Recent trends in the prevalence of under- and overweight among adolescent girls in low- and middle-income countries.

BACKGROUND: Most studies of childhood malnutrition in low- and middle-income countries (LMICs) focus on children <5 years, with few focusing on adolescence, a critical stage in development. OBJECTIVE: This study aimed to evaluate recent trends in the prevalence of under- and overweight among girls (15-18 years) in LMICs. METHODS: Data are from Demographic and Health Surveys (53 countries) and national surveys conducted in Indonesia, China, Vietnam, Brazil and Mexico. The most recent surveys with sample sizes ≥50 when stratified by rural-urban status were included: 46.6% of countries had a survey conducted in the past 5 years, while the most recent survey for 10.3% of countries was over 10 years old. The overall rural sample size was 94,857 and urban sample size was 81,025. Under- and overweight were defined using the International Obesity Task Force (IOTF) sex- and age-specific body mass index cut points. RESULTS: South Asia had the highest prevalence of underweight; nearly double that of East Asia and the Pacific and sub-Saharan Africa, and increasing annually by 0.66% in rural areas. Latin America and the Caribbean had the highest regional prevalence of overweight in both rural and urban settings, and this prevalence is increasing annually by about 0.50%. In urban areas, 38% of countries had both an under- and overweight prevalence ≥10%. CONCLUSIONS: There is substantial variation across and within regions in the burden of under- and overweight, with increasing dual burdens in urban areas. Innovative public health interventions capable of addressing both ends of the malnutrition spectrum are urgently needed.

New dynamics in global obesity facing low- and middle-income countries.

Levels of overweight and obesity across low- and middle-income countries (LMIC) have approached levels found in higher-income countries. This is particularly true in the Middle East and North Africa and in Latin America and the Caribbean. Using nationally representative samples of women aged 19-49, n = 815,609, this paper documents the annualized rate of increase of overweight from the first survey in early 1990 to the last survey in the present millennium. Overweight increases ranged from 0.31% per year to 0.92% per year for Latin America and the Caribbean and for the Middle East and North Africa, respectively. For a sample of eight countries, using quantile regression, we further demonstrate that mean body mass index (BMI) at the 95th percentile has increased significantly across all regions, representing predicted weight increases of 5-10 kg. Furthermore we highlight a major new concern in LMICs, documenting waist circumference increases of 2-4 cm at the same BMI (e.g. 25) over an 18-year period. In sum, this paper indicates growing potential for increased cardiometabolic problems linked with a large rightward shift in the BMI distribution and increased waist circumference at each BMI level.

Infant BMI trajectories are associated with young adult body composition.

The dynamic aspect of early life growth is not fully captured by typical analyses, which focus on one specific time period. To better understand how infant and young child growth relate to the development of adult body composition, the authors characterized body mass index (BMI) trajectories using latent class growth analysis (LCGA) and evaluated their association with adult body composition. Data are from the Cebu Longitudinal Health and Nutrition Survey, which followed a birth cohort to age 22 years (n = 1749). In both males and females, LCGA identified seven subgroups of respondents with similar BMI trajectories from 0 to 24 months (assessed with bimonthly anthropometrics). Trajectory groups were compared with conventional approaches: (1) accelerated growth between two time points (0-4 months), (2) continuous BMI gain between two points (0-4 months and 0-24 months) and (3) BMI measured at one time point (24 months) as predictors of young adult body composition measures. The seven trajectory groups were distinguished by age-specific differences in tempo and timing of BMI gain in infancy. Infant BMI trajectories were better than accelerated BMI gain between 0 and 4 months at predicting young adult body composition. After controlling for BMI at age 2 years, infant BMI trajectories still explained variation in adult body composition. Using unique longitudinal data and methods, we find that distinct infant BMI trajectories have long-term implications for the development of body composition.

Trends in intakes and sources of solid fats and added sugars among U.S. children and adolescents: 1994-2010.

