Gender inequalities in excess adiposity and anaemia combine in a large double burden of malnutrition gap detrimental to women in an urban area in North Africa

Traissac, Pierre; Ati, Jalila El; Gartner, Agnès; Gharbia, Houda Ben; Delpeuch, Francis

doi:10.1017/s1368980016000689

Cited by 21 publications

(36 citation statements)

References 45 publications

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“…Vuong et al demonstrated similar findings in 6766 NHANES patients; hemoglobin levels increased with increasing AC in both male and female patients [ 6 ]. Traissac et al reported that, in a non-CKD cohort of 1689 female patients and 930 male patients, the prevalence of anemia (hemoglobin < 12.0 g/dL) was significantly higher in females with BMI ≥ 25 kg/m 2 than in males with BMI ≥ 25 kg/m 2 [ 33 ]. Thus, in general, BMI and AC appear to be positively associated with hemoglobin levels in the non-CKD population.…”

Section: Discussionmentioning

confidence: 99%

Association of adiposity with hemoglobin levels in patients with chronic kidney disease not on dialysis

et al. 2017

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BackgroundIn the general population, adiposity influences erythropoiesis and iron metabolism. We aimed to assess the relationships between adiposity [estimated by body mass index (BMI) and abdominal circumference (AC)] and biomarkers of erythropoiesis in patients with chronic kidney disease (CKD) not on dialysis.MethodsA total of 2322 patients from the Chronic Kidney Disease Japan Cohort study were included. Patients were grouped according to BMI (low: < 18.5 kg/m2, normal: 18.5–24.5 kg/m2, and high: ≥ 25 kg/m2) and AC categories (large: ≥ 90 cm for men and ≥ 80 cm for women; small: < 90 cm and < 80 cm, respectively). Body composition and laboratory data were assessed at baseline, and at 1 and 2 years of follow-up.ResultsMultivariate regression analysis of the 3 time-points showed that high BMI and large AC in male patients were significantly associated with higher hemoglobin levels. Hemoglobin levels were lower in female patients with low BMI and small AC than that in female patients with normal BMI and large AC, respectively; however, hemoglobin levels plateaued above a threshold of 25 kg/m2 for BMI and 80 cm for AC. While BMI and AC were positively associated with C-reactive protein levels, they were not associated with levels of transferrin saturation, ferritin, and erythropoietin in multivariate models.ConclusionsBody composition appears to be associated with erythropoiesis; however, adiposity may be only associated with increased erythropoiesis in male patients. In addition, body composition does not appear to hamper iron metabolism in CKD patients not on dialysis.Electronic supplementary materialThe online version of this article (10.1007/s10157-017-1501-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Association of adiposity with hemoglobin levels in patients with chronic kidney disease not on dialysis

et al. 2017

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“…Tunisia is a country emblematic of the MENA region undergoing the nutrition transition and currently features high prevalences of excess adiposity and nutrition related NCDs, especially in urban areas where obesity concerns a third of the women and about one man out of six [4, 14, 15]. Tunisia has long been one of the most advanced countries of the MENA region regarding gender legislation [16].…”

Section: Introductionmentioning

confidence: 99%

“…non-egalitarian division of household labour, lower expectations regarding education or professional insertion for women, gender constraints on physically active leisure activities or not completely gender neutral legislation. This partly underlies the marked gender inequality in overweight and obesity harmful to women, who, in this context, have been shown to be two to three times more prone to excess adiposity than men [1, 10, 15]. On the other hand, this phenomenon is not exclusive of the persistence of certain types of undernutrition partly linked to micro-nutrient deficiency, e.g.…”

Section: Introductionmentioning

confidence: 99%

Gender inequalities in diet quality and their socioeconomic patterning in a nutrition transition context in the Middle East and North Africa: a cross-sectional study in Tunisia

