conducted using the most appropriate eligibility criteria, followed by a methodological quality assessment ensuring the robustness of the included studies. This review identifies several AI applications in nutrition, spanning smart and personalized nutrition, dietary assessment, food recognition and tracking, predictive modeling for disease prevention, and disease diagnosis and monitoring. The selected studies demonstrated the versatility of machine learning and deep learning techniques in handling complex relationships within nutritional datasets. This study provides a comprehensive overview of the current state of AI applications in nutrition sciences and identifies challenges and opportunities. With the rapid advancement in AI, its integration into nutrition holds significant promise to enhance individual nutritional outcomes and optimize dietary recommendations. Researchers, policymakers, and healthcare professionals can utilize this research to design future projects and support evidence-based decision-making in AI for nutrition and dietary guidance.
... However, the prevalence of overweight and obesity has increased globally leading to a nutrition and epidemiological transition in recent times [7,8]. Previous reports indicated widespread malnutrition among Nigerian adolescents and increasing incidence of micronutrient deficiencies, overweight and obesity among children and adolescents [9,10]. ...
Background: Adolescence is a vulnerable stage of life within which there is rapid growth and
development and increased nutrients requirement. However, the period of adolescence has been
characterized by poor dietary practices that may lead to health problems such as under nutrition
and obesity.
Objectives: To assess the nutritional status and eating habits of in-school adolescents within
Sokoto metropolis
Methods: A cross-sectional survey of adolescents selected through multistage random sampling.
Data was obtained using pre-tested semi-structured interviewer administered questionnaire.
Subjects’ body mass index (BMI) was determined using Centre for Disease Control BMI percentiles.
Data was analyzed using IBM® SPSS version 25.
Results: A total of 389 subjects were recruited with a mean age of 15.46 ± 1.67 SD and more than
half of them 231(59.4%) were females. The BMI was normal among 276(71.0%) of the
respondents, 93(23.9%) were underweight, while 4(1.0%) were obese. Most of the respondents
318(81.7%) reported taking at least 3 meals per day, 257(66.0%) reported breakfast as their
heaviest meal. The frequency of skipping meals was 300(77.1%). The main reason for meal
skipping was non-availability of food as at meal time by 99(33.0%) of them. Frequent snacking
occurred amongst 330(84.8%) subjects. The independent predictors of BMI were age category
(p=0.015), gender (p=0.012), tribe (p=0.031), father’s education status (p=0.002), mother’s
education status (p=0.003), number of people in the household (p=0.004), social class (p<0.001),
and frequent snacking (p=0.034)
Conclusion: Two-third of the respondents had normal BMI for age while about a quarter of them
were underweight. A high proportion of them engaged in meal skipping and snacking. The BMI was
associated with socio-demographics and frequent snacking.
Keywords: Body mass index; eating habits; adolescents; Sokoto; Nigeria.
... Modern dietary habits, particularly the consumption of fast food, sugarsweetened beverages, and the trends toward larger portion sizes and increased eating frequency, significantly influence the prevalence and progression of metabolic diseases such as obesity and MASLD [55]. These food and beverage consumption patterns, hallmarks of a rapidly globalizing food environment, contribute to an excess caloric intake and poor nutritional quality, setting the stage for a host of metabolic dysfunctions [56]. ...
Metabolic syndrome, a cluster of conditions including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels, significantly heightens the risk of cardiovascular disease, diabetes, obesity, and fatty liver disease. With the adoption of a Western-style diet characterized by a high intake of corn sugar, saturated fats, and ultra-processed foods, these metabolic disorders have reached pandemic proportions globally. This chapter addresses the rising rates of obesity and MASLD, stressing the critical impact of dietary habits on these issues. It highlights how a healthy diet can mitigate risks, pointing out the detrimental effects of poor nutrition. The text examines the complex relationship between diet, adiposity, and liver health, analyzing the role of macronutrient composition, calorie intake, and processed foods in metabolic dysregulation. It proposes comprehensive nutritional strategies and public health policies, including the adoption of an inverted food pyramid, to tackle metabolic syndrome, obesity, and MASLD effectively, advocating for a holistic approach to dietary changes.
... As an example, unplanned urbanization is always characterized by the absence of spaces dedicated to physical activity. Furthermore, the urban environment provides an abundant market for the consumption of tobacco, alcohol and unhealthy food [5,6]. ...
Background
The prevalence of cardiometabolic risk factors (CMRFs) is increasing in sub-Saharan Africa and represents a serious public health issue. Accurate data are required to implement adapted prevention programs and healthcare strategies. Thus, the aim of this study was to estimate the prevalence rates of CMRFs according to the level of urbanization, age and gender in Gabon.
Methods
A cross-sectional study was conducted in northern (Bitam), western coast (Libreville, Melen) and southeast (Koulamoutou) areas of Gabon using the World Health Organization’s (WHO) stepwise approach for the surveillance of chronic disease risk factors. Participants over 18 years of age, without known underlying disease, living in rural and urban areas of Gabon were included. Sociodemographic, biological, and behavioral data were collected. Univariate and multivariate analysis were used to identify the CMRFs.
Results
Of the 978 participants, 499 lived in urban and 479 in rural areas. Their median age was 38[28–50] years. Tobacco (26.1% vs 6.2%; p < 0.01) and excessive alcohol consumption (19.4% vs 9.6%; p < 0.01) predominated in rural than in urban areas, respectively. Urban dwellers had more often insufficient physical activity than rural people (29.5% vs 16.3%; p < 0.01). In total, 79.9% of participants aged under 54 years had a high blood pressure;10.6% of the younger participants had pre-hypertension. Metabolic syndrome was more frequent in women (21.7%) than in men (10.0%) (p < 0.01); 6.4% of men and 2.5% of women had a high Framingham score (p = 0.03). Finally, 54.0% of the participants had three or four CMRFs. The multivariate analysis showed that men were more likely to be smokers and to be at risk of pre-hypertension or high blood pressure (p < 0.01). Women were more likely to be obese or to have a metabolic syndrome (p < 0.01). Living in urban areas was also a risk factor for hypertension, diabetes, metabolic syndrome and high LDL cholesterol level.
Conclusion
The prevalence of CMRFs was high in the study population. Disparities were observed according to urban and rural areas, gender and age. National prevention and healthcare strategies for cardiometabolic diseases in Gabon should consider these observed differences.
... In low-and middle-income countries (LMICs), HBV and HCV infections have been reported as the leading causes of liver disease [5,6]. However, the prevalence of metabolic diseases is increasing in many LMICs, linked to changes in dietary practices and lower physical activity [7]. In high-income countries, liver steatosis has increased significantly among PLHIV, and is often secondary to the metabolic syndrome and its components (T2DM, hypertension and dyslipidaemia), and mitochondrial damage leading to insulin resistance and dyslipidaemia [8,9]. ...
Introduction
Liver disease is a leading cause of morbidity and mortality among persons living with HIV (PLHIV). While chronic viral hepatitis has been extensively studied in low‐ and middle‐income countries (LMICs), there is limited information about the burden of metabolic disorders on liver disease in PLHIV.
Methods
We conducted a cross‐sectional analysis of baseline data collected between October 2020 and July 2022 from the IeDEA‐Sentinel Research Network, a prospective cohort enrolling PLHIV ≥40 years on antiretroviral treatment (ART) for ≥6 months from eight clinics in Asia, Americas, and central, East, southern and West Africa. Clinical assessments, laboratory testing on fasting blood samples and liver stiffness measurement (LSM)/controlled attenuation parameter (CAP) by vibration‐controlled transient elastography were performed. Multivariable logistic regression models assessed factors associated with liver fibrosis (LSM ≥7.1 kPa) and steatosis (CAP ≥248 dB/m). Population attributable fraction (PAF) of each variable associated with significant liver fibrosis was estimated using Levin's formula.
Results
Overall, 2120 PLHIV (56% female, median age 50 [interquartile range: 45−56] years) were included. The prevalence of obesity was 19%, 12% had type 2 diabetes mellitus (T2DM), 29% had hypertension and 53% had dyslipidaemia. The overall prevalence of liver fibrosis and steatosis was 7.6% (95% confidence interval [CI] 6.1−8.4) and 28.4% (95% CI 26.5−30.7), respectively, with regional variability. Male sex at birth (odds ratio [OR] 1.62, CI 1.10−2.40), overweight/obesity (OR = 2.50, 95% CI 1.69−3.75), T2DM (OR 2.26, 95% CI 1.46−3.47) and prolonged exposure to didanosine (OR 3.13, 95% CI 1.46−6.49) were associated with liver fibrosis. Overweight/obesity and T2DM accounted for 42% and 11% of the PAF for liver fibrosis, while HBsAg and anti‐HCV accounted for 3% and 1%, respectively. Factors associated with steatosis included overweight/obesity (OR 4.25, 95% CI 3.29−5.51), T2DM (OR 2.06, 95% CI 1.47−2.88), prolonged exposure to stavudine (OR 1.69, 95% CI 1.27−2.26) and dyslipidaemia (OR 1.68, 95% CI 1.31−2.16).
Conclusions
Metabolic disorders were significant risk factors for liver disease among PLHIV in LMICs. Early recognition of metabolic disorders risk factors might be helpful to guide clinical and lifestyle interventions. Further prospective studies are needed to determine the causative natures of these findings.
... Conversely, reductions in the prevalence of undernourishment boost the welfare and productivity of individuals and, in the aggregate, lead to economy-wide gains, especially when driven by improved agricultural incomes (Asenso-Okyere et al. 2011; Webb and Block 2012). As incomes continue to grow, and as urbanization gains traction, growth in dietary adequacy benefits slows and problems associated with the immoderate intake of unhealthy foods speed up, along with the prevalence of obesity, diabetes, colorectal cancer, and cardiovascular disease, among others (Popkin 2003;Popkin, Adair, and Ng 2012). ...
