Energy intake, expenditure and balance, and factors associated with energy balance of young adults (20-39 years): a retrospective cross-sectional community-based cohort study.

BACKGROUND: Obesity epidemic presents major challenge to chronic disease prevention. Young adults may be at higher risk due to consumption of energy dense foods/beverages and low physical activity. This study assessed the energy intake, expenditure and balance of 20-39 year-old adults and also evaluated factors associated with energy balance to provide basis for obesity prevention and control. METHODS: This retrospective cross-sectional cohort study involved 240 respondents selected through multistage random sampling. Data were collected through questionnaire, anthropometry and three 24-h dietary recall. Energy expenditure was assessed as the sum of resting energy expenditure (REE), energy expenditure of activity (EEA) and diet-induced energy expenditure of three days. Frequencies and percentages were employed in analysing general characteristics of the respondents. T-test and analysis of variance were used to assess relationships between and among numerical variables while relationships among categorical variables were evaluated through Chi-square test. Binary and multivariate logistic regression analyses were used to evaluate the factors associated with energy balance. RESULTS: Majority (53.2%) had normal body mass index and this decreased as age increased (P < 0.001); 23.8% had overweight, 21.7% had general obesity, 38.3% had abdominal obesity and 39.2% had high risk waist hip ratio. Total energy intake (TEI) of the respondents was 2416.0 ± 722.728 kcal/day. Males had lower energy intake (kcal/day) of 2398.8 ± 494.761 than females (2431.1 ± 876.664). Male intake contributed less (85.7%) than female intake (110.5%) to recommended energy intake. TEI (kcal/day) was lowest among 25-29 (2285.3 ± 497.793) but highest (2586.0 ± 467.587) among 35-39 year-olds (P < 0.05). Total energy expenditure (TEE) was 2195.5 ± 384.544 kcal/day; a value of 2274.3 ± 385.792 was found among males while the females had a lower value of 2126.6 ± 371.403. TEE (kcal/day) ranged from 2169.4 ± 411.625 in 20-24 to 2248.8 ± 273.534 in 30-34 year-olds. Those with general obesity had higher energy (kcal/day) intake (2733.7 ± 1171.073), expenditure (2431.7 ± 491.666) and balance (302.0 ± 1300.186) than those without obesity (P < 0.01). Energy intake (2573.0 ± 966.553) and expenditure (2226.4 ± 372.621) were significantly higher among those with abdominal obesity than those with normal waist circumference (P < 0.05). Overall positive energy balance of the adults was 220.5 ± 787.271. The females had higher positive energy balance (304.4 ± 921.041) than males (124.5 ± 588.637). Energy balance was lowest (102.5 ± 629.780) among 25-29 and highest (373.5 ± 494.546) in 35-39 year-olds. Most (68.8%) of the participants had positive energy balance. Age (AOR:2.89, 95% C.I.:1.27-6.56) and occupation (AOR:2.30, 95% C.I.:1.05-5.03) increased the likelihood of positive energy balance by 2. CONCLUSIONS: The study showed lower energy intake among the respondents than the recommended value; females had a value higher than what was recommended, males had less. Majority had positive energy balance and this was mostly found among those with obesity. Age and occupation were factors associated with positive energy balance. Nutrition education, health education and dietary counselling are recommended strategies to control sustained weight gain.

Epidemiological characteristics of different patterns of obesity among adults in rural communities of south-east Nigeria: a population-based cross-sectional study.

