Meet World Health Organization Recommendations Research Articles

Gender-specific social and environmental correlates of active travel to school in four European countries: the HBSC Study.

Despite the health benefits, a large proportion of girls and boys in Europe do not travel to school actively. A better understanding of the correlates associated with this behavior could guide interventions. This study examines perceived social and environmental correlates of active travel to school (ACTS) from the 2017/18 Health Behavior in School-Aged Children (HBSC) survey in four European countries, with a special emphasis on gender differences (n = 22,023). Logistic regression was conducted to analyze associations between the perceived importance of each correlate and ACTS behavior for 11-, 13-, and 15-year-old girls and boys from Germany, Czechia, Poland, and Slovakia. All models were adjusted for age, family affluence, and meeting World Health Organization recommendations for moderate-to-vigorous physical activity. Rates of ACTS significantly differed between girls and boys. In Czechia, 65% of girls and boys traveled to school actively, followed by Slovakia (61.4% girls and 58.4% boys), Poland (57.7% girls and 60.2% boys), and Germany (42.6% girls and 48.6% boys). Girls were less likely to actively travel to school compared to boys (odds ratio [OR]: 0.92, 95% confidence interval [CI]: 0.87-0.97). Increasing age (OR: 0.95, 95% CI: 0.93-0.97) and a greater distance to school index (OR: 0.89, 95% CI: 0.88-0.90) were both negatively associated with ACTS. The perceived importance of living closer to school and of road and neighborhood safety was positively associated with ACTS, with a stronger association in boys than in girls for neighborhood safety. On the contrary, the perceived importance of having people to walk with was negatively associated with ACTS, with a stronger association in girls (OR: 0.74, 95% CI: 0.65-0.84) than in boys (OR: 0.77, 95% CI: 0.66-0.88). This study provides insights into perceived social and environmental correlates associated with ACTS behavior. Future research should include gender-specific perceptions and more in-depth investigations of correlates encouraging ACTS, especially considering social aspects, safety issues, and the structuring of the environment in different cultural settings.

Prevalence of physical health conditions and health risk behaviours in people with severe mental illness in South Asia: multi-country cross-sectional survey.

People with severe mental illness (SMI) die earlier than the general population, primarily because of physical disorders. We estimated the prevalence of physical health conditions, health risk behaviours, access to healthcare and health risk modification advice in people with SMI in Bangladesh, India and Pakistan, and compared results with the general population. We conducted a cross-sectional survey in adults with SMI attending mental hospitals in Bangladesh, India and Pakistan. Data were collected on non-communicable diseases, their risk factors, health risk behaviours, treatments, health risk modification advice, common mental disorders, health-related quality of life and infectious diseases. We performed a descriptive analysis and compared our findings with the general population in the World Health Organization (WHO) 'STEPwise Approach to Surveillance of NCDs' reports. We recruited 3989 participants with SMI, of which 11% had diabetes, 23.3% had hypertension or high blood pressure and 46.3% had overweight or obesity. We found that 70.8% of participants with diabetes, high blood pressure and hypercholesterolemia were previously undiagnosed; of those diagnosed, only around half were receiving treatment. A total of 47% of men and 14% of women used tobacco; 45.6% and 89.1% of participants did not meet WHO recommendations for physical activity and fruit and vegetable intake, respectively. Compared with the general population, people with SMI were more likely to have diabetes, hypercholesterolemia and overweight or obesity, and less likely to receive tobacco cessation and weight management advice. We found significant gaps in detection, prevention and treatment of non-communicable diseases and their risk factors in people with SMI.

Pharmaceutical brochures in Lebanon: do they meet WHO recommendations?

