Journal of Health, Population, and Nutrition最新文献

Background: Undernutrition, manifested as stunting and/or thinness, is a major public health concern in low-income countries, including Ethiopia. Factors such as sociodemographic, economic, and dietary status influence children's academic achievement. This study aimed to assess the association between dietary diversity, nutritional status, and academic performance of school-age children in pastoral communities in Southeast Ethiopia.

Methods: A school-based cross-sectional study was conducted among 395 randomly selected school-age children. A multistage sampling followed by systematic random sampling was used to collect the data. Students' academic performance (AP) was evaluated by computing two-semester average grade scores of the 2016/17 academic year in all disciplines using the school record. A pre-tested, interviewer-administered, structured questionnaire was used to collect the data. To assess nutritional status, the z scores of height for age (HAZ) and BMI for age (BAZ) were employed according to WHO's new reference values. The WHO Anthroplus software was used to generate nutritional indices. A structural equation model (SEM) was used to examine the direct, indirect, and total effects of the dietary diversity score (DDS), HAZ score, and BAZ score on AP. The beta coefficient (β) along with the confidence interval (CI) were used to estimate the strength of the association.

Results: The prevalence of stunting and thinness was 26.6% (95% CI: 21.8, 31.4%) and 28.9% (95% CI: 24.3, 33.2%), respectively. The proportion of dietary diversity (DD) among school-age children was 40% (95% CI: 35.7, 45.3%) low DD and 60% (95% CI: 54.7, 64.3%) adequate DD. The SEM revealed that a unit increment in the child's DDS (unstandardised β = 0.130, 95% CI: 0.049 to 0.211) did have direct and total effects on the HAZ score. However, HAZ score, BAZ score, and DDS did not have direct, indirect, or total effects on AP. Similarly, DDS did not have direct or total effects on the BAZ score.

Conclusion: The academic performance (AP) was low among these school-age children, and the prevalence of stunting and thinness was high. Thus, nutrition interventions on dietary diversity for school-age children would be crucial interventions for increasing academic achievement.

Background: This cross-sectional descriptive study aimed to determine the prevalence and risk factors of technology addiction (TA) in adolescents, as well as investigate the association of TA with food addiction and emotional eating by body weight status.

Methods: Adolescents (n = 1388) completed a questionnaire that featured socio-demographic characteristics, the Game Addiction Scale (GAS), the Social Media Disorder Scale (SMD), the dimensional Yale Food Addiction Scale for Children 2.0 (dYFAS-C 2.0), and the Emotional Eating Scale Adapted for Use in Children and Adolescents (EES-C). The body mass index (BMI) Z-score was classified according to the World Health Organization.

Results: TA was present in one-fifth of adolescents, and boys were four times more likely to develop a digital game addiction (p < 0.001). A 1-point increase in the GAS score is associated with a 1.08-point increase in the dYFAS-C-2.0 score and a 0.5-point increase in the total EES-C score (p < 0.001). A 1-point increase in the SMD score was also related to an increased of 1.21 and 1.26, respectively (p < 0.001). All of these positive associations were significant in adolescents with overweight (p < 0.001).

Conclusions: Given the rapidly increasing prevalence of TA among adolescents, its association with food addiction, emotional eating, and body weight status is worrisome, and our findings shed light on the relevance of developing strategies to reduce the prevalence of TA in this population.

Background: Central and general obesity are commonly measured using tools like waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). However, the universally recognized cutoffs for these measures may be inadequate for individuals of Ethiopian descent. Due to the lack of universally applicable cutoffs, studies recommend tailoring the optimal screening thresholds to each population's specific characteristics. Therefore, this study aimed to determine body composition-based WC, WHR, and WHtR cutoffs for the healthy adult population of Ethiopia.

Method: A population based cross-sectional study was conducted in the Amhara region of Ethiopia from June to August 2023, collecting anthropometric and body composition data from 838 adult participants. Data were analyzed using Stata, and MedCalc software. The cut-off values were determined using ROC analysis, and performance was assessed using area under the curve (AUC), Youden index, sensitivity, and specificity.

