Journal of Health, Population, and Nutrition最新文献

Background: Globally, approximately 30% of women of reproductive age are affected by anaemia. Anaemia is of major public health concern due to its strong association with increased morbidity and mortality among women of reproductive age. This study aimed to examine the trends and factors influencing anaemia among women of childbearing age in Tanzania.

Methods: An analytical cross-sectional study was conducted using data from the Tanzania Demographic and Health Surveys collected between 2004/05, 2010, 2015/16, and 2022. The study included 40,632 women of reproductive age who were selected for haemoglobin measurements. Two stage sampling was used to select survey participants. A modified Poisson regression model was used to identify factors associated with anaemia. Adjusted prevalence ratios (APR) with 95% Confidence Intervals (CI) were calculated to estimate the strength of the association.

Results: The overall pooled prevalence of anaemia was 44.0% (95% CI: 43.0-44.9) among women of reproductive age. Among these women, 29.2% (95% CI: 28.4-29.9) had mild anaemia, 13.4% (95% CI: 12.9-13.9) had moderate anaemia, and 1.4% (95% CI: 1.3-1.6) had severe anaemia. Looking at the trend over time, the prevalence of anaemia was 48.4% in 2004/05 (95% CI: 46.2-50.5), 40.1% in 2010 (95% CI: 38.4-41.9), 44.8% in 2015/16 (95% CI: 43.4-46.4), and 41.5% in 2022 (95% CI: 39.8-43.3).

Conclusion: The findings demonstrate anaemia as both a clinical and public health challenge, requiring multi-sectoral approaches. The persistent associations across demographic, socioeconomic, and reproductive domains suggest that singular interventions are unlikely to address this prevalence sufficiently. Reducing the burden of anaemia will require coordinated efforts across clinical care, public health programming, and social policy to address both immediate nutritional needs and underlying determinants.

Background: The prognostic utility of the triglyceride-glucose (TyG) index and its anthropometry-enhanced variants (TyG-WC, TyG-WHtR, TyG-BMI) for mortality risk in advanced cardiovascular-liver-kidney-metabolic syndrome (CLKM), a multisystem condition involving heart, liver, kidney, and metabolic health, remains unknown.

Methods: This nationwide prospective cohort study included 1384 adults with advanced CLKM syndrome from NHANES 1999-2018. The associations between the TyG index, its modified variants, and all-cause mortality were assessed using weighted multivariable Cox proportional hazards models. Restricted cubic splines (RCS) were used to identify nonlinear associations. To compare predictive performance, C-index, net reclassification index (NRI) and integrated discrimination improvement (IDI) were calculated. RESULTS: Over a mean 56-month follow-up, 360 deaths were recorded. RCS revealed U-shaped associations (i.e., lower risk at intermediate levels and higher risk at both low and high levels) between TyG indices and mortality (P for nonlinear< 0.05), with inflection points at TyG = 9.56, TyG-WC = 1,039.11, TyG-WHtR = 5.17, and TyG-BMI = 215.85. At values below the inflection points, higher indices were associated with reduced mortality risk. Comparison based on the C-index, NRI, and IDI showed that the modified TyG indices did not outperform the original TyG in mortality prediction. Subgroup analyses confirmed consistency (P for interaction >0.05). CONCLUSION: In advanced CLKM syndrome, TyG indices exhibit U-shaped mortality association, revealing dual metabolic roles. The original TyG index performs comparably to anthropometry-enhanced variants, supporting its use as a parsimonious risk-stratification tool. Identified inflection points offer actionable thresholds for personalized management.

Background: Malnutrition and food insecurity remain major public health issues in Ethiopia. Although several studies in the Sidama region have explored their association, few have jointly analyzed these outcomes using an integrated statistical framework. Identifying shared and unique predictors is crucial for developing context-specific prevention strategies.

Methods: A cross-sectional study was conducted from November 2023 to February 18, 2024, involving 1,149 households with children under five years of age. Participants were selected using a multistage sampling technique. Data were collected through a pre-tested structured questionnaire administered by trained data collectors. Child nutritional status was assessed using height-for-age Z-scores (HAZ), where children with HAZ < - 2 SD were coded as stunted (1), and those with HAZ ≥ - 2 SD were coded as not stunted (0). The Household Food Insecurity Access Scale (HFIAS) was used to categorize households according to food access levels using its nine standard questions. Joint generalized linear mixed models were applied to identify predictors of both stunting and food insecurity and assess the correlation between them. Statistical significance was set at p < 0.05.

