Chronic non-communicable diseases (NCDs) are the leading causes of morbidity and mortality in the United States and globally, and are attributable largely to poor nutrition and suboptimal lifestyle ...behaviors. The 2015-2020 Dietary Guidelines for Americans promote healthy eating and lifestyle patterns across the lifespan to reduce risk of NCDs. Physicians are well positioned to provide lifestyle preventive interventions that are personalized to their patients' biological needs and cultural preferences through multidisciplinary team activities or referral to professional nutrition and physical activity experts. They can also advocate for environmental changes in healthcare and community settings that promote healthful lifestyle behaviors.
The proportion of the population that is ≥60 years of age in sub‐Saharan Africa (SSA) is increasing rapidly and is likely to constrain healthcare systems in the future. Nevertheless, the elderly are ...not a health policy priority for African countries. This paper reviews the nutritional and health status of older adults in SSA and their determinants. Literature was ed through the Medline, Google Scholar, and Dogpile databases using the following search terms: sub‐Saharan Africa, older adults, nutrition, health. Findings showed that up to half (6–48%) of elderly Africans in SSA are underweight and almost a quarter (2.5–21%) are overweight, while 56% of older South Africans are obese. Low‐quality diets contribute to poor nutritional status. Poverty, HIV/AIDS, and complex humanitarian emergencies are major determinants of undernutrition. Effective interventions need to consider socioeconomic, health, and demographic factors; social pensions may be the most cost‐effective option for improving the health and nutritional status of the elderly in SSA.
The objective of this study was to determine whether attainment of clinical and lifestyle targets varied by race and sex among adults with diabetes onset in older adulthood.
This study included 1420 ...black and white adults from the REGARDS study without diabetes at baseline (2003–07) but with diabetes onset at the follow-up exam (2013–16). Attainment of clinical targets (A1c <8%; blood pressure < 140/90 mmHg; and statin use) and lifestyle targets (not smoking; physical activity≥ 4 times/week; and moderate/no alcohol use) was assessed at the follow-up exam. Modified Poisson regression was used to obtain prevalence ratios (PR) for meeting clinical and lifestyle targets stratified by race and sex, separately.
The mean age was 71.5 years, 53.6% were female, and 46.1% were black. The majority were aware of their diabetes status (85.7%) and used oral or injectable hypoglycemic medications (64.8%). Overall, 39.4% met all 3 clinical targets and 18.8% met all 3 lifestyle targets. Meeting A1c and blood pressure targets were similar by race and sex. Statin use was more prevalent for men than women among white adults (PR = 1.13; 95% CI = 0.99–1.29) and black adults (PR = 1.23; 95% CI = 1.06–1.43). For lifestyle factors, the non-smoking prevalence was similar by race and sex, while white men were more likely than white women to be physically active.
Although the attainment of each clinical and lifestyle target separately was generally high among adults with diabetes onset in older adulthood, race and sex differences were apparent. Comprehensive management of clinical and lifestyle factors in people with diabetes remains suboptimal.
•Overall, 39.4% of participants with diabetes met all three clinical targets (A1c, blood pressure, statin use).•For lifestyle factors, 18.8% met all three targets (non-smoking, physically active, no or moderate alcohol consumption).•Meeting each clinical and lifestyle target was similar for urban, rural and mixed community types.•Meeting A1c, blood pressure, and non-smoking targets were similar by race and sex.•Women were less likely to use statins and be physically active than men.