Established by the United Nations in 2015 with a target date of 2030, the Sustainable Development Goals (SDGs) provide a framework with specific objectives to guide global development policy. The SDGs extend and modify an earlier framework, the Millennium Development Goals (MDGs), established in 2000 with a target date of 2015. Goal 1 of the MDGs was to eradicate extreme poverty and hunger, with the specific goals of halving the proportions of both undernourished and malnourished people between 1990 and 2015. The poverty goal was met fully, ahead of schedule, and substantive progress was made toward the hunger goal due, in large part, to gains in agricultural production and productivity. Building on this progress, SDG 2 aims to "end hunger" and "achieve food security and improved nutrition," while promoting "sustainable agriculture." Lifting millions of families from the desperate cycle of hunger and poverty also had consequences for the environment. Roughly 72% of the world's freshwater supplies go to agriculture; in South Asia, agriculture uses over 90%. On-farm greenhouse gas emissions (GHGs) are growing too. Global on-farm GHG emissions grew by about 10% between 1990 and 2020, from 6.7 to 7.4 GtCO2e; in Asia, during the same period, on-farm GHG emissions grew by 27%, from 2.5 to 3.2 GtCO2e. All of this puts agriculture and food systems at odds with other SDG goals, particularly Goal 6, which calls for efforts to better manage water supplies; Goal 12, which aims to reduce agriculture's environmental footprint; and Goal 13, which calls for urgent action to combat climate change. This paper looks at how past technology choices opened a pathway to prosperity in Asia that now threatens the region's natural resources and the stability of the planet's climate. Specifically, the paper focuses on the greenhouse gas emissions from two practices, the cultivation of paddy rice and the growth in livestock production, in 15 countries in South and Southeast Asia, which collectively account for more than 80% of the global emissions from each practice. Based on country-specific habit-formation models of dietary choice estimated from a 15-country panel of annual data from 1970 to 2020, out-of-sample projections show that business-as-usual emissions from rice production and animal waste will increase by 57% and 204%, respectively, over the next three decades. The projections are robust to alternative assumptions about income growth. This illustrates how the past success of the intensive agricultural technologies, and the income gains they helped spur, has led to still-ongoing dietary transitions that will complicate and hinder future efforts to reduce on-farm emissions, as researchers and policymakers strive to foster greener technologies to reduce agriculture's environmental footprint-technologies that must also sustain continued productivity gains if all SDGs are to be met.
... Food production makes up 16% of all GHGE in the US, a country for which per-capita emissions are more than three times the global average [6,7]. Beyond environmental impact, these dietary shifts are also a key part of the nutrition transition and are a major contributor to the burden of non-communicable disease in the US [8,9]. In this context, dietary guidelines are one strategy to alter consumer behavior and the composition of federal food policies, with the potential for food production to shift in response to changing dietary preferences [10]. ...
Background
The Planetary Health Diet Index (PHDI) measures adherence to the dietary pattern presented by the EAT-Lancet Commission, which aligns health and sustainability targets. There is a need to understand how PHDI scores correlate with dietary greenhouse gas emissions (GHGE) and how this differs from the carbon footprints of scores on established dietary recommendations. The objectives of this study were to compare how the PHDI, Healthy Eating Index-2015 (HEI-2015) and Dietary Approaches to Stop Hypertension (DASH) relate to (a) dietary GHGE and (b) to examine the influence of PHDI food components on dietary GHGE.
Methods
We used life cycle assessment data from the Database of Food Recall Impacts on the Environment for Nutrition and Dietary Studies to calculate the mean dietary GHGE of 8,128 adult participants in the 2015–2016 and 2017–2018 cycles of the National Health and Nutrition Examination Survey (NHANES). Poisson regression was used to estimate the association of (a) quintiles of diet score and (b) standardized dietary index Z-scores with dietary GHGE for PHDI, HEI-2015, and DASH scores. In secondary analyses, we used Poisson regression to assess the influence of individual PHDI component scores on dietary GHGE.
Results
We found that higher dietary quality on all three indices was correlated with lower dietary GHGE. The magnitude of the dietary quality-dietary GHGE relationship was larger for PHDI [-0.4, 95% CI (-0.5, -0.3) kg CO2 equivalents per one standard deviation change] and for DASH [-0.5, (-0.4, -0.6) kg CO2-equivalents] than for HEI-2015 [-0.2, (-0.2, -0.3) kg CO2-equivalents]. When examining PHDI component scores, we found that diet-related GHGE were driven largely by red and processed meat intake.
Conclusions
Improved dietary quality has the potential to lower the emissions impacts of US diets. Future efforts to promote healthy, sustainable diets could apply the recommendations of the established DASH guidelines as well as the new guidance provided by the PHDI to increase their environmental benefits.
... Several epidemiologic studies have shown that the multiple environmental factors to which individuals are exposed during early life and young adulthood have changed significantly since the second half of the 20th century. 2,15,26,27 These factors include changes in diet, adoption of a Western-style diet, and an increase in sugar- sweetened beverages. 28,29 As a result of these changes, the prevalence of obesity and type 2 diabetes mellitus has increased and, therefore, so have the adverse effects of both pathologies on the future development of possible neoplasms. ...
PURPOSE
Data from population-based studies have shown an increased incidence of certain types of neoplasms in patients younger than 50 years (early-onset cancer [EOC]); however, little information is derived from other real-world data sources. In a nonpopulation registry, we analyzed changes in the incidence of several neoplasms in successive generations.
METHODS
This cross-sectional study included all patients with a cancer diagnosis registered in one university hospital in Málaga, Spain, between 1998 and 2021, and 18 neoplasms were analyzed. For each neoplasm, the proportion of patients younger than 50 years and age 50 years and older (late-onset cancer [LOC]) of the total number of patients diagnosed each year was determined. In addition, the age limit was lowered to 45-40 years. Changes in these proportions between each year and the following year were assessed by calculating the annual percentage change (APC), and a final assessment of these changes was performed by determining the average APC (AAPC).
RESULTS
Of the 24,596 patients, 5,466 (22.2%) had EOC, and 19,130 (77.8%) had LOC. The incidence of all tumors increased throughout the study period in both age groups. The AAPC increase was higher in patients with EOC than in those with LOC for the following neoplasms: head and neck (6.1% v 4.6%), colon (11.0% v 8.2%), testicular (16.3% v –13.1%), non-Hodgkin lymphoma (8.4% v 5.9%), rectum (16.1% v 6.8%), kidney (27.8% v 20.1%), and sarcoma (43.4% v 28.6%). This increase was confirmed in patients younger than 45 years and 40 years.
CONCLUSION
Our results are consistent with the data published for most tumor sites analyzed. This global public health problem requires the utmost attention to decrease excess cancer in young patients.
... Some authors state that rapid urbanization can lead to "incorrect food choices" due to high consumption of ultra-processed food. The lack of time and education, in combination with the issue of poverty in this fast-paced world, can lead to poor food choices with a lack of nutritional value and quality and excessive sugar intake, along with a lack of physical activity (PA), which can lead to obesity [15,16]. Different methods for managing weight loss in individuals with overweight or obesity have been developed. ...
Digital technologies have greatly developed and impacted several aspects of life, including health and lifestyle. Activity tracking, mobile applications, and devices may also provide messages and goals to motivate adopting healthy behaviors, namely physical activity and dietary changes. This review aimed to assess the effectiveness of digital resources in supporting behavior changes, and thus influencing weight loss, in people with overweight or obesity. A systematic review was conducted according to the PRISMA guidelines. The protocol was registered in PROSPERO (CRD42023403364). Randomized Controlled Trials published from the database’s inception to 8 November 2023 and focused on digital-based technologies aimed at increasing physical activity for the purpose of weight loss, with or without changes in diet, were considered eligible. In total, 1762 studies were retrieved and 31 met the inclusion criteria. Although they differed in the type of technology used and in their design, two-thirds of the studies reported significantly greater weight loss among electronic device users than controls. Many of these studies reported tailored or specialist-guided interventions. The use of digital technologies may be useful to support weight-loss interventions for people with overweight or obesity. Personalized feedback can increase the effectiveness of new technologies in motivating behavior changes.
... In the 1970s, the first warnings about harmful diets with a high content of sugars and/or too high fat intake, were reported. However, it was not until the 1990s when these tendencies normally linked to sedentarism began to show their negative effects on health, such as diabetes, hypertension, or obesity [2]. These consumption trends can also have a significant impact on the environment; for instance, by 2050, if these diets are not controlled, they will result in an 80% increase in greenhouse gas emissions [3]. ...
(1) Background: Oxalis pes-caprae L. is a plant considered within the group of so-called Wild Edible Plants (WEPs). The particularity of these plants is that they grow only with the natural resources at their disposal. Unfortunately, these types of plants are undervalued, being regularly uprooted from the fields. (2) Methods: Therefore, this study aimed to valorize the Oxalis pes-caprae plant, analyzing the proximate composition (sugars, organic acids, minerals, amino acids profile, fatty acids content, and volatile profile) of the plant shoots (flower, leaves, and stem) to demonstrate the full potential of this WEP. (3) Results: The results showed that Oxalis pes-caprae can be considered a natural source of minerals; furthermore, 19 essential and non-essential amino acids were found. Regarding the fatty acid profile, flowers are an important source of linoleic acid, and leaves present a high amount of α-linolenic acid. (4) Conclusions: Therefore, this research provides new information that reaffirms the capacity of Oxalis pes-caprae L. (WEP) to be a plant with great future progression due to its nutritional quality since it could be used in the food, nutritional, or pharmaceutical fields. Further research must be conducted to assay the biomass production and the costs of recommending farmers not to destroy this plant in their fields.
... As excess body weight arises from sustained positive energy balance [5], the role of food choice and intake are central to understanding the multifactorial nature of obesity [6]. Although genetic factors [7] and changes in the environment significantly contribute to this rapid upward trend in obesity rates e.g., [8][9][10][11], individual differences in taste hedonics may increase susceptibility to consume the energy-dense, high-fat sugar and nutrient-poor food and beverages found in 'westernised diets' and could therefore play a role in the obesity epidemic e.g., [6,12,13]. Taste hedonics have important influences on eating behaviour, informing food preference, selection and, consequently, nutritional intake and health [14]. Therefore, a greater understanding of individual differences in hedonic responses to sweet taste may provide insights into predispositions to diet-related health outcomes to better support public health strategies to prevent obesity and non-communicable diseases [15,16]. ...
Background
Legislation aimed at reducing sugar intake assumes that sweet-liking drives overconsumption. However, evidence that a greater liking for sweet taste is associated with unhealthier body size is mixed and complicated by relatively small samples, an overreliance on body mass index (BMI) and lack of classification using sweet-liking phenotypes.
Methods
We first examined body size data in two larger samples with sweet-liking phenotyping: extreme sweet-likers, moderate sweet-likers and sweet-dislikers. Adults (18-34yrs), attended a two-session lab-based experiment involving phenotyping for sweet-liking status and a bioelectrical impedance body composition measurement (Experiment One: N = 200; Experiment Two: N = 314). Secondly, we conducted an individual participant data (IPD) meta-analysis: systematic searches across four databases identified 5736 potential articles. Of these, 53 papers met our search criteria: a taste assessment that measured liking using sucrose (>13.7% w/v ), which allowed sweet-liking phenotyping and included either BMI, body fat percentage (BF%), fat-free mass (FFM) or waist-circumference.