BACKGROUND: There are increasing global concerns about improving the dietary intakes of children and adolescents. In the United States (U.S.), the focus is on reducing energy from foods and beverages that provide empty calories from solid fats and added sugars (SoFAS). OBJECTIVE: We examine trends in intakes and sources of solid fat and added sugars among U.S. 2-18 year olds from 1994 to 2010. METHODS: Data from five nationally representative surveys, the Continuing Survey of Food Intakes by Individuals Surveys (1994-1996) and the What We Eat In America, National Health and Nutrition Examination Surveys (2003-2004, 2005-2006, 2007-2008 and 2009-2010) were used to examine key food sources and energy from solid fats and added sugars. Sample sizes ranged from 2594 to 8259 per survey period, for a total of 17 268 observations across the five surveys. Food files were linked over time to create comparable food groups and nutrient values. Differences were examined by age, race/ethnicity and family income. RESULTS: Daily intake of energy from SoFAS among U.S. 2-18 year olds decreased from 1994 to 2010, with declines primarily detected in the recent time periods. Solid fats accounted for a greater proportion of total energy intake than did added sugars. CONCLUSIONS: Although the consumption of solid fats and added sugars among children and adolescents in the U.S. decreased between 1994-1998 and 2009-2010, mean intakes continue to exceed recommended limits.

Perceived weight status, overweight diagnosis, and weight control among US adults: the NHANES 2003-2008 Study.

OBJECTIVES: To examine the association between perceived overweight status and weight control, discrepancies between perceived and measured weight status, and opportunities for health care professionals (HCPs) to correct weight perception among US adults. DESIGN: Population-based cross-sectional study. SUBJECTS: In all, 16,720 non-pregnant adults from the 2003 to 2008 National Health and Nutrition Examination Survey. RESULTS: Overall, 64% (73% women, 55% men) reported a desire to weigh less and 48% (57% women, 40% men) reported pursuing weight control. Weight control was positively associated with overweight perception (odds ratio (OR) women 3.74; 95% confidence interval (CI) 2.96, 4.73; OR men 2.82; 95% CI 2.11, 3.76) and an HCP diagnosis of overweight/obesity (OR women 2.22; 95% CI 1.69, 2.91; OR men 2.14; 95% CI 1.58, 2.91), independent of measured weight status. A large proportion of overweight individuals (23% women, 48% men) perceived themselves as having the right weight. Also, 74% of overweight and 29% of obese individuals never had an HCP diagnosis of overweight/obesity. Although the majority of overweight/obese individuals (74% women, 60% men) pursued at least one weight management strategy, fewer (39% women, 32% men) pursued both dietary change and physical activity. Among overweight/obese adults, those with an HCP diagnosis of overweight/obesity were more likely to diet (74 versus 52%), exercise (44 versus 34%), or pursue both (41 versus 30%, all P<0.01) than those who remained undiagnosed. CONCLUSION: HCPs have unused opportunities to motivate their patients to control and possibly lose weight by correcting weight perceptions and offering counseling on healthy weight loss strategies.

Growth rate of human fingernails and toenails in healthy American young adults.

BACKGROUND: Human nail clippings are increasingly used in epidemiological studies as biomarkers for assessing diet and environmental exposure to trace elements or other chemical compounds. However, little is known about the growth rate of human nails. OBJECTIVE: To estimate the average growth rate of fingernails and toenails and examine factors that may influence nail growth rate. METHODS: Twenty-two healthy American young adults marked their nails close to the proximal nail fold with a provided nail file following a standardized protocol, and recorded the date and the distance from the proximal nail fold to the mark. One to three months later, participants recorded the date and distance from the proximal nail fold to the mark again. Nail growth rate was calculated based on recorded distance and time between the two measurements. RESULTS: Average fingernail growth rate was faster than that of toenails (3.47 vs. 1.62 mm/month, P < 0.01). There was no significant difference between right and left fingernail/toenail growth rates. The little fingernail grew slower than other fingernails (P < 0.01); the great toenail grew faster than other toenails (P < 0.01). Younger age, male gender, and onychophagia were associated with faster nail growth rate; however, the differences were not statistically significant. CONCLUSION: Nail growth rates have increased compared with previous estimates conducted decades ago. Toenail clippings may reflect a long exposure time frame given the relatively slow growth rate.