Obesity affects one in three American adult women and is associated with overall mortality and major morbidities. A composite diet index to evaluate total diet quality may better assess the complex ...relationship between diet and obesity, providing insights for nutrition interventions. The purpose of the present investigation was to determine whether diet quality, defined according to the previously validated Framingham nutritional risk score (FNRS), was associated with the development of overweight or obesity in women. Over 16 years, we followed 590 normal-weight women (BMI < 25 kg/m2), aged 25 to 71 years, of the Framingham Offspring and Spouse Study who presented without CVD, cancer or diabetes at baseline. The nineteen-nutrient FNRS derived from mean ranks of nutrient intakes from 3 d dietary records was used to assess nutritional risk. The outcome was development of overweight or obesity (BMI ≥ 25 kg/m2) during follow-up. In a stepwise multiple logistic regression model adjusted for age, physical activity and smoking status, the FNRS was directly related to overweight or obesity (P for trend = 0·009). Women with lower diet quality (i.e. higher nutritional risk scores) were significantly more likely to become overweight or obese (OR 1·76; 95 % CI 1·16, 2·69) compared with those with higher diet quality. Diet quality, assessed using a comprehensive composite nutritional risk score, predicted development of overweight or obesity. This finding suggests that overall diet quality be considered a key component in planning and implementing programmes for obesity risk reduction and treatment recommendations.
Abstract Generating valid estimates of dietary glycemic index (GI) and glycemic load (GL) has been a challenge in nutritional epidemiology. The methodologic issues may have contributed to the wide ...variation of GI/GL associations with health outcomes observed in existing literature. We describe a standardized methodology for assigning GI values to items in the National Health and Nutrition Examination Survey (NHANES) nutrient database using the new International Tables to develop research-driven, systematic procedures and strategies to estimate dietary GI/GL exposures of a nationally representative population sample. Nutrient databases for NHANES 2003-2006 contain information on 3,155 unique foods derived from the US Department of Agriculture National Nutrient Database for Standard Reference versions 18 and 20. Assignment of GI values were made to a subset of 2,078 carbohydrate-containing foods using systematic food item matching procedures applied to 2008 international GI tables and online data sources. Matching protocols indicated that 45.4% of foods had identical matches with existing data sources, 31.9% had similar matches, 2.5% derived GI values calculated with the formula for combination foods, 13.6% were assigned a default GI value based on low carbohydrate content, and 6.7% of GI values were based on data extrapolation. Most GI values were derived from international sources; 36.1% were from North American product information. To confirm data assignments, dietary GI and GL intakes of the NHANES 2003-2006 adult participants were estimated from two 24-hour recalls and compared with published studies. Among the 3,689 men and 4,112 women studied, mean dietary GI was 56.2 (men 56.9, women 55.5), mean dietary GL was 138.1 (men 162.1, women 116.4); the distribution of dietary GI was approximately normal. Estimates of population GI and GL compare favorably with other published literature. This methodology of adding GI values to an existing population nutrient database utilized systematic matching protocols and the latest comprehensive data sources on food composition. The database can be applied in clinical and survey research settings where there is interest in estimating individual and population dietary exposures and relating them to health outcomes.
Healthy obese individuals may be protected against adverse health outcomes. Diet and race might influence healthy obesity, but data on their roles and interactions on the phenotype are limited.
We ...compared the food intake of metabolically healthy obese men to those of other weight status-metabolic health phenotypes.
Men (n = 4855) aged ≥ 45 y with BMI ≥ 18.5 kg/m(2) and free of cardiovascular diseases, diabetes, and cancer were evaluated in a cross-sectional study of the REGARDS (REasons for Geographic And Racial Differences in Stroke) study cohort. Food intake was assessed with the use of a food frequency questionnaire. Weight status-metabolic health phenotypes were defined by using metabolic syndrome (MetS) and homeostasis model assessment of insulin resistance (HOMA-IR) criteria. Mean differences in food intake among weight status-metabolic health phenotypes were compared with the use of linear regression.
