Multinomial Regression Research Articles

Longitudinal Trajectories of Physical Teen Dating Perpetration and Trait Anger Expression: A Group-Based Trajectory Approach.

Dating violence is often perpetrated among adolescents, which increases the efforts to better understand individual risk factors for preventive efforts. Although multiple forms (i.e., physical and psychological) often coexist, few studies have studied the chronicity and developmental classes of physical teen dating violence and examined whether subtypes of trait anger predict teen dating perpetration over time. Thus, the purpose of the current study is to investigate: (a) the developmental group-based patterns of physical teen dating violence; and (b) whether subtypes of trait anger expression predict association in these classes using the Bullying, Sexual, and Dating Violence Trajectories from Early to Late Adolescence in the Midwestern United States, 2007 to 2013 dataset. Group-based trajectory modeling results identified four classes of teen dating violence perpetration (e.g., Accelerating, Abstaining, Desisting, and High Chronic). Multinomial logistic regression results indicated that expressing anger outwardly was positively associated with Desisting and High Chronic patterns, but not Accelerating patterns. These results suggest that there are four classes of teen dating violence perpetration and underscore the effects of expression of trait anger as a risk factor of teen dating violence perpetration. Practical and theoretical implications are discussed.

The link between serum cotinine levels and gallstones prevalence in adults: a cross-sectional analysis using NHANES data (2017–2020)

BackgroundGallstones represent a prevalent health issue globally, resulting in significant annual healthcare costs. While tobacco exposure is recognized for its association with numerous diseases, its correlation with gallstones remains contentious. Serum cotinine, a metabolite of nicotine, serves as a widely utilized indicator for assessing tobacco exposure. Crucially, no research has yet examined the association between serum cotinine levels and the gallstones.MethodsThis study is designed as a cross-sectional analysis, utilizing data from the NHANES public database. The relationship between serum cotinine levels and gallstones was analyzed using multinomial logistic regression models and smooth curve fitting. Subgroup analyses and interaction tests were performed to examine the potential contributions of different populations and covariates to the findings.ResultsA total of 5,856 participants were included in this study. After adjusting for relevant covariates, the multiple logistic regression model results indicated that for each unit increase in serum cotinine concentration above 0.29 ng/mL, there was a 29% increase in the prevalence of gallstones. Furthermore, smooth curve fitting analysis revealed a positive correlation between these variables. These findings underscore the impact of tobacco exposure on gallstone prevalence.ConclusionThis study demonstrates a positive correlation between tobacco exposure, as measured by serum cotinine levels, and the prevalence of gallstones, thus adding to the body of existing research on this relationship.

Youth and young adult flavour expectancies for new ‘non-menthol’ cigarettes introduced following California’s ban on flavoured tobacco products

BackgroundFollowing California’s statewide law prohibiting the sale of flavoured tobacco products, some cigarette brands introduced new variants advertised as non-menthol, yet featuring design and text commonly found in menthol cigarette...

Effects of trade and poaching pressure on extinction risk for cacti in the Atacama Desert.

In this era of a global biodiversity crisis, vascular plants are facing unprecedented extinction rates. We conducted an assessment of the extinction risk of 32 species and 7 subspecies of Copiapoa, a genus endemic to Chile's fog-dependent coastal Atacama Desert. We applied the International Union for Conservation of Nature Red List Categories and Criteria enhanced by expert insights and knowledge. Our primary aim was to analyze the impact of trade and poaching on their extinction risk. We employed machine learning models, including multinomial logistic regression (MLR), decision tree (DT), and random forest (RF), to analyze the relationships between conservation status and various factors. These factors encompassed trade and poaching activities, landscape condition, human footprint, monthly cloud frequency, and biological traits such as evolutionary distinctiveness and maximum diameter. Seven taxa had an area of occupancy (AOO) of <10km2, 10 additional taxa had an AOO of <20km2, and 16 taxa had an AOO of ≤100km2. This reassessment exposed a critical level of extinction risk for the genus; 92% of the taxa were classified as threatened, 41% as critically endangered, 41% as endangered, and 10% as vulnerable. MLR, DT, and RF exhibited accuracies of 0.784, 0.730, and 0.598, respectively, and identified trade and poaching pressure and landscape condition as the primary drivers of extinction risk. Our assessment of Copiapoa showed trade, poaching, habitat degradation, and their synergic impacts as the main drivers of the genus' extinction risk. Our results highlight the urgent need for nations to develop and enforce strategies to monitor and control trade and poaching pressure because these factors are crucial for the long-term persistence of desert plants.

