RESUMEN
This paper proposes a pseudo-birth-cohort approach to deal with a lack of longitudinal data to measure health inequities over time. Using Roemer's framework for inequality of opportunity, this study measures ex-ante and ex-post inequalities in malnutrition, a concept that spans both sides of the nutrition continuum. The total contribution of observed circumstances and the direct contribution of observed efforts to the variation of malnutrition are disentangled for people born between 1983 and 1988 in Mexico. Results indicate that inequality of opportunity has been persistent across this 30-year lifespan for that cohort. Some evidence suggests that a lack of opportunities has been transmitted from parents to children and that people's circumstances account for most of the explained variation in the double burden of malnutrition. However, stratifying the analysis by sex shows that efforts account for more of the explained variation of inequality of opportunity for women in their middle adulthood than for men in most of the outcomes analyzed.
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Desnutrición , Factores Socioeconómicos , Humanos , México , Femenino , Masculino , Desnutrición/epidemiología , Adulto , Persona de Mediana Edad , Disparidades en el Estado de Salud , Factores Sexuales , Estudios LongitudinalesRESUMEN
The allele frequency net database (AFND, http://www.allelefrequencies.net ) is an online web-based repository that contains information on the frequencies of immune-related genes and their corresponding alleles in worldwide human populations. At present, the website contains data from 1784 population samples in more than 14 million individuals from 129 countries on the frequency of genes from different polymorphic regions including data for the human leukocyte antigen (HLA) system. In addition, over the last four years, AFND has also incorporated genotype raw data from 85,000 individuals comprising 215 population samples from 39 countries. Moreover, more population data sets containing next generation sequencing data spanning >3 million individuals have been added. This resource has been widely used in a variety of contexts such as histocompatibility, immunology, epidemiology, pharmacogenetics, epitope prediction algorithms for population coverage in vaccine development, population genetics, among many others. In this chapter, we present an update of the most used searching mechanisms as described in a previous volume and some of the latest developments included in AFND.
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Bases de Datos Genéticas , Frecuencia de los Genes , Genética de Población , Humanos , Genética de Población/métodos , Antígenos HLA/genética , Alelos , Biología Computacional/métodos , Internet , Navegador Web , Genotipo , Secuenciación de Nucleótidos de Alto Rendimiento/métodosRESUMEN
OBJECTIVE: Historically, the American Board of Surgery required surgeons to pass the qualifying examination (QE) before taking the certifying examination (CE). However, in the 2020-2021 academic year, with mitigating circumstances related to COVID-19, the ABS removed this sequencing requirement to facilitate the certification process for those candidates who were negatively impacted by a QE delivery failure. This decoupling of the traditional order of exam delivery has provided a natural comparator to the traditional route and an analysis of the impact of examination sequencing on candidate performance. METHODS: All candidates who applied for the canceled July 2020 QE were allowed to take the CE before passing the QE. The sample was then reduced to include only first-time candidates to ensure comparable groups for performance outcomes. Logistic regression was used to analyze the relationship between the order of taking the QE and the CE, controlling for other examination performance, international medical graduate status, and gender. RESULTS: Only first-time candidates who took both examinations were compared (n=947). Examination sequence was not a significant predictor of QE pass/fail outcomes, OR=0.54; 95% CI, 0.19-1.61, P =0.26. However, examination sequence was a significant predictor of CE pass/fail outcomes, OR=2.54; 95% CI, 1.46-4.68, P =0.002. CONCLUSIONS: This important study suggests that preparation for the QE increases the probability of passing the CE and provides evidence that knowledge may be foundational for clinical judgment. The ABS will consider these findings for examination sequencing moving forward.