Results: Out of the total households surveyed with under-five children, 801 (78.2%; 95% CI: 75.2-83.7) were found to be food insecure, and 541 children (47.08%; 95% CI: 42.5-51.5) were stunted. The random effects in the joint generalized linear mixed model indicated significant variability across clusters (Kebeles), with variance estimates of 0.30 (p = 0.001) for food insecurity and 0.45 (p < 0.001) for stunting. A moderate positive correlation of 0.52 (p = 0.039) was observed between the two outcomes. Significant predictors for both stunting and food insecurity included: employment status, father's age, number of under-five children in the household, mother's age at first birth, succeeding birth interval, household wealth index, husband's occupation, parental education levels, dietary diversity score, and meal frequency per day.

Conclusions: This study revealed a high prevalence of stunting and food insecurity among households with under-five children in Hawassa Zuria district, Sidama region, Ethiopia. Household and child-level factors were significantly associated with these conditions. Integrated, multisectoral interventions should prioritize vulnerable households, focusing on dietary diversity, maternal and child health services, and sustainable food access. Policymakers should strengthen community-based programs to tackle both the immediate and underlying causes of child malnutrition and household food insecurity.

Background: Age-, sex-, and country-specific reference values for lipoprotein levels are essential for identifying lipoprotein disorders, such as familial hypercholesterolemia (FH). However, the Thai-specific data are limited. This study aimed to establish age-and sex-specific reference percentiles for lipid and lipoprotein levels in Thai adults.

Methods: This study analyzed plasma lipid and lipoprotein levels from the 6th National Health Examination Survey (NHES-VI) conducted in Thailand. Data from Thai adults without cardiovascular disease or lipid-lowering medication were examined to determine age- and sex-specific percentiles. Participants were grouped into 5-year age intervals for both sexes to assess trends across the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles of lipid measurements. The weighting was applied to account for the complex survey design and ensure representativeness of the national population. The Kruskal-Wallis test was used to examine statistically significant differences in lipid levels between age groups within sex. A P-value < 0.05 was considered significant.

Results: 17,018 participants (7,244 men and 9,774 women) aged ≥ 20 years were included. Both total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels increased with age in both sexes. The highest median LDL-C levels were found in men aged 45-49 (129 mg/dL) and women aged 55-59 (137 mg/dL). The median and 95th percentile values of LDL-C across different age groups were 126 and 194 mg/dL in men, and 131 and 198 mg/dL in women, respectively. High-density lipoprotein cholesterol (HDL-C) levels were higher in women than in men across all age categories, whereas triglyceride levels were higher in men than in women in all age categories below 70 years old. These findings highlight important age-and sex-related differences that may inform clinical cut-offs for lipoprotein disorders in Thailand.

Conclusions: This study establishes the first comprehensive, population-based reference values for lipids in the Thai adult population. Our data reveal notably high LDL-C levels compared with other populations, suggesting that the current universal diagnostic thresholds for lipid disorders may need re-evaluation in the Thai context. These findings provide a crucial evidence base for updating national clinical guidelines and public health strategies.

The Body Roundness Index (BRI) has recently been proposed as an effective metric for assessing obesity-related health risks, but its association with female infertility remains insufficiently studied. This study aims to evaluate the predictive power of BRI in comparison to traditional obesity measures (waist circumference (WC) and body mass index (BMI)) for predicting female infertility using data from the National Health and Nutrition Examination Survey (NHANES). A total of 2962 women aged 18-45 years were included in this cross-sectional analysis. Multivariable logistic regression models were employed to examine the relationship between BRI and infertility, adjusting for demographic, behavioral, and metabolic factors. In addition, Generalized Additive Models (GAM) and Restricted Cubic Spline (RCS) regression were used to investigate potential non-linear associations, and machine learning algorithms were applied to assess the predictive performance and identify significant features. Our results demonstrated a significant positive association between BRI and female infertility. In the fully adjusted model, each unit increase in BRI was associated with 18% higher odds of infertility (OR = 1.18, p = 0.032). A dose-response relationship was also observed across BRI quartiles, with women in the highest quartile (Q4) exhibiting 125% higher odds of infertility compared to those in the lowest quartile. Machine learning analysis further confirmed the robustness of BRI in predicting infertility risk, with the XGBoost model providing the highest area under the curve (AUC = 0.935). These findings highlight BRI as a superior predictor for female infertility compared to traditional obesity measures, suggesting its potential for improving clinical risk stratification in reproductive health.

