Anthropometry-Based Prediction Equation of Body Composition in a Population Aged 12-88 Years.

BACKGROUND: Direct anthropometric measurements to assess body composition have limited precision and/or specificity. OBJECTIVES: The study aimed to develop a prediction equation based on anthropometric measurements for estimating total body water (TBW) in a healthy population. METHODS: TBW was assessed using the deuterium dilution method in 398 Moroccan participants (235 women and 163 men) aged 11.6-88 y, then compared to the estimations made by previously published anthropometric equations. By sex, participants were randomly assigned into development (n = 199) and validation subgroups (n = 199). A new anthropometric equation was developed in the development subgroup from data obtained on body volume (BV), weight, and sex, where the BV was calculated from participants' height. Then the equation was validated in the validation subgroup using the Bland and Altman procedure, bias, and pure error. External validation was performed using a sample from Tunisia (n = 220, 51.8% female, 18-65 y). RESULTS: Bias in predicting TBW showed unacceptable value for all previously published equations as it was significantly overestimated. The following new equation using anthropometric measurements [TBW (kg) = -5.249 + 107.502 BV (L) + 0.289 weight (kg) + 2.015 sex (male: 1, female: 0); (R2 = 0.91, RMSE = 1.885 kg)] was developed, and its internal validation was confirmed. The generated bias and pure error values were 0.047 kg (95% CI: -0.235, 0.330) and 2.02 kg (95% CI: 1.73, 2.31), respectively. The external validation of the new TBW prediction equation on a Tunisian sample showed a bias and pure error values of 0.07 kg (95% CI: -0.289, 0.429) and 2.36 kg, respectively. CONCLUSIONS: The results indicate that the new anthropometric-based prediction equation provides a good estimation of TBW and other body composition compartments. It could be recommended as an alternative method to assess body composition for epidemiological and clinical studies.

Cut-point values for classifying active children and validity and reliability of physical activity questionnaire for children in Morocco.

BACKGROUND: The Physical Activity Questionnaire for Children (PAQ-C) is widely used to assess physical activity in populations; however, there is a lack of information about the psychometric properties (validity and reliability) and about the PAQ-C score meaning in populations from low-middle income countries. AIMS: The aim of this study is to evaluate the reliability and validity of PAQ-C and to determine the cut-point values of PAQ-C using accelerometry as a reference in a group of Moroccan children. METHODS: In a sample of 171 children and adolescents aged 8 to 14 years, physical activity was assessed with the GT3X + accelerometer and the PAQ-C. PAQ-C was administered for a second time (retest) after 1 week for a subsample (n = 73). Reliability was analyzed by intraclass correlation coefficient (ICC). The PAQ-C was compared against count per minute CPM and moderate to vigorous intensity PA (MVPA) obtained by accelerometry. Receiver operating curve analyses were performed to assess the performance of PAQ-C in identifying MVPA as measured by accelerometry (reference method). RESULTS: Test-retest reliability was poor with an ICC = (0.48 [0.27; 0.63] for the whole sample, while for the ≥11 year group, the intra-class correlation coefficient was moderate (0.71 [0.42; 0.86]. PAQ-C scores were significantly related to accelerometry-derived metrics of physical activity, CPM (R = 0.29, P < 0.001) and MVPA (R = 0.26, P < 0.001). For the age group ≥11 years, the associations between PAQ-C Scores and CPM and MVPA were stronger, respectively, R = 0.37 (P < 0.001), R = 0.38 (P < 0.0001). We identified that a PAQ-C Score cut-point of 2.33 (95%CI [0.43-0.68]) discriminated adequately between those who met physical activity guidelines and those that did not in the overall sample. CONCLUSIONS: The PAQ-C is valid and useful to assess population level physical activity in those ≥11 years in Morocco and so might be helpful in population surveillance of physical activity in Moroccan adolescents.

Estimated 24-Hour urinary sodium and potassium excretion in adults in the Northwest Region of Morocco, 2017.

BACKGROUND: Excessive sodium (Na) and insufficient potassium (K) intake contribute to a high risk of cardiovascular events. Morocco lacks data on actual Na and K intake in adults. We estimated mean Na and K intake in a Moroccan population of adults residing in the Northwest region using 24-h urinary excretion and examined their association with blood pressure (BP). METHODS: A total of 371 adults from this region, who were recruited for the STEPs Survey Morocco 2017, completed demographic, anthropometric as well as BP data and provided a valid 24-h urine collection according to the standard World Health Organization (WHO) protocol. Multiple Linear Regression analysis was used to examine the association between 24-h urinary sodium (24-hUNa) and 24-h potassium excretion (24-hUK) with BP. RESULTS: Mean Na excretion was 2794 mg/day and mean K excretion was 1898 mg/day. Overall, only 114 (30.7%) adults met the WHO recommendation for Na intake (< 2000 mg/d) and 31 (8.4%) met the adequate level for K intake (⩾3510 mg/d). There was no association between 24-hUNa and 24-hUK with BP (P > 0.05 for all). CONCLUSION: Na intake was higher and K intake was lower than WHO recommendations in the study population. There was no association between estimated Na and K intake levels with BP in this population.