BackgroundDrug promoting brochures can influence physicians prescription patterns. The validity of the info presented in these brochures is of major importance. World Health Organization (WHO) issued criteria to guarantee validity, equity and ethical presentation of data in medical brochures. This study aims to evaluate the quality and the validity of information presented in the pharmaceutical brochures distributed among family physicians in Lebanon.MethodsPharmaceutical brochures were randomly collected at the family medicine center in Hôtel Dieu de France hospital in Beirut - Lebanon. These brochures were evaluated in reference to the WHO ethical criteria for medicinal drug promotion and on guidelines for quality assurance of the graphs, references, texts and illustrations.ResultsAmong the 60 brochures collected, only 4 fulfilled all the WHO ethical criteria, and 24 presented less than half the required criteria. Information concerning the drug safety are the least mentioned. Only 11.8% of the presented graphs are based on studies of high methodological level. Half of the brochures presented necessary information to identify studies references which are not always retrievable. Texts present mainly brand names instead of generic names and emphasize on information reflecting the drug efficacy.ConclusionThe pharmaceutical brochures in this study presented incomplete or invalid information. Prescribing physicians should be aware of the claims found in the brochures distributed by pharmaceutical companies and should be familiar with the principles of the evidence-based medicine to be able to critically appraise the validity of the reference studies and avoid the pitfalls in graphs reading.

Physical Inactivity and Sedentariness: Languorous Behavior Among Adolescents in 80 Countries

PurposeHigh rates of adolescent physical inactivity and sedentary behavior have been reported worldwide, but the combined prevalence of languorous behavior (physical inactivity and/or sedentary behavior) may more accurately reflect just how few adolescents meet World Health Organization recommendations. MethodsWe analyzed nationally representative data from 325,219 students in 80 countries that participated in the Global School-based Student Health Survey between 2009 and 2018. Students were classified as physically inactive if they reported engaging in moderate or vigorous physical activity less than 60 minutes daily. Students were classified as being sedentary if they sat for three or more hours per day outside of school, such as when having screen time not related to studying. Statistics for each country were generated using complex samples analysis, then the results from all countries were synthesized. ResultsIn total, 84% of students were physically inactive, 37% were sedentary, and 91% met the definition for the concept we are calling languorous behavior. DiscussionEstablishing specific evidence-based guidelines for increasing physical activity and decreasing sitting time will enable progress toward reducing languorous behavior among adolescents.

Physical inactivity and headache disorders: Cross-sectional analysis in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Physical inactivity has been linked to headache disorders but estimates based on the current World Health Organization physical activity guidelines are unknown. To test the associations between headache disorders and physical inactivity in the ELSA-Brasil cohort. In a cross-sectional analysis, linear (continuous variables) and logistic regression models (categorical variables) tested the associations of physical activity levels in the leisure time, commuting time, and combined leisure time physical activity + commuting time physical activity domains with headache disorders, adjusted for the effects of sociodemographic data, cardiovascular risk variables, psychiatric disorders, and migraine prophylaxis medication. Of 15,105 participants, 14,847 (54.4% women) provided data on physical activity levels and headache. Higher physical activity levels (continuous values) in the leisure time physical activity domain associated with lower migraine and tension-type headache occurrence and lower headache attack frequency, while in the commuting time physical activity domain it associated with more frequent headache attacks. Compared to people who met World Health Organization physical activity levels in the leisure time physical activity or combining leisure time physical activity + commuting time physical activity domains (i.e. ≥150 min.wk-1 of moderate and/or ≥75 min.wk-1 of vigorous physical activity), physical inactivity associated with higher migraine occurrence, while somewhat active (i.e. not meeting World Health Organization recommendations) associated with higher migraine and tension-type headache occurrence. Physical inactivity in the commuting time physical activity domain associated with higher tension-type headache in men and lower migraine in women. Physical inactivity within vigorous leisure time physical activity intensity, but not moderate leisure time physical activity, associated with higher migraine, mostly in women. Finally, physical inactivity associated with higher headache attack frequency regardless headache subtype. Physical inactivity and unmet World Health Organization physical activity levels associate with primary headaches, with heterogeneous associations regarding headache subtype, sex, physical activity domain/intensity, and headache frequency in the ELSA-Brasil study.

