The Prevalence of Multimorbidity among Foreign-born Adults in the United States.

Objective: We examined multimorbidity among foreign-born adults in the United States. This population may be particularly affected by chronic conditions and limited health care access. Design: Longitudinal cohort. Setting: United States. Participants: Foreign-born adults at the point of legal permanent residency. Main Outcome Measures: Multimorbidity defined as two or more of eight chronic conditions (hypertension, diabetes, obesity, arthritis, stroke, cancer, chronic lung disease, and heart problems). Methods: We estimated the prevalence of multimorbidity and patterns over time. Data are from the New Immigrant Survey (NIS), a nationally representative study of adult immigrants at green card status in 2003 (N=8,174) and reinterview in 2008. Results: The prevalence of multimorbidity was 6% in 2003, and 12% in 2008. The most common condition dyad at both time points was hypertension-obesity; the largest increase over time was in combinations that included hypertension, diabetes, and obesity. The odds of having multimorbidity compared to no chronic conditions were higher among older immigrants and those who had seen a doctor in the past year. The odds of gaining one chronic condition over a 5-year period increased with age; 45-65 years: OR 2.8[CI 2.3,3.5]; aged ≥65 years: OR 3.2 CI[2.2,4.7]. Conclusions: The prevalence of multimorbidity among immigrants was lower than the prevalence in the overall US population of the same age, consistent with studies showing an immigrant health advantage.

Obesity Incidence in U.S. Children and Young Adults: A Pooled Analysis.

INTRODUCTION: Obesity prevalence among children and adolescents has risen sharply, yet there is a limited understanding of the age-specific dynamics of obesity as there is no single nationally representative cohort following children into young adulthood. Investigators constructed a pooled data set of 5 nationally representative panels and modeled age-specific obesity incidence from childhood into young adulthood. METHODS: This longitudinal prospective follow-up used 718,560 person-years of observation in a pooled data set of 5 high-quality nationally representative panels-National Longitudinal Survey of Youth 1979 and 1997, National Longitudinal Study of Adolescent Health, and Early Childhood Longitudinal Study-Kindergarten cohorts of 1998 and 2011-constructed by the authors, covering 1980-2016. Differences in obesity incidence across birth cohorts and disparities in obesity incidence by sex and race/ethnicity (non-Hispanic Black, Hispanic, and non-Hispanic White) were tested in multivariate models. Data were analyzed from September 2018 to October 2021. RESULTS: Obesity incidence increased by approximately 6% for each 1 year of age (hazard ratio=1.06, 95% CI=1.05, 1.07); however, incidence was nonlinear, exhibiting an inverted "U"-shaped pattern before 15 years of age and then rising from adolescence through 30 years. Obesity incidence more than doubled between the cohorts born in 1957-1965 and those born in 1974-1985 during adolescence. There was no significant change among those born in 1991-1994 and 2003-2006 up to age 15 years. Compared with non-Hispanic White children, non-Hispanic Black and Hispanic children had higher obesity incidence in all study cohorts. The magnitude of these disparities on the relative scale remained stable throughout the study period. CONCLUSIONS: Although many children become obese before the age of 10, obesity incidence rises from about 15 years into early adulthood, suggesting that interventions are required at multiple developmental stages.

Food Choices in the Context of Globalizing Food Options among Adolescents in Rural Southern India.

Changes in food choice often accompany globalization and economic growth. These changes have not been well documented in rural settings and among young people. To advance research on food choice, we demonstrate adolescents' selection of local vs.non-local foods in a rural area of India where globalization is just reaching. A representative sample of 237 school-going adolescents in a village in Southern India completed a survey in 2019 to understand how adolescents decide among foods traditional to the area and foods arriving from other parts of the country and the world. Adolescents most frequently consumed local foods but also occasionally consumed non-local items. In hypothetical scenarios, 81% of the adolescents reported being most interested in substituting local foods with non-local foods if they were to have more money. Among the few who currently consumed non-local snacks and drinks, very few would be willing to replace them with local alternatives, particularly if they were to have more money (snacks: 10% and drinks: 5% respectively). Overall, adolescents were most interested in switching to non-local items when considering fruits, vegetables and snacks. As India faces the dual burden of undernutrition and overnutrition, understanding the changing food environment may help inform efforts to improve nutrition.

Intrinsic and instrumental agency associated with nutritional status of East African women.

The 2030 Agenda for Sustainable Development prioritizes women's empowerment in Sustainable Development Goal (SDG) #5: to achieve gender equality and empowerment among all women and girls. Research on the relationships of women's empowerment and nutrition has focused on the child's nutrition. Less is known about how women's empowerment influences their own nutritional status. We examined the pathways by which three domains of women's empowerment (WE)-assets, intrinsic agency, and instrumental agency-may influence women's nutritional status (WNS) in East Africa. We used data from 42,721 married non-pregnant women, 15-49 years old interviewed in Demographic and Health Surveys (DHS) from five east Africa countries (2011-2016). WNS was operationalized through body mass index (BMI) and altitude-adjusted blood-hemoglobin level (Hb). A latent factor for women's human/social assets (assets) measured women's enabling resources. Two additional latent factors measured women's intrinsic agency (power within; women's non-justification of intimate partner violence (IPV) against wives) and instrumental agency (power to; influence in household decision-making). We used structural equation models with latent variables to estimate the strength of the hypothesized pathways from women's assets to WNS through measures of intrinsic and instrumental agency. All three domains of WE had direct, positive associations with women's BMI [(estimate (95% CI) (Assets: [0.17 (0.14,0.20)]; Intrinsic Agency: [0.25 (0.22,0.27)]; Instrumental Agency [0.08 (0.03,0.10)])]. Women's instrumental agency was positively associated with women's Hb [0.12 (0.09,0.14)]. Total associations, including direct and indirect effects, with women's BMI were positive through intrinsic agency & instrumental agency. Total associations with women's Hb were positive through instrumental agency. Direct and indirect effects from assets through both components of agency to BMI were higher in magnitude by household wealth category. Domains of WE were positively associated with WNS. Findings indicate that the process of women's empowerment may be an important driver of their nutritional status.

Overweight and Obesity in Children under 5 Years: Surveillance Opportunities and Challenges for the WHO European Region.

BACKGROUND: Many children who have overweight or obesity before puberty can develop obesity in early adulthood, which is associated with increased morbidity and mortality. The preschool years (ages 0-5) represents a point of opportunity for children to be active, develop healthy eating habits, and maintain healthy growth. Surveillance of childhood overweight and obesity in this age group can help inform future policies and interventions. OBJECTIVE: To review and report available prevalence data in WHO European Region Member States and determine how many countries can accurately report on rates of overweight and obesity in children under 5 years. METHODS: We conducted a rapid review of studies reporting on overweight and obesity prevalence in children ages 0-5 in the WHO European region member states from 1998 to 2015. RESULTS: Currently, 35 of the 53 member states have data providing prevalence rates for overweight and obesity for children under 5 years. There was little consistency in study methods, impacting comparability across countries. The prevalence of overweight and obesity in children under 5 years ranges from 1 to 28.6% across member states. CONCLUSION: Although measuring overweight and obesity in this age group may be challenging, there is an opportunity to leverage existing surveillance resources in the WHO European Region.