GROWING UP IN PORTUGAL: CAPE VERDEAN ANCESTRY CHILDREN EXHIBIT LOW OVERWEIGHT AND OBESITY COMPARED WITH PORTUGUESE IN URBAN LISBON.

Portugal has one of the highest rates of childhood overweight and obesity in Europe. However, little is known about the health of ethnic minorities living in its capital city, Lisbon. The Cape Verdean community in Lisbon tend to have low educational levels, material deprivation and struggle with discrimination and racism, factors that would probably be associated with a higher prevalence of overweight and obesity. Data for the Cape Verdean population were collected in three different time periods by three different research teams in 1993, 2009 and 2013 and included children aged 6-12 years living in the Cova da Moura neighbourhood of the Greater Lisbon Metro Area. The Portuguese national survey was conducted between 2009 and 2010 at public and private schools in mainland Portugal and included height, weight, skinfolds and arm and waist circumferences. From these survey data body mass index (BMI) and prevalence of stunting (chronic malnutrition - low height-for-age) and underweight (low weight-for-age) were calculated according to reference values proposed by Frisancho (2008). Overweight and obesity prevalence values were defined based on the references established by the International Obesity Task Force. The results show significant differences in height between Cape Verdean and Portuguese boys and girls. Generally, Cape Verdeans' growth falls within the healthy range of international growth references across all of the survey data collected. Cape Verdean rates for combined overnutrition (overweight and obesity) in 2013 (9.8% for boys and 16.7% for girls) were lower than those of the Portuguese (33% for boys and 31.7% for girls). Logistic regression models showed that Cape Verdean children had a lower risk of being overweight or obese when accounting for breast-feeding, birth weight, maternal education and occupation. Despite living in a deprived neighbourhood these Cape Verdean children seemed to have grown more healthily than Portuguese ancestry children. The challenge for policymakers will be to support improvement of the poverty-related living conditions of this community without creating a risky environment for increasing prevalence of overweight and obesity.

Potential effectiveness of Community Health Strategy to promote exclusive breastfeeding in urban poor settings in Nairobi, Kenya: a quasi-experimental study.

Early nutrition is critical for later health and sustainable development. We determined potential effectiveness of the Kenyan Community Health Strategy in promoting exclusive breastfeeding (EBF) in urban poor settings in Nairobi, Kenya. We used a quasi-experimental study design, based on three studies [Pre-intervention (2007-2011; n=5824), Intervention (2012-2015; n=1110) and Comparison (2012-2014; n=487)], which followed mother-child pairs longitudinally to establish EBF rates from 0 to 6 months. The Maternal, Infant and Young Child Nutrition (MIYCN) study was a cluster randomized trial; the control arm (MIYCN-Control) received standard care involving community health workers (CHWs) visits for counselling on antenatal and postnatal care. The intervention arm (MIYCN-Intervention) received standard care and regular MIYCN counselling by trained CHWs. Both groups received MIYCN information materials. We tested differences in EBF rates from 0 to 6 months among four study groups (Pre-intervention, MIYCN-Intervention, MIYCN-Control and Comparison) using a χ(2) test and logistic regression. At 6 months, the prevalence of EBF was 2% in the Pre-intervention group compared with 55% in the MIYCN-Intervention group, 55% in the MIYCN-Control group and 3% in the Comparison group (P<0.05). After adjusting for baseline characteristics, the odds ratio for EBF from birth to 6 months was 66.9 (95% CI 45.4-96.4), 84.3 (95% CI 40.7-174.6) and 3.9 (95% CI 1.8-8.4) for the MIYCN-Intervention, MIYCN-Control and Comparison group, respectively, compared with the Pre-intervention group. There is potential effectiveness of the Kenya national Community Health Strategy in promoting EBF in urban poor settings where health care access is limited.

Sitting time and step counts in office workers.