Effects of Breastfeeding on Maternal Body Composition in Moroccan Lactating Women during Twelve Months after Birth Using Stable Isotopic Dilution Technique.

BACKGROUND: Exclusive breastfeeding during the first six months of an infant's life is an important factor for their optimal growth and health. Breastfeeding also has maternal benefits and can assist with postpartum weight loss. As shown by previous studies, postpartum weight retention can contribute to obesity. OBJECTIVE: To quantify the human milk and evaluate the effect of breastfeeding on maternal weight loss during the 12 months postpartum. METHOD: This study included 70-mother-baby pairs. Infants' intake of human milk and water from other sources, as well as the body composition of the mothers, were measured at the 1st, 3rd, 6th, 9th and 12th month postpartum by using the deuterium oxide dose-to-mother technique. RESULTS: There was a significant change in the mothers' body composition between the first and twelfth months in exclusive breastfeeding women compared to not-exclusive ones. Similarly, the difference between the quantities of human milk intake was highly significant in exclusive breastfeeding women compared to women who were not exclusively breastfeeding. CONCLUSION: Our results showed that exclusive breastfeeding for twelve months has a significant effect on postpartum weight loss among Moroccan women and that it is an effective way to control overweight and obesity among lactating women.

A Household-Based Survey of Iodine Nutrition in Moroccan Children Shows Iodine Sufficiency at the National Level But Risk of Deficient Intakes in Mountainous Areas.

Historically, mountainous areas of Morocco have been affected by endemic goiter and severe iodine deficiency. In 1995, Morocco legislated salt iodization to reduce iodine deficiency. There has been no national survey of iodine nutrition in school-age children for nearly 3 decades. Our aim was to assess iodine nutrition in a national sample of 6-12-year-old children in Morocco to inform the national salt iodization strategy. In this cross-sectional household-based survey, we randomly recruited healthy 6-12-year-old children from 180 clusters in four geographic zones (north and east, central, north and south) covering the 12 regions of Morocco. A questionnaire was completed, including socio-economic status and parental level of education. In addition, anthropometric measurements were taken to assess nutrition status, and a spot urine sample was collected to measure urinary iodine concentration (UIC). A total of 3118 households were surveyed, and 1043 eligible children were recruited, 56% from urban areas and 44% from rural areas. At the national level, the percentage of surveyed samples with UIC < 50 µg/L was 21.6% (19.2%; 24.2%), which exceeds the WHO suggestion of no more than 20% of samples below 50 µg/L, despite an adequate level of median urinary iodine concentration (mUIC) at 117.4 µg/L (110.2; 123.3). There were no statistically significant differences in mUIC comparing urban vs. rural areas and socio-economic status. However, the mUIC was significantly lower in the central (high-altitude non-coastal) zone (p < 0.004), where the mUIC (95% CI) was deficient at 89.2 µg/L (80.8; 102.9). There was also a significant difference in the mUIC by head of household education level (p = 0.008). The mUIC in Moroccan children >100 µg/L indicates iodine sufficiency at the national level. However, the percentage of surveyed samples with UIC < 50 µg/L above suggests that a significant proportion of children remain at risk for iodine deficiency, and it appears those at greatest risk are residing in the central (high altitude non-coastal) zone. A national level mUIC value may conceal discrepancies in iodine intake among different sub-groups, including those defined by geographic region.

Effect of multiple micronutrient fortified milk consumption on vitamin D status among school-aged children in rural region of Morocco.

Vitamin D deficiency is a health problem in both developed and developing countries. The aim of this study was to determine the effect of multi-vitamin fortified milk consumption on vitamin D status among children living in the mountainous region of Morocco. Children aged 7 to 9 years (n = 239; 49% of girls vs 51% of boys) participated in a double-blind longitudinal study, where they were divided in 2 groups: a fortified group that received daily 200 mL of fortified ultra-high-temperature (UHT) milk enriched with 3 µg of vitamin D3 and a nonfortified group that received 200 mL of nonfortified UHT milk with a natural abundance of vitamin D3 (about 1.5 µg). Blood samples were collected 3 times (at baseline, then at the fourth and ninth months). The average weight, height, and z score of body mass index for age of participants were 22.8 ± 2.6 kg, 121.5 ± 5.2 cm, and -0.2 ± 0.6 kg/m2, respectively. At baseline, 47.5% of children had a concentration of 25-hydroxyvitamin D below 50 nmol/L. At the end of the study the prevalence of vitamin D <50 nmol/L decreased significantly by 37.6% in the fortified group. These results reveal prevalent vitamin D insufficiency (<50 nmol/L) during winter among rural Moroccan school-aged children, which seems to be better improved by consuming the fortified milk instead of the nonfortified one.