Background: Despite growing recognition of the complex interplay between eating patterns and health outcomes, few studies have simultaneously examined the associations between Mediterranean diet adherence, binge eating behavior, and oral health-related quality of life (OHRQoL). This study aimed to address this gap by exploring these variables in a large adult population.

Methods: A cross-sectional study was conducted among 1006 adults (aged 18-65 years) in Türkiye using an online survey. Validated instruments included the Mediterranean Diet Adherence Scale (MEDAS), Binge Eating Scale (BES), and the OHQoL-UK. Spearman correlation and multiple linear regression analyses were performed. A p-value < 0.05 was considered statistically significant.

Results: The mean age of participants was 32.52 ± 12.8 years. Based on MEDAS scores, 46.7% of participants were classified as adherent to the Mediterranean diet. Binge eating behavior was significantly and negatively correlated with MD adherence (r = - 0.112, p < 0.001) and OHRQoL (r = - 0.078, p < 0.05), and positively correlated with BMI (r = 0.235, p < 0.001). Regression analysis identified BMI (β = 0.425, p < 0.001), gender (female; β = - 0.169, p < 0.001), marital status (single; β = 0.259, p < 0.001), income status (β = - 0.061, p = 0.034), MEDAS score (β = - 0.100, p < 0.001), and OHQoL-UK score (β = - 0.069, p = 0.017) as significant predictors of binge eating behavior, collectively explaining 20.5% of the variance (R² = 0.205).

Conclusion: This study is among the first to explore these variables simultaneously and demonstrates that, beyond sociodemographic and weight-related factors, dietary and oral health indicators also independently contribute to binge eating behavior. These findings highlight the need for multidisciplinary prevention strategies integrating nutritional, psychological, and oral health dimensions.

Background: Data completeness is crucial in making evidence-based decisions in low- and middle-income countries (LMICs). A total of 130 countries have adopted the District Health Information System (DHIS2) platform in the health sector to generate good-quality data. In 2021, Bangladesh implemented DHIS2 as a platform for monitoring and surveillance of adverse events following immunization (AEFI). This study aimed to assess the level of completeness of AEFI data reported in DHIS2 during the early implementation phase through existing AEFI surveillance systems in Bangladesh.

Methods: We conducted a facility-based cross-sectional study. Based on a desk review of the 2023 AEFI data, we selected three divisions (Chattogram, Sylhet, and Rangpur) of Bangladesh based on high-, medium-, and low-performing groups according to the AEFI reporting rate. A total of 97 AEFI cases were found in the DHIS2 system for the assessment from six selected health facilities, which were reported between January and December 2023. The AEFI reporting form contains 50 variables to be completed by health assistants on paper-based forms (established method), and the DHIS2 tracker contains the identical variable set as a paper-based AEFI form. A comparative analysis was conducted between these two data sources, field by field, with the number count and percentages using McNemar's test.

Results: Ninety-five paper-based AEFI reporting forms were found to be consistent with the DHIS2 AEFI tracker system (two hard copies were misplaced in two sites), and these matched AEFI cases were assessed for overall data completeness in the paper-based forms and the DHIS2 system. We found that 75.04% of the variable entries were available in paper-based forms, whereas 67.87% were available in the DHIS2 system (p < 0.001). The name of the patient, date of birth, AEFI (signs and symptoms), and date of AEFI onset were documented appropriately in the paper-based AEFI and the DHIS2 Tracker. Other variables were found to be either overreported or underreported in the DHIS2.