Non-communicable diseases in Lebanon: results from World Health Organization STEPS survey 2017

ObjectivesNon-communicable diseases (NCDs) are a major global health problem. The objective of the study was to estimate the prevalence of common risk factors for NCDs in Lebanon, both among the Lebanese population and Syrian refugees, aged 18–69 years, residing in communities. Study designTwo national cross-sectional surveys using a two-stage cluster sampling design were conducted among the Lebanese and Syrian refugee adults. MethodsWe used the World Health Organization (WHO) STEPwise approach through questionnaire assessment and physical and biochemical measurements. All reported results were weighted to provide prevalence estimates at the population level. ResultsA total of 1899 Lebanese and 2134 Syrians adults participated in the survey. More than one-third of participants were current smokers at the time of the assessment, and 23% of Lebanese participants were current drinkers (almost all Syrian refugees were lifetime abstainers). Vegetable and fruit consumption was rated moderately low, in 73% and 93% of Lebanese and Syrian refugees, respectively. Many respondents did not meet WHO recommendations on physical activity. More than one-third of participants had raised blood pressure or were on antihypertensive medications. One in 10 participants had either raised blood glucose level or were currently on glycemic control medications. For all risk factors and in both samples, women consistently had lower prevalence of NCD risk factors. ConclusionsPrevalence of risk factors for NCDs is high in Lebanon, and given the recent rise in population size, the financial and social burden of NCDs will grow dramatically in the next years. The results highlight the need for interventions to address behavioral changes, including reduction in smoking, improvement of dietary habits, optimization of management of diabetes and cardiovascular diseases, and conducting continuous surveillance to monitor the trends in NCD prevalence, their risk factors, and treatments.

Are yuppies and muppies more physically active than the others aged 20-39?

Background: Values of young urban professionals (yuppies) are still valid and it is possible to find references to the lifestyle of young people. This also applies to the younger generation, in other words, middle-aged urban professionals (muppies). Objective: The aim is evaluating whether yuppies and muppies can be a role model for society in the field of taking care of leisure-time physical activity (PA). Methods: Surveys were conducted by an Omnibus survey on the representative sample of Poles in two studies (N = 1053, N = 1067). Persons aged 20-39 (N = 762 were selected) and based on the criteria: education, residence in cities, study skills character of work, income, there was created a yuppie/muppie group (n = 67) and non-yuppies (n = 695). International Physical Activity Questionnaire - Long Form was used. Results: Recommendations of WHO were met by 43.3% of yuppies/muppies and 33.4% of non-yuppies. No significant differences between groups were observed (p = .103) in this regard. There were no significant differences also between groups in practiced days per week leisure-time PA (walking p = .069, moderate PA p = .095, vigorous PA p = .256). The average value of MET-min/week for vigorous PA during leisure time was significantly higher declared (p = .03) by the yuppie/muppie group (628.7 ± 1415.5 vs. 345.8 ± 1073.4 MET-min/week). Conclusions: Yuppies and muppies cannot be regarded as a role model for Polish society in terms of taking up active leisure-time activities and meeting World Health Organization recommendations. Thus, it seems valuable to carry out further research in order to find role-model groups within the population aged 20-39.

Compliance to dietary guidelines on fruit and vegetable intake and prevalence of hypertension among Vietnamese adults, 2015.

The aim of this study was to investigate whether the Western dietary guidelines on fruit and vegetable intake are associated with blood pressure parameters and hypertension among Vietnamese adults. Participants included 1384 women and 1049 men aged 18-69 years from the 2015 Vietnam national survey on risk factors of non-communicable diseases. Associations between dietary intake score based on the Dietary Approaches to Stop Hypertension (DASH) guidelines and World Health Organization recommendations on fruit and vegetable consumption and blood pressure parameters and hypertension were evaluated by multivariate regression analyses. Approximately 17.0% and 40.1% of participants met the respective definitions of hypertension according to Joint National Committee 7 (JNC7) and 2017 American College of Cardiology/American Heart Association (ACC/AHA) Hypertension Guideline. Highest tertiles of DASH scores for fruit intake were significantly associated with increased blood pressure parameters, particularly in women. Hypertension was associated with DASH score for fruit intake with odds ratios and 95% confidence intervals for tertiles 2-3 versus tertile 1: 1.31 (0.98, 1.76) and 1.43 (1.05, 1.93) for JNC7; 1.26 (1.01, 1.58) and 1.31 (1.04, 1.66) for 2017 ACC/AHA guideline (all p-trend <0.05). No association with blood pressure parameters and hypertension was observed for DASH score for vegetable intake and meeting World Health Organization recommendations for fruit and vegetable intake. We found an unexpected positive association between DASH score for fruit intake and blood pressure parameters and hypertension among Vietnamese adults. More research is needed in this population to understand the relationship between vegetable and fruit intake with hypertension before a firm conclusion and recommendation are made.