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Cirugía General , Internado y Residencia , Cirujanos , Estados Unidos , Humanos , Consejos de Especialidades , Evaluación Educacional , Certificación , Modelos Logísticos , Cirugía General/educación , Competencia ClínicaRESUMEN
Adopting sustainable dietary patterns is essential for planetary and human health. As data to address this issue are lacking in Latino populations, this study examined the association between diet-attributable greenhouse gas emissions (GHGEs) and myocardial infarction (MI) in a Costa Rica Heart Study. This analysis included 1817 cases of a first non-fatal acute MI during hospitalization and their matched population-based controls, by age, sex, and area of residence. A validated food frequency questionnaire was used to quantify habitual dietary intake and diet-attributable GHGEs (kg CO2 equivalent (eq.)/year). Due to the matching design, conditional logistic regression was used. Red meat consumption contributed approximately 50% to the total diet-attributable GHGEs among both cases and controls. Higher diet-attributable GHGEs were associated with increased odds of acute MI. The odds of MI were 63% higher (OR = 1.63; 95% CI 1.20-2.21) among participants in the highest quintile (median diet-attributable GHGEs = 6247 kg CO2 eq./year) compared to the lowest quintile (median diet-attributable GHGEs = 2065 kg CO2 eq./year). An increasing linear trend in the odds of acute MI and diet-attributable GHGEs was detected (p-trend 0.0012). These findings highlight the importance of reducing red meat consumption to sustainably mitigate the incidence of MI and improve planetary health.
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Gases de Efecto Invernadero , Infarto del Miocardio , Humanos , Gases de Efecto Invernadero/efectos adversos , Dióxido de Carbono , Costa Rica/epidemiología , Dieta/efectos adversos , Infarto del Miocardio/epidemiología , Infarto del Miocardio/etiologíaRESUMEN
OBJECTIVE: To measure associations between surgeons' examination performance and obtaining American Board of Surgery certification with the likelihood of having medical malpractice payments. BACKGROUND: Further research is needed to establish a broader understanding of the association of board certification and patient and practice outcomes. METHODS: Retrospective analysis using propensity score-matched surgeons who attempted to obtain American Board of Surgery certification. Surgeons who completed residency between 2000 and 2019 (n=910) and attempted to become certified were categorized as certified or failing to obtain certification. In addition, groups were categorized as either passing or failing their first attempt on the qualifying and certifying examinations. Malpractice payment reports were dichotomized for surgeons who either had a payment report or not. RESULTS: The hazard rate (HR) of malpractice payment reports was significantly greater for surgeons who attempted and failed to obtain certification [HR=1.87; 95% confidence interval (CI), 1.28-2.74] than for surgeons who were certified. Moreover, surgeons who failed either the qualifying (HR=1.64; 95% CI, 1.14-2.37) or certifying examination (HR=1.72; 95% CI, 1.14-2.60) had significantly higher malpractice payment HRs than those who passed the examinations on their first attempt. CONCLUSIONS: Failing to obtain board certification was associated with a higher rate of medical malpractice payments. In addition, failing examinations in the certification examination process on the first attempt was also associated with higher rates of medical malpractice payments. This study provides further evidence that board certification is linked to potential indicators for patient outcomes and practice quality.
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Cirugía General , Internado y Residencia , Mala Praxis , Cirujanos , Certificación , Cirugía General/educación , Humanos , Estudios Retrospectivos , Estados UnidosRESUMEN
CONTEXT: Heart conditions affect salt and water homeostasis as a consequence of the underlying condition, compensatory processes, and therapy, and can result in nocturnal polyuria. These processes need to be identified as part of a full evaluation of nocturia. OBJECTIVE: To conduct a systematic review of nocturia in cardiovascular disease and achieve expert consensus for primary care management. Primary care was defined as a health care setting in which the expertise did not include specialist cardiology. EVIDENCE ACQUISITION: Four databases were searched from January 2000 to April 2020. A total of 3524 titles and abstracts were screened and 27 studies underwent full-text screening. Of these, eight studies were included in the analysis. The nominal group technique (NGT) was used to achieve consensus among an expert panel incorporating public involvement. EVIDENCE SYNTHESIS: Most studies focused on nocturia related to blood pressure (BP), while one investigated leg oedema. Hypertension, particularly overnight blood pressure above normal, corresponds with higher risk of nocturia. NGT identified fluid and salt overload, nondipping hypertension, and some therapeutic interventions as key nocturia contributors. History taking and examination should identify raised jugular venous pressure/ankle swelling, with relevant investigations including measurement of BP, resting electrocardiogram, and B-type natriuretic peptide. Treatment recommends reducing salt (including substitutes), alcohol and caffeine. Heart failure is managed according to local guidance and controlling fluid intake to 1-2 l daily. If there is no fluid retention, reduce or discontinue diuretics or calcium channel blockers and follow up to reassess the condition. The target clinic blood pressure is 140/90 mm Hg. CONCLUSIONS: Cardiovascular disease and its treatment are influential for understanding nocturia. Management aims to identify and treat heart failure and/or hypertension. PATIENT SUMMARY: People with cardiovascular disease can suffer severe sleep disturbance because of a need to pass urine at night due to increased overnight blood pressure or heart failure. Following a detailed evaluation of the published research, a group of experts recommended practical approaches for assessing and treating these issues.