BACKGROUND: Obesity is a complex disease characterised by excess fat accumulation and health risks. There is paucity of data on epidemiology of obesity patterns among adults in rural Nigeria. This study aimed to provide current data on the prevalence and predictors of three patterns of obesity (abdominal obesity alone, general obesity alone and a combination of both) among adults in three rural communities of Enugu State, South-east Nigeria to enhance specific obesity prevention and control programmes/interventions. METHODS: This population-based cross-sectional study involved 500 adults selected through a six-stage random sampling technique. Questionnaire was used to obtain data on socio-economic, dietary and lifestyle characteristics of the respondents. Weight, height and waist circumference were measured by standard procedures. Body mass index was used to assess general obesity while abdominal obesity was assessed through waist circumference. Each respondent was classified under only one of the three patterns: general obesity alone, abdominal obesity alone and combined obesity. Binary and multivariate logistic regression analyses were used to assess the predictors. Significance was set P<0.05. RESULTS: Prevalence of abdominal obesity alone was 6.0%. General obesity alone was found among 31.4% and 45.6% were affected by combined obesity. Being a female (AOR:0.35, 95% C.I.: 0.14, 0.88) and not skipping meals (AOR:0.24, 95% C.I.: 0.10, 0.55) were associated with less likelihood of abdominal obesity but ≥3 times daily meal intake increased the risk by 2.52 (AOR:2.52, 95% C.I.:1.10, 5.75). Predictors of general obesity alone were age 41-60 years (AOR:1.84, 95% C.I.:1.14, 2.97), being a female (AOR:7.65, 95% C.I.:4.77, 12.26) and having any form of formal education (AOR:2.55, 95% C.I.:1.10, 5.91). Combined obesity was less likely among 41-60 year-olds (AOR:0.36, 95% C.I.:0.23, 0.56) and females (AOR:0.21, 95% C.I.:0.13, 0.32). Never married (AOR:1.94, 95% C.I.:1.03, 3.67) and vigorous physical activities (AOR:1.81, 95% C.I.:1.08, 3.02) increased the risk of combined obesity by almost 2. CONCLUSIONS: Prevalence of abdominal obesity alone, general obesity alone and combined obesity were high. They were functions of age, sex, never married, having any form of formal education, skipping meals, ≥3 daily meal intake and self-reported vigorous physical activity. Focused nutrition and health education are recommended strategies for prevention and control of obesity.

Prevalence and predictors of different patterns of hypertension among adults aged 20-60 years in rural communities of Southeast Nigeria: a cross-sectional study.

BACKGROUND: Hypertension, a major cardiovascular disease risk factor exists several years without symptoms. Few data exist on prevalence and predictors of hypertension among apparently healthy Nigerian adults. This makes it difficult for policy-makers to concentrate efforts to control emerging health burden of the disease. This study assessed prevalence and predictors of isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH) and combined systolic and diastolic hypertension (CSDH). METHODS: Cross-sectional survey design was employed in the study of 517 adult participants (20-60 years) in a rural setting. Selection of the respondents was through multistage sampling which involved systematic, proportionate and simple random sampling. Data on socio-demographic characteristics, blood pressure, height, weight, and waist circumference were collected. Frequencies, T-test, analysis of variance and Chi square were used in statistical analysis. Bivariate and multivariate logistic regressions were used to evaluate variables associated with different patterns of hypertension with significance accepted at P < 0.05. Frequencies, percentages, crude and adjusted odd ratios were reported. Statistical Product and Service Solutions version 21.0 was used in statistical analysis. RESULTS: ISH (10.6%), IDH (18.2%) and CSDH (37.8%) were observed among the participants. ISH was less likely among 20-29 year-olds (adjusted odds ratio (aOR) = 0.35, 95% confidence interval (C.I.) = 0.13-0.94), 30-39 year-olds (aOR = 0.30, 95% C.I. = 0.11-0.82) and those with abdominal obesity (aOR = 0.12, 95% C.I. = 0.03-0.56). Participants who perceived their health status as good (aOR = 3.80, 95% C.I. = 1.29-11.18) and excellent (aOR = 5.28, 95% C.I. = 1.54-18.07) were respectively 3.80 and 5.28 times more likely to have ISH. Those with secondary education had significantly higher likelihood for IDH (aOR = 2.05, 95% = 1.02-4.14) whereas self-perceived poor health status (aOR = 0.24, 95% C.I. = 0.09-0.65), absence of obesity (aOR = 0.10, 95% C.I. = 0.01-0.81) and general obesity (aOR = 0.35, 95% C.I. = 0.17-0.72) were associated with reduced risk for IDH. Secondary (aOR = 0.60, 95% C.I. = 0.36-0.99) and tertiary (aOR = 0.49, 95% C.I. = 0.28-0.85) education were associated with reduced risk for CSDH but combined obesity (aOR = 4.39, 95% C.I. = 2.25-8.58) increased the risk for CSDH by 4. CONCLUSION: ISH, IDH and CSDH were problems among the adults with age, obesity, self-perception of good/excellent health status and low education level as significant predictors. Health and nutrition education to prevent comorbidities and cerebrovascular accidents are recommended.