Results
A significant effect of sweet-liking phenotype on FFM was found in both Experiment One and Two, with extreme sweet-likers having significantly higher FFM than sweet-dislikers. In Experiment One, sweet-dislikers had a significantly higher BF% than extreme sweet-likers and moderate sweet-likers. However, as these data are from one research group in a young, predominantly westernised population, and the results did not perfectly replicate, we conducted the IPD meta-analyses to further clarify the findings. Robust one-stage IPD meta-analyses of 15 studies controlling for sex revealed no significant differences in BF% ( n = 1836) or waist-circumference ( n = 706). For BMI ( n = 2368), moderate sweet-likers had slightly lower BMI than extreme sweet-likers, who had the highest overall BMI. Most interestingly, for FFM ( n = 768), moderate sweet-likers and sweet-dislikers showed significantly lower FFM than extreme sweet-likers.
Conclusion
The higher BMI often seen in sweet-likers may be due to a larger FFM and questions the simple model where sweet liking alone is a risk factor for obesity.
... Females working outside the home and alterations in gender roles substantially changed time use available for food choice and dietary patterns. The consumption of ultraprocessed foods contribute to poor health, including overweight, obesity and diet-related noncommunicable diseases, and environmental harms, with increased greenhouse gas emissions, loss of biodiversity, and environmental degradation from food production [94]. ...
Livelihoods have changed dramatically over the past decade in low- and middle-income countries (LMIC). These shifts are happening in tandem with shifts in individual and household food choice behaviors. This scoping review aimed to identify and characterize mechanisms through which livelihood changes could affect food choice behaviors in LMIC, including behaviors relating to food production, acquisition, preparation, distribution, and consumption. A literature search was conducted using 4 databases: PubMed, PsycInfo, AGRICOLA, and Embase. The search was further enhanced by expert solicitations. Studies were included if they measured or focused on a livelihood change, described or assessed a change in ≥1 food choice behavior, and focused on LMIC. Studies were excluded if they focused on migration from LMIC to a high-income country. Of the 433 articles that were identified, 53 met the inclusion criteria. Five mechanisms of how livelihood change can affect food choice were identified: occupation, locality, time, income, and social relations. Changes in occupation altered the balance of the availability and affordability of foods in local food environments compared with individual food production. Changes in location, time use, and income influenced where food was purchased, what types of foods were acquired, and how or where foods were prepared. Additionally, changes in social relationships and norms led to expanded food preferences, particularly among urban populations. Time limitations and higher discretionary income were associated with consumption of ultraprocessed foods. Understanding the relationships between the changes in livelihood occuring in LMIC and food choices of households in these countries can inform the development of policies, programs, and other actions to promote sustainable healthy diets and planetary health.
... The consumption of processed food made using refined grains has increased, a significant cause of vitamin B complex deficiency with global modernization [318][319][320]. Energy production in the human body is mainly regulated by thiamin (vitamin B1), which is necessary to metabolize branched-chain amino acids and carbohydrates [321][322][323]. ...
This is an exhaustive narrative review on nutritional importance regarding periodontium health. Macronutrients have
a significant impact on oral health. Highly refined carbohydrate intake has been linked to dental cavities and periodontal
diseases. In contrast, complex carbohydrates in whole grains and vegetables promote periodontal health. Proteins are
essential for host defenses and the synthesis of connective tissues, making them crucial for periodontal well-being.
Vegetable proteins positively affect periodontal health. Dietary fats promote inflammation and increase the risk of
periodontal disease. Omega-3 fatty acids are well-known for their anti-inflammatory properties and minimizing
periodontal inflammation. Vitamins and minerals are essential in maintaining periodontal health. Vitamins A, D, and
K are necessary for oral epithelial integrity, bone growth, and tissue maintenance. Ca2+ and Mg2+ deficiencies have
been associated with severe periodontal diseases. Antioxidants like vitamin C can mitigate periodontal inflammation.
Most dental practitioners acknowledge that a person’s nutritional status attenuates periodontal disorders. The severity
of inflammation in the gums is indirectly impacted by the inherent resistance of the periodontal tissues to infection
at a systemic level. Dental professionals should address local irritants through different procedures, promote daily
plaque control at home, and offer nutritional counseling on improving overall periodontal health
... World Health Organization (WHO) declared obesity a global epidemic [1]. That affects people of all ages and socioeconomic groups, independent of a country's income level [2,3]. Over the past few decades, the prevalence of obesity has steadily risen, becoming a significant public health challenge globally [4]. ...
Background
Observational studies have suggested associations between sedentary behaviors (SB), physical activity (PA), sleep duration (SD), and obesity, but the causal relationships remain unclear.
Methods
We used Mendelian randomization (MR) with genetic variation as instrumental variables (IVs) to assess the causality between SB/PA/SD and obesity. Genetic variants associated with SB/PA/SD were obtained from Genome-wide association study (GWAS), and obesity data came from FinnGen. The primary MR analysis used the instrumental variable weighted (IVW) method, with sensitivity tests including Cochran Q, MR-Egger intercepts, and MR-Radial. Expression Quantitative Trait Loci (eQTL) analysis was applied to identify significant genetic associations and biological pathways in obesity-related tissues.
Results
The MR analysis revealed causal relationships between four SB-related lifestyle patterns and obesity. Specifically, increased genetic liability to television watching (IVW MR Odds ratio [OR] = 1.55, [95% CI]:[1.27, 1.90], p = 1.67×10 ⁻⁵ ), computer use ([OR] = 1.52, [95% CI]:[1.08, 2.13], p = 1.61×10 ⁻² ), leisure screen time (LST) ([OR] = 1.62, [95% CI] = [1.43, 1.84], p = 6.49×10 ⁻¹⁴ , and driving (MR [OR] = 2.79, [95% CI]:[1.25, 6.21], p = 1.23×10 ⁻² ) was found to increase the risk of obesity. Our findings indicate that no causal relationships were observed between SB at work, sedentary commuting, PA, SD, and obesity. The eQTL analysis revealed strong associations between specific genes (RPS26, TTC12, CCDC92, NICN1) and SNPs (rs10876864, rs2734849, rs4765541, rs7615206) in both subcutaneous and visceral adipose tissues, which are associated with these SBs. Enrichment analysis further revealed that these genes are involved in crucial biological pathways, including cortisol synthesis, thyroid hormone synthesis, and insulin secretion.
Conclusions
Our findings support a causal relationship between four specific SBs (LST, television watching, computer use, driving) and obesity. These results provide valuable insights into potential interventions to address obesity effectively, supported by genetic associations in the eQTL and enrichment analysis. Further research and public health initiatives focusing on reducing specific SBs may be warranted.
... Moreover effective intervention in acute care for CVD is not readily available and affordable in developing countries [5]. Failure to prevent CVD risk factors among adolescents promoted by urbanization and adopted westernized lifestyle [6] may result in a future adult CVD epidemic in developing countries, which will mirror the current situation in many developed countries [7]. Motivated by the world-wide increasing mortality of heart disease patients each year and the availability of huge amount of patients' data from which to extract useful knowledge, researchers have been using data mining techniques to help health care professionals in the diagnosis of heart disease [8]. ...
Empirical report has confirmed cardiovascular disease as the highest cause of mortality rate in the world. In an attempt to avert this, researchers have adopted various data mining algorithms to help health care professionals in the detection of heart disease. Decision Tree (C4.5) is one of the successful data mining techniques used due to it classification power. Also other discretization techniques, voting method, and reduced error pruning are known to produce more accurate Decision Trees. More so Naïve bayes has also been frequently used because of its predictive power. However this research adopted a hybrid of decision tree and naïve bayes to enhance a more accurate and time efficient diagnoses of cardiovascular disease. A widely used benchmark data set issued in this research. To evaluate the performance of the hybrid model the sensitivity, specificity, and accuracy are calculated. The research proposes a model that outperforms C4.5 and naïve bayes in the diagnosis of cardiovascular disease among patients.
... This can be attributed to the fact that refined grains and added sugars, salt, trans fats, and animal-source foods are abundant in poor-quality diets, whereas whole grains, fruits, vegetables, legumes, fish, and nuts are scarce. They are frequently rich in processed food products, which are typically packed and precooked, and low in whole foods and freshly made dishes 35 . Systematic reviews and high-quality RCTs back up the idea that highly refined, high-glycemic-load carbs are hazardous. ...
A decrease in cardiovascular event risk with a decrease in total and LDL – cholesterol level is termed as “cholesterol paradox” or “risk factor reversal”. Cardiovascular risk does not have a linear relationship between LDL – cholesterol levels, and other substantial risk factors of cardiovascular events are being disregarded.The aim of this study is, to identify modifiable risk factors of cardiovascular events other than those well proved to cause dyslipidemia. A cross-sectional study was conducted with 652 participants in a tertiary care hospital. Patients were grouped into two, based on the history of cardiovascular events. Demographics and patient responses captured using pre-validated questionnaires were analyzed. 5mL blood samples were collected by venipuncture and lipid profile was estimated. Association between cardiovascular events and explanatory variables. was determined using Chi square test and Odds ratio at 95% confidence intervals. Higher risk of CV events was found among smokers 0.232 [0.144 – 0.373]. Consumption of white sugar, refined oil, processed cold beverages and fast food products increased CV risk respectively. Moreover, total cholesterol, LDL-C and triglycerides were found to decrease after one year of counselling the patients. The classical hypothesis of dyslipidemia induced atherosclerosis may not be the predominant cause of CV events. Herein, we report no association between high fat diet and CV risk while we observed higher risk in consumers of refined and ultra processed food products. However, significant control of cholesterol was observed in patients who shifted to Unrefined food products.
Through the perspectives of impact investors, and the nutrition community, this paper explores whether impact investment in food‐related small and medium enterprises (SMEs) creates a viable path to improved nutrition in Sub‐Saharan Africa. From the nutrition perspective, investment in food SMEs could help address coexisting multiple forms of malnutrition by shifting nutritional quality of available foods. From the investor perspective, attractiveness of investment in food SMEs depends on financial risks, how costs are passed on to consumers, and probability of impact. Clear nutritional objectives and investment criteria are needed, as well as research to maximize the potential of this innovative approach.
Background
As one of the world’s biodiversity hotspots, Indonesia contains over 19,000 plant species, including wild edible plants (WEPs). These WEPs complement people’s diets and substitute for common vegetables, particularly in rural areas. However, in West Java, the biodiversity of WEPs is declining, which coincides with public health issues related to malnutrition. Because they often contain high levels of micronutrients WEPs can be used as a healthy dietary alternative, especially given the growing prevalence of micronutrient deficiency and diet-related diseases among the Indonesian population. Despite the potential benefits of addressing these issues, limited research has been conducted on this topic. This study aims to document the diversity of WEPs in rural West Java, assess communities’ perceptions regarding their availability and importance, and determine factors influencing their consumption.
Methods
Mixed methods were employed, including ethnobotanical surveys with 20 key informants and a cross-sectional survey assessing perceptions, attitudes, and correlates of WEP consumption among 107 women in three villages in the region. The nutritional compositions of documented WEPs were obtained from literature and analysis. Bivariate correlation was used to analyze the relationships between WEP consumption frequency and potential correlates.