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Enfermedades Cardiovasculares , Insuficiencia Cardíaca , Hipertensión , Nocturia , Enfermedades Cardiovasculares/complicaciones , Consenso , Edema , Insuficiencia Cardíaca/complicaciones , Humanos , Hipertensión/complicaciones , Nocturia/tratamiento farmacológico , Nocturia/terapia , Atención Primaria de SaludRESUMEN
OBJECTIVE: To Study the Outcomes of the First Virtual General Surgery Certifying Exam of the American Board of Surgery. SUMMARY OF BACKGROUND DATA: The ABS General Surgery CE is normally an in-person oral examination. Due to the COVID-19 outbreak, the ABS was required to reschedule these. After 2 small pilots, the CE's October administration represented the first large-scale remote virtual exam. The purpose of this report is to compare the outcomes of this virtual and the previous in-person CEs. METHODS: CE candidates were asked to provide feedback on their experience via a survey. The passing rate was compared to the 1025 candidates who took the 2019-2020 in-person CEs. RESULTS: Of the 308 candidates who registered for the virtual CE, 306 completed the exam (99.4%) and 188 completed the survey (61.4%). The majority had a very positive experience. They rated the virtual CE as very good/excellent in security (90%), ease of exam platform (77%), audio quality (71%), video quality (69%), and overall satisfaction (86%). Notably, when asked their preference, 78% preferred the virtual exam. There were no differences in the passing rates between the virtual or in-person exams. CONCLUSIONS: The first virtual CE by the ABS was completed using available internet technology. There was high satisfaction, with the majority preferring the virtual platform. Compared to past in-person CEs, there was no difference in outcomes as measured by passing rates. These data suggest that expansion of the virtual CE may be desirable.
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Certificación/métodos , Cirugía General , Sistemas en Línea , Consejos de Especialidades , Encuestas y Cuestionarios , Estados UnidosRESUMEN
Emerging infectious diseases (EIDs) caused by viruses are increasing in frequency, causing a high disease burden and mortality world-wide. The COVID-19 pandemic caused by the novel SARS-like coronavirus (SARS-CoV-2) underscores the need to innovate and accelerate the development of effective vaccination strategies against EIDs. Human leukocyte antigen (HLA) molecules play a central role in the immune system by determining the peptide repertoire displayed to the T-cell compartment. Genetic polymorphisms of the HLA system thus confer a strong variability in vaccine-induced immune responses and may complicate the selection of vaccine candidates, because the distribution and frequencies of HLA alleles are highly variable among different ethnic groups. Herein, we build on the emerging paradigm of rational epitope-based vaccine design, by describing an immunoinformatics tool (Predivac-3.0) for proteome-wide T-cell epitope discovery that accounts for ethnic-level variations in immune responsiveness. Predivac-3.0 implements both CD8+ and CD4+ T-cell epitope predictions based on HLA allele frequencies retrieved from the Allele Frequency Net Database. The tool was thoroughly assessed, proving comparable performances (AUC ~0.9) against four state-of-the-art pan-specific immunoinformatics methods capable of population-level analysis (NetMHCPan-4.0, Pickpocket, PSSMHCPan and SMM), as well as a strong accuracy on proteome-wide T-cell epitope predictions for HIV-specific immune responses in the Japanese population. The utility of the method was investigated for the COVID-19 pandemic, by performing in silico T-cell epitope mapping of the SARS-CoV-2 spike glycoprotein according to the ethnic context of the countries where the ChAdOx1 vaccine is currently initiating phase III clinical trials. Potentially immunodominant CD8+ and CD4+ T-cell epitopes and population coverages were predicted for each population (the Epitope Discovery mode), along with optimized sets of broadly recognized (promiscuous) T-cell epitopes maximizing coverage in the target populations (the Epitope Optimization mode). Population-specific epitope-rich regions (T-cell epitope clusters) were further predicted in protein antigens based on combined criteria of epitope density and population coverage. Overall, we conclude that Predivac-3.0 holds potential to contribute in the understanding of ethnic-level variations of vaccine-induced immune responsiveness and to guide the development of epitope-based next-generation vaccines against emerging pathogens, whose geographic distributions and populations in need of vaccinations are often well-defined for regional epidemics.