BACKGROUND: Technological advances mean that many adults are now employed in sedentary occupations. Given evidence linking prolonged sitting to chronic disease risk, understanding sitting and physical activity in and outside the workplace may usefully inform effective interventions. AIMS: To assess sitting time and physical activity during and outside working hours in full-time office workers. METHODS: Participants wore a pedometer and recorded sitting times and step counts during and outside working hours for 7 days. Participants were divided into tertiles based on the proportion of time spent sitting at work. Sitting times and step counts reported outside work were compared between groups, using one-way analysis of variance. RESULTS: There were 72 participants. Almost two-thirds (65%) of time at work was spent sitting. The sample accumulated 3742±2493 steps at work and 5159±2474 steps outside work on workdays. Participants in the highest tertile for workplace sitting reported sitting for longer than those in the lowest tertile during transport (64±59 versus 21±16min), after work (154±30 versus 126±51min) and at weekends (382±133 versus 288±124min, all P < 0.05). Work duration and steps reported outside work did not differ between groups. CONCLUSIONS: Office workers who sit for a large proportion of their working day also report sitting for longer outside work. They do not compensate for their sedentary behaviour at work by being more active outside work. Occupational health interventions should focus on reducing workplace and leisure-time sitting in sedentary office workers.

A systematic review to determine the effectiveness of interventions designed to prevent overweight and obesity in pre-adolescent girls.

Childhood overweight/obesity is recognized as an increasing health problem. The objective of this review was to determine the effectiveness of interventions designed to prevent overweight and obesity in pre-adolescent girls. The papers included were those studying children (must include results for girls) from within the 7-11 years age range from any country and ethnic background. The included interventions lasted at least 12 weeks and modified a combination of nutrition, physical activity, knowledge, attitudes or health-related behaviours associated with the development of childhood overweight and obesity. Effect sizes were calculated where possible using Cohen's classifications of small (0.2-0.5), medium (0.5-0.8) and large (>0.8) effect sizes. Thirty studies met the inclusion criteria of which four were cluster randomized controlled trials, 14 were randomized controlled trials, 11 were controlled trials and one was a cohort pre-post trial. There were four weak, 11 moderate and 15 strong quality studies. Eleven studies were considered short term and 19 long term (≥12 months). There were 66 effect sizes less than 0.2, 56 categorized as low, 16 as medium and two as high. There is the potential for interventions aimed at pre-adolescent girls to reduce the risk factors associated with childhood overweight and obesity, although the sustainability of the effects of such interventions is less clear.

Evaluation of a commercially available pedometer used to promote physical activity as part of a national programme.

OBJECTIVE: To assess the accuracy of a pedometer (manufactured by Silva) currently being used as part of a national programme to promote physical activity in the UK. METHODS: Laboratory study: 68 participants (aged 19.2 years (SD 2.7), body mass index (BMI) 22.5 kg/m(2) (SD 3.3)) wore two Silva pedometers (over the right and left hips) while walking on a motorised treadmill at 2, 2.5, 3, 3.5 and 4 mph. Pedometer step counts were compared with actual steps counted. Free-living study: 134 participants (aged 36.4 years (SD 18.1), BMI 26.3 kg/m(2) (SD 5.1)) wore one Silva pedometer, one New-Lifestyles NL-1000 pedometer and an ActiGraph GT1M accelerometer (the criterion) during waking hours for one day. Step counts registered by the Silva and NL-1000 pedometers were compared with ActiGraph step counts. Percentage error of the pedometers were compared across normal-weight (n = 58), overweight (n = 45) and obese (n = 31) participants. RESULTS: Laboratory study: Across the speeds tested percentage error in steps ranged from 6.7 (4 mph) to 46.9% (2 mph). Free-living study: Overall percentage errors of the Silva and NL-1000 pedometers relative to the criterion were 36.3% and 9%, respectively. Significant differences in percentage error of the Silva pedometer were observed across BMI groups (normal-weight 21%, overweight 40.2%, obese 59.2%, p<0.001). CONCLUSION: The findings suggest the Silva pedometer is unacceptably inaccurate for activity promotion purposes, particularly in overweight and obese adults. Pedometers are an excellent tool for activity promotion; however, the use of inexpensive, untested pedometers is not recommended as they will lead to user frustration, low intervention compliance and adverse reaction to the instrument, potentially impacting future public health campaigns.

How well do waist circumference and body mass index reflect body composition in pre-pubertal children?