Results
The study documented 53 species of WEPs from 27 families, and many of which are rich in nutritional value, serving as sources of both macro- and micronutrients. WEP use prevalence was found to be 97%. The main motivations for using WEPs were their availability as free food (33%), medicinal value (26%), nostalgic value (23%), and preferred taste (18%). WEP consumption frequency was positively correlated with age, livestock possession (p < 0.05), and knowledge related to WEP (p < 0.01), while being negatively associated with the number of family members (p < 0.05). Most respondents (92%) agreed that consumption has declined compared to the past.
Conclusions
WEP use is common in the study area, and these plants are highly valued for their critical roles in diet, economy, and culture. They have the potential to improve community diets and nutrition. Educating and raising awareness about their nutritional values among communities can enhance their consumption, thereby contributing to addressing nutrition disparities.
Objective: This bibliometric analysis seeks to summarize research papers on Patanjali's Ashtanga Yoga and investigate its influence on health and well-being. Methods: A thorough search of the PubMed database was done to find papers that were pertinent to Ashtanga Yoga. VOSviewer software was used to retrieve and analyze 2,864 articles in total. Findings: The examination uncovered a wide range of advantages linked to Ashtanga Yoga, such as enhancements in psychological, immunological, and neurological well-being, improved quality of life, and heightened levels of awareness. Research has demonstrated that Ashtanga Yoga effectively mitigates stress, sadness, and anxiety, while concurrently enhancing cardiovascular and mental well-being, alleviating persistent pain, and optimizing sleep quality. The ethical standards delineated in Yama and Niyama were recognized as factors that contribute to self-discipline and ethical deliberations. Moreover, the bodily positions (Asanas), strategies for controlling breath (Pranayama), and withdrawal of senses (Pratyahara) that are linked to Ashtanga Yoga were discovered to have beneficial impacts on different elements of health and overall well-being. The ultimate stages of Ashtanga Yoga, namely Dharana, Dhyan, and Samadhi, were emphasized for their ability to promote deep internal focus, mindfulness, and spiritual illumination. Conclusion: This bibliometric research highlights the holistic approach of Patanjali's Ashtanga Yoga to enhance physical, mental, and spiritual well-being. The results indicate that Ashtanga Yoga provides significant knowledge for improving general well-being and cultivating a sense of inner balance and spiritual awareness.
Introduction
Feeding infants a sub-optimal diet deprives them of critical nutrients for their physical and cognitive development. The objective of this study is to describe the intake of foods of low nutritional value (junk foods) and identify the association with growth and developmental outcomes in infants up to 18 months in low-resource settings.
Methods
This is a secondary analysis of data from an iron-rich complementary foods (meat versus fortified cereal) randomized clinical trial on nutrition conducted in low-resource settings in four low- and middle-income countries (Democratic Republic of the Congo, Guatemala, Pakistan, and Zambia). Mothers in both study arms received nutritional messages on the importance of exclusive breastfeeding up to 6 months with continued breastfeeding up to at least 12 months. This study was designed to identify the socio-demographic predictors of feeding infants’ complementary foods of low nutritional value (junk foods) and to assess the associations between prevalence of junk food use with neurodevelopment (assessed with the Bayley Scales of Infant Development II) and growth at 18 months.
Results
1,231 infants were enrolled, and 1,062 (86%) completed the study. Junk food feeding was more common in Guatemala, Pakistan, and Zambia than in the Democratic Republic of Congo. 7% of the infants were fed junk foods at 6 months which increased to 70% at 12 months. Non-exclusive breastfeeding at 6 months, higher maternal body mass index, more years of maternal and paternal education, and higher socioeconomic status were associated with feeding junk food. Prevalence of junk foods use was not associated with adverse neurodevelopmental or growth outcomes.
Conclusion
The frequency of consumption of junk food was high in these low-resource settings but was not associated with adverse neurodevelopment or growth over the study period.
Background
During the 1990s, global eating habits changed, affecting poorer and middle-income nations, as well as richer countries. This shift, known as the "obesity transition," led to more people becoming overweight or obese worldwide. In Ecuador, this change is happening, and now, one in three children is affected by overweight or obesity (OW/OB). This study explores the links between social, economic, and demographic factors and childhood obesity in Ecuador, seeking to provide insights for shaping future health policies in response to this intricate shift.
Methods
A cross-sectional study using 2018 National Health and Nutrition Survey data from Ecuador. Weighted percentages were computed, and odds ratios for OW/OB unadjusted and adjusted for each category of explanatory variables were estimated using multilevel multivariate logistic regression models.
Results
Among 10,807 Ecuadorian school children aged 5 to 11, the prevalence of OW/OB was 36.0%. Males exhibited 1.26 times higher odds than females (95% CI: 1.20 to 1.33), and each additional year of age increased the odds by 1.10 times (95% CI: 1.09 to 1.10). Economic quintiles indicated increased odds (1.17 to 1.39) from the 2nd to 5th quintile (the richest) compared with the first quintile (the poorest). Larger household size slightly reduced odds of OW/OB (adjusted odds ratio [aOR] = 0.93, 95% CI: 0.91 to 0.95), while regular physical activity decreased odds ([aOR] = 0.79, 95% CI: 0.75 to 0.82). The consumption of school-provided meals showed a non-significant reduction (aOR: 0.93, 95% CI: 0.82 to 1.06). Children from families recognizing and using processed food labels had a higher likelihood of being overweight or obese (aOR = 1.14, 95% CI: 1.02 to 1.26).
Conclusion
Age, male gender, and higher economic quintile increase OW/OB in Ecuadorian school children. Larger households and physical activity slightly decrease risks. Ecuador needs policies for healthy schools and homes, focusing on health, protection, and good eating habits.
The ‘double burden of malnutrition’ is a global health challenge that increasingly affects populations in both low‐ and middle‐income countries (LMICs). This phenomenon refers to the coexistence of undernutrition and overweight or obesity, as well as other diet‐related non‐communicable diseases, in the same population, household or even individual. While noteworthy progress has been made in reducing undernutrition in some parts of the world, in many of these areas, the prevalence of overweight and obesity is increasing, particularly in urban areas, resulting in greater numbers of people who were undernourished in childhood and have overweight or obesity in adulthood. This creates a complex and challenging situation for research experts and policymakers who must simultaneously address the public health burdens of undernutrition and overweight/obesity. This review identifies key challenges and limitations in the current research on the double burden of malnutrition in individuals, including the need for a more comprehensive and nuanced understanding of the drivers of malnutrition, the importance of context‐specific interventions and the need for greater attention to the food environment and food systems. We advocate for the re‐evaluation of research strategies and focus, with a greater emphasis on multidisciplinary and systems approaches and greater attention to the synergistic relationship between the biological, environmental, commercial and socio‐economic determinants of malnutrition. Addressing these key challenges can enable us to better comprehend and tackle the multifaceted and dynamic issues of the double burden of malnutrition, particularly in individuals and work towards more effective and sustainable solutions.
Background
Stroke is the second leading cause of death and the leading cause of disability worldwide. However, how the the prevalence of stroke varies across the world is uncertain.
Aims
The aim of this study was to and analyze temporal trends of prevalence for Stroke, including Ischemic stroke (IS), Intracerebral hemorrhage (ICH), and Subarachnoid hemorrhage (SAH) at the global, regional, and national levels.
Methods
The age-standardized prevalence rates (ASPR) of stroke, IS, ICH, and SAH, along with their corresponding 95% uncertainty intervals (UI), were derived from data in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. This provides estimates for the burden of 369 diseases and injuries globally in 2019, as well as their temporal trends over the past 30 years. Joinpoint regression analysis was used to analyze the 1990–2019 temporal trends by calculating the annual percentage change (APC) and average APC (AAPC), as well as their 95% confidence interval (CI).
Results
In 2019, the global ASPR of stroke was 1240.263 per 100,000 population (95% UI: 1139.711 to 1352.987), with ASPRs generally lower in Europe compared to other regions. Over the period from 1990 to 2019, a significant global decrease in ASPR was observed for stroke (AAPC -0.200, 95% CI: -0.215 to -0.183), IS (AAPC -0.059%, 95% CI: -0.077 to -0.043), SAH (AAPC -0.476, 95% CI: -0.483 to -0.469), and ICH (AAPC -0.626, 95% CI: -0.642 to -0.611). The trends of ASPR of stroke, IS, SAH and ICH varied significantly across 204 countries and territories.
Conclusions
Our findings highlight significant global disparities in stroke prevalence, emphasizing the need for ongoing monitoring and intensified efforts in developing regions to reduce the global burden of stroke.
The Mexican food system has suffered deep transformations due to multiple technological advances and political and free trade agreements, transiting from a food system for self-consumption to a system based on exports and imports that has resulted in excessive agricultural activity intensifi-cation, leading to environmental deterioration. Our species' survival will depend on our capacity to manage systems, considering all ecosystems, especially the climate and food systems. International organizations insist that sustainable food systems could be a useful strategy to address malnutrition and hunger while respecting the environment. However, the food system in Mexico needs to be connected to the environmental, social, health, and food security dimensions. Sustainability in Mexico synthesizes the contradictions of agriculture and the Mexican diet, not only in its economic and productive dimensions but also in the social and environmental ones. Public policies in all sectors of the country must be interconnected and organized to guarantee the sustainability of a system that benefits the environment and population health while respecting the related economic and social elements. This review aims to offer a comprehensive understanding of the Mexican food system's history and current situation and analyze proposals for its sustainability.
Liking for the sweetness of sugars and consumption of high fat-sugar diets are hot topics in the study of human ingestive behaviour, where controlling excess sugar and saturated fat intake is the focus of dietary guidelines and public health nutrition policies to tackle obesity globally. Contrary to the simple view that sweet liking is universal, in the first section of this chapter we review half a decade of empirical evidence for clear interpersonal variations in hedonic responses to sweetness with a three-phenotype model prevailing: a rise in liking with increasing sweetness (extreme sweet likers), liking for moderate but not intense sweetness (moderate sweet likers), and a decline in liking as sweetness increases (sweet dislikers). We then summarise how these phenotypic differences relate to diet and anthropometry and discuss the potential link between a strong liking for sweetness and enhanced responsiveness to internal cues considering alliesthesia and contemporary theories of interoception. In the second section we re-examine fat taste, distinguishing between oral detection of specific free fatty acids (FFAs) (i.e., fat “taste”) and hedonic evaluations of complex fat-based stimuli (i.e., fat “flavour”) and discuss how they might relate to body size and obesity. Finally, we review how fat perception may change with both accumulation and loss of fat from the body. Overall, we question the claims that sweetness elicits universal liking responses, with particular emphasis on disentangling the conventional wisdom that a strong liking for sweetness drives overconsumption, ultimately leading to weight gain and obesity. Instead, we propose that liking for fat may be a better predictor and propose future perspectives that take into account wider interpersonal characteristics.