Abassi

Sassi

Ati

et al. 2019

Nutr J

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BackgroundIn a context of nutrition transition and major shifts in lifestyle and diet, the Middle East and North Africa features a marked gender excess adiposity gap detrimental to women. In this setting, where gender issues are especially acute, we investigated gender differences in dietary intake with a focus on diet quality, and how the differences varied with the area of residence and socio-demographic characteristics.MethodsThe study was conducted in 2009–2010 in the Greater Tunis region (Tunisia), as a case study of an advanced nutrition transition context in the region. A cross-sectional survey used a random, stratified, clustered sample of households: 1689 women and 930 men aged 20–49 years were analyzed. Dietary intake was assessed using a 3-day food record. Nutrient content was derived from a specific Tunisian food composition database. We analysed the Diet Quality Index-International (DQI-I) and sub-scores (variety, adequacy, moderation and balance). A score of DQI-I > 60 defined good diet quality. Inequality measures were women vs. men differences in means for interval variables and odds-ratios (OR) for DQI-I > 60. Their variation with socio-demographic characteristics was estimated using models featuring gender x covariate interactions.ResultsMean energy intake/day was 2300 ± 15 kcal for women vs. 2859 ± 32 kcal for men. By 1000 g/kcal/d women consumed more fruits and sweets but less red meat and soft drinks than men. Women had a higher mean moderation sub-score than men (+ 1.8[1.4, 2.2], P < 0.0001) but lower variety (− 2.0[− 2.3, − 1.6], P < 0.0001) and adequacy (− 1.8[− 2.0, − 1.5], P < 0.0001). Thus, the overall mean DQI-I was lower among women than men (58.6 ± 0.3 vs. 60.4 ± 0.3, − 1.8[− 2.6, − 1.0], P < 0.0001) as was the proportion of DQI-I > 60 (45.2% vs. 55.7%, OR = 0.7[0.5, 0.8], P < 0.0001). Adjusted gender differences in DQI-I decreased with age but were higher in larger households and extreme categories of education (no-schooling and university) vs. the middle categories.ConclusionIn this nutrition transition context with only average diet quality, it was somewhat lower for women. Socioeconomic patterning of gender contrasts was mild. Beyond, that women had lower adequacy and variety scores but better moderation is a possible pathway for gender specific prevention messages.Electronic supplementary materialThe online version of this article (10.1186/s12937-019-0442-6) contains supplementary material, which is available to authorized users.

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“…This has resulted in some contexts, in a double burden of malnutrition resulting from the co-existence of excess adiposity and/or associated Noncommunicable diseases (NCDs) and undernutrition phenomena partly linked to micronutrient de ciencies, e.g. as documented for iron de ciency and anaemia [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…This USI programme achieved some success in reducing ID, in certain contexts ( [8]), but defaults in the process of salt iodization, were also sometimes shown to increase the risk of iodine excess (IE) [7,9]. Also, in the context of the nutrition transition, the salt-rich westernized diet which underlies the progression of hypertension [4,5,20,21]. As for control of iodine de ciency, mandatory salt iodization had been implemented in speci c areas since 1984, but the national USI program was adopted in 1995 and launched in 1996 [18,22].…”

Section: Introductionmentioning

confidence: 99%

Flaws of universal salt iodization programmes in nutrition transition contexts: is there a risk of a double burden of inadequate iodine intake and excess adiposity? A case study in Tunisia

Doggui

Ati-Hellal²,

Ati

et al. 2020

Preprint

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Background In the Middle East and North Africa (MENA) region, universal salt iodization (USI) programs defaults were sometimes shown to increase the risk of iodine excess. Also, the nutrition transition which underlies the obesity epidemic in the MENA region is characterized by salt-rich diets, so that there could be a cumulative effect with respect to iodine status. We assess the within-subject co-existence of overweight and inadequate iodine intake, and associated factors.Methods A national cross-sectional study used a stratified, clustered random sample and conducted among Tunisian school-age children aged from 6 to 12 y. (n = 1560). Overweight (Ow) was body mass index (BMI)-for-age ≥ + 1z. Iodine deficiency was UIC (Urinary Iodine Content) < 100 µg/L and iodine intake above requirements (IAR) UIC ≥ 200 µg/L. Association of covariables with the within-subject double burden Ow–IAR was assessed by multinomial regression.Results The prevalences of Ow-ID or Obe-ID were marginal, but not so for excess adiposity and IAR as for example prevalence of Ow-IAR was 9.8% (95% CI:[7.7–12.3]). OW and IAR were found to co-occur independently (P = 0.29). Socio-economic patterning of Ow-IAR was mild. Nevertheless, prevalence were the lowest among children of mother with no formal schooling and in the South-East region. Beyond school-age children, we estimated that this double burden of overweight and excess iodine could concern a third of Tunisian adults (all the more for women).Conclusions Among Tunisian children, iodine deficiency coupled with excess adiposity was quite marginal. Coexistence of overweight and excess iodine may affect a tenth of these children. More data would be needed to document a possibly even higher rate among adults. Cumulative effects of unhealthy lifestyle due to the nutrition transition interacting with metabolic pathways may be involved in this potential overweight-high iodine intake double burden. In the MENA region, obesity and salt reduction policies should continue to be monitored.

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Gender inequalities in excess adiposity and anaemia combine in a large double burden of malnutrition gap detrimental to women in an urban area in North Africa

Cited by 21 publications

References 45 publications

Association of adiposity with hemoglobin levels in patients with chronic kidney disease not on dialysis

Association of adiposity with hemoglobin levels in patients with chronic kidney disease not on dialysis

Gender inequalities in diet quality and their socioeconomic patterning in a nutrition transition context in the Middle East and North Africa: a cross-sectional study in Tunisia

Flaws of universal salt iodization programmes in nutrition transition contexts: is there a risk of a double burden of inadequate iodine intake and excess adiposity? A case study in Tunisia

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