Epidemiological characteristics of hypertension, impaired fasting capillary glucose and their comorbidity: a retrospective cross-sectional population-based study of rural adolescents in Southeast Nigeria.

OBJECTIVE: To assess the prevalence of hypertension, impaired fasting capillary glucose (IFCG) and coexistence of both as well as determinants of these conditions among rural adolescents. DESIGN: A retrospective cross-sectional population-based study. SETTING: Three rural communities in southeast Nigeria. PARTICIPANTS: A total of 401 adolescents (10 - 19 years) selected through a five-stage sampling technique completed the study. Sick adolescents, pregnant and nursing adolescent mothers were excluded. PRIMARY OUTCOME MEASURES: Prevalence and determinants of hypertension, IFCG and comorbidity of both were assessed through weight, height, blood pressure, fasting capillary glucose measurements and statistical analysis. RESULTS: Prehypertension (10.7%), hypertension alone (12.7%), IFCG alone (11.0%), diabetes (0.2%) and hypertension with IFCG (6.2%) were prevalent among the adolescents. The adolescents aged 15 - 19 years were less likely to be affected by hypertension alone (adjusted OR (AOR)=0.36, 95% CI 0.18 to 0.74, p<0.01). The likelihood of having hypertension alone was three times higher among those who smoked any substance (AOR=3.43, 95% CI 1.34 to 8.78, p<0.05) and 2.85 times higher among those who consumed alcohol (AOR=2.85, 95% CI 1.33 to 6.10, p<0.01). Meal skipping (AOR=2.69, 95% CI 1.16 to 6.25, p<0.05), consumption of fried/baked snacks (AOR=15.46, 95% CI 1.62 to 147.37, p<0.05) and vegetables (AOR=2.27, 95% CI 1.11 to 4.66, p<0.05) were also significant risk factors of hypertension alone. Skipping meals (AOR=2.15, 95% CI 0. 93 to 4.99, p>0.05) and longer than 7 hours of night sleep (AOR=1.88, 95% CI 0.94 TO 3.73, p>0.05) increased the risk of IFCG alone by twofold. Female adolescents (AOR=0.29, 95% CI 0.10 to 0.78, p<0.05) and those who consumed fried/baked snacks (AOR=0.09, 95% CI 0.02 to 0.37, p<0.01) were less likely to have hypertension with IFPG than males and those who consumed non-fried/baked snacks, respectively. CONCLUSION: This study reported relatively low prevalence of hypertension alone, IFCG alone, hypertension with IFCG and epidemiological characteristics that can become focus of interventions to curtail the emergence of cardiovascular events at an early age. Awareness creation through health and nutrition education is emphasised.

Prevalence and associated factors of dyslipidaemia among university workers in Southeast Nigeria: a cross-sectional study.