Result: The optimal cut-off values for WC, HC, WHR, and WHtR to define obesity in men were 85.0 cm, 93.5 cm, 0.89, and 0.53 respectively. Correspondingly, these values in women were 81.1 cm, 97.2 cm, 0.84, and 0.5. These cutoff values showed the highest effectiveness in defining obesity especially for WC and WHtR. The new proposed cutoff values for waist circumference, hip circumference, and waist-to-height ratio had sensitivity ranging 76-93% and specificity of 83-94% in accurately identifying obesity. The current study also determined the cut-off values for underweight, normal weight, and overweight body weight categories. Accordingly, for men, the WC cut-offs were: ≤ 74.55 cm (underweight), 74.56-78.95 cm (normal), and 79.0-85.0 cm (overweight). For women, the cut-offs were: ≤ 68.25 cm (underweight), 68.26-79.59 cm (normal), and 79.60-81.10 cm (overweight). The WHtR thresholds were: ≤0.43 (underweight), 0.44-0.47 (normal), and 0.48-0.53 (overweight) in men; ≤0.43 (underweight), 0.44-0.50 (normal), and 0.50-0.51 (overweight) in women.

Conclusion: The findings indicate that the WC, WHR, and WHtR cutoff values for defining obesity in Ethiopian adults are lower than international standards. The newly proposed cutoff values showed improved sensitivity and specificity, suggesting their potential diagnostic relevance. Considering these country-specific cutoffs may be beneficial for clinical practice and obesity-related research in Ethiopia.

Background: Chlamydia trachomatis is a common sexually transmitted disease that is associated with considerable morbidity and harmful sequelae, including pelvic inflammatory disease and infertility. Strategies for prevention and treatment of infertility in women with C. trachomatis infection require further investigation. There is evidence suggesting that vitamin D could be a potential treatment. This study aimed to investigate the relationship between serum 25-hydroxyvitamin D [25(OH)D] levels, chlamydia seropositivity, and the risk of infertility in women.

Methods: We conducted this cross-sectional study using 2013-2016 National Health and Nutrition Examination Survey data. Women aged 18-39 years with complete serum 25(OH)D and chlamydia Pgp3Ab multiplex bead/enzyme-linked immunosorbent assay data available were included. The correlation between 25(OH)D level, chlamydia seropositivity, and infertility was evaluated using the weighted chi-squared test and the t-test with multivariate logistic regression and moderation effect models.

Results: Among the 1424 women who met our eligibility criteria, the weighted chlamydia seropositivity rate was 36.8%. The 25(OH)D level was significantly lower in the seropositive group compared with seronegative control. (P = 0.009). After adjusting for ethnicity, the effect of 25(OH)D was no longer significant (P = 0.693). Further analysis in the chlamydia-seropositive subset revealed that the vitamin D level was lower in the infertile group (P = 0.024). In an interaction model, 25(OH)D was found to antagonizes the positive relationship between chlamydia and infertility (OR = 0.985, 95% CI: 0.971-0.999, P = 0.040).

Conclusion: The serum vitamin D level may be more related to the prognosis in terms of infertility than to the risk of chlamydia infection. This finding may reveal a possible treatment strategy for chlamydia infection.

Background: Erectile dysfunction (ED) is a common issue among adult males. The Composite Dietary Antioxidant Index (CDAI) reflects anti-inflammatory levels and has been linked to various diseases, but its relationship with ED is unclear.

Materials and methods: This cross-sectional study utilised comprehensive data on clinical factors from the 2001-2004 National Health and Nutrition Examination Survey (NHANES). To investigate the link between variables and ED, we used multivariate regression analysis, univariate analysis, and subgroup analysis. The linear relationship between CDAI and ED was investigated by dose-response curve analysis. For sensitivity analysis, propensity score matching (PSM) was utilised to exclude the influence of potential confounders. Finally, we investigated the association between CDAI and ED using threshold effects analysis.

Results: We included in our research a total of 2896 persons with data on CDAI from NHANES 2001-2004. Among these, 2,098 participants were thought to be free of ED, whereas 798 participants had ED. We found that compared to the ED group, men in the non-ED group had higher levels of CDAI (p < 0.0001 before PSM and p = 0.0145 after PSM). Additionally, after adjusting for covariates, it was found that an elevated CDAI was associated with a reduced incidence of ED [OR = 0.65(p = 0.001) before PSM and OR = 0.62(p = 0.002) after PSM]. Subgroup analysis indicated stronger associations in high-risk groups, and dose-response curves confirmed a linear negative correlation between CDAI and ED.