Objectively Measured Physical Activity and Sedentary Time among Children and Adolescents in Morocco: A Cross-Sectional Study.

BACKGROUND: Regular physical activity in childhood and adolescent plays an important role in reducing the risk of cardiovascular health diseases, diabetes, and obesity in adulthood. However, little is known about physical activity levels (PA) and sedentary time among children and adolescents in Morocco. OBJECTIVE: To examine gender, type of day, and age grade differences in objectively measured sedentary time, physical activity levels, and physical activity guideline attainment among children and adolescents in Morocco. METHOD: 172 children/adolescents (mean age = 10.92 ± 1.55 years, 49.4% are boys) were recruited for this study and wore a tri-axial accelerometer (GT3X+) for 7 consecutive days. Time spent in sedentary, PA levels, and daily steps were measured and compared according to gender, age grade, and the type of day (weekdays/weekends). RESULTS: In weekdays children/adolescents spent more time in sedentary than weekends (p < 0.001). Boys were eight times more likely to meet the recommendation for at least 60 min of moderate to vigorous physical activity per day than girls (OR: 8.569; 95% [CI]: 4.23-17.32), p < 0.001. CONCLUSION: These findings highlight the need for effective and sustainable strategies and programs aiming to promote physical activity and to reduce sedentary behavior among children and adolescents in Morocco.

Assessment of Sodium and Potassium Intakes in Children Aged 6 to 18 Years by 24 h Urinary Excretion in City of Rabat, Morocco.

BACKGROUND: The incidence of noncommunicable diseases (NCDs) has greatly increased, mainly due to high level of dietary sodium. Thus, reduction of sodium intake in population has been recognized as one of the most cost-effective strategies to reduce NCDs. The aim of this study was to estimate sodium and potassium consumption in a sample of Moroccan children as a baseline study to implement national strategy for salt intake reduction. METHODS: The study was conducted on 131 children aged 6-18 years recruited from Rabat and its region. Sodium excretion and potassium excretion were measured on 24 h urinary collection, and the creatinine excretion was used to validate completeness of urine collections. RESULTS: The average of urinary sodium was 2235.3 ± 823.2 mg/day, and 50% of children consume more than 2 g/d of sodium (equivalent to 5 g/day of salt), recommended by the WHO. However, daily urinary excretion of potassium was 1431 ± 636.5 mg/day, and 75% of children consume less than adequate intake. Sodium consumption increased significantly with age. Of particular interest, 46.7% of children aged 6-8 years and 49.3% of children aged 9-13 years consume more than the corresponding upper limits. CONCLUSIONS: Children have high sodium and low potassium status. There is evidence of the urgent need to implement a strategy for reduction of dietary sodium intake in Morocco.

Development and validation of bioelectrical impedance analysis equations for prediction total body water and fat-free mass using D2O technique in Moroccan children aged between 8 and 11 years old.

BACKGROUND/OBJECTIVES: Estimating body composition using bioelectric impedance analysis (BIA) requires specific prediction equations. The purpose of our study was to examine the validity of published BIA equations for assessing total body water (TBW) and fat-free mass (FFM) using deuterium oxide dilution (D2O) as a reference method and to develop new FFM and TBW BIA equations if needed for Moroccan pre-pubertal children. SUBJECTS/METHODS: Data were collected from 247 schoolchildren aged 8-11 years old. Children were sorted by gender and age group and assigned in development and validation groups. D2O dilution was used as reference method for estimating TBW and FFM. Bland and Altman test, effect size, pure error, and proportional bias were used to assess the reliability of previous published equations. Cross-validation was performed by Bland and Altman test and BIA new equations were developed by linear regression. RESULTS: Previously published equations were tested and showed significant bias values indicating that if used they would provide biased values of TBW and FFM. The new prediction equations developed were: [Formula: see text] (l) = 0.269 + 0.292 Ht2/R (cm2/Ω) + 0.221 weight (kg) + 0.824 sex (boys = 1, girls = 0) + 0.291 age (years) (R2 = 0.91, RMSE = 1.54 kg); [Formula: see text] (kg) = -0.450 + 0.380 Ht2/R (cm2/Ω) + 0.291 weight (kg) + 1.294 sex (boys = 1, girls = 0) + 0.446 age (years) (R2 = 0.91, RMSE = 1.97 kg). These equations provide better values of proportional bias, agreement, and pure error than the other tested equations. CONCLUSIONS: The new BIA prediction equations seem to be the most accurate for Moroccan pre-pubertal children.