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Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD8-positivos/inmunología , COVID-19/inmunología , Epítopos de Linfocito T/metabolismo , Etnicidad , Antígenos HLA/metabolismo , Proteómica/métodos , SARS-CoV-2/fisiología , Glicoproteína de la Espiga del Coronavirus/metabolismo , COVID-19/epidemiología , Vacunas contra la COVID-19 , Enfermedades Transmisibles Emergentes , Epítopos de Linfocito T/genética , Antígenos HLA/genética , Humanos , Inmunogenicidad Vacunal , Aplicaciones de la Informática Médica , Pandemias/prevención & control , Polimorfismo Genético , Unión Proteica , Programas Informáticos , Glicoproteína de la Espiga del Coronavirus/genéticaRESUMEN
OBJECTIVE: Social and economic changes associated with new roads can bring about rapid nutritional transitions. To study this process, we: (1) describe trends in adult overweight and obesity (OW/OB) among rural Afro-Ecuadorians over time and across a gradient of community remoteness from the nearest commercial centre; (2) examine the relationship between male and female adult OW/OB and factors associated with market integration such as changing livelihoods and (3) examine the co-occurrence of adult OW/OB and under-five stunting and anaemia. DESIGN: Adult anthropometry was collected through serial case-control studies repeated over a decade across twenty-eight communities. At the same time, anthropometry and Hb were measured for all children under 5 years of age in every community. SETTING: Northern coastal Ecuador. PARTICIPANTS: Adults (n 1665) and children under 5 years of age (n 2618). RESULTS: From 2003 and 2013, OW/OB increased from 25·1 % to 44·8 % among men and 59·9 % to 70·2 % among women. The inverse relationship between remoteness and OW/OB in men was attenuated when adjusting for urban employment, suggesting that livelihoods mediated the remoteness-OW/OB relationship. No such relationship was observed among women. Communities with a higher prevalence of male OW/OB also had a greater prevalence of stunting, but not anaemia, in children under 5 years of age. CONCLUSIONS: The association between male OW/OB and child stunting at the community level, but not the household level, suggests that changing food environments, rather than household- or individual-level factors, drove these trends. A closer examination of changing socio-economic structures and food environments in communities undergoing rapid development could help mitigate future public health burdens.
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Desnutrición , Preescolar , Ecuador/epidemiología , Femenino , Humanos , Masculino , Desnutrición/epidemiología , Obesidad , Sobrepeso/epidemiología , Prevalencia , Población RuralRESUMEN
The EAT-Lancet Commission promulgated a universal reference diet. Subsequently, researchers constructed an EAT-Lancet diet score (0-14 points), with minimum intake values for various dietary components set at 0 g/d, and reported inverse associations with risks of major health outcomes in a high-income population. We assessed associations between EAT-Lancet diet scores, without or with lower bound values, and the mean probability of micronutrient adequacy (MPA) among nutrition-insecure women of reproductive age (WRA) from low- and middle-income countries (LMIC). We analysed single 24-h diet recall data (n 1950) from studies in rural DRC, Ecuador, Kenya, Sri Lanka and Vietnam. Associations between EAT-Lancet diet scores and MPA were assessed by fitting linear mixed-effects models. Mean EAT-Lancet diet scores were 8·8 (SD 1·3) and 1·9 (SD 1·1) without or with minimum intake values, respectively. Pooled MPA was 0·58 (SD 0·22) and energy intake was 10·5 (SD 4·6) MJ/d. A one-point increase in the EAT-Lancet diet score, without minimum intake values, was associated with a 2·6 (SD 0·7) percentage points decrease in MPA (P < 0·001). In contrast, the EAT-Lancet diet score, with minimum intake values, was associated with a 2·4 (SD 1·3) percentage points increase in MPA (P = 0·07). Further analysis indicated positive associations between EAT-Lancet diet scores and MPA adjusted for energy intake (P < 0·05). Our findings indicate that the EAT-Lancet diet score requires minimum intake values for nutrient-dense dietary components to avoid positively scoring non-consumption of food groups and subsequently predicting lower MPA of diets, when applied to rural WRA in LMIC.