This paper analyses the impact of a healthy food nudge intervention on purchases of 1590 customers of a supermarket chain's loyalty program in Uruguay through a randomized controlled trial. Nudges were presented in the form of messages sent through WhatsApp to customers three times a week for 8 weeks (between July and September 2020). Messages highlighted the benefits of cooking at home and eating mindfully and healthy (vegetables, fruits, healthy snacks, legumes, and fish), and included easy to implement tips. Results show that, on average, customers assigned to the treatment group increased their purchases of healthy food by 8% and substituted sugar‐sweetened for sugar‐free beverages. We find an unintended increase in purchases of unhealthy food of 7%, with no correlative increase in calories, suggesting that customers substituted higher calorie products for lower calorie ones. We find that households with lower educational attainment, lower income, and with children under the age of 12 are more likely to increase purchases of fruits and vegetables, while other households are more likely to improve the diet quality without increasing expenditure. Effects do not persist after the intervention is over, suggesting that salience, rather than information is the main channel triggering the effects.
Currently the socioeconomic gradient of obesity it is not well understood in the urban population in Latin American. This study reviewed the literature assessing associations between pre-obesity, obesity, and socioeconomic position (SEP) in adults living in urban areas in Latin American countries. PubMed and SciELO databases were used. Data extraction was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We extracted data on the association between SEP (e.g., education, income), pre-obesity (body mass index [BMI] ≥ 25 and < 30 kg/m ² ) and obesity (BMI ≥ 30 kg/m ² ). Relative differences between low and high SEP groups were assessed and defined a priori as significant at p < 0.05. Thirty-one studies met our inclusion criteria and most were conducted in Brazil and Mexico (22 and 3 studies, respectively). One study presented nonsignificant associations. Forty-seven percent of associations between education or income and pre-obesity were negative. Regarding obesity, 80 percent were negative and 20 percent positive. Most negative associations were found in women while in men they varied depending on the indicator used. Pre-obesity and obesity by SEP did not follow the same pattern, revealing a reversal of the obesity social gradient by SEP, especially for women in Latin America, highlighting the need for articulated policies that target structural and agentic interventions.
Background
The impact of non-communicable diseases (NCDs) is disproportionately felt by immigrants from low- to medium-income countries (LMICs), partly due to their dietary habits. To thrive in their new environment, migrants either omit or consume certain food items, which could lead to nutritional deficits. As a result, most migrants experience more NCDs than their compatriots in their native countries. Therefore, we evaluated the difference in dietary habits, quality, and the influencing factors of overweight or obesity among African migrant students in Nanjing (China) and non-migrant students in Africa using cross-sectional data.
Methods
The researchers used the food frequency questionnaire and the global diet quality score metrics to assess food intake and quality, respectively. Then, cross-tabulation was employed to explore the differences between the groups in meal skipping, eating habits, and diet quality. Finally, the factors associated with overweight or obesity were assessed with binary logistic regression stratified by African students in Nanjing and students in their native countries.
Results
Approximately 678 responses were received, mainly between 18–25 years (46.7%) and 26–36 years (45.4 %). The majority of them (52.3%) were international students. The non-migrant African students' diets lacked citrus fruits (22.2%), deep orange fruits (15.4%), deep orange vegetables (18%), cruciferous vegetables (24.6%), and dark leafy vegetables (26.5%). While the African migrant students consumed more high-fat dairy (50.7%), processed meats (23.9%), sweets and ice creams (51.3%), sugar-sweetened beverages (40.5%), and juice (61.5%), p < 0.001. Furthermore, consuming late-night meals constantly [Exp (B) = 39.607, p = 0.049], eating twice a day [Exp (B) = 6.527, p = 0.036], consuming red meat [Exp (B) = 29.287, p = 0.001], processed meats [Exp (B) = 719.979, p = 0.0011], refined grains and baked foods [Exp (B) = 15.752, p = 0.013], and sweets and ice cream [Exp (B) = 193.633, p = 0.006] were factors inducing overweight or obesity among only African migrant students.
Conclusion
Controlling the what (Western diet and nature of late-night meals) and the when of eating can drastically reduce their influence on obesogenic condition formation in African migrant students in China and elsewhere.
Background: A high early protein intake has been proposed to increase obesity risk.
Objective: We examined whether a critical period of protein intake for later obesity may exist early in childhood and investigated the relation between protein intake from different sources and body mass index SD score and body fat percentage (BF%) at 7 y of age.
Design: The study population included 203 participants of the Dortmund Nutritional and Longitudinally Designed Study with information on diet at 6 mo, 12 mo, 18-24 mo, 3-4 y, and 5-6 y. Life-course plots were constructed to assess when protein intake (% of energy) was associated with body mass index SD score and BF% at 7 y. Mean values were then compared among tertiles (T1-T3) of protein from different sources at the important time points.
Results: The ages of 12 mo and 5-6 y were identified as critical ages at which higher total and animal, but not vegetable, protein intakes were positively related to later body fatness. In fully adjusted models, animal protein intake at 12 mo was associated with BF% at 7 y as follows [x̄ (95% CI) BF%]: T1, 16.20 (15.23, 17.25); T2, 17.21 (16.24, 18.23); T3, 18.21 (17.12, 19.15); P for trend = 0.008. With respect to food groups, dairy, but not meat or cereal protein intake, at 12 mo was related to BF% at 7 y (P for trend = 0.07). Animal protein at 5-6 y yielded similar results (P for trend = 0.01), but food group associations were less consistent.
Conclusion: A higher animal, especially dairy, protein intake at 12 mo may be associated with an unfavorable body composition at 7 y. The age of 5-6 y might represent another critical period of protein intake for later obesity risk.
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the Na- tional ...
It is traditionally believed that genetic susceptibility and adult faulty lifestyle lead to type 2 diabetes, a chronic non-communicable disease. The "Developmental Origins of Health and Disease" (DOHaD) model proposes that the susceptibility to type 2 diabetes originates in the intrauterine life by environmental fetal programming, further exaggerated by rapid childhood growth, i.e. a biphasic nutritional insult. Both fetal under nutrition (sometimes manifested as low birth weight) and over nutrition (the baby of a diabetic mother) increase the risk of future diabetes. The common characteristic of these two types of babies is their high adiposity. An imbalance in nutrition seems to play an important role, and micronutrients seem particularly important. Normal to high maternal folate status coupled with low vitamin B(12) status predicted higher adiposity and insulin resistance in Indian babies. Thus, 1-C (methyl) metabolism seems to play a key role in fetal programming. DOHaD represents a paradigm shift in the model for prevention of the chronic non-communicable diseases.
AIMS/HYPOTHESIS: Raised maternal plasma total homocysteine (tHcy) concentrations predict small size at birth, which is a risk factor for type 2 diabetes mellitus. We studied the association between maternal vitamin B12, folate and tHcy status during pregnancy, and offspring adiposity and insulin resistance at 6 years. METHODS: In the Pune Maternal Nutrition Study we studied 700 consecutive eligible pregnant women in six villages. We measured maternal nutritional intake and circulating concentrations of folate, vitamin B12, tHcy and methylmalonic acid (MMA) at 18 and 28 weeks of gestation. These were correlated with offspring anthropometry, body composition (dual-energy X-ray absorptiometry scan) and insulin resistance (homeostatic model assessment of insulin resistance [HOMA-R]) at 6 years. RESULTS: Two-thirds of mothers had low vitamin B12 (<150 pmol/l), 90% had high MMA (>0.26 micromol/l) and 30% had raised tHcy concentrations (>10 micromol/l); only one had a low erythrocyte folate concentration. Although short and thin (BMI), the 6-year-old children were relatively adipose compared with the UK standards (skinfold thicknesses). Higher maternal erythrocyte folate concentrations at 28 weeks predicted higher offspring adiposity and higher HOMA-R (both p < 0.01). Low maternal vitamin B12 (18 weeks; p = 0.03) predicted higher HOMA-R in the children. The offspring of mothers with a combination of high folate and low vitamin B12 concentrations were the most insulin resistant. CONCLUSIONS/INTERPRETATION: Low maternal vitamin B12 and high folate status may contribute to the epidemic of adiposity and type 2 diabetes in India
Background: It was shown that men who were conceived during the Dutch famine of 1944–1945 had higher rates of obesity at age 19 y than those conceived before or after it.
Objective: Our objective was to study the effects of prenatal exposure to the Dutch famine on obesity in women and men at age 50 y.
Design: We measured the body size of 741 people born at term between November 1943 and February 1947 in Amsterdam. We compared people exposed to famine in late, mid, or early gestation (exposed participants) with those born before or conceived after the famine period (nonexposed participants).
Results: The body mass index (BMI; in kg/m²) of 50-y-old women exposed to famine in early gestation was significantly higher by 7.4% (95% CI: 0.7%, 14.5%) than that of nonexposed women. BMI did not differ significantly in women exposed in mid gestation (−2.1%; −7.0%, 3.1%) or in late gestation (−1.3%; −6.3%, 3.9%). In 50-y-old men, BMI was not significantly affected by exposure to famine during any stage of gestation: BMI differed by 0.4% (−3.5%, 4.5%) in men exposed to famine in late gestation, by −1.2% (−5.5%, 3.3%) in those exposed in mid gestation, and by 0.5% (−4.6%, 6.0%) in those exposed in early gestation compared with nonexposed men.
Conclusions: Maternal malnutrition during early gestation was associated with higher BMI and waist circumference in 50-y-old women but not in men. These findings suggest that pertubations of central endocrine regulatory systems established in early gestation may contribute to the development of abdominal obesity in later life.
The Expert Committee in charge of developing the Bever- age Consumption Recommendations for the Mexican Population was convened by the Secretary of Health for the purpose of developing evidence-based guidelines for consumers, health professionals, and government officials. The preva- lence of overweight, obesity and diabetes have dramatically increased in Mexico; beverages contribute a fifth of all calories consumed by Mexicans. Extensive research has found that caloric beverages increase the risk of obesity. Taking into consideration multiple factors, including the health benefits, risks, and nutritional implications associated with beverage consumption, as well as consumption patterns in Mexico, the committee classified beverages into six levels. Classifications were made based on caloric content, nutritional value, and health risks associated with the consumption of each type of beverage and range from the healthier (level 1) to least healthy (level 6) options, as follows: Level 1: water; Level 2: skim or low fat (1%) milk and sugar free soy beverages; Level 3: coffee and tea without sugar; Level 4: non-caloric bever
Aims/hypothesis
Raised maternal plasma total homocysteine (tHcy) concentrations predict small size at birth, which is a risk factor for type 2 diabetes mellitus. We studied the association between maternal vitamin B12, folate and tHcy status during pregnancy, and offspring adiposity and insulin resistance at 6 years.