BACKGROUND: The job one does for a living may increase ones propensity to cardiovascular diseases due to many associated risk factors. University staff may be at high risk of dyslipidaemia, a major cardiovascular disease risk factor. This study assessed prevalence of dyslipidaemia and its associated factors among the staff of University of Nigeria, Nsukka campus, Nigeria. METHODS: A cross-sectional survey of 386 workers selected through a 4-stage sampling technique was conducted. Data were obtained through questionnaire and lipid profile determination. Bivariate analysis using Cochran and Mantel-Haenszel test was used to determine associations between dyslipidaemia and selected variables. Odds ratios and significance at p < 0.05 were reported. RESULTS: Respondents who were 46 years and above accounted for 51.3 % while 95.3 % had tertiary education. Administrative/technical staff were 76.4 % while academic staff were only 23.6 %; 73.8 % were senior staff and 26.2 % were junior staff. More than half (60.4 %) consumed alcohol above recommendation. Lipid biomarkers of the workers were not sex dependent (p > 0.05). Few (23.4 and 6.5 %) of the respondents had borderline high and high total cholesterol values, respectively. Whereas none (0.0 %) had low high density lipoprotein cholesterol (HDL-c), borderline low values were observed among 1.3 %. High low density lipoprotein cholesterol (LDL-c) affected 1.3 %. Triglyceride was high among 3.9 %; 20.8 % had high atherogenic index of plasma (AIP) and 2.6 % had impaired fasting blood glucose (IFBG). Dyslipidaemia had a prevalence of 54.5 % with female dominance. Hypercholesterolemia with high LDL-c was the commonest combined dyslipidaemia observed (7.8 %). Dyslipidaemia was dependent on hypercholesterolemia (OR = 0.352, 95 % C.I.=0.245-0.505), high LDL-c (OR = 0.462, 95 % C.I.=0.355-0.600) and hypertriglyceridemia (OR = 0.462, 95 % C.I.=0.355-0.600). Alcohol intake above normal was associated with almost 6 times higher risk of dyslipidaemia (OR = 5.625, 95 % C.I.=1.062-29.799). CONCLUSIONS: Dyslipidaemia is a problem among the workers with hypercholesterolemia in combination with high LDL-c and hypertriglyceridemia compounding the problem. Nutrition education and physical activity are advocated to prevent cardiovascular events among the university staff.

Components and Risk Factors of Metabolic Syndrome among Rural Nigerian Workers.

BACKGROUND: Metabolic syndrome (MetS) is a serious public health risk predisposing the workforce to cardiovascular diseases and diabetes. AIM: The aim of this study was to determine the components and risk factors of MetS among Nigerian teachers and bank workers (BWs). SETTINGS AND DESIGN: The cross-sectional study was conducted in Idemili South Local Government Area, Southeast Nigeria. MATERIALS AND METHODS: The study involved 427 teachers and 66 BWs in 14 secondary schools and 5 microfinance banks, respectively. Data collection methods included questionnaire, lipid profile, fasting plasma glucose (FPG), weight, height, waist circumference, and blood pressure (BP) measurements. Inferential statistical analysis involved Pearson correlation and Chi square with Cochran-Mantel-Haenszel test. Significance was accepted at P < 0.05. RESULTS: Most (73.3%) of the teachers were 40-60-year-olds; 75.8% of BWs were 19-39-year-olds (P < 0.01). Underweight (7.7%), overweight (26.8%), obesity (17.2%), impaired FPG (IFPG) (14.0%), hypertriglyceridemia (38.0%), and hypertension (40.0%) were prevalent with similarity (P > 0.05) between occupations, age, and gender. Females were more likely to have abdominal obesity (P < 0.01) than males. MetS prevalence was 20%. MetS was more likely among females (odds ratio [OR] =0.63, 95% confidence interval [CI] =0.471-0.841); workers with abdominal obesity (OR = 1.67, 95% CI = 1.210-2.295), IFPG (OR = 0.05, 95% CI = 0.008-0.347), raised diastolic BP (OR = 12.00, 95% CI = 2.177-66.134), and hypertriglyceridemia (OR = 1.55, 95% CI = 1.931-5.600); and those who often drank fluids other than water (OR = 0.11, 95% CI = 0.013-0.961). CONCLUSION: MetS was a problem of public health significance among the workers with higher prevalence among teachers, 40-60-year-olds, and females. Abdominal obesity was the strongest risk factor of metabolic syndrome among the workers.

Prevalence and predictors of under-nutrition among school children in a rural South-eastern Nigerian community: a cross sectional study.