Predicting Trust Dynamics With Personal Characteristics

Previous research into trust dynamics in human-autonomy interaction has demonstrated that individuals exhibit specific patterns of trust when interacting repeatedly with automated systems. Moreover, people with different types of trust dynamics have been shown to differ across seven personal characteristic dimensions: masculinity, positive affect, extraversion, neuroticism, intellect, performance expectancy, and high expectations. In this study, we develop classification models aimed at predicting an individual’s trust dynamics type–categorized as Bayesian decision-maker, disbeliever, or oscillator–based on these key dimensions. We employed multiple classification algorithms including the random forest classifier, multinomial logistic regression, Support Vector Machine, XGBoost, and Naive Bayes, and conducted a comparative evaluation of their performance. The results indicate that personal characteristics can effectively predict the type of trust dynamics, achieving an accuracy rate of 73.1%, and a weighted average F1 score of 0.64. This study underscores the predictive power of personal traits in the context of human-autonomy interaction.

Screening for depression in patients with epilepsy: same questions but different meaning to different patients.

Patient-reported outcome measures (PROMs) such as the Neurological Disorders Depression Inventory in Epilepsy (NDDI-E), a 6-item epilepsy-specific PROM, is used to screen for major depressive disorder symptoms for patients with epilepsy (PWE). The validity and interpretation of PROMs can be affected by differential item functioning (DIF), which occurs when subgroups of patients with the same underlying health status respond to and interpret questions about their health status differently. This study aims to determine whether NDDI-E items exhibit DIF and to identify subgroups of PWE that exhibit DIF in NDDI-E items. Data were from the Calgary Comprehensive Epilepsy Program database, a clinical registry of adult PWE in Calgary, Canada. A tree-based partial credit model based on recursive partitioning (PCTree) was used to identify subgroups that exhibit DIF on NDDI-E items using patients' characteristics as covariates. Differences in the identified subgroups were characterized using multinomial logistic regression. Of the 1,576 patients in this cohort, 806 (51.1%) were female, and the median age was 38.0 years. PCTree identified four patient subgroups defined by employment status, age, and sex. Subgroup 1 were unemployed patients ≤ 26 years old, subgroup 2 were unemployed patients > 26 years, subgroup 3 were employed females, while subgroup 4 were employed male patients. The subgroups exhibited significant differences on education level, comorbidity index scores, marital status, type of epilepsy, and driving status. PWE differed in their interpretation and responses to questions about their depression symptoms, and these differences were a function of sociodemographic and clinical characteristics.

Trajectories of cognitive function development and predictive factors in disabled middle-aged and older adults

ObjectiveTo explore the trajectories of cognitive function development and predictive factors in disabled middle-aged and older adults.MethodsUtilizing data from 983 disabled middle-aged and older adults in the China Health and Retirement Longitudinal Study (CHARLS) from 2013 to 2020, latent growth mixture models were constructed to analyze the categories of cognitive function development trajectories and their predictive factors.ResultsThe cognitive function trajectories of the disabled middle-aged and older adults were classified into three categories: rapid decline (32.6%), Slow decline (36.1%), and Stable (31.2%). Multinomial logistic regression analysis identified age, gender, residence, education, marital status, household income, sleep duration, depression, hearing ability, and social participation as predictors of these trajectories.ConclusionThere is heterogeneity in the cognitive function development trajectories among disabled middle-aged and older adults. Healthcare professionals can implement targeted health management based on the characteristics of different groups to prevent the deterioration of cognitive function in this population.

Associations between work-related factors and sickness presenteeism: a prospective study using the national French working conditions survey

ObjectivesThe objectives were to assess the prospective associations between work-related factors, including psychosocial and physical work factors and working time/hours factors, and sickness presenteeism alone or combined with sickness absence.MethodsThe...

Associations between rural/urban status, duration of untreated psychosis and mode of onset of psychosis: a mental health electronic clinical records analysis in the East of England, UK.