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Países en Desarrollo , Dieta , Micronutrientes/administración & dosificación , Oligoelementos , República Democrática del Congo , Ingestión de Alimentos , Ecuador , Femenino , Humanos , Kenia , Población Rural , Sri Lanka , Oligoelementos/administración & dosificación , VietnamRESUMEN
The Allele Frequency Net Database (AFND, www.allelefrequencies.net) provides the scientific community with a freely available repository for the storage of frequency data (alleles, genes, haplotypes and genotypes) related to human leukocyte antigens (HLA), killer-cell immunoglobulin-like receptors (KIR), major histocompatibility complex Class I chain related genes (MIC) and a number of cytokine gene polymorphisms in worldwide populations. In the last five years, AFND has become more popular in terms of clinical and scientific usage, with a recent increase in genotyping data as a necessary component of Short Population Report article submissions to another scientific journal. In addition, we have developed a user-friendly desktop application for HLA and KIR genotype/population data submissions. We have also focused on classification of existing and new data into 'gold-silver-bronze' criteria, allowing users to filter and query depending on their needs. Moreover, we have also continued to expand other features, for example focussed on HLA associations with adverse drug reactions. At present, AFND contains >1600 populations from >10 million healthy individuals, making AFND a valuable resource for the analysis of some of the most polymorphic regions in the human genome.
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Citocinas/genética , Bases de Datos Genéticas , Frecuencia de los Genes/genética , Antígenos HLA/genética , Antígenos de Histocompatibilidad Clase I/genética , Receptores KIR/genética , Genoma Humano , Humanos , Polimorfismo Genético , Interfaz Usuario-ComputadorRESUMEN
Alterations in pubertal timing have been associated with long-term health outcomes. While a few reports have shown that dietary intake of selenium is associated with fertility and testosterone levels in men, no human studies have considered the association between selenium and pubertal development in children. We examined the cross-sectional association of childhood dietary intake of selenium with pubertal development among 274 girls and 245 boys aged 10-18 years in Mexico City. Multiple logistic and ordinal regression models were used to capture the association between energy-adjusted selenium intake (below Recommended Dietary Allowance (RDA) vs. above RDA) and stages of sexual maturity in children, adjusted for covariates. We found that boys with consumption of selenium below the RDA had lower odds of a higher stage for pubic hair growth (odds ratio (OR) = 0.51, 95% confidence interval (95% CI): 0.27-0.97) and genital development (OR = 0.53, 95% CI: 0.28-0.99) as well as a lower probability of having matured testicular volume (OR = 0.37, 95% CI: 0.15-0.88) compared with boys who had adequate daily dietary intake of selenium (above RDA). No associations were found in girls. According to our results, it is possible that inadequate consumption of selenium may be associated with later pubertal development in boys, suggesting a sex-specific pattern. Future work with a larger sample size and measures of selenium biomarkers is needed to confirm our findings and improve understanding of the role of this mineral in children's sexual development.
