DO BIOMARKERS VARY BY SOCIAL CLASS, EDUCATION AND REGION AND IS MIGRATION IMPORTANT? EVIDENCE FROM A COHORT OF BRITISH ADULTS.

The aim of this study was to test whether Body Mass Index (BMI), waist circumference, systolic and diastolic blood pressure, Forced Expiratory Volume (FEV1) and Peak Expiratory Flow (PEF) vary in relation to social class at birth and adulthood, educational level and region of residence, and also with inter-generational social, educational and regional mobility/migration. The study used 5702 adults (2894 males and 2718 females) from the longitudinal British National Child Development Study (all children born in England, Scotland and Wales during the first week in March 1958 with follow-up throughout childhood and adulthood, most recently at 55 years of age). In both sexes BMI and waist circumference tended to increase from social classes I+II to IV+V and higher social class was associated with higher mean FEV1 and PEF. Better-educated adults tended to have lower BMI and waist circumference, and higher mean FEV1 and PEF. Women from Wales had the highest mean BMI and waist circumference but the lowest mean PEF, while women in Scotland had the highest mean systolic blood pressure and the lowest mean FEV1. For men only, FEV1 and PEF showed regional variation and the lowest mean FEV1 was in Wales and the lowest PEF in Yorkshire & Humberside. Inter-generational social mobility was not found to be associated with any of the biomarkers, while educational mobility was related only to FEV1 and PEF. In both sexes, in unadjusted regression analysis regional migrant cohort members tended to have a lower mean BMI than sedentes. Regional male migrants also tended to have a lower waist circumference and a higher FEV1 and PEF than sedentes.

SOCIOECONOMIC AND DEMOGRAPHIC VARIATION IN NUTRITIONAL STATUS OF UNDER-FIVE BANGLADESHI CHILDREN AND TREND OVER THE TWELVE-YEAR PERIOD 1996-2007.

The nutritional status of under-five-year-old children is a sensitive indicator of a country's health status as well as economic condition. The objectives of this study were to analyse trends in the nutritional status in Bangladeshi children over the period 1996-2007 and to examine the associations between nutritional and socioeconomic status variables. Bangladesh Demographic Health Surveys (BDHS) were the source of data, and a total of 16,278 children were examined. The Z-scores of the children were analysed as continuous as well as categorical variables (stunted, underweight and wasted). The socioeconomic status variables used were region, urban-rural residence, education and occupation of the parents, house type and household possession score. A series of General Linear Model and Sequential Linear and Binary Logistic Regression analyses were done to assess the relationship between demographic and socioeconomic variables and nutritional status. The trends of Z-scores were analysed by survey, as well as by child birth cohort. Region, house type, educational level of parents and household possession score showed significant associations with all three Z-scores of children after removing the effects of age, period of DHS and other explanatory variables in the model. No significant sex difference was observed between any of the Z-scores. There were improvements in mean WAZ and HAZ between 1996 and 2007 but deterioration in mean WHZ over this period. The obesity rate was below 2% in 2007, although the absolute numbers of obese children had nearly doubled in this 12-year period. Children from poorer households showed greater improvement than their better-off counterparts. The study reveals that over the years there has been substantial improvement in nutritional status of under-five children in Bangladesh and the main gains have been amongst the lower socioeconomic groups; it is also evident that malnutrition in Bangladesh is a multidimensional problem, like poverty itself, and warrants a proper policy mix and programme intervention.

Biosocial correlates of age at menarche in a British cohort.