Longitudinal patterns of physical activity, sedentary behavior and sleep in urban South African adolescents, Birth-To-Twenty Plus cohort

BackgroundAdolescence is a critical phase of human development that lays the foundation for health in later life. Of the 1.8 billion adolescents in the world, roughly 90% live in low and middle-income countries. Yet most longitudinal studies of adolescent physical activity, sedentary behavior, and sleep come from high-income countries. There is a need for a better understanding of these behaviors to inform obesity and chronic disease prevention strategies.AimsThe aim of this study is to identify longitudinal patterns and associations between physical activity, sedentary behavior and sleep in urban South African adolescents.MethodsWe analyzed data from the Birth-to-Twenty Plus Cohort (Bt20+), a longitudinal study of children in Soweto, Johannesburg, South Africa. Behaviors were self-reported annually between ages 12 and 17 y. We used Latent Class Growth Analysis to group participants into classes based on common longitudinal trajectories of time spent in informal physical activity, organized sports, walking to and from school, sedentary behavior, and school-night and weekend sleep, respectively. We performed group-based multi-trajectory modeling to identify latent clusters of individuals who followed similar trajectories of informal physical activity, organized sports and walking to and from school, and who followed similar trajectories of these three domains together with sedentary behavior and sleep.ResultsThe large majority of males (82%) and all females failed to meet the World Health Organization (WHO) physical activity recommendation for adolescents of 60 min of moderate-vigorous intensity physical activity per day. The physical activity domains clustered together in three multi-trajectory groups that define individuals’ overall physical activity pattern. While two patterns indicated decreases in physical activity throughout adolescence, one pattern, including 29% of the sample in males and 17% of the sample in females, indicated higher levels of activity throughout adolescence. Sedentary behavior and sleep trajectories did not cluster together with the physical activity domains.ConclusionMost adolescents in this South African population did not meet WHO recommendations for physical activity. In this population, trajectories of sedentary behavior and sleep were independent of physical activity.

Taking the path of least resistance: a qualitative analysis of return to work or study while breastfeeding

BackgroundIn order to meet World Health Organization recommendations for breastfeeding, many women need to combine breastfeeding with return to work or study. Barriers are often encountered when returning to work or study, which can lead to premature cessation of breastfeeding. This study aimed to explore Australian women’s experiences of breastfeeding at one multi-campus university.MethodThis paper draws on the qualitative findings from a mixed-methods study conducted between April and November 2017. An online survey was used to explore women’s experiences of breastfeeding at university. In total, 108 people participated in the survey. After the deletion of incomplete surveys, 79 staff and students survey responses were analysed. In-depth interviews were also carried out with 10 staff and students. Open text responses and in-depth interviews were analysed using thematic analysis.ResultsThe analysis revealed four themes. The first theme, University as a positive and progressive environment for breastfeeding, explores staff and students’ experiences of maternity leave, flexible work arrangements, and on-campus childcare, and their relationships with tutors, supervisors, managers and colleagues. The second theme, Finding private and safe spaces for breastfeeding, presents staff and students’ experiences of using designated rooms, car parks, corridors, classrooms, and offices to breastfeed and express breast milk, and their experiences related to storage of breast milk. The third theme, Feeling self-conscious and unprofessional, reflects women’s experiences of mixing their professional and personal lives, and feeling guilty for taking time out to breastfeed. The fourth theme, Developing resilience to judgement, captures women’s realisation that breastfeeding on campus requires the development of a “thick skin” and the capacity to not be offended easily.ConclusionsSustaining breastfeeding requires time and commitment on behalf of the mother, as well as a supportive workplace or study environment. Transforming university campuses into breastfeeding friendly environments is long overdue and requires organisational commitment to achieve genuine reform.

Stay active for life: physical activity across life stages.