MetS-defined healthy obesity was present in 44% of white obese men and 58% of black obese men; the healthy obese phenotype, based on HOMA-IR, was equally prevalent in both white (20%) and black (21%) obese men. Among white men, MetS-defined healthy and unhealthy obesity were associated with lower wholegrain bread intake and higher consumption of red meat (P < 0.001), whereas HOMA-IR-defined healthy and unhealthy obesity were associated with lower red meat intake (P < 0.0001) compared with healthy normal weight in multivariable-adjusted analyses that adjusted for sociodemographic, lifestyle, and clinical confounders. However, results were attenuated and became nonsignificant after further adjustment for BMI. Healthy and unhealthy overweight, defined by both criteria, were associated with lower whole grain bread intake (P < 0.001) in all models. Among black men, weight status-metabolic health phenotypes were not associated with food intake in all models.
Healthy obesity in men is not associated with a healthier diet. Future studies need to consider dietary patterns, which may better inform the holistic effect of diet on healthy obesity, in prospective analyses.
Background
High body mass index (BMI) is associated with stroke, ischemic heart disease (IHD), and type 2 diabetes mellitus (T2DM). An epidemiological analysis of the prevalence of high BMI, stroke, ...IHD, and T2DM was conducted for 16 Southern Africa Development Community (SADC) using Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study data.
Methods
GBD obtained data from vital registration, verbal autopsy, and ICD codes. Prevalence of high BMI (≥25 kg/m2), stroke, IHD, and T2DM attributed to high BMI were calculated. Cause of Death Ensemble Model and Spatiotemporal Gaussian regression was used to estimate mortality due to stroke, IHD, and T2DM attributable to high BMI.
Results
Obesity in adult females increased 1.54‐fold from 12.0% (uncertainty interval UI: 11.5–12.4) to 18.5% (17.9–19.0), whereas in adult males, obesity nearly doubled from 4.5 (4.3–4.8) to 8.8 (8.5–9.2). In children, obesity more than doubled in both sexes, and overweight increased by 27.4% in girls and by 37.4% in boys. Mean BMI increased by 0.7 from 22.4 (21.6–23.1) to 23.1 (22.3–24.0) in adult males, and by 1.0 from 23.8 (22.9–24.7) to 24.8 (23.8–25.8) in adult females. South Africa 44.7 (42.5–46.8), Swaziland 33.9 (31.7–36.0) and Lesotho 31.6 (29.8–33.5) had the highest prevalence of obesity in 2019. The corresponding prevalence in males for the three countries were 19.1 (17.5–20.7), 19.3 (17.7–20.8), and 9.2 (8.4–10.1), respectively. The DRC and Madagascar had the least prevalence of adult obesity, from 5.6 (4.8–6.4) and 7.0 (6.1–7.9), respectively in females in 2019, and in males from 4.9 (4.3–5.4) in the DRC to 3.9 (3.4–4.4) in Madagascar.
Conclusions
The prevalence of high BMI is high in SADC. Obesity more than doubled in adults and nearly doubled in children. The 2019 mean BMI for adult females in seven countries exceeded 25 kg/m2. SADC countries are unlikely to meet UN2030 SDG targets. Prevalence of high BMI should be studied locally to help reduce morbidity.
Background: Metabolically healthy obesity may confer lower risk of adverse health outcomes compared with abnormal obesity. Diet and race are postulated to influence the phenotype, but their roles and ...their interrelations on healthy obesity are unclear.
Objective: We evaluated food intakes of metabolically healthy obese women in comparison to intakes of their metabolically healthy normal-weight and metabolically abnormal obese counterparts.
Methods: This was a cross-sectional study in 6964 women of the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Participants were aged 45–98 y with a body mass index (BMI; kg/m2) ≥18.5 and free of cardiovascular diseases, diabetes, and cancer. Food intake was collected by using a food-frequency questionnaire. BMI phenotypes were defined by using metabolic syndrome (MetS) and homeostasis model assessment of insulin resistance (HOMA-IR) criteria. Mean differences in food intakes among BMI phenotypes were compared by using ANCOVA.