The influence of rurality on the duration of untreated psychosis (DUP) in first-episode psychosis (FEP) is poorly understood. We investigated factors associated with FEP in rural/urban settings and whether there are rural/urban differences in DUP and the mode (speed) of onset of psychosis. We used the Cambridgeshire and Peterborough NHS Foundation Trust Research Database (CPFTRD) to identify all persons presenting to an early intervention for psychosis service with FEP between 2013 and 2015. We performed descriptive statistics and multivariable linear and multinomial regression to assess the relationships between the study outcomes and the independent variables. One hundred and fifty-five FEP patients were identified, with a mean age of 23.4 (SD, 5.3) years. The median DUP was 129.0 (IQR: 27.5-524.0) days. In rural areas, FEP patients were more likely to be employed and live with family than those in urban areas. A longer DUP was observed among patients with an insidious onset of psychosis compared with an acute onset (619.5 (IQR: 333.5-945.0)) vs. (17.0 (IQR: 8.0-30.5)) days respectively, p < 0.0001. We found evidence that the mode of onset of psychosis differed by employment status and living circumstances. There was insufficient evidence of rural/urban differences in DUP and mode of onset of psychosis. Our results suggest that the mode of onset of psychosis is an important indicator of treatment delay and could provide vital information for service planning and delivery. Sociodemographic variations in FEP exist in rural populations, and our findings are similar to those observed in urban settings.

The association between dietary antioxidant quality score and intensity and frequency of migraine headaches among women: a cross-sectional study

BackgroundMigraine is an episodic disorder and a frequent form of headache. An impaired balance between free radical production and an impaired antioxidant defense system leading to oxidative damage may play a major role in migraine etiology. We sought to investigate whether dietary antioxidant quality score (DAQS) is associated with migraine intensity and frequency among women suffering from migraine.MethodsThis cross-sectional study was conducted on 265 women. The data related to anthropometric measures and dietary intake were collected. DAQS score was calculated based on FFQ (food frequency questionnaire) vs. the reference daily intake (RDI) quantity. To measure migraine intensity, the migraine disability assessment questionnaire (MIDAS) and visual analog scale (VAS) were used. The frequency of headaches was defined as the days the participants had headaches in the last month and a 30-day headache diary was used.ResultsThe results of the study demonstrated that VAS, MIDAS, and frequency of headaches were reduced significantly from the low DAQS (poor quality of antioxidants) to high DAQS (high quality of antioxidants) after adjusting covariates. Also, multinomial regression showed there was an inverse association between higher DAQS and the frequency of headaches. In the adjusted model, subjects with the higher DAQS were 69% less likely to have moderate migraine disability, compared with those with the lower DAQS. Linear regression showed, there was an inverse association between vitamin C intake and the grades of pain severity.َAlso in a crude model, a negative association was found between vitamin E and the frequency of headaches.ConclusionIn conclusion, Participants with higher DAQS had lower migraine intensity and headache frequency. In addition, the consumption of vitamin C may potentially associate with decreasing the severity of headaches. Dietary antioxidants should be monitored closely in individuals suffering from migraine.

Effects of Social Vulnerability and Environmental Burden on Care Fragmentation and Social Needs Among Individuals with Rheumatic Conditions.

Environmental hazards and heightened neighborhood social vulnerability coexist and disproportionately affect minoritized populations. We investigated associations between adverse environmental burden concentrated in areas with high social vulnerability with care fragmentation (missed appointments, Emergency Department (ED) visits and hospitalizations) and social needs (e.g., food and housing insecurity) among individuals with rheumatic conditions. We identified adults receiving care in a Massachusetts multihospital system with >2 rheumatic disease codes and complete street addresses. Geocoded addresses were linked to the CDC/ATSDR Social-Environmental Ranking (SER), which combines census tract social vulnerability variables (e.g., socioeconomic status) with environmental hazards (e.g., air and water pollution). Social needs were from self-reported surveys. Multilevel, multinomial regression models estimated associations between SER quartiles, care fragmentation, and social need burden, accounting for demographics and comorbidities. Among 16,856 individuals with rheumatic conditions, 70% were female, 6% were Black, 82% were White, and 7% resided in the highest combined social vulnerability and environmental burden (SER Quartile 4) areas. Among 7,083 with social needs data, 19% experienced >1 challenge. Individuals in SER Quartile 4 areas (vs. Quartile 1), had 2.02 (95% CI 1.67-2.46) times greater odds of >4 care fragmentation occurrences (vs. 0) and 2.37 (95% CI 1.73-3.25) times greater odds of >2 social needs (vs. 0). Residence in areas of high combined adverse environmental burden and social vulnerability was associated with significantly greater odds of care fragmentation and social needs. Addressing structural factors and emerging environmental threats contributing to these adverse exposures is essential to reduce rheumatic disease care inequities.