PurposeThis paper concerns participation of Poles aged 15+ years in leisure time and transport-related physical activity (PA) with a special focus on the life stages. The purpose of the paper was to analyze types of exercises, current and future behavior concerning PA, availability of sport and recreation facilities, and factors having the strongest relation with undertaking PA at a sufficient level according to pro-health recommendations of World Health Organization (WHO).Patients and methodsA survey was carried out on the representative sample (n=2,000). Respondents were classified in accordance to their life stages with a two-step cluster analysis. Relationships between meeting the dose of PA required for health recommendations and a membership in groups of life stages were evaluated using log-linear analysis. The strength of this relationship was expressed by the odds ratio. In order to capture relationships between meeting WHO recommendations and a set of explanatory variables, a predictive model was built.ResultsLife stages and various related events have a significant relation with a decrease of PA. Among groups of a particular risk, there are professionally active and unemployed people aged 50–64 years without children as well as retirees aged 65+ years who do not meet WHO recommendations (45.3; 50.4% and 47.6%). The unemployed and retirees more frequently (p<0.0001) do not or cannot practice sport and do not think that a change of their situation is expected soon. However, 35% of professionally active people aged 50–64 years without children and 18.2% of unemployed people declare that they are currently not active but if they had the possibility, they would start practicing sport.ConclusionCampaigns promoting PA should be targeted at groups of a particular risk. Any attempts of increasing PA or changing tendencies of its decrease should consider life conditions of these persons, as well as their needs, motivations, and barriers.

Prevalence and determinants of physical activity and sedentary behaviour before and up to 12 months after total knee replacement: a longitudinal cohort study

Objective: This study aims to evaluate the prevalence and determinants of inadequate physical activity and excessive sedentary behaviour before and after total knee replacement. Design, setting and subjects: Secondary analysis was performed on data from a cohort of 422 adults (45–74 years), drawn from 12 public or private hospitals, undergoing primary unilateral or bilateral total knee replacement surgery. Main measures: Questionnaires were used to determine the presence of inadequate physical activity and excessive sedentary behaviour before and 6 and 12 months after total knee replacement surgery. Knee pain, activity limitations, comorbidities, muscle strength, psychological well-being, fatigue, sleep and body mass index were measured/assessed as possible determinants of physical activity or sedentary behaviour. Results: Before surgery, 77% (n = 326) of the cohort participated in inadequate physical activity according to World Health Organization guidelines, and 60% (n = 253) engaged in excessive sedentary behaviour. Twelve months after surgery, 53% (n = 185) of the cohort engaged in inadequate physical activity and 45% (n = 157) in excessive sedentary behaviour. Inadequate physical activity before surgery (P = 0.02), obesity (P = 0.07) and comorbidity score >6 (P = 0.04) predicted inadequate physical activity 12 months after surgery. Excessive sedentary behaviour and activity limitations before surgery predicted excessive sedentary behaviour 12 months after surgery. Conclusion: Although there were improvements after total knee replacement, 12 months after surgery about half the cohort did not meet World Health Organization recommendations for activity. Pre-surgery assessment of physical activity, activity limitations, sedentary behaviour and body mass index is essential to identify patients at risk for long-term inactivity.

Potential Impact of Changes in the Schedule for Primary Diphtheria-Tetanus Toxoids-Pertussis Immunization as Control Strategy for Pertussis.

Pertussis is a vaccine-preventable respiratory disease that may cause death mainly in infants. The schedules for primary pertussis vaccination are set in each country by the local health authorities. Several different schedules meet World Health Organization recommendations, 2-4-6 months, 6-10-14 weeks, 2-3-4 months and 3-4-5 months being the most commonly used worldwide. In this work, we analyze the benefits of changing the vaccination schedule to control the disease. We used an age-structured deterministic mathematical model for pertussis transmission to compute the incidences for the 4 above-mentioned schedules. Different vaccination coverages and vaccine effectiveness levels were considered. Immunization data from Argentina and Belgium were used. The highest reduction in incidence was obtained by adopting the 6-10-14 weeks schedule, reaching about a 36% reduction of 0-1-year incidence with respect to the 2-4-6 months schedule. We show the dependence of this reduction on both vaccine effectiveness and coverage. The severe pertussis incidence decreased significantly when the first dose of the 2-4-6 months schedule was accelerated to 6 weeks. Finally, we estimated that the communication campaign adopted in Flanders (Belgium) to improve compliance with the vaccine schedule could lead to a reduction of 16% in severe pertussis incidence and about 7% in total incidence in infants. Our work highlights the use of mathematical modeling to quantify the benefits of the existing vaccination schedules and the strategies that could be implemented to improve their compliance. Our results indicated that the 6-10-14 weeks is the best schedule option and that the Belgium vaccination campaign significantly reduced the incidence of severe cases.