BACKGROUND: School children in developing countries like Nigeria are faced with numerous nutrition and health problems. Lack of functional school health and nutrition programmes in Enugu state, Nigeria may be associated with dearth of data on associated factors. Identifying these factors could inform the design and implementation of school-based programmes aimed at ameliorating these problems. METHODS: A cross sectional survey involving 450 primary and secondary school children aged 6-15 years was conducted in Ede-Oballa, a rural community in Enugu state, South-eastern Nigeria. Selection of the pupils was by multistage sampling technique. Data were collected through interviewer administered questionnaire, anthropometric measurements of weight and height, 3-day weighed food intake, stool microscopy and blood analyses for malaria, zinc and vitamin A. Bivariate and multivariate logistic regression analyses were used to evaluate associations of interest with significance accepted at P < 0.05. RESULTS: The school children were affected by underweight (18.2%), stunting (41.6%), thinness (20.0%), zinc (43.3%) and vitamin A (51.1%) deficiencies. After adjusting for potential confounders, weekly food expenditure was a major predictor of under-weight (AOR = 0.19, 95% CI: 0.08, 0.46), stunting (AOR = 0.36, 95% CI: 0.13, 0.95) and thinness (AOR = 0.49, 95% CI: 0.30, 0.80); household income was also a predictor of thinness (AOR = 0.47, 95% CI: 0.25, 0.88). Males had lower odds of being stunted than females (AOR = 0.31, 95% CI: 0.11, 0.83). The odd of being underweight was higher in female headed households than in households headed by males (AOR = 0.30, 95% CI: 0.12, 0.75). Tapeworm was an independent predictor of vitamin A (AOR = 3.59; 95% CI: 1.06, 12.13) and zinc (AOR = 3.64; 95% CI: 1.02, 12.98) deficiencies. Children with whipworm were more likely to be zinc (AOR = 3.80; 95% CI: 1.11, 13.04) and vitamin A (AOR = 3.79; 95% CI: 1.12, 12.89) deficient than those uninfected. CONCLUSION: Underweight, stunting, thinness, vitamin A and zinc deficiency among the school children were functions of weekly food expenditure, gender of household head and household income, tapeworm, whipworm, and sex. These findings emphasize the need for effective school- and community-based interventions.

Nutritional value of school meals and their contributions to energy and nutrient intakes of rural school children in Enugu and Anambra States, Nigeria.

BACKGROUND: Nutritional deficiencies among school children may hinge on inadequate nutrient intake. School meals should improve nutrient intakes by providing a third of recommended daily energy and nutrient intakes (RNI). The study aimed at evaluating school meals served in three rural schools to determine if they met one third of the RNI of the children. This will enhance meal planning. METHODS: Food samples (20 g) that constituted the school meals were collected for five consecutive days from three schools where school lunch programme was implemented. These were put in labelled small air tight plastic containers and stored in deep freezers in the Department of Home Science, Nutrition and Dietetics, University of Nigeria, Nsukka. The samples were analysed chemically using standard methods. Portion sizes of foods were obtained and the contributions made by these meals to the children's RNI were calculated. Results were presented in percentages and means ± standard deviations. RESULTS: The results showed that energy value of the meals ranged from 32.27 - 243.4 Kcal/100 g. The school meals contained carbohydrate (0.7 - 48.4 g), protein (0.69 - 12.6 g), vitamin C (0.7 - 8.22 mg), vitamin A (3.0 - 255.5 RE), iron (0.05 - 1.7 mg), calcium (3.0 -120 mg) and zinc (0.14 - 3.0 mg) per 100 g of food consumed. They contributed 16.4 - 25.5% energy, 53.4 - 116.9% protein, 66.0 - 159.5% vitamin A, 37.3 - 45.7% vitamin C, 13.2 - 28.5% calcium, 5.9 - 20.6% iron and 35.1 - 92.9% zinc to the children's daily requirements. CONCLUSION: The school meals provided over one third of the RNI for protein, vitamins A and C, and zinc but did not meet a third of the RNI for energy, calcium and iron.

Evaluation of two local cowpea species for nutrient, antinutrient, and phytochemical compositions and organoleptic attributes of their wheat-based cookies.