Methods
In the Pune Maternal Nutrition Study we studied 700 consecutive eligible pregnant women in six villages. We measured maternal nutritional intake and circulating concentrations of folate, vitamin B12, tHcy and methylmalonic acid (MMA) at 18 and 28 weeks of gestation. These were correlated with offspring anthropometry, body composition (dual-energy X-ray absorptiometry scan) and insulin resistance (homeostatic model assessment of insulin resistance [HOMA-R]) at 6 years.
Results
Two-thirds of mothers had low vitamin B12 (<150 pmol/l), 90% had high MMA (>0.26 μmol/l) and 30% had raised tHcy concentrations (>10 μmol/l); only one had a low erythrocyte folate concentration. Although short and thin (BMI), the 6-year-old children were relatively adipose compared with the UK standards (skinfold thicknesses). Higher maternal erythrocyte folate concentrations at 28 weeks predicted higher offspring adiposity and higher HOMA-R (both p < 0.01). Low maternal vitamin B12 (18 weeks; p = 0.03) predicted higher HOMA-R in the children. The offspring of mothers with a combination of high folate and low vitamin B12 concentrations were the most insulin resistant.
Conclusions/interpretation
Low maternal vitamin B12 and high folate status may contribute to the epidemic of adiposity and type 2 diabetes in India.
The U.S.’s and U.K.’s efforts to combat obesity reflect underlying differences in the two countries’ understandings of obesity’s causes. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.
Mexico and other Latin American countries are currently undergoing important demographic, epidemiologic and nutrition transitions. Noncom-municable chronic diseases such as obesity, type 2 diabetes mellitus, and high blood pressure are becoming public health problems as the population experiences an important reduction in physical activity and an increase in energy-dense diets. In contrast, the prevalence of undernutrition is declining in most countries, although several decades will be needed before the prevalence drops to acceptable values. The objective of this article is to discuss the characteristics of the nutrition transition with emphasis in data from Mexico, Brazil, and Chile
Relevance and background Over the past half century, food preparation methods and consumption patterns have moved steadily away from reliance on relatively simple, basic foods to dependence on more prepared, processed, and “convenience” foods. At the same time, nutrition concerns in the United States have transitioned from primarily nutrient deficiencies to a combination of positive energy balance, nutrient imbalances, and overconsumption of food components associated with chronic, degenerative diseases. Consequently, since the early 1970s and in response to the 1969 White House Conference on Food, Nutrition and Health, the FDA has responded to consumer demand by requiring certain nutrition-related information be provided on food packaging. What is required and how it must be presented has evolved tremendously since that time, but the main goal of federal regulations in this regard has remained the provision of consumer-friendly nutrition information to improve health. In one of its most recent attempts to accomplish this goal, Congress directed the CDC to undertake a study in collaboration with the Institute of Medicine (IOM) to examine and provide recommendations regarding front-of-package nutrition rating systems and symbols. This initiative was implemented in 2 phases. In Phase I, an expert committee reviewed front-ofpackage systems being used in the United States and abroad and considered their purpose, overall merits, and scientifi cu nderpinnings. Among other findings, they concluded that the most critical nutritional components to include in front-of-package nutrition rating systems are calories, saturated fat and trans fats, and sodium; they found insufficient evidence that other nutrients and food components (including total fat, cholesterol, added sugars, vitamins, and minerals other than sodium) should be included. After the publication of the Phase I report (IOM, 2010), Phase II was collaboratively commenced by the CDC, FDA, and the U.S. Department of Agriculture’s Center for Nutrition Policy and Promotion. The findings and recommendations of the Phase II initiative are the subject of the publication reviewed here. Objectives and approach The tasks of the Phase II committee were as follows.
Many dietary recommendations include reduction of excessive intake of sugar-sweetened beverages (SSB) and other energy-rich beverages such as juices and alcohol. The present study examines surveys of both individual dietary intake data and household food expenditure surveys to provide a picture of patterns and trends in beverage intake and purchases in Great Britain from 1986 to 2009, and estimates the potential for pricing policy to promote more healthful beverage purchase patterns. In 2008-9, beverages accounted for 21, 14 and 18 % of daily energy intake for children aged 1·5-18 and 4-18 years, and adults (19-64 years), respectively. Since the 1990s, the most important shifts have been a reduction in consumption of high-fat dairy products and an increased consumption of fruit juices and reduced-fat milk among preschoolers, children and adolescents. Among adults, consumption of high-fat milk beverages, sweetened tea and coffee and other energy-containing drinks fell, but reduced-fat milk, alcohol (particularly beer) and fruit juice rose. In testing taxation as an option for shifting beverage purchase patterns, we calculate that a 10 % increase in the price of SSB could potentially result in a decrease of 7·5 ml/capita per d. A similar 10 % tax on high-fat milk is associated with a reduction of high-fat milk purchases by 5 ml/capita per d and increased reduced-fat milk purchase by 7 ml/capita per d. This analysis implies that taxation or other methods of shifting relative costs of these beverages could be a way to improve beverage choices in Great Britain.
Urine and plasma metabolites originate from endogenous metabolic pathways in different organs and exogenous sources (diet). Urine and plasma were obtained from advanced cancer patients and investigated to determine if variations in lean and fat mass, dietary intake, and energy metabolism relate to variation in metabolite profiles. Patients (n = 55) recorded their diets for 3 d and after an overnight fast they were evaluated by DXA and indirect calorimetry. Metabolites were measured by NMR and direct injection MS. Three algorithms were used [partial least squares discriminant-analysis, support vector machines (SVM), and least absolute shrinkage and selection operator] to relate patients' plasma/urine metabolic profile with their dietary/physiological assessments. Leave-one-out cross-validation and permutation testing were conducted to determine statistical validity. None of the algorithms, using 63 urine metabolites, could learn to predict variations in individual's resting energy expenditure, respiratory quotient, or their intake of total energy, fat, sugar, or carbohydrate. Urine metabolites predicted appendicular lean tissue (skeletal muscle) with excellent cross-validation accuracy (98% using SVM). Total lean tissue correlated highly with appendicular muscle (Pearson r = 0.98; P < 0.0001) and gave similar cross-validation accuracies. Fat mass was effectively predicted using the 63 urine metabolites or the 143 plasma metabolites, exclusively. In conclusion, in this population, lean and fat mass variation could be effectively predicted using urinary metabolites, suggesting a potential role for metabolomics in body composition research. Furthermore, variation in lean and fat mass potentially confounds metabolomic studies attempting to characterize diet or disease conditions. Future studies should account or correct for such variation.
To evaluate the associations between birth weight (BW), infancy, and childhood weight gain and adult body composition.
Subjects included participants of five birth cohort studies from low and middle income nations (Brazil, Guatemala, India, Philippines, and South Africa; n = 3432). We modeled adult body composition as a function of BW and conditional weight gain (CW), representing changes in weight trajectory relative to peers, in three age intervals (0-12 months, 12-24 months, 24 months-mid childhood).
In 34 of 36 site- and sex-specific models, regression coefficients associated with BW and CWs were higher for adult fat-free than for fat mass. The strength of coefficients predicting fat-free mass relative to those predicting fat mass was greatest for BW, intermediate for CWs through 24 months, and weaker thereafter. However, because fat masses were smaller and showed larger variances than fat-free masses, weaker relationships with fat mass still yielded modest but significant increases in adult % body fat (PBF). CW at 12 months and mid-childhood tended to be the strongest predictors of PBF, whereas BW was generally the weakest predictor of PBF. For most early growth measures, a 1 SD change predicted less than a 1% change in adult body fat, suggesting that any health impacts of early growth on changes in adult body composition are likely to be small in these cohorts.
BW and weight trajectories up to 24 months tend to be more strongly associated with adult fat-free mass than with fat mass, while weight trajectories in mid-childhood predict both fat mass and fat-free mass.
We examined associations of birth weight and weight gain in infancy and early childhood with type 2 diabetes (DM) risk in five cohorts from low- and middle-income countries.
Participants were 6,511 young adults from Brazil, Guatemala, India, the Philippines, and South Africa. Exposures were weight at birth, at 24 and 48 months, and adult weight, and conditional weight gain (CWG, deviation from expected weight gain) between these ages. Outcomes were adult fasting glucose, impaired fasting glucose or DM (IFG/DM), and insulin resistance homeostasis model assessment (IR-HOMA, three cohorts).
Birth weight was inversely associated with adult glucose and risk of IFG/DM (odds ratio 0.91[95% CI 0.84-0.99] per SD). Weight at 24 and 48 months and CWG 0-24 and 24-48 months were unrelated to glucose and IFG/DM; however, CWG 48 months-adulthood was positively related to IFG/DM (1.32 [1.22-1.43] per SD). After adjusting for adult waist circumference, birth weight, weight at 24 and 48 months and CWG 0-24 months were inversely associated with glucose and IFG/DM. Birth weight was unrelated to IR-HOMA, whereas greater CWG at 0-24 and 24-48 months and 48 months-adulthood predicted higher IR-HOMA (all P < 0.001). After adjusting for adult waist circumference, birth weight was inversely related to IR-HOMA.
Lower birth weight and accelerated weight gain after 48 months are risk factors for adult glucose intolerance. Accelerated weight gain between 0 and 24 months did not predict glucose intolerance but did predict higher insulin resistance.
Our objective was to describe the fluid and energy consumption of beverages in a large sample of European adolescents.
We used data from 2741 European adolescents residing in 8 countries participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS). We averaged two 24-h recalls, collected using the HELENA-dietary assessment tool. By gender and age subgroup (12.5-14.9 years and 15-17.5 years), we examined per capita and per consumer fluid (milliliters (ml)) and energy (kilojoules (kJ)) intake from beverages and percentage consuming 10 different beverage groups.
Mean beverage consumption was 1611 ml/day in boys and 1316 ml/day in girls. Energy intake from beverages was about 1966 kJ/day and 1289 kJ/day in European boys and girls, respectively, with sugar-sweetened beverages (SSBs) (carbonated and non-carbonated beverages, including soft drinks, fruit drinks and powders/concentrates) contributing to daily energy intake more than other groups of beverages. Boys and older adolescents consumed the most amount of per capita total energy from beverages. Among all age and gender subgroups, SSBs, sweetened milk (including chocolate milk and flavored yogurt drinks all with added sugar), low-fat milk and fruit juice provided the highest amount of per capita energy. Water was consumed by the largest percentage of adolescents followed by SSBs, fruit juice and sweetened milk. Among consumers, water provided the greatest fluid intake and sweetened milk accounted for the largest amount of energy intake followed by SSBs. Patterns of energy intake from each beverage varied between countries.