Exclusive breastfeeding and associated factors among mothers in Gozamin district, northwest Ethiopia: a community based cross-sectional study

BackgroundExclusive breastfeeding is defined as feeding infants only breast milk, be it directly from breast or expressed, except drops or syrups consisting of vitamins, mineral supplements or medicine. Exclusive breastfeeding is one of the essential actions for infant development and survival. However, the prevalence of exclusive breastfeeding in Ethiopia has been estimated at 52% which is far less than the World Health Organization (WHO) recommendations. Moreover, there are inconsistencies among estimates in different districts of the country. Therefore, this study aimed to assess the prevalence and associated factors of exclusive breastfeeding among mothers in Gozamin district, northwest Ethiopia.MethodsUsing the simple random sampling technique, seven kebeles (lowest administrative units) were selected as the primary sampling unit of the district. Sample mother-infant pairs were then selected using the systematic random sampling technique that involved our moving from house to house in each village. Data were collected from 506 mother-infant pairs using interviews. Factors associated with exclusive breastfeeding were determined using logistic regression. The measure of association used was the odds ratio, and statistical tests with p-values of less than 0.05 were considered as statistically significant.ResultsIn this study, the prevalence of exclusive breastfeeding among mothers was 74.1% (95% CI 70.80, 79.10). For government employee mothers, the odds of exclusive breastfeeding were reduced by half compared to housewives (AOR 0.49, 95% CI 0.26, 0.94). Mothers who did not receive breastfeeding counseling after delivery were 0.43 times less likely to practice exclusive breastfeeding compared with mothers who received the services (AOR 0.43, 95% CI 0.25, 0.72). Mothers who gave birth at health institutions were more likely to practice exclusive breastfeeding.ConclusionEven though the estimated prevalence is relatively high, more effort to meet WHO recommendations is still necessary. Therefore, we suggest health institutions encourage hospital birthing and increase breastfeeding counseling after delivery, and employers needs to give longer maternity leave to improve exclusive breastfeeding practice.

Physical activity of disabled individuals in the context of meeting WHO recommendations and support of local authorities.

This study aims to evaluate physical activity of disabled individuals in the context of fulfilling the World Health Organization (WHO) recommendations and to investigate the relationship between the risk of inactivity and activity of local authorities in this field. The sample consisted of 155 disabled individuals selected from a representative sample of the Polish society. The long version of the International Physical Activity Questionnaire (IPAQ-LF) and the survey of the determinants of a sport activity among the Polish population were applied. The relationship between meeting the WHO recommendations and environmental factors were investigated. According to the IPAQ-LF, 68.2% of the Polish disabled adults performed a recommended dose of physical activity during their leisure time. The total leisure activity was composed mainly of vigorous activities (58.8%), in a less extent of moderate activities (11.8%), and walking (7.2%). According to the survey of the sport activity determinants, 10.3% is active (0.7% exercises for ≥60 min 3 to 4 times a week, 3.9% per day). Based on our study results, there is a need to increase the activity of local authorities, promoting a participation in sport for all among Polish disabled individuals. In addition, these study results indicate methodological problems related with the implementation of the IPAQ-LF.