Conclusions: This study revealed a negative linear relationship between CDAI and the incidence of ED. The CDAI can be used as an indicator for assessing ED risk and for ED prevention.

Introduction: The Global Adult Tobacco Survey (GATS) shows a drop in tobacco use worldwide. Despite the drop, there still continues to be a significant number of tobacco users in India. Research on tobacco use among young persons is commonly prioritised in India, while studies on tobacco use among middle-aged (45-59 years) and elderly (≥ 60 years) adults are noticeably lacking. We have conducted this study with objective to estimate the distribution, determinants and socioeconomic inequalities of smoking (SM) and smokeless tobacco (SLT) consumption across Indian states and union territories.

Methods: This study was based on 66,606 participants aged ≥ 45 years using Longitudinal Aging Study in India (LASI)-1 (2017-2018) data. Distribution of tobacco consumption (any form, smoking (SM), smokeless (SLT) and both) was documented as per Indian states and union territories with spatial distribution by Indian map. Demographic, socioeconomic, health related and behavioural determinants were established using nested multilevel regression modelling. Socioeconomic disparities were documented using concentration curve. P-value < 0.05 was considered as statistically significant.

Results: Overall, 36.78% participants documented using any form of tobacco; with higher consumption of SLT (19.88%) than smoking/SM (13.92%). Only 2.98% consumed both. Mizoram had highest consumption of tobacco in any form (78.21%) and smoking (35.18%). Elderly participants had higher odds of consuming tobacco (any 1.23 (1.18-1.28), SM 1.99 (1.14-1.27), SLT 1.08 (1.03-1.14) and both 1.27 (1.14-1.40 times) than middle aged participants. Females, OBC (other backward castes), urban residence had lower odds in all the categories, while being widow/ separated/ divorced, belonging to Muslim community, having clerical and skilled occupation, poor self-rated health, comorbidity and multimorbidity had higher odds. With decrease in the wealth index, educational status and frequency of physical activity the odds of tobacco consumption increased. The odds of higher tobacco consumption were documented from northeast region (2.56 (2.37-2.76) higher than north). Alcohol consumption had the highest odds (4.94 (4.69-5.21)). Participants exposed to media had lower odds (11% lower) of consuming tobacco. The socioeconomic inequalities in tobacco consumption were significantly distributed more among the poorest (any -0.064 (-0.072 to -0.056) and SLT -0.069 (-0.072 to -0.056)).

Conclusion: Prioritising tobacco prevention and increasing availability and accessibility of cessation programmes that are suited with unique requirements and circumstances, even for elderly population, are essential focusing on the higher determinants across poorest section in the country.

Background: Increasing evidence suggests that serum urea nitrogen may be a risk factor for prostate cancer (PCa) and influence serum prostate-specific antigen (PSA) concentrations, but direct evidence of a relationship between PSA and serum urea nitrogen levels in the general population is still lacking. The aim of this study was to demonstrate the relationship between serum urea nitrogen levels and prostate-specific antigen (PSA) and prostate cancer.

Methods: We conducted a cross-sectional study using the National Health and Nutrition Examination Survey (NHANES, 2003-2010) database. We performed a multifactorial regression analysis of the association between serum urea nitrogen levels and PSA and PCa, followed by subgroup analyses.

Results: A total of 5256 subjects were included in this study, and after adjusting for demographic, biological, and immunologic variables, we found that there was a threshold for blood urea nitrogen concentration below which every 1 ng/mL increase in serum urea nitrogen was associated with a 0.0325 ng/mL increase in PSA concentration (log2 transformed) (95% CI: 0.0064, 0.0586), and the P trend was was less than 0.05 and the difference was statistically significant. Sensitivity analyses using the generalized additive model (GAM) showed a linear relationship between serum urea nitrogen and serum PSA concentrations when blood urea nitrogen concentrations ranged from 0 ng/ml to 6.78 ng/ml.

Conclusion: Serum urea nitrogen was independently and positively correlated with serum PSA concentration when the concentration of serum urea nitrogen ranged from 0 ng/ml to 6.78 ng/ml.

Background: The double burden of malnutrition (DBM) during adolescence is associated with growth and developmental impairment and risk of non-communicable diseases. There is limited evidence on adolescent's dietary patterns (DPs), and how they contribute to DBM in urban low income contexts in sub Saharan Africa. This study assessed DPs of adolescents, their drivers and association with DBM in Kenya's urban slums.