Effect of Non-Farm Income on Income Inequality in Pakistan

The portion of farm households' income outside the farm, such as non-farm salaries and wages, pensions, and interest income, is referred to as non-farm income. In Pakistan, non-farm profit is an essential source of income. "income inequality" describes the inequitable income distribution between people or families in a community or economy. Income inequality is a significant issue worldwide, including in Pakistan. This research estimated the effect of non-farm income on rural and urban areas and analyzed the relationship between non-farm income and income inequality within households. Secondary data from the Pakistan Social and Living Standard Measurement Survey Household data (2019-20) was used. Multinomial Logistic Regression was applied to the data, and income inequality was calculated using the Gini coefficient. The population was divided into quartiles to measure income distribution. The research found that non-farm income raises income inequality, while farm income is an income equalizer among the population. The reason behind this is that a major portion of income or wealth is accessed by the upper society, with only a minor portion reaching the lower levels of the population. Specifically, the Gini coefficient for non-farm income was 0.65, indicating higher inequality, compared to 0.45 for farm income. In urban areas, non-farm income provides large opportunities, while rural areas predominantly depend on the farm sector. There is a need to raise awareness about the non-farm sector in rural sector. The study's policy implications include the following: In order to improve agricultural households' income and low-income disparity, non-farm income activities have to be promoted. The study also suggests that Inequalities within rural communities should be addressed as part of an equal development strategy, in addition to the rural-urban gap.

Understanding community hate crimes as an incorrigible proposition: Local political attitudes, path dependence, and the ceremonious reporting of hate crime statistics

AbstractThe Hate Crime Statistics Act (HCSA) of 1990 requires the federal government to publicly release official hate crime statistics annually; the HCSA does not, however, mandate that local agencies submit hate crime reports to the government in the first place. Although research has evaluated the reporting of hate crime statistics in a dichotomous fashion (compliance vs. noncompliance), the current study suggests that the consistent and invariable reporting of zero hate crimes in a particular jurisdiction over time is unlikely and thus better conceptualized as a third response strategy: ceremonious compliance. We examine this strategy as a potentially unique institutional behavior, structured by local political and historical contexts, including discursive differences in the identification of hate crime as an important social problem, and localized histories of racial oppression. This research then uses multilevel multinomial logistic regression models to estimate variation in the likelihood of differential compliance strategies (i.e., true compliance, ceremonious compliance, noncompliance), according to several political and historical factors, including Republican vote share, location in the Confederate South, and historical lynchings. Findings reveal that political and historical contexts are important predictors of agency responses to hate crime, with a particular tendency toward ceremonious compliance in Republican‐leaning locales.

Self-perceived barriers to healthcare access for patients with post COVID-19 condition

BackgroundMany patients with post COVID-19 condition (PCC) require healthcare services. However, qualitative studies indicate that patients with PCC encounter many barriers to healthcare access. This cross-sectional study aimed to determine how many PCC patients report barriers to healthcare access and which barriers are reported, and to explore differences between subgroups.MethodsData were collected via an online survey from 10,462 adult patients with a confirmed or suspected COVID-19 infection in the Netherlands, who experienced persisting symptoms ≥ 3 months after the initial infection. To study self-perceived barriers, a list of eleven possible barriers was used, covering multiple aspects of healthcare access. Differences between subgroups based on sociodemographic characteristics, medical characteristics, PCC symptoms (fatigue, dyspnoea, cognitive problems, anxiety and depression), and healthcare use (general practitioner, paramedical professional, medical specialist, occupational physician and mental health professional) were studied through multivariable multinomial (0 vs. 1 vs. > 1 barrier) and binomial regression analyses (for each individual barrier).ResultsA total of 83.2% of respondents reported at least one barrier to healthcare access. Respondents reported a median of 2.0 (IQR = 3.0) barriers. The barriers “I didn’t know who to turn to for help” (50.9%) and “No one with the right knowledge/skills was available” (36.8%) were most frequently reported. Respondents with younger age, higher educational level, not hospitalized during acute COVID-19 infection, longer disease duration, who had more severe PCC symptoms, and who did not consult an occupational physician or paramedical professional, were more likely to report barriers. Analyses per barrier showed that women were more likely to report financial and help-seeking barriers, while men were more likely to report barriers related to availability of care. Hospitalized respondents were less likely to report barriers related to availability of care, but not less likely to report financial or help-seeking barriers.ConclusionsThis study shows that the majority of patients with PCC experiences barriers to healthcare access. Particular attention should be paid to younger, non-hospitalized patients with a long disease duration and severe PCC symptoms. Efforts to remove barriers should focus not only on improving availability of care, but also on helping patients navigate care pathways.

