Journal of Health, Population, and Nutrition最新文献

Background: Exposure to metals from the combustion of biomass via inhalation may result in negative health outcomes affecting a variety of organs and systems. Pregnant women cooking with biomass fuels may be exposed to metals, such as lead (Pb) and cadmium (Cd), and have unique risks for adverse health effects with potential impacts on the growing fetus. We assessed the associations between household air pollution and metals detected in dried blood spots from pregnant women at baseline in Rwanda.

Methods: We analyzed data from 781 pregnant women aged 18-35 years who resided in rural households using biomass fuel and who were enrolled in the Household Air Pollution Intervention Network (HAPIN) Trial in Rwanda. We explored associations between 24-h average natural log-transformed personal exposures to fine particulate matter (PM_2.5), black carbon (BC), and carbon monoxide (CO) and K + standardized Pb and Cd concentrations using linear regression models adjusted for potential confounders (i.e., age, body mass index, bicycle ownership, fish consumption, and food insecurity).

Results: The adjusted models showed positive but non-significant associations between air pollutant concentrations and metals detected in blood: PM₂.₅ and Pb (β coefficient: 0.06; 95% CI - 0.03-0.15), BC and Pb (0.11; 95% CI - 0.01-0.24), PM₂.₅ and Cd (0.04; 95% CI - 0.02-0.09), and BC with Cd (0.02; 95% CI - 0.05-0.09).

Conclusions: While associations were not statistically significant, the directionally consistent increases in blood Pb and Cd with increased PM₂.₅ and BC exposures align with existing evidence and underscore the need for continued research and policy action to reduce household air pollution exposures and protect maternal and fetal health.

Background: It is estimated that approximately 80% of childhood cancer cases occur in resource-limited settings and that most unvaccinated children live in middle-income countries. This creates an overlap of burdens for children with cancer, who are especially vulnerable to vaccine-preventable infections such as influenza and invasive pneumococcal disease. Given the complexity of vaccinating children with cancer because of the multidisciplinary care they require, it is unclear how such vaccination is achieved in these settings.

Methods: A self-administered, anonymized, cross-sectional survey was distributed to providers of healthcare for children with cancer in Latin America and the Caribbean through a contact list of 3236 email addresses. A total of 378 participant responses were included in the final analysis. This study used the Consolidated Framework for Implementation Research to understand the implementation factors influencing the vaccination of children with cancer in Latin America and the Caribbean.

Results: Most respondents (n = 246, 65.3%) reported that vaccines were always, almost always, or often available for administration at their institution - and were willing to recommend children with cancer for vaccination. Most respondents reported receiving no training or education on immunizing children with cancer at their current institution (n = 297, 78.6%) or before joining it (n = 242, 64.0%). Furthermore, only a small minority reported working in institutions with written policies on vaccinating children with cancer (n = 53, 14.0%) or clinical guidelines (n = 97, 25.7%) for vaccinating these patients. Respondents estimated that most pediatric patients with cancer at their hospital were not up to date on childhood immunizations and did not receive the annual influenza vaccine. Although most respondents (n = 345, 91.3%) reported that their government provides funding for childhood vaccinations, fewer than half (n = 183, 48.5%) reported that government funding was available for re-immunizing children with cancer.

Conclusions: We found a clear willingness to recommend vaccines for children with cancer in Latin America and the Caribbean, a trend not found in similar studies in the literature. Our findings support the notion that interventions to improve vaccination for children with cancer should gear their efforts towards building an institutional culture that prioritizes immunization for both patients and staff and that supports providers in their already established practice of recommending vaccines to their patients.

Background: There's still a gap in research on phosphorus intake for elderly patients with chronic kidney disease. Processed and ultra-processed foods provide convenient dietary options but are significant source of harmful inorganic phosphorus. This study attempts to evaluate total phosphorus intake in elderly chronic kidney disease (CKD) patients across different stages, focusing on dietary contribution of inorganic phosphorus, stratified into tertiles, from processed and ultra-processed foods.

Methods: Cross-sectional analytical study conducted using an adapted food frequency questionnaire to assess weekly consumption phosphorus patterns over the last year among 232 participants. The study investigates the frequency and types of natural high-phosphorus foods, as well as processed and ultra-processed foods commonly available in the Egyptian market. It focused on elderly chronic kidney disease patients aged over 65 years, covering various stages of chronic kidney disease, including those receiving haemodialysis, and compared their dietary intake to their caregivers and an age-matched group of individuals over 65 years without CKD.

Results: Phosphorus intake among elderly CKD subgroups showed considerable inter-individuals difference, ranging 880 - 16,804 mg/week. The total median weekly phosphorus intake in CKD patients > 65 years was lower compared to caregivers, with a statistically significant difference (p = 0.011) for patients aged 65-74 years. Phosphorus intake declined as CKD progressed from stage II to V. Among CKD, patients with a diploma education& who cook for themselves were significantly more likely to exceed the Dietary Reference Intake, (p < 0.05).Weekly inorganic phosphorous intake showed significant proportionate with frailty score (p = 0.024). Phosphorus intake from processed food/UPF was categorized into tertiles (low (< 694.39 mg), moderate (694.39-2382.53 mg), and high (> 2382.53 mg). 41% CKD patients > 75 years were classified as low inorganic phosphorus consumers compared to 33.3% in CKD aged 65-74 years. Education level, BMI showed a significant association, p < 0.05. Patients undergoing three dialysis sessions per week consumed more than twice the inorganic phosphorus (1,314.9 mg) compared to those receiving two sessions (552.1 mg), (p > 0.05). CKD patients > 75 years had significantly lower consumption of nuts, legumes, and beans than caregivers (p = 0.048).