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Dieta , Pubertad/efectos de los fármacos , Pubertad/fisiología , Selenio/administración & dosificación , Maduración Sexual/efectos de los fármacos , Adolescente , Niño , Estudios Transversales , Femenino , Humanos , Masculino , México , Ingesta Diaria Recomendada , Selenio/deficiencia , Factores Sexuales , Maduración Sexual/fisiologíaRESUMEN
Background: The extent to and mechanisms by which agricultural biodiversity may influence diet diversity and quality among women are not well understood. Objectives: We aimed to 1) determine the association of farm-level agricultural biodiversity with diet diversity and quality among women of reproductive age in Peru and 2) determine the extent to which farm market orientation mediates or moderates this association. Methods: We surveyed 600 households with the use of stratified random sampling across 3 study landscapes in the Peruvian Andes with diverse agroecological and market conditions. Diet diversity and quality among women were assessed by using quantitative 24-h dietary recalls with repeat recalls among 100 randomly selected women. We calculated a 10-food group diet diversity score (DDS), the Minimum Dietary Diversity for Women (MDD-W) indicator, probability of adequacy (PA) of 9 micronutrients by using a measurement-error model approach, and mean PA (MPA; mean of PAs for all nutrients). Agricultural biodiversity was defined as a count of crop species cultivated by the household during the 2016-2017 agricultural season. Results: In regression analyses adjusting for sociodemographic and agricultural characteristics, farm-level agricultural biodiversity was associated with a higher DDS (incidence rate ratio from Poisson regression: 1.03; P < 0.05) and MPA (ordinary least-squares ß-coefficient: 0.65; P < 0.1) and higher odds of achieving a minimally diverse diet (MDD-W: OR from logistic regression: 1.17; 95% CI: 1.11, 1.23) and a diet that met a minimum threshold for micronutrient adequacy (MPA >60%: OR: 1.21; 95% CI: 1.10, 1.35). Farm market orientation did not consistently moderate these associations, and in path analyses we observed no consistent evidence of mediation of these associations by farm market orientation. Conclusions: Farm-level agricultural biodiversity was associated with moderately more diverse and more micronutrient-adequate diets among Peruvian women. This association was consistent across farms with varying levels of market orientation, although agricultural biodiversity likely contributed to diets principally through subsistence consumption.
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Agricultura , Biodiversidad , Productos Agrícolas , Dieta Saludable , Abastecimiento de Alimentos , Micronutrientes/administración & dosificación , Población Rural , Adolescente , Adulto , Comercio , Registros de Dieta , Encuestas sobre Dietas , Composición Familiar , Granjas , Femenino , Humanos , Modelos Logísticos , Persona de Mediana Edad , Evaluación Nutricional , Estado Nutricional , Oportunidad Relativa , Perú , Adulto JovenRESUMEN
The allele frequency net database (AFND, http://www.allelefrequencies.net ) is an online web-based repository that contains information on the frequencies of immune-related genes and their corresponding alleles in worldwide human populations. At present, the system contains data from 1505 populations in more than ten million individuals on the frequency of genes from different polymorphic regions including data for the human leukocyte antigens (HLA) system. This resource has been widely used in a variety of contexts such as histocompatibility, immunology, epidemiology, pharmacogenetics, and population genetics, among many others. In this chapter, we present some of the more commonly used searching mechanisms and some of the most recent developments included in AFND.
Asunto(s)
Bases de Datos Genéticas , Frecuencia de los Genes , Internet , Alelos , Epítopos/genética , Genética de Población , Geografía , Antígenos HLA/genética , Haplotipos/genética , HumanosRESUMEN
Background: Urban populations have grown globally alongside emerging simultaneous burdens of undernutrition and obesity. Yet, how heterogeneous urban environments are associated with this nutritional double burden is poorly understood. Objective: We aimed to determine: 1) the prevalence of the nutritional double burden and its components in urban, peri-urban, and rural areas of Bolivia; and 2) the association of residence in these areas with the nutritional double burden and its components. Design: We surveyed 3946 randomly selected households from 2 metropolitan regions of Bolivia. Census data and remotely sensed imagery were used to define urban, peri-urban, and rural districts along a transect in each region. We defined 5 nutritional double burdens: concurrent overweight and anemia among women of reproductive age (15-49 y), and children (6-59 mo), respectively; concurrent overweight and stunting among children; and households with an overweight woman and, respectively, an anemic or stunted child. Capillary hemoglobin concentrations were measured to assess anemia (women: hemoglobin <120 g/L; children: hemoglobin <110 g/L), and overweight and stunting were calculated from height, weight, and age data. Results: In multiple logistic regression models, peri-urban, but not urban residence, was associated with higher odds of concurrent overweight and anemia among children (OR: 1.8; 95% CI; 1.0, 3.2) and of households with an overweight woman and stunted child (1.8; 1.2, 2.7). Examining the components of the double burden, peri-urban women and children, respectively, had higher odds of overweight than rural residents [women (1.5; 1.2, 1.8); children (1.5; 1.0, 2.4)], and children from peri-urban regions had higher odds of stunting (1.5; 1.1, 2.2). Conclusions: Peri-urban, but not urban, residence in Bolivia is associated with a higher risk of the nutritional double burden than rural areas. Understanding how heterogeneous urban environments influence nutrition outcomes could inform integrated policies that simultaneously address both undernutrition and obesity.