European adolescents consume an average of 1455 ml/day of beverages, with the largest proportion of consumers and the largest fluid amount coming from water. Beverages provide 1609 kJ/day, of which 30.4%, 20.7% and 18.1% comes from SSBs, sweetened milk and fruit juice, respectively.
Overweight prevalence has increased globally; however, current time trends of overweight prevalence by social class in lower income countries have not been fully explored.
We used repeated cross-sectional, nationally representative data from the Demographic and Health Surveys on women aged 18-49 years with young children (n=421,689) in 39 lower-income countries. We present overweight (body mass index ≥ 25 kg m⁻²) prevalence at each survey wave, prevalence difference and prevalence growth rate for each country over time, separately by wealth quintile and educational attainment. We present the correlation between nation wealth and differential overweight prevalence growth by wealth and education.
In the majority of countries, the highest wealth and education groups still have the highest prevalence of overweight and obesity. However, in a substantial number of countries (14% when wealth is used as the indicator of socioeconomic status and 28% for education) the estimated increases in overweight prevalence over time have been greater in the lowest- compared with the highest-wealth and -education groups. Gross domestic product per capita was associated with a higher overweight prevalence growth rate for the lowest-wealth group compared with the highest (Pearson's correlation coefficient: 0.45).
Higher (vs lower) wealth and education groups had higher overweight prevalence across most developing countries. However, some countries show a faster growth rate in overweight in the lowest- (vs highest-) wealth and -education groups, which is indicative of an increasing burden of overweight among lower wealth and education groups in the lower-income countries.
Developed countries are struggling to control epidemics of obesity and related chronic diseases; thus, we can expect only limited success from applying the current approaches to the developing world, which is experiencing an alarming increase in such disorders. This failure results in part from the fact that our focus on adult life-styles, although important, ignores data that suggest that biological and cultural factors operating early in life affect adult health status. To stem the rising obesity burden in developing countries, scientists and policy-makers must address obesity-promoting factors from early development to adulthood.
Global shifts toward an increasingly Western diet and rises in nutrition-related noncommunicable diseases necessitate systematic examination of dietary change in adults and children. This study longitudinally examined mother and child dietary intakes and their relationship with socioeconomic factors across 4 mutually exclusive cohorts followed over 6- to 7-y time periods (cohort A: 1991-1997, cohort B: 1993-2000, cohort C: 1997-2004, cohort D: 2000-2006). The cohorts included 966 mother-child pairs (children 3-5 y at baseline) from the China Health and Nutrition Survey. Dietary intake was assessed using 24-h recall and household food consumption data; dietary variables were the percentage of total energy from animal-source foods (ASF), fats/oils, and grains. Mother-child comparison of dietary variables used average annual change measures, Spearman partial correlations, random effects models, and seemingly unrelated regression models and estimation. Whereas children were earlier adopters and maintainers of a less traditional Chinese diet, mothers experienced greater shifts away from the traditional Chinese diet with increasing child age. Mother-child correlations for the dietary variables ranged from 0.46 to 0.89 (P < 0.001). Similar increased intake of ASF and decreased intake of grains were reported for mothers and children of urban (vs. rural) residence and with higher levels of maternal education (P < 0.001). A comparable cohort effect was shown, with mothers and children consuming a less traditional Chinese diet in the later (C and D) compared to earlier (A and B) cohorts (P < 0.05). Our findings provide insight into dietary changes in mothers and children within the context of a rapidly changing nutrition and socioeconomic environment.
Background: The evidence that breastfeeding protects against obesity and a variety of chronic diseases comes almost entirely from observational studies, which have a potential for bias due to confounding, selection bias, and selective publication.
Objective: We assessed whether an intervention designed to promote exclusive and prolonged breastfeeding affects children's height, weight, adiposity, and blood pressure at age 6.5 y.
Design: The Promotion of Breastfeeding Intervention Trial (PROBIT) is a cluster-randomized trial of a breastfeeding promotion intervention based on the WHO/UNICEF Baby-Friendly Hospital Initiative. A total of 17 046 healthy breastfed infants were enrolled from 31 Belarussian maternity hospitals and their affiliated clinics; of those infants, 13 889 (81.5%) were followed up at 6.5 y with duplicate measurements of anthropometric variables and blood pressure. Analysis was based on intention to treat, with statistical adjustment for clustering within hospitals or clinics to permit inferences at the individual level.
Results: The experimental intervention led to a much greater prevalence of exclusive breastfeeding at 3 mo in the experimental than in the control group (43.3% and 6.4%, respectively; P < 0.001) and a higher prevalence of any breastfeeding throughout infancy. No significant intervention effects were observed on height, body mass index, waist or hip circumference, triceps or subscapular skinfold thickness, or systolic or diastolic blood pressure.
Conclusions: The breastfeeding promotion intervention resulted in substantial increases in the duration and exclusivity of breastfeeding, yet it did not reduce the measures of adiposity, increase stature, or reduce blood pressure at age 6.5 y in the experimental group. Previously reported beneficial effects on these outcomes may be the result of uncontrolled confounding and selection bias.
The possibility that underweight and overweight coexist within households and understanding such an occurrence have not been studied sufficiently. In fact, underweight and overweight are thought of as resulting from very different environmental, behavioral and individual risk factors. This study identified households in which overweight and underweight coexist and explored household-level associations such as urban residence and income. Using three large national surveys from Brazil, China and Russia, the prevalence of such households ranged from 8% in China and Russia to 11% in Brazil. Even more important from the public health perspective is the finding that these under/over households accounted for a high proportion of all households with an underweight member in China (23%), Brazil (45%), and Russia (58%). The prevalence of the underweight/overweight household was highest in the urban environment in all three countries. There was no clear pattern in the prevalence of the underweight/overweight household type by income. Multivariable logistic regression was used to test the significance of the association of household type with urban residence and income while controlling for household size and household demographics by gender. Further analysis was done to consider the age relationships within the underweight/overweight pair. The underweight child coexisting with an overweight nonelderly adult was the predominant pair combination in all three countries. These findings illustrate the need for public health programs that are able to address underweight and overweight simultaneously.
Very few books, especially when written by many authors, have passed through any serious process of peer review. That this one has done so is due to the special way in which it was produced. All eighteen authors were asked to submit chapters which were then circulated to each of the others. Everyone was asked to write considered Commentaries on each chapter, with references where necessary, and these too were circulated to all the other authors. The purpose of the Commentaries was to be constructively critical and, where appropriate, to highlight areas of difference rather than to reach a consensus. Research workers, of course, always strive to reach a common truth in the end, but in the process their findings and ideas pass through a seemingly interminable period of discussion and argument; and during this time their enthusiasm is sharpened by the constructive cut-and-thrust of lively debate. Progress, indeed, comes as much from open discussion as from new discovery. New ideas and new results are regularly dipped in the acid of other people's opinions and findings, so that what remains is refined and likely to be reliably contributory. Our book is meant to be a contribution to that process.
People in developing countries currently consume on average one-third the meat and one-quarter of the milk products per capita compared to the richer North, but this is changing rapidly. The amount of meat consumed in developing countries over the past has grown three times as much as it did in the developed countries. The Livestock Revolution is primarily driven by demand. Poor people everywhere are eating more animal products as their incomes rise above poverty level and as they become urbanized. By 2020, the share of developing countries in total world meat consumption will expand from 52% currently to 63%. By 2020, developing countries will consume 107 million metric tons (mmt) more meat and 177 mmt more milk than they did in 1996/1998, dwarfing developed-country increases of 19 mmt for meat and 32 mmt for milk. The projected increase in livestock production will require annual feed consumption of cereals to rise by nearly 300 mmt by 2020. Nonetheless, the inflation-adjusted prices of livestock and feed commodities are expected to fall marginally by 2020, compared to precipitous declines in the past 20 y. Structural change in the diets of billions of people is a primal force not easily reversed by governments. The incomes and nutrition of millions of rural poor in developing countries are improving. Yet in many cases these dietary changes also create serious environmental and health problems that require active policy involvement to prevent irreversible consequences.
Increased prevalence of obesity in the United States has been paralleled by increased consumption of refined sugars and fat (Drewnowski et al. 1982b; Page and Friend 1978). According to USDA estimates for 1985, the average American consumed a total of 127.4 lb. (57.8 kg) of nutritive sweeteners, including 67.5 lb. (30.6 kg) of sucrose, consumed chiefly in processed foods and beverages. There is a popular belief that sugar is uniquely fattening. Overindulgence in soft drinks, sweets, and desserts has long been thought to be a causal factor in the development of obesity, adult-onset diabetes, and coronary heart disease (Yudkin 1966). To the obese, it is claimed, many of the most attractive, almost irresistible foods are those that are rich in carbohydrates, especially sugar (Yudkin 1983).
On June 16, 2004, cigarette smoking killed some twelve hundred Americans. That shocking death toll warranted no headlines. Neither did the same outcome-some twelve hundred more deaths-the following day, nor the day after. Indeed, it is the rare headline that informs the public that smoking accounts for nearly one of every five deaths in the United States, one in three during middle age. Smoking is simply too commonplace, too mundane. Ye t it is far and away the nation's- and increasingly the world's-leading killer. In this chapter I examine the burden smoking has imposed on society and what we have learned in attempting to deal with that burden. I then consider lessons drawn from this experience for addressing the most rapidly growing behavioral cause of chronic disease: the epidemic of obesity, the only behavior that threatens to overtake smoking as a cause of death. Copyright
A WHO expert consultation addressed the debate about interpretation of recommended body-mass index (BMI) cut-off points for determining overweight and obesity in Asian populations, and considered whether population-specific cut-off points for BMI are necessary. They reviewed scientific evidence that suggests that Asian populations have different associations between BMI, percentage of body fat, and health risks than do European populations. The consultation concluded that the proportion of Asian people with a high risk of type 2 diabetes and cardiovascular disease is substantial at BMIs lower than the existing WHO cut-off point for overweight (greater than or equal to25 kg/m(2)). However, available data do not necessarily indicate a clear BMI cut-off point for all Asians for overweight or obesity. The cut-off point for observed risk varies from 22 kg/m(2) to 25 kg/m(2) in different Asian populations; for high risk it varies from 26 kg/m(2) to 31 kg/m(2). No attempt was made, therefore, to redefine cut-off points for each population separately. The consultation also agreed that the WHO BMI cut-off points should be retained as international classifications. The consultation identified further potential public health action, points (23.0, 27.5, 32.5, and 37.5 kg/m(2)) along the continuum of BMI, and proposed methods by which countries could make decisions about the definitions of increased risk for their population.
