How gender norms affect anemia in select villages in rural Odisha, India: A qualitative study.

BACKGROUND: In India, 50% of women of reproductive age, compared with 23% of men, have iron deficiency anemia. Extant research focuses on biological, not social, determinants of this disparity. OBJECTIVES: The aim of this study was to examine how gender norms may affect anemia prevalence among women in rural India. METHODS: We conducted 16 focus group discussions (N = 124) with women of reproductive age, husbands, and mothers-in-law and 25 key informant interviews in four villages in Odisha, India. RESULTS: We identified the following themes that help explain how inequitable gender norms exacerbate anemia among women from different castes and tribes: Due to a double burden of work outside the home and completing the majority of unpaid work in the home, women lack time to visit health centers to get tested for anemia and to obtain iron supplements. Women are expected to prioritize the health of their family over their own, thus affecting their access to health care. Women's autonomy to leave the house to seek health care is limited. Men are the primary breadwinners for the family, but often spend their money on alcohol, rather than on iron-rich food for the household. Intra-household food allocation favors men, in-laws, and children, thus women serve their family first, often being left with little food. CONCLUSION: Anemia reduction interventions need to include examination of the whole social context to successfully increase iron supplement use and iron-rich food intake. Understanding how gender norms contribute to anemia could change the narrative from a biomedical to a social justice issue.

An aerobic weight-loaded pilot exercise intervention for breast cancer survivors: bone remodeling and body composition outcomes.

OBJECTIVE: Weight gain and bone loss are commonly reported in breast cancer survivors. The purpose of this pilot study is to assess feasibility and explore the effect of an aerobic weight-loaded exercise intervention on bone remodeling, weight, and body composition. DESIGN: A one-group pre-posttest design was used to test a 16-24-week supervised walking exercise intervention among women within 2 years of menopause. Through Weeks 1-4, time and weight were progressively increased. By Week 5 and through the end of the intervention, a waist belt was loaded with 5 lb and participants spent 45 min on the treadmill 3 times/week. Bone remodeling was measured by serum biomarkers (N-terminal propeptides of type I collagen [NTX] and serum osteocalcin). Dual-energy absorptiometry scans assessed body composition. Data were collected at baseline and 16 and 24 weeks. RESULTS: The majority of the 26 participants were married, well educated, and employed, with a mean age of 51.3 years (SD = 6.2). The high adherence (M = 88.2%, SD = 6.8) demonstrated feasibility. There were no significant changes in serum osteocalcin (p = .67), serum NTX (p = .31), lean muscle mass (p = .08), or percent fat mass for the group as a whole (p = .14), but fat mass increased for women on adjuvant endocrine therapy (p = .04). The women maintained their weight. CONCLUSIONS: This novel exercise intervention for breast cancer survivors was feasible, and women otherwise at high risk for weight gain and bone loss maintained their weight and bone mass.

Abdominal obesity in older women: potential role for disrupted fatty acid reesterification in insulin resistance.

CONTEXT: Excess abdominal adiposity is a primary factor for insulin resistance in older age. OBJECTIVES: Our objectives were to examine the role of abdominal obesity on adipose tissue, hepatic, and peripheral insulin resistance in aging, and to examine impaired free fatty acid metabolism as a mechanism in these relations. DESIGN: This was a cross-sectional study. SETTING: The study was performed at a General Clinical Research Center. PARTICIPANTS: Healthy, inactive older (>60 yr) women (n = 25) who were not on hormone replacement therapy or glucose-lowering medication were included in the study. Women with abdominal circumference values above the median (>97.5 cm) were considered abdominally obese. MAIN OUTCOME MEASURES: Whole-body peripheral glucose utilization, adipose tissue lipolysis, and hepatic glucose production were measured using in vivo techniques according to a priori hypotheses. RESULTS: In the simple analysis, glucose utilization at the 40 mU insulin dose (6.3 +/- 2.8 vs. 9.1 +/- 3.4; P < 0.05), the index of the insulin resistance of basal hepatic glucose production (23.6 +/- 13.0 vs. 15.1 +/- 6.0; P < 0.05), and insulin-stimulated suppression of lipolysis (35 vs. 54%; P < 0.05) were significantly different between women with and without abdominal obesity, respectively. Using the glycerol appearance rate to free fatty acid ratio as an index of fatty acid reesterification revealed markedly blunted reesterification in the women with abdominal adiposity under all conditions: basal (0.95 +/- 0.29 vs. 1.35 +/- 0.47; P < 0.02); low- (2.58 +/- 2.76 vs. 6.95 +/- 5.56; P < 0.02); and high-dose (4.46 +/- 3.70 vs. 12.22 +/- 7.13; P < 0.01) hyperinsulinemia. Importantly, fatty acid reesterification was significantly (P < 0.01) associated with abdominal circumference and hepatic and peripheral insulin resistance, regardless of total body fat. CONCLUSION: These findings support the premise of dysregulated fatty acid reesterification with abdominal obesity as a pathophysiological link to perturbed glucose metabolism across multiple tissues in aging.