Conclusion: Age, CKD diagnosis and stage may be additional factors in the observed variations in phosphorus-containing food intake patterns.

Background: Chronic low-grade systemic inflammation (CLGSI) is implicated in depression and its amelioration. Pro-inflammatory nutrition and inactivity are associated with CLGSI. We triangulated the degree to which recent literature on anti-inflammatory nutrition and physical activity/physical exercise (PA/PE) corroborates the extant body of knowledge related to depression management and is reflected in the guidelines of leading mental health domains (national/international mental health associations/bodies).

Methods: We used mini-review methodology. The search was narrowed to recent state-of-the-art literature (2024) in PubMed, on diet and exercise specifications in depression management. Then, we compared recommendations of aforementioned domains regarding diet and PA/PE in depression management.

Results: Of 73 nutrition source studies, 50 (68%) focused on anti-inflammatory whole food, plant-based (WFPB) nutrition to manage depression; 4 (5%) on reducing consumption of animal-sourced foods; 16 (23%) focused on the effect of ultra-processed food (UPF) and its role in depression and its avoidance vis-à-vis its anti-depressant effects. Of the 55 PA/PE source studies, 49 (89%) focused on the effects of aerobic exercise; 14 (29%) described specific parameters to achieve an anti-depressant effect and 35 (71%) were non-specific. Twelve (22%) studies focused on resistance muscle training; 2 (17%) that reported specific training parameters and 10 (83%) that were non-specific. Nine domains were identified with established depression management guidelines: Australia/New Zealand; Canada; Europe (Belgium, Scotland, Spain); United Kingdom; United States; WFSBP and ASLM; and World Health Organization. Regarding nutrition, 5 (55%) domains recommended WFPB nutrition; 4 (44%) reduced animal-sourced foods; and 3 (33%), avoidance of UPF. With respect to sedentarism, 3 (33%) domains recommended reduced prolonged sitting. Eight domains (89%) mentioned aerobic exercise; 3 (33%) resistance training. Three domains mentioned aerobic exercise non-specifically; 5 (56%) made specific recommendations. Three domains mentioned resistance muscle training; 2 (22%) made non-specific recommendations and 1 (11%) made specific recommendations.

Conclusions: Disparities that exist in leading depression management guidelines vis-à-vis inclusion of evidence-informed nutrition and PA/PE recommendations, warrant reconciliation. Evidence supporting anti-depressant WFPB nutrition and limiting pro-inflammatory animal-sourced food and UPF and supporting anti-inflammatory aerobic exercise and resistance training warrants being translated into national/international depression management guidelines as consistently as recommendations for pharmacotherapy and psychotherapy.

Background: Globally, access to healthcare among women of reproductive age is among top most health agenda. In line with the endeavor, the government of Tanzania strive to ensure healthcare is accessible to every community member particularly women of reproductive age (15-49 years). However, there are limited scientific evidence on the proportion of women aged 15-49 who can access and the determinants of healthcare services in Tanzania. This study intended to fill the gap.

Methods: In this study, we analysed secondary information of a weighted sample 15,254 women aged 15-49 years collected using cross-sectional design during the 2022 Tanzania Demographic and Health Survey(TDHS). The binary dependent variable was healthcare access status and independent variables were women's social demographical characteristics. Descriptive analysis and multivariable modified Poisson regression analysis were performed. The p-value < 0.05 at 95% was set to determine the significant determinant.

Results: The proportion of women with access to healthcare in Tanzania, stand at 50.2%. After controlling for other covariates, the modified Poisson regression showed that women with secondary and higher education level (Adjusted Prevalence Ratio (APR);1.21,95%CI:1.12,1.30), women who are covered by health insurance (APR;1.18,95%CI:1.11,1.26), belonging to richest households (APR;1.62,95%CI:1.45,1.80), residing in southern zone (APR;1.32,95%CI:1.22,1.42) and women living in union (APR;1.10,95%C:1.05,1.16); had higher prevalence ratio of healthcare access compared to their counter parts. "Conversely, negative determinants of healthcare access included being aged 35-49 years (APR; 0.92; 95% CI: 0.88, 0.97), living in households with 5-6 members, and residing in rural areas (APR; 0.78; 95% CI: 0.73, 0.83). These groups had a lower prevalence of healthcare access compared to their counterparts.

Conclusion: Only half of Tanzanian women of reproductive age had adequate healthcare access. Its positive determinants included having secondary and above education level, being covered by health insurance, belonging to richest households, residing in southern and coast zones and living in union. Negative determinants included residing in rural, coming from poor households and having no formal education. As a motive toward universal health coverage in Tanzania, the government should design targeted health interventions focusing on poor women in rural areas with low levels of education to improve the healthcare access for all.

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.