What should we have for dinner? When you can eat just about anything nature (or the supermarket) has to offer, deciding what you should eat will inevitably stir anxiety, especially when some of the foods might shorten your life. Today, buffeted by one food fad after another, America is suffering from a national eating disorder. As the cornucopia of the modern American supermarket and fast food outlet confronts us with a bewildering and treacherous landscape, what's at stake becomes not only our own and our children's health, but the health of the environment that sustains life on earth. Pollan follows each of the food chains--industrial food, organic or alternative food, and food we forage ourselves--from the source to the final meal, always emphasizing our coevolutionary relationship with the handful of plant and animal species we depend on. The surprising answers Pollan offers have profound political, economic, psychological, and even moral implications for all of us.--From publisher description.
The unrelenting rise in global rates of non-communicable disease has necessitated a thorough re-evaluation of the current use of adult- and lifestyle-based strategies to curb the growing epidemic. There is a rapidly emerging set of epidemiological, experimental and clinical data suggesting that developmental factors play a considerable role in determining individual disease risk later in life. This phenomenon is known as the Developmental Origins of Health and Disease (DOHaD). Developmental factors, such as maternal and paternal nutrition, gestational diabetes mellitus, and even the normative range of developmental experiences, may evoke the processes of developmental plasticity which enable an organism to change its developmental trajectory in response to environmental cues. However in the event of a mismatch between the early and mature environment, such anticipatory responses may become maladaptive and lead to elevated risk of disease. The evo-devo and eco-evo-devo framework for DOHaD has more recently been supported by mechanistic insights enabled by rapid advances in epigenetic research. Increasing evidence suggests that developmental plasticity may be effected by epigenetically mediated modulation of the expression of specific genes. These mechanisms include DNA methylation, histone modifications and noncoding RNA activity. A growing number of animal studies also point towards the transgenerational inheritance of epigenetic marks, which may have implications for the perpetuation of ill-health. However early-life epigenotyping may find utility as a prognostic marker of metabolic dysfunction for identification and treatment of at-risk individuals.
This paper provides empirical evidence on the gendered impact of the 2007–08 food price crisis using panel data on 1,400 households from rural Ethiopia that were initially surveyed before the onset of the crisis, in 1994–95, 1997, and 2004, and after food prices spiked, in 2009. It investigates whether female-headed households are more likely to report experiencing a food price shock, and whether female-headed households experiencing a shock are more (or less) likely to adopt certain coping strategies, controlling for individual, household, and community characteristics. Our findings suggest that female-headed households are more vulnerable to food price changes and are more likely to have experienced a food price shock in 2007–08. Because female-headed households are also resource poor and have a larger food gap compared with male-headed households, they cope by cutting back on the number of meals they provide their households during good months and eating less preferred foods in general. Our findings that land—particularly better quality land—has a protective effect against food price shocks also highlight the role of strengthening land rights of the poor, particularly poor women, to enable them to cope better with food price increases.
Golden Arches East, McDonald's in East Asia by James L. Watson. Editor Stanford University Press 1998
"We all witness, in advertising and on supermarket shelves, the fierce competition for our food dollars. In this engrossing exposé, Marion Nestle goes behind the scenes to reveal how the competition really works and how it affects our health. The abundance of food in the United States--enough calories to meet the needs of every man, woman, and child twice over--has a downside. Our over-efficient food industry must do everything possible to persuade people to eat more--more food, more often, and in larger portions--no matter what it does to waistlines or well-being. Like manufacturing cigarettes or building weapons, making food is big business. Food companies in 2000 generated nearly $900 billion in sales. They have stakeholders to please, shareholders to satisfy, and government regulations to deal with. It is nevertheless shocking to learn precisely how food companies lobby officials, co-opt experts, and expand sales by marketing to children, members of minority groups, and people in developing countries. We learn that the food industry plays politics as well as or better than other industries, not least because so much of its activity takes place outside the public view. Editor of the 1988 Surgeon General's Report on Nutrition and Health, Nestle is uniquely qualified to lead us through the maze of food industry interests and influences. She vividly illustrates food politics in action: watered-down government dietary advice, schools pushing soft drinks, diet supplements promoted as if they were First Amendment rights. When it comes to the mass production and consumption of food, strategic decisions are driven by economics--not science, not common sense, and certainly not health. No wonder most of us are thoroughly confused about what to eat to stay healthy. An accessible and balanced account, Food Politics will forever change the way we respond to food industry marketing practices. By explaining how much the food industry influences government nutrition policies and how cleverly it links its interests to those of nutrition experts, this path-breaking book helps us understand more clearly than ever before what we eat and why." © 2002, 2007, 2013 by The Regents of the University of California.
This landmark publication provides the first definitive account of how and why subtle influences on the fetus and during early life can have such profound consequences for adult health and diseases. Although the epidemiological evidence for this link has long proved compelling, it is only much more recently that the scientific and physiological basis for this has begun to be studied in depth and fully understood. This compilation, written by many of the world’s leading experts in this exciting field, summarizes these scientific and clinical advances. The link between early development and the onset of many chronic diseases such as coronary heart disease, diabetes and osteoporosis, also raises important public health issues. Another fascinating theme in the book concerns evolutionary developmental biology and how the ‘evo-devo’ debate can cast light on these concepts. Clinicians and scientists alike will all learn a lot about this exciting and emerging field. © P. D. Gluckman and M. A. Hanson 2006 and Cambridge University Press, 2009.
The concept of developmental origins of health and disease (DOHaD) grew from the earlier concept of fetal origins of adult disease (FOAD) (reviewed in Barker 1995, 1998). There are two important reasons for the change. The first results from the large amount of research (much of it reviewed in this book) showing that the early life events which determine in part the risk of later disease occur not only in the fetal period specifically, but throughout the plastic phase of development. In this respect the use of the word ‘development’ is helpful because it implies not only effects operating during early stages of embryonic life (usually the preserve of developmental biology) but also those in infancy. Secondly, the DOHaD terminology emphasises that this area of science has implications not only for disease, and its prevention, but also for health promotion. The latter is of great importance in public health and education programmes in many parts of the world. But the accent on ‘developmental origins’ is more than just a flag of convenience under which several disciplines may sail: it represents a fundamental shift in thinking about the way in which early life processes affect later health and disease in humans. Previously, proponents of FOAD championed the view that prenatal events were of utmost importance. © P. D. Gluckman and M. A. Hanson 2006 and Cambridge University Press, 2009.
Technology linked with reduced physical activity (PA) in occupational work, home/domestic work, and travel and increased sedentary activities, especially television viewing, dominates the globe. Using detailed historical data on time allocation, occupational distributions, energy expenditures data by activity, and time-varying measures of metabolic equivalents of task (MET) for activities when available, we measure historical and current MET by four major PA domains (occupation, home production, travel and active leisure) and sedentary time among adults (>18 years). Trends by domain for the United States (1965-2009), the United Kingdom (1961-2005), Brazil (2002-2007), China (1991-2009) and India (2000-2005) are presented. We also project changes in energy expenditure by domain and sedentary time (excluding sleep and personal care) to 2020 and 2030 for each of these countries. The use of previously unexplored detailed time allocation and energy expenditures and other datasets represents a useful addition to our ability to document activity and inactivity globally, but highlights the need for concerted efforts to monitor PA in a consistent manner globally, increase global PA and decrease sedentary behavior. Given the potential impact on weight gain and other cardiometabolic health risks, the differential declines in MET of activity and increases in sedentary time across the globe represent a major threat to global health.
A WHO expert consultation addressed the debate about interpretation of recommended body-mass index (BMI) cut-off points for determining overweight and obesity in Asian populations, and considered whether population-specific cut-off points for BMI are necessary. They reviewed scientific evidence that suggests that Asian populations have different associations between BMI, percentage of body fat, and health risks than do European populations. The consultation concluded that the proportion of Asian people with a high risk of type 2 diabetes and cardiovascular disease is substantial at BMIs lower than the existing WHO cut-off point for overweight (⩾25 kg/m2). However, available data do not necessarily indicate a clear BMI cut-off point for all Asians for overweight or obesity. The cut-off point for observed risk varies from 22kg/m2 to 25kg/m2 in different Asian populations; for high risk it varies from 26kg/m2 to 31kg/m2. No attempt was made, therefore, to redefine cut-off points for each population separately. The consultation also agreed that the WHO BMI cut-off points should be retained as international classifications. The consultation identified further potential public health action points (23·0, 27·5, 32·5, and 37·5 kg/m2) along the continuum of BMI, and proposed methods by which countries could make decisions about the definitions of increased risk for their population.
Diet and activity have been affected by the rapid worldwide shifts in technological innovations reducing energy expenditures during leisure, transportation, and work; globalized modern food processing, marketing and distribution techniques; global mass media. The increases occur increasingly in rural areas on all continents. The resultant global increase in obesity increasingly is shifting the burden of obesity to the poor. While few direct linkages between globalization of trade in goods, services, and technology can be directly linked to diet and activity, a strong case exists for globalization’s role as a key underlying force behind this stage of the nutrition transition.
Carbonated soft drinks and other beverages make up an increasing percentage of energy intake, and there are rising public health concerns about the links between consumption of sugar‐sweetened beverages and weight gain, obesity, and other cardiometabolic problems. In response, the food and beverage industry claims to be reformulating products, reducing package or portion sizes and introducing healthier options. Comparative analysis on various changes and their potential effects on public health are needed.
We conduct a case study using the two largest and most influential producers of sweetened beverages, The Coca‐Cola Company and PepsiCo Inc., who together control 34% of the global soft drink market, examining their product portfolios globally and in three critical markets (the United States, Brazil and China) from 2000 to 2010. On a global basis, total revenues and energy per capita sold increased, yet the average energy density (kJ 100 mL ⁻¹ ) sold declined slightly, suggesting a shift to lower‐calorie products. In the United States, both total energy per capita and average energy density of beverages sold decreased, while the opposite was true in the developing markets of Brazil and China, with total per capita energy increasing greatly in China and, to a lesser extent, in Brazil.
Although the role of Mediterranean diet on cardiovascular disease prevention has long been evaluated and understood, its association with the development of stroke has been rarely examined. The aim of the present work was to comparatively evaluate the association between adherence to the Mediterranean diet and the development of an acute coronary syndrome (ACS) or ischemic stroke.
During the period from 2009 to 2010, 1,000 participants were enrolled; 250 were consecutive patients with a first ACS, 250 were consecutive patients with a first ischemic stroke, and 500 population-based, control subjects, 1-for-1 matched to the patients by age and sex. Sociodemographic, clinical, psychological, dietary, and other lifestyle characteristics were measured. Adherence to the Mediterranean diet was assessed by the validated MedDietScore (theoretical range 0-55).
After various adjustments were made, it was observed that for each 1-of-55-unit increase of the MedDietScore, the corresponding odds ratio for having an ACS was 0.91 (95% CI 0.87-0.96), whereas regarding stroke, it was 0.88 (95% CI 0.82-0.94).
The present work extended the current knowledge about the cardioprotective benefits from the adoption of the Mediterranean diet by showing an additional protective effect on ischemic stroke development.