OBJECTIVE: To investigate the quantitative relationship between waist circumference (WC) and height (Ht), and subsequently the association between waist circumference index (WCI), body mass index (BMI) and body composition in pre-pubertal children. DESIGN: Cross-sectional sample (n=227; boys=127) of pre-pubertal black children (age range 8.8-11.0 years) from the Bone Health sub-study of the Bt20 birth cohort study set in Soweto-Johannesburg, South Africa. Measures of height, weight and WC by anthropometry, total and truncal fat and lean mass by dual-energy X-ray absorptiometry were used in the analysis. Pearson's correlation coefficients were used to examine the associations between BMI, WC and body composition outcomes. RESULTS: WC was independent of height when height was raised to a power of approximately 0.8. BMI and WCI (WC/Ht) were significantly associated with total and truncal fat and lean mass in both sexes (all P<0.001). BMI showed consistently and significantly higher correlations with body composition than WCI and this association was significantly greater for fat mass than lean mass. CONCLUSION: BMI, rather than WCI, would be a better screening tool for total and truncal fat mass in both sexes before puberty.

Socio-economic status and body composition outcomes in urban South African children.

OBJECTIVE: To determine which aspects of socio-economic status (SES) measured at birth and at ages 9 or 10 years, are associated with body composition at ages 9 or 10 years. DESIGN: Mixed longitudinal cohort. SETTING: Johannesburg-Soweto South Africa. PARTICIPANTS: A sub-sample of the Birth to Twenty (Bt20) cohort (n = 281) with data on birth weight, height, weight, fat and lean tissue (whole body dual-energy x ray absorptiometry (DXA)), and birth and ages 9 or 10 years SES measures. MAIN OUTCOME MEASURES: Linear regression was used to estimate the influence of birth and ages 9 or 10 years SES measures on three outcomes: fat mass index (FMI) (fat mass (kg)/height (m)4), lean mass index (LMI) (lean mass (kg)/height (m)2), and body mass index (BMI) at ages 9 or 10 years controlling for sex, age, birth weight and pubertal status. RESULTS: Compared to the lowest SES tertile, being in the highest birth SES tertile was associated with increased LMI at ages 9 or 10 years (beta = 0.43, SE = 0.21 for white and black children and beta = 0.50, SE = 0.23 for black children only), whereas children in the high SES tertile at ages 9 or 10 years had increased FMI (beta = 0.46, SE = 0.22 for white and black children, and beta = 0.65, SE = 0.23 for black children only). SES at birth and at ages 9 or 10 years accounted for 8% and 6% of the variance in FMI and BMI, respectively (black children). CONCLUSIONS: These findings underline the importance of examining SES across childhood ages when assessing nutrition inequalities. Results emphasise the need to consider lean and fat mass as well as BMI when studying SES and body composition in children.

Four-week pedometer-determined activity patterns in normal weight and overweight UK adults.

OBJECTIVE: To assess pedometer-determined physical activity levels and activity patterns in a sample of free-living normal weight and overweight UK adults. DESIGN: Pedometer-based 4-week observational study. PARTICIPANTS: One hundred and twenty-two healthy participants, recruited from two regions in the UK, classified as normal weight (33 females and 26 males) or overweight (31 females and 32 males), in the age range of 18 to 65 years, completed the study. MEASUREMENTS: Daily step counts were measured using a Yamax SW-200 pedometer, and were then recorded in an activity log. Comparisons were made between activity patterns occurring over different days of the week for the normal weight and overweight groups. Measurements of height, weight and percentage body fat, by bioelectrical impedance, were taken pre- and post-study. RESULTS: A consistent reduction in activity was observed on a Sunday in the overweight group, and mean daily step counts accumulated on Sundays were significantly lower, by an average of 2221 steps/day, when compared with all other days of the week (all P<0.001). In comparison, no day-of-the-week effect was observed in the normal weight group. Mean step counts reported on each day of the week did not differ significantly between the two groups, with the exception of Sunday when the overweight group reported significantly fewer steps than the normal weight participants (8093 versus 10 538, P<0.001). CONCLUSIONS: Activity levels dropped dramatically in the sample of overweight adults on a Sunday. Simple instructions to at-risk individuals, to increase their general activity levels on a Sunday, via general practitioners and public health messages could prove to be a subtle, but effective, strategy to tackle obesity.

Community-based nutrition education for improving infant growth in rural Karnataka.