Methods: Anthropometric, socio-demographic and dietary-intake data were collected through a cross-sectional survey of 621 adolescents from three major urban slums in Nairobi, Kenya. DPs were derived using principal component analysis. Multinomial-logistic-regression was used to assess the association between the DPs, individual and environmental factors and DBM.

Results: Two DPs were identified: traditional DP (whole grains/cereals, rice, fruits, legumes/nuts, and water) and transitioning DP (refined cereals (maize/wheat), vegetables, meat, tea/coffee, sweet ultra-processed/deep fried snacks). Adolescents from Mathare (the largest slum) were more likely to adhere to the traditional DP (RRR = 3.43; 95% CI 1.85-6.37). Cultural background (Luo) had a positive association (RRR = 4.28; 95% CI 1.97-9.32), while longer residency in the slum (> 10 years) had a negative association (RRR = 0.47; 95% CI 0.25-0.90) with transitioning DP. The transitioning DP had a positive (non-linear) association with overweight/obesity in girls (RRR = 2.79; 95% CI 1.16-6.71). The DPs were not associated with thinness or stunting.

Conclusion: The DPs indicate various stages of nutrition transition of adolescent diets, which are influenced by cultural background, neighbourhood and duration of stay in the slum. Transitioning DP may expose adolescents to the risks of overweight/obesity in the long-term.

Introduction: Data on child functioning and disability are important for public policy development which aimed at reducing child disability prevalence and strengthening the provision of appropriate and timely health care services. This study reports the prevalence of functional difficulty in Malaysian children aged 2-17 years and its associated sociodemographic factors and epilepsy.

Methods: Data on children aged 2-17 years (n = 4576) were generated from the National Health and Morbidity Survey (NHMS) 2019, a population-based cross-sectional survey. Functional difficulty in children was assessed using the United Nations Children's Fund (UNICEF)/Washington Group on Disability Statistics (WG) Child Functioning Module (CFM). The questionnaires were administered to the parents or guardians of the children via face-to-face interviews. Functional difficulty, defined as having difficulty in at least one domain, was examined for its prevalence and associations with sociodemographic variables and the epilepsy variable in children using descriptive analysis and multiple logistic regression.

Results: The overall prevalence of functional difficulty among children aged 2-17 years was 4.7%. Multiple logistic regression analysis revealed that older children, children from households whose heads of household had a lower education level and children who have epilepsy were significantly more likely to experience functional difficulty (p < 0.05). Children of Chinese ethnicity were less likely to experience functional difficulty compared to children of Malay ethnicity.

Conclusions: This study provides baseline findings on the prevalence of functional difficulty among children in Malaysia using nationally representative data. Although the prevalence was relatively low, the information is important for the planning of strategies to improve the development and well-being of children in Malaysia and for achieving the Sustainable Development Goals (SDGs).

Introduction: Menopause is a natural phase in a woman's life, but the quality of life and health of postmenopausal women are often compromised by unhealthy lifestyles. Therefore, it is crucial to identify the factors that influence their well-being. The main objective of this study is to explore the barriers to a healthy lifestyle among Iranian postmenopausal women.

Methods: Qualitative exploratory research was conducted among postmenopausal women aged 45-65 years in three different health centers located in urban areas with varying economic level in a central city of Iran. These areas represented upscale, downtown, and downscale areas with different economic statuses (wealthy, relatively wealthy, and less wealthy). Nine focus group discussions were held, focusing on managing menopausal symptoms, physical activity, and healthy nutrition. Each topic was discussed separately in a different health center, with 10 women participating in each session. Data analysis was conducted using Graneheim and Lundman's method.

Results: The study revealed a prominent theme, "perceived lack of behavioral control as a barrier to a healthy lifestyle in post-menopause." Two categories, "False attitudes" and "Perceived inability to engage in behavior," were derived from 26 codes related to managing menopausal symptoms. Furthermore, a category, "Perceived inability to engage in behavior," was formed from 11 to 13 codes related to physical activity and healthy nutrition, respectively. The theme highlighted that the perceived lack of behavioral control prevented the women from adopting a healthy lifestyle.

Conclusion: Improving perceived behavioral control through the modification of attitudes and abilities is essential for maintaining a healthy postmenopausal lifestyle.