BACKGROUND: A large number of biosocial variables have been shown to associate with age at menarche, but the results are inconsistent and differentiate not only between countries but within countries as well. AIM: This study examined age at menarche in a British national cohort in relation to 21 biosocial and anthropometric variables. SUBJECTS AND METHODS: The analyses were based on 4483 girls from the British National Child Development Study (NCDS). RESULTS: The majority of girls reached menarche between 12-14 years of age. Girls from smaller families, those living in the East and South East, South West, West Midlands and Wales regions, in tied housing and uncrowded conditions, not sharing a bedroom, not having free school meals, whose families lived in households without financial problems had started menstruating earlier than their peers from families with lower socioeconomic status. However, when all the significant variables were analysed together significant associations remained only for mother's age at menarche, height and weight at 7 years, family size and tenure. CONCLUSIONS: The results of this study support the hypotheses that intra-uterine growth and conditions in early life as well as socio-economic background are associated with the timing of menarche and that greater childhood growth and better SES are related to earlier menarche.

Is human mating for height associated with fertility? Results from a British National Cohort Study.

OBJECTIVES: Very few studies have investigated whether spousal similarity for height is related to fertility. This study examined the relationship between mating for height and fertility after correction for spousal age, social class, education, and region. METHODS: The data used were collected as part of the British National Child Development Study and 6,535 husband-wife pairs for whom data were available on measured height, spousal age, education, social class, region, and the number of children were studied. RESULTS: Fertility varied between the regions with the highest fertility in Scotland. Fertility tended to increase from more to less educated and from higher to lower social classes in both sexes. These relationships remained significant after correction for mean age. A negative association between husband's height in relation to fertility was noted as well as the negative and the quadratic term for wife's height. Both the linear as well as the quadratic effects of parental height difference were significantly related to fertility, but after removing the effects of mean age, age difference and mean height these effects disappeared. Analysis of region, mean age, social class, education, height, and differences in age, social class, education, and height together revealed that 32.4% of variation in fertility was explained but only mean age, mean social class and mean height and difference in social class remained significant. CONCLUSIONS: The results did not provide any evidence that differential fertility was associated with spousal height difference after taking into account age, social class, education and region.

Educational and social class assortative mating in fertile British couples.

BACKGROUND: Positive assortative mating for education and social position has been widely reported in a number of countries, but very few studies have tested whether or not educational or social class homogamy is related to differential fertility. AIM: This study examined the relationship between educational and social class assortative mating and fertility in a British national cohort. SUBJECTS AND METHODS: The analyses were based on 7452 husband-wife pairs from the British National Child Development Study (NCDS). RESULTS: The mean fertility was 3.22 children per couple; the number of children significantly increased from higher to lower social classes and from the more educated to the less educated. The extent of assortative mating for social class and educational level was related to fertility; as educational assortative mating decreased so did the average number of children, whereas the opposite trend was observed for social class. When assortative mating for education and social class were considered together, educational assortative mating was the more significant predictor of the number of children and educationally homogamous couples had higher fertility independent of their social class assortative mating. CONCLUSIONS: The relationship between assortative mating and fertility for education and social class appeared to be acting in the opposite direction.

Association between socio-economic status and childhood undernutrition in Bangladesh; a comparison of possession score and poverty index.

OBJECTIVE: To determine how much of the variation in nutritional status of Bangladeshi children under 5 years old can be attributed to the socio-economic status of the family. DESIGN: Nutritional status used reference Z-scores of weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height (WHZ). A 'possession score' was generated based on ownership of a radio, television, bicycle, motorcycle and telephone, and the availability of electricity, with categories of 0 to 4+ possessions. A five-point (quintile) 'poverty index' was created using principal component analysis. SETTING: The Bangladesh Demographic and Health Survey 2004 was the source of data. SUBJECTS: A sample of 4891 children aged <5 years was obtained. RESULTS: Some 57.8 % of the sample was either stunted, wasted or underweight (7.7 % were stunted, wasted and underweight). Of those stunted (48.4 %), 25.7 % were also underweight. Underweight and wasting prevalences were 40.7 % and 14.3 %, respectively. Mean WAZ, HAZ and WHZ did not differ by sex. Children of mothers with no education or no possessions were, on average, about 1 sd more underweight and stunted than those with higher educated mothers or with 4+ possessions. The possession score provided much greater discrimination of undernutrition than the poverty index. Nearly 50 % of children from households with no possessions were stunted, wasted or underweight (only 27 % in the poorest quintile), compared with only 3-6 % of children from households with 4+ possessions (over 13 % in the richest quintile). CONCLUSIONS: Maternal education and possession score were the main predictors of a child's nutritional status. Possession score was a much better indicator of undernutrition than the poverty index.