OBJECTIVE: To evaluate a nutrition education intervention designed to improve infant growth and feeding practices. DESIGN: An intervention study using monthly nutrition education delivered by locally trained counsellors targeted at caregivers of infants aged 5-11 months. Comparison of outcomes for 2 groups--one non-intervention group of infants enrolled in 1997 that did not receive the intervention in the first year of life, and an intervention group of infants enrolled 1998-1999 that received the nutrition education. SETTING: 11 randomly selected and 2 purposively selected villages of south Karnataka. SUBJECTS: 138 Infants (n = 69 intervention) aged 5-11 months. METHODS: Families were administered a monthly questionnaire on feeding and child care behavior, and study infants were weighed at this time, using the SECA solar scales, developed for UNICEF. Logistic regression was used to examine differences between intervention and non-intervention infants in infant feeding behavior outcomes. RESULTS: Statistically significant improvement was found in weight velocity for female infants in the intervention group. These infants were also more likely to exhibit at least four positive feeding behaviors--intervention infants had a higher mean daily feeding frequency (more likely to be fed solids at least four times a day (OR = 4.35, 95% CI = 1.96, 10.00), higher dietary diversity (more likely to receive a more diverse diet OR = 3.23, 95% CI = 1.28, 7.69), and were more likely to be fed foods suggested by the counsellors such as bananas (OR = 10.00, 95% = 2.78, 33.3) compared to non-intervention infants. CONCLUSION: Nutrition education and counselling was significantly associated with increased weight velocity among girls and improved feeding behavior among both boys and girls. These results provide further evidence that community-based nutrition programs that emphasise appropriate feeding and care behavior can be used to prevent and address early childhood malnutrition in poor households.

The burden of anemia among women in India.

OBJECTIVE: This research investigates the prevalence and determinants of anemia among women in Andhra Pradesh. We examined differences in anemia related to social class, urban/rural location and nutrition status body mass index (BMI). We hypothesized that rural women would have higher prevalence of anemia compared to urban women, particularly among the lower income groups, and that women with low body mass index (BMI; <18.5 kg/m(2)) would have a higher risk compared to normal or overweight women. DESIGN: The National Family Health Survey 1998/99 (NFHS-2) provides nationally representative cross-sectional survey data on women's hemoglobin status, body weight, diet, social, demographic and other household and individual level factors. Ordered logit regression analyses were applied to identify socio-economic, regional and demographic determinants of anemia. SETTING: Andhra Pradesh, a southern Indian state. SUBJECTS: A total of 4032 ever-married women aged 15-49 from 3872 households. RESULTS: Prevalence of anemia was high among all women. In all 32.4% of women had mild (100-109.99 g/l for pregnant women, 100-119.99 for non-pregnant women), 14.19% had moderate (70-99.99 g/l), and 2.2% had severe anemia (<70 g/l). Protective factors include Muslim religion, reported consumption of alcohol or pulses, and high socioeconomic status, particularly in urban areas. Poor urban women had the highest rates and odds of being anemic. Fifty-two percent of thin, 50% of normal BMI, and 41% of overweight women were anemic. CONCLUSIONS: New program strategies are needed, particularly those that improve the overall nutrition status of women of reproductive ages. This will require tailored programs across socio-economic groups and within both rural and urban areas, but particularly among the urban and rural poor.

The nutrition transition is underway in India.

Nutrition research in India has previously focused on the serious problem of undernutrition related to nutrient deficit and high rates of infection. Recent data from the National Family Health Survey 1998/99 (NFHS 2), however, identified a significant proportion of Indian women as overweight, coexisting with high rates of malnutrition. This paper examines the emerging nutrition transition for women living in rural and urban communities of Andhra Pradesh, India. NFHS 2 provides nationally representative data on women's weight and height. In this paper, we examine representative data from the state of Andhra Pradesh (n = 4032 women). Logistic regression analyses are applied to the data to identify socioeconomic, regional and demographic determinants of overweight and thinness. The major nutrition problem facing women continues to be undernutrition, with 37% having a low body mass index [(BMI) < 18.5 kg/m(2)]; 8% of these women are severely malnourished (BMI < 16 kg/m(2)). However, 12% of the women can be classified as overweight (BMI > 25 kg/m(2)) and 2% are obese (BMI > 30 kg/m(2)). Furthermore, in the large cities of the state in which 4% of the sample live, 37% of women are overweight or obese, whereas in the rural areas in which 74% reside, 43% have a low BMI. Women from lower socioeconomic groups are also significantly more likely to have a low BMI. Findings from the logistic regression models reveal socioeconomic status to be a more important predictor of both over- and underweight than location of residence.