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Anemia/complicaciones , Índice de Masa Corporal , Trastornos del Crecimiento , Obesidad/complicaciones , Población Urbana , Adolescente , Adulto , Estatura , Peso Corporal , Bolivia , Preescolar , Composición Familiar , Femenino , Hemoglobinas/metabolismo , Humanos , Lactante , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estado Nutricional , Oportunidad Relativa , Características de la Residencia , Factores Socioeconómicos , Adulto JovenRESUMEN
Road access can influence protective and risk factors associated with nutrition by affecting various social and biological processes. In northern coastal Ecuador, the construction of new roads created a remoteness gradient among villages, providing a unique opportunity to examine the impact of roads on child nutritional outcomes 10 years after the road was built. Anthropometric and haemoglobin measurements were collected from 2,350 children <5 years in Esmeraldas, Ecuador, from 2004 to 2013 across 28 villages with differing road access. Logistic generalized estimating equation models assessed the longitudinal association between village remoteness and prevalence of stunting, wasting, underweight, overweight, obesity, and anaemia. We examined the influence of socio-economic characteristics on the pathway between remoteness and nutrition by comparing model results with and without household-level socio-economic covariates. Remoteness was associated with stunting (OR = 0.43, 95% CI [0.30, 0.63]) and anaemia (OR = 0.56, 95% CI [0.44, 0.70]). Over time, the prevalence of stunting was generally decreasing but remained higher in villages closer to the road compared to those farther away. Obesity increased (0.5% to 3%) over time; wasting was high (6%) but stable during the study period. Wealth and education partially explained the better nutritional outcomes in remote vs. road villages more than a decade after some communities gained road access. Establishing the extent to which these patterns persist requires additional years of observation.
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Trastornos del Crecimiento/epidemiología , Desnutrición/epidemiología , Sobrepeso/epidemiología , Obesidad Infantil/epidemiología , Delgadez/epidemiología , Antropometría , Preescolar , Ecuador/epidemiología , Composición Familiar , Femenino , Humanos , Lactante , Masculino , Estado Nutricional , Prevalencia , Salud Pública , Factores de Riesgo , Población Rural , Factores SocioeconómicosRESUMEN
We aimed to determine the association between household food insecurity (HFI) and the co-occurrence of overweight and anemia among women of reproductive age in the Mexican population. We analyzed data on 4,039 nonpregnant female adolescents (15-19 years) and 10,760 nonpregnant adult women of reproductive age (20-49 years) from the 2012 National Health and Nutrition Survey of Mexico. The survey uses a two-stage sampling design, stratified by rural and urban regions. The Latin American and Caribbean Food Security Scale was used to assess HFI. We assessed overweight and obesity in women based on World Health Organization classifications for body mass index, and BMI-for-age Z-scores for female adolescents, and defined anemia as an altitude-adjusted hemoglobin (Hb) concentration < 120 g/L based on measurement of capillary Hb concentrations. In multiple logistic regression models adjusting for potential confounding covariates, HFI was not associated with the co-occurrence of anemia and overweight among female adolescents. The adjusted odds of women of reproductive age from mildly and moderately food-insecure households, respectively, experiencing concurrent anemia and overweight were 48% (OR: 1.48; 95% CI: 1.15, 1.91) and 49% (OR: 1.49; 95% CI: 1.08, 2.06) higher than among women from food-secure households. Severe HFI was not associated with concurrent overweight and anemia among female adolescents or women. HFI may be a shared mechanism for dual forms of malnutrition within the same individual, simultaneously contributing to overconsumption and dietary inadequacy.