BACKGROUND: Childhood and adolescent malnutrition is a function of inadequate intake. Cookies are favourite snacks of children and adolescents. OBJECTIVE: This work determined the nutrient, antinutrient, and phytochemical compositions of two local cowpea (oraludi and apama) flours and evaluated the organoleptic properties of their wheat-based cookies. DESIGN: The two local cowpea species were processed into flours separately and blended with wheat on a 56-g protein basis. Chemical compositions of the processed cowpea flours were analysed using standard methods. Organoleptic attributes were evaluated with a nine-point Hedonic scale. Statistical analysis, which involved mean and standard deviations, were computed by analysis of variance, and Duncan's new multiple range tests were used to separate and compare group means of sensory evaluation data, with significance accepted at P<0.05. RESULTS: The results revealed that oraludi had superior percentage values compared to apama in protein (26.22 and 20.88), fat (7.98 and 6.65), and ash (3.81 and 3.13), while apama proved superior in moisture (9.76 and 7.82), crude fibre (5.49 and 4.91), and carbohydrate (54.09 and 49.26). The values were higher for oraludi than apama in iron (8.62 and 6.49 mg), zinc (1.61 and 0.95 mg), and beta-carotene (223.24 and 190.63 mg) but lower in sodium (34.79 and 56.72 mg), potassium (25.73 and 30.65 mg), phosphorus (13.35 and 18.26 mg), thiamine (5.33 and 9.41 mg), vitamin C (16.63 and 21.09 mg), and vitamin E (0.51 and 0.67 mg). Apama had 0.06 mg phytate, 0.09 mg oxalate, 15.22 mg tannins, 3.59 mg flavonoids, and 0.19 mg saponin. Oraludi had 0.03 mg phytate, 0.32 mg oxalate, 15.94 mg tannins, 3.14 mg flavonoid, and 0.13 mg saponin. Mean scores of general acceptability for wheat:apama (80:20) and wheat:oraludi:apama (60:20:20) cookies (7.71 and 7.41) were superior (P<0.05) to others. CONCLUSIONS: Oraludi and apama proved nutrient dense. Their use improved the acceptability of some of the wheat-based cookies. Use of these local cowpeas in cookie production is, therefore, encouraged.

Iron status of schoolchildren (6-15 years) and associated factors in rural Nigeria.

BACKGROUND: Schoolchildren are vulnerable to anaemia because of their higher iron need to meet the demands of puberty and adolescence. OBJECTIVE: The survey determined the haemoglobin levels of schoolchildren aged 6-15 years and the factors affecting their haemoglobin status. DESIGN: Data were obtained through a cross sectional survey of 450 randomly selected schoolchildren in Ede-Oballa, Nsukka, Enugu State, Nigeria. Ninety were selected for clinical examination, biochemical tests, and nutrient intake study. Haemoglobin, malaria, and stool analysis were carried out by the cyanmethaemoglobin, thin blood film, and wet mount direct methods, respectively. Iron intake was determined by a three-day weighed food intake. RESULTS: Results showed that the schoolchildren had pallor (35.6%), brittle hair (31.1%), koilonychia (2.2%), oedema (4.4%) and sore/smooth tongue (7.8%). The children also had malaria (58.9%) and Entamoeba histolytica (42.2%), hookworm (36.7%), tapeworm (35.6%), whipworm (34.5%), and roundworm (27.9%) infestations. Iron intake was inadequate (<100% of recommended nutrient intake) for most of the children. The mean haemoglobin levels of the schoolchildren were low. The 6-9, 10-12, and 13-15 year olds had 9.0, 9.1, and 9.3 g/dl, respectively. Most (85.5%) of them had anaemia. Moderate anaemia was prevalent in 62.2%. Severe anaemia affected the 6-9 year olds more. Malaria (P<0.001), Entamoeba histolytica (P<0.01), hookworm (P<0.05), tapeworm (P<0.01), and whipworm (P<0.001) caused significant reduction in haemoglobin level. Age (b=1.284, P<0.05), birth order (b=-0.629, P<0.01), frequency of illness attack (b=-1.372, P<0.01), household size (b=-0.526, P<0.05), and frequency of skipping breakfast (b=-1.542, P<0.001) were factors that influenced the haemoglobin status of the children. CONCLUSION: The schoolchildren had poor iron status as a result of consumption of plant sources of iron with low bioavailability, parasitic infections, birth order, skipping of breakfast, large household size, and frequent bouts of illnesses.