Transcription of the Campylobacter jejuni cell division gene ftsA.

As part of a study of genes whose transcription is maintained in stationary phase, cloned segments of DNA were selected from a Lambda ZAP II library of Campylobacter jejuni NCTC 11,168. One such clone was found to encode a homologue of the Escherichia coli cell division gene ftsA. Examination of mRNA by transcription mapping revealed that the Campylobacter gene has one major and three minor transcription start sites. There were several significant differences in the structure and organisation of the C. jejuni ftsA promoter compared to that of E. coli.

Morphological changes of Campylobacter jejuni growing in liquid culture.

Campylobacter jejuni growing in liquid culture was found to exhibit gross morphological changes with time. Exponentially growing cells showed typical short spiral forms. At mid-stationary phase the cells became approximately twice the length of the exponential forms. Late stationary/early decline phase cells were seen to be a mixture of coccal forms and cells which were between 3 and 4 times the length of exponentially growing cells. Continued incubation of cultures eventually resulted in a population largely of coccal forms. These morphological changes have not previously been observed when Camp. jejuni has been grown on agar-based solid medium. It is likely that such changes result from the differential expression of genes that control the timing of cell division.

Campylobacter jejuni and Guillain-Barré syndrome.

Campylobacter jejuni is the most frequently identified bacterial cause of gastroenteritis in the UK, and commonly precedes Guillain-Barré syndrome (GBS). There is some evidence that the resultant neurological disease may be a more severe variant of GBS with predominant axonal degeneration. Crossreactivity between neural antigens and C. jejuni may be one of the mechanisms by which GBS is triggered. Unravelling the immunopathogenesis of GBS following C. jejuni enteritis may shed light on the way in which bacterial infections induce autoimmune disease.

Siderophore production and iron-regulated envelope proteins of Helicobacter pylori.

All Helicobacter pylori strains tested produced extracellular siderophores, detected by a modified Universal Detection medium, but growth on this medium was poor. By using the iron chelating compound, 2,2'-dipyridyl, outer membrane proteins of 78 and 40 kDa were detected in some, but not all strains examined. No direct binding of lactoferrin or transferrin (the mechanism used by Neisseria to obtain iron) could be demonstrated for H. pylori. Some other techniques for the study of iron-limitation on bacteria were found to be unsuitable for H. pylori.

Occurrence of campylobacters in small domestic and laboratory animals.

Faeces samples from 156 healthy domestic pets and laboratory animals were examined for campylobacters with both a selective medium (Campylobacter Blood Free Medium; Oxoid, CM739) and selective filtration through a 0.65 micron pore size filter. Campylobacter spp. were isolated from 78 of the samples; filtration was the most effective method. Isolates were characterized by biochemical tests and DNA/DNA hybridization with whole chromosomal DNA from reference strains as probes. Campylobacter upsaliensis was the most common species isolated from cats (45 from 68 samples) whilst Camp. jejuni was more often isolated from dogs (19 from 56 samples). More attention should be paid to pets as a potential source of campylobacters capable of causing diarrhoea in human beings. Procedures other than those involving currently-used selective agents must be employed to efficiently detect all campylobacters.

Differentiation between thermophilic Campylobacter species by species-specific antibodies.

The four species of thermophilic campylobacters, Campylobacter jejuni, C. coli, C. upsaliensis and C. lari, are difficult to distinguish from each other because of their lack of reactivity in many conventional biochemical and physiological tests. Those tests which do discriminate sometimes give discordant results. Species-specific antibody preparations (APs), capable of discriminating between the thermophilic campylobacter species by dot-ELISA, were raised by inoculation of mice with partially purified membrane protein. The APs produced were absorbed with cells of cross-reactive species and tested by dot-ELISA against reference and natural strains, the identities of which were confirmed by DNA/DNA hybridization. The results showed that such APs could be useful as an alternative to DNA/DNA hybridization for rapid species identification, for example in epidemiological surveys. Western blotting experiments with the APs showed that the specificity of the antibodies was not due to a single antigen.