Impact of targeted food supplementation on pregnancy weight gain and birth weight in rural Bangladesh: an assessment of the Bangladesh Integrated Nutrition Program (BINP).

OBJECTIVES: To assess whether the Bangladesh Integrated Nutrition Programme (BINP) correctly identified which pregnant women should be enrolled in the food supplementation programme, whether supplementation commenced on time and was taken on a regular basis. A second objective was to determine whether food supplementation led to enhanced pregnancy weight gain and reduction in the prevalence of low birth weight. DESIGN: A one-year community-based longitudinal study. SETTING: A rural union of Bhaluka Upazila, Mymensingh, located 110 km north-west of Dhaka City, the capital of Bangladesh.ParticipantsA total of 1104 normotensive, non-smoking pregnant women who attended Community Nutrition Centres were studied from first presentation at the centre until child delivery. RESULTS: Pregnant women who had a BMI of <18.5 kg/m(2) on first presentation should have been selected for supplementary feeding (2512 kJ (600 kcal)/d for six days per week) starting at month 4 (16 weeks) of pregnancy. However, of the 526 women who had BMI < 18.5 kg/m(2), only 335 received supplementation; so the failure rate was 36.3 %. In addition, of those receiving supplementation, only 193 women (36.7 % of 526 women) commenced supplementation at the correct time, of whom thirty-two (9.6 % of 335 women) received supplementation for the correct number of days (100 % days). There were no significant differences in mean weight gain between BMI < 18.5 kg/m(2) supplemented or non-supplemented groups or between the equivalent groups with BMI > or = 18.5 kg/m(2). Weight gain was inversely related to initial weight, so lighter women gained relatively more weight during their pregnancy than heavier women. The mean birth weight in the supplemented and non-supplemented groups was 2.63 kg and 2.72 kg, respectively. Mothers with BMI < 18.5 kg/m(2) who were or were not supplemented had almost equal percentages of low-birth-weight babies (21 % and 22 %, respectively). CONCLUSION: The study raises doubt about the efficiency of the BINP to correctly target food supplementation to pregnant women. It also shows that food supplementation does not lead to enhanced pregnancy weight gain nor does it provide any evidence of a reduction in prevalence of low birth weight.

The burden of chronic disease.

The shift from acute infectious and deficiency diseases to chronic noncommunicable diseases is not a simple transition but a complex and dynamic epidemiological process, with some diseases disappearing and others appearing or reemerging. The unabated pandemic of childhood and adulthood obesity and concomitant comorbidities are affecting both rich and poor nations, while infectious diseases remain an important public health problem, particularly in developing countries. More attention should be given to the high burden of disease associated with soil-transmitted helminths and schistosomiasis, which until recently was not considered a priority even though regular drug treatment is obtainable at relatively little cost. In developing countries, the pressing requirement is to provide an accessible and good quality health-care system, whereas industrialized countries have a major need for greater public health education and the promotion of healthy life-styles.

Relationship between mother's age and health care received by the firstborn child.

Data from a British national study of all children born in one week of 1958 were used to test whether there was any relationship between the age of the mother at the time of the birth of her first child and the health care received by the child up to 7 years of age. This relationship was tested before and after statistically removing the effects of several potentially confounding social factors (social class, education level, and housing facilities), which were thought to associate with maternal age. The results indicated that maternal age effects were significant for attendance at infant and toddler clinics, but generally less important than social factors for immunization acceptances. © 1993 Wiley-Liss, Inc.