Results: Approximately one-half of obese women (white: 45%; black: 55%) as defined by MetS criteria and approximately one-quarter of obese women (white: 28%; black: 24%) defined on the basis of HOMA-IR values were metabolically healthy. In age-adjusted analyses, healthy obesity and normal weight as defined by both criteria were associated with lower intakes of sugar-sweetened beverages compared with abnormal obesity among both white and black women (P < 0.05). HOMA-IR–defined healthy obesity and normal weight were also associated with higher fruit and low-fat dairy intakes compared with abnormal obesity in white women (P < 0.05). Results were attenuated and became nonsignificant in multivariable-adjusted models that additionally adjusted for BMI, marital status, residential region, education, annual income, alcohol intake, multivitamin use, cigarette smoking status, physical activity, television viewing, high-sensitivity C-reactive protein, menopausal status, hormone therapy, and food intakes.
Conclusions: Healthy obesity was not associated with a healthier diet. Prospective studies on relations of dietary patterns, which may be a better indicator of usual diet, with the phenotype would be beneficial.
To evaluate long-term patterns of weight change and progression to overweight and obesity during adulthood.
Prospective study. Changes in mean BMI, waist circumference (WC) and weight were assessed ...over a mean 26-year follow-up (1971–1975 to 1998–2001). Mean BMI (95% CI) and mean WC (95% CI) of men and women in BMI and age groups were computed. Mean weight change in BMI and age categories was compared using analysis of covariance.
Framingham Heart Study Offspring/Spouse Nutrition Study.
Men and women (n 2394) aged 20–63 years.
During follow-up, increases in BMI (men: 2?2 kg/m2; women: 3?7 kg/m2) and WC (men: 5?7 cm; women: 15?1 cm) were larger in women than men. BMI gains were greatest in younger adults (20–39 years) and smallest in obese older adults (50–69 years). The prevalence of obesity doubled in men (to 33?2%) and tripled in women (to 26?6 %). Among normal-weight individuals, abdominal obesity developed in women only. The prevalence of abdominal obesity increased 1?8-fold in men (to 53?0%) and 2?4-fold in women (to 71?2 %). Weight gain was greatest in the youngest adults (20–29 years), particularly women. Gains continued into the fifth decade among men and then declined in the sixth decade; in women gains continued into the sixth decade.
Patterns of weight change and progression to obesity during adulthood differ in men and women. Preventive intervention strategies for overweight and obesity need to consider age- and sex-specific patterns of changes in anthropometric measures.
BACKGROUND: Diet is recognized as a key factor in the cause and management of the metabolic syndrome (MetS). However, policies to guide preventive clinical nutrition interventions of the condition ...are limited. OBJECTIVES: We examined the relation between dietary quality and incident MetS in adult women and identified foci for preventive nutrition interventions. DESIGN: This was a prospective study of 300 healthy women (aged 30-69 y) in the Framingham Offspring-Spouse study who were free of MetS risk factors at baseline. The development of individual MetS traits and overall MetS status during 12 y of follow-up were compared in women by tertile of nutritional risk, based on intake of 19 nutrients. Multivariate logistic regression models considered age, smoking, physical activity, and menopausal status. RESULTS: Baseline age-adjusted mean nutrient intake and ischemic heart disease risk profiles differed by tertile of nutritional risk. Women with higher nutritional risk profiles consumed more dietary lipids (total, saturated, and monounsaturated fats) and alcohol and less fiber and micronutrients; they had higher cigarette use and waist circumferences. Compared with women with the lowest nutritional risk, those in the highest tertile had a 2- to 3-fold risk of the development of abdominal obesity and overall MetS during 12 y of follow-up odds ratio: 2.3 (95% CI: 1.2, 4.3) and 3.0 (95% CI: 1.2, 7.6), respectively. CONCLUSIONS: Higher composite nutritional risk predicts the development of abdominal obesity and MetS during long-term follow-up in healthy women, independent of lifestyle and ischemic heart disease risk factors. Preventive nutrition interventions for obesity and MetS risk reduction should focus on the overall nutritional quality of women's dietary profiles.
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