Conclusion: At this early stage of the DHIS2 implementation, the data completeness of mandatory field entries was moderate. We recommend periodic supportive supervision by health management teams, including regular data feedback to improve completeness.

This umbrella review evaluated the effects of Technology-Based Exercise (Tele-exercise) on balance and Quality of Life (QoL) in individuals with multiple sclerosis (MS). A comprehensive search across multiple databases identified meta-analyses and individual studies published up to June 3, 2025. Eligible studies included meta-analyses assessing tele-exercise interventions, while reviews with insufficient data were excluded. Methodological quality was assessed using the Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) checklist. The pooled findings indicate that tele-exercise is not associated with meaningful improvements in balance among individuals with multiple sclerosis (SMD = 0.587, 95% CI: -0.533-1.706, N = 243 based on SMD). Likewise, tele-exercise shows minimal impact on quality of life (QOL) (SMD = 0.169, 95% CI: -0.025-0.362, N = 407 based on SMD). Although trends toward benefit were observed, findings remain inconclusive due to variability in protocols, methodological limitations, and low patient engagement. Overall, tele-exercise is feasible and may support patient-centered care, but current evidence does not confirm significant improvements in balance and QoL for people with MS. Standardized protocols, greater personalization, and higher-quality trials are needed to strengthen future clinical guidelines.

Objectives: This study aims to systematically review the economic evaluations of various embryo transfer strategies, including single embryo transfer (SET), double embryo transfer (DET) and others in IVF.

Methods: Web of Science, Scopus, PubMed, Embase, and the NHS Economic Evaluation Database were searched since January 1980 to 1 October 2023. Full economic evaluations comparing embryo transfer strategies were included; while review articles, editorials, abstracts, and non-English articles were excluded. The CHEERS 2022 checklist was used to assess the quality of the included studies.

Findings: Out of 4,336 records, 16 studies were included, mostly from Europe (75%), with a few from North America (19%) and Asia (6%). Most studies (94%) assessed the cost-effectiveness of SET versus DET using cost-effectiveness analysis (CEA), one study (6%) used cost-utility analysis (CUA). The Markov model was most common, with some using decision-tree or other modeling approaches. Study perspectives were societal (50%), healthcare system (25%), service provider (12.5%), or insurer (12.5%). The most reported outcomes were live birth rate (50%) and incremental cost per live birth (56%), while other outcomes, such as expected life years or quality-adjusted life years were less frequently reported.

Conclusion: Findings indicate that SET and SET-based strategies, such as combining fresh and frozen SET cycles or mild stimulation protocols, are often more cost-effective than DET and other strategies, especially among younger women, by reducing maternal and neonatal complications and long-term healthcare costs. Cost-effectiveness, however, varies by maternal age, healthcare system context, modeling approach, patient preferences, and societal willingness-to-pay thresholds. Most evidence comes from high-income countries, but the findings provide insights to guide evidence-based embryo transfer decisions that balance clinical effectiveness, patient preferences, and economic sustainability.

Background: Excessive exposure to toxic trace elements through food ingestion can adversely affect infant health. This study assesses the carcinogenic and non-carcinogenic risks associated with trace elements (iron, selenium, zinc, chromium, mercury, cadmium, aluminium, barium, and strontium) in infant formula and complementary foods.

Methods: A total of 80 formula milks and 27 baby food samples from 6 commercial brands have been collected from June 2020 to June 2021 from the Iranian market. The potential lifetime health risk posed to infants and toddlers is measured based on daily intake of elements, non-cancer hazard indices (HIs), hazard quotient (HQ), and cancer risks (CR).

Results: The average concentrations of aluminium, cobalt, chromium, copper, iron, and zinc in infant formula and complementary foods significantly exceeded FAO/WHO standards across all seasons (P < 0.05). All HI values exceeded the safety threshold (HI > 1) for all age groups. Cancer risks ranged from 9.55 × 10⁻⁵ to 3.57 × 10⁻⁴, indicating potential carcinogenic and non-carcinogenic risks for infants and children.

Conclusions: Therefore, authoritative action limits should be set for baby food manufacturers to evaluate both their finished products for toxic trace elements and phase out products that have high toxic trace elements.