Decreased Vigorous Physical Activity in School-Aged Children with Human Immunodeficiency Virus in Johannesburg, South Africa

To describe physical activity in South African children with and without HIV. Study measurements were obtained in 218 children with perinatal HIV and 180 children without HIV aged 5-9years in a study conducted in Johannesburg, South Africa. Weight-for-age z-score, height-for-age z-score, frequency and duration of moderate and vigorous physical activity, and sedentary behaviors were obtained. These measurements were compared between children with and without HIV. Weight-for-age z-score and height-for-age z-score were significantly lower for children with HIV compared with those without HIV. Among children who attended school, fewer children with HIV than children without HIV participated in physical education (41% vs 64%; P=.0003) and organized after-school sports (38% vs 64%; P<.001). The proportion of children in both groups meeting World Health Organization recommendations for physical activity was similar (84% overall); however, girls with HIV spent less time in vigorous physical activity than girls without HIV (420 vs 780minutes/week; P=.001). This difference remained significant even when girls with a medical condition with the potential to limit physical activity were excluded, and after adjusting for age. Time spent in sedentary behaviors did not differ significantly between the two groups. Although children with HIV with well-controlled disease after initiating antiretroviral therapy early in life achieve high levels of physical activity, vigorous physical activity is lower in girls with HIV than in healthy controls. This finding may reflect lower participation in school-based physical education and organized after-school physical activity.

Fortification of Staple Cereal Flours with Iron and other Micronutrients: Cost Implications of following World Health Organization—Endorsed Recommendations

Wheat and maize flours are widely used delivery vehicles for mass fortification. In lower-income countries, most, if not all, national-level cereal flour fortification programs routinely fortify with iron; however, cofortification with other micronutrients is common. Little information is available on the cost implications programs face when considering current fortification practices versus what the World Health Organization (WHO) interim consensus statement recommends. The objectives of the present paper are to provide information on the costs of adding different chemical forms of iron and/or other micronutrients to premix formulations, and to discuss some of the issues that should be considered regarding which micronutrients to include in the premix. Nine countries in Latin America, Africa, and Asia (three countries per region) that currently cofortify with multiple micronutrients including iron were selected based on low (< 75 g/day), medium (75 to 149 g/day), and high (> or = 150 g/day) mean population flour consumption levels. Premix costs per metric ton of flour produced were estimated for improving iron formulations and for following WHO recommendations for other micronutrients. For the selected programs to maintain current premix formulations and improve iron compounds, premix costs would increase by between 155% and 343% when the iron compound was switched from electrolytic iron to sodium iron ethylenediaminetetraacetate (NaFeEDTA), by 6% to 50% when it was switched from electrolytic iron to ferrous sulfate, and by 4% to 13 when iron addition rates were adjusted without switching the compound. To meet WHO recommendations for other micronutrients, premix costs would increase the most when the amounts of vitamins B12 and A were increased. For programs that currently cofortify with iron and additional micronutrients, the quality of the iron fortificant should not be overlooked simply to be able to afford to add more micronutrients to the premix. Micronutrients should be selected according to population needs, costs, and potential beneficial synergistic reactions the added micronutrients may have.

Food groups and risk of forearm fractures in postmenopausal women in Chengdu, China

Background Forearm fractures are a major cause of disability in postmenopausal women. However, no prior report on the relationship of dietary patterns and forearm fracture in mainland China is available and the results from Western studies may not be applicable to the Chinese population.Objective To determine whether food groups are associated with the risk of forearm fracture among postmenopausal women in China.Design Case–control study.Methods Cases were 209 postmenopausal women aged 50–70 years with new forearm fractures, identified in hospitals in Chengdu. Controls were age- and district-matched subjects randomly selected from the community of Chengdu. Dietary habits and food group intake were measured by a structured food frequency questionnaire.Results The dietary pattern in Chinese postmenopausal women was of high intakes of cereals, vegetables, fruits, beans or bean products, but lower intakes of meat and milk. The estimated odds ratios (95% confidence intervals) for forearm fracture were 0.53 (0.42–0.67) for each quintile increase in vegetable intake, 0.73 (0.59–0.92) for each quintile increase in cereal intake, and 0.26 (0.14–0.48) in subjects who met World Health Organization (WHO) dietary recommendations for vegetables and fruits.Conclusions This is the first report indicating that the levels of vegetable and cereal intake, and that meeting WHO recommendations for vegetable and fruit intake, are associated with a decrease in the risk of forearm fractures in Chinese postmenopausal women.