Predictors of outcomes in conservative management of high-grade renal trauma

BackgroundManagement of high-grade renal trauma is debatable, with the recent evidence embracing a conservative approach in the management of even grade 5 renal injuries. The study aimed to analyze the clinical profile of patients with high-grade renal trauma, assessing their management strategies, outcomes, complications, and need for ancillary procedures.MethodsA retrospective analysis of prospectively maintained data was performed involving blunt abdominal trauma patients with high-grade renal injuries (Grade 4 and 5) presenting to our hospital from January 2018 to December 2022. Patient data analyzed included demographics, clinical presentation, injury characteristics, complications, ancillary procedures, and mortality rates. All patients underwent renal functional assessment using an isotope renogram scan at the 3-month follow-up. Data collected were entered into a database and subjected to descriptive analysis using Jamovi version 2.3.28.ResultsThe study included 45 patients with a mean age of 29 years and a male-to-female ratio of 41:4. Most patients (n = 42) were managed conservatively. Thirty-eight patients had grade 4 injuries, and seven had grade 5 injuries. Twenty-six patients suffered renal parenchymal injuries alone, three patients had renal vascular injuries alone, and 16 patients had both parenchymal and vascular injuries. Grade 5 renal injury (p < 0.001), vascular high-grade injury (p < 0.001), angioembolization (p < 0.001), and blood transfusions (p = 0.021) were significantly associated with the incidence of poorly functioning kidney in high-grade renal trauma patients managed conservatively. Multinomial logistic regression analysis revealed angioembolization (p < 0.001), poorly functioning kidney post-trauma (p < 0.001), and blood transfusions (p < 0.001) were significantly associated with high-grade renal vascular injuries compared to high-grade renal parenchymal injuries.ConclusionConservative management is advisable for high-grade renal trauma in hemodynamically stable patients. High-grade vascular injuries are more severe than parenchymal injuries and correlate with poorer renal functional outcomes. Grade 5 renal injury, predominantly vascular high-grade injury, and the requirement for angioembolization and blood transfusions serve as significant predictors of poorly functioning kidneys post-trauma. Urologists should consider these predictors when counseling patients regarding potential outcomes following conservative management of high-grade renal trauma.

Effect of mothers‘ health literacy on early childhood allergy prevention behaviours: results from the KUNO-Kids health study

BackgroundParents can engage in several behaviours with regard to early childhood allergy prevention (ECAP). These can be related to diet of mother/child and the modification of the home environment; not all of them are justified by current evidence. Previous studies showed that parental health literacy (HL) is related to favourable health behaviours directed at the child. This study aimed to investigate the causal effect of mothers’ HL on ECAP behaviours and to test different moderators of this effect.MethodsOne thousand six hundred sixty-two mothers participating in the KUNO-Kids health study in the area of Regensburg, Germany were surveyed on HL (assessed via the health care scale of the Health Literacy Survey-EU questionnaire, HLS-EU-Q47) and ECAP behaviours implemented during pregnancy and the child’s first year of life. Patterns in ECAP behaviours were identified by latent class analysis. Multinomial regression modelling was performed with HL as exposure, ECAP as outcome variable, allergy risk, parental competence and bonding, anxiety and depression as moderators as well as potentially confounding variables.ResultsWe identified three classes of ECAP behaviours (class 1: „breastfeeding “ N = 871; class 2: „allergen-avoidance “ N = 490; class 3: „mixed behaviours “ N = 301). In univariable as well as fully adjusted regression models, compared to class 1, class 2 was negatively, and class 3 was not associated with HL. None of the tested moderating variables altered the association between HL and ECAP significantly.ConclusionsWe found an effect of mothers’ HL on ECAP behaviours: lower HL of mothers increased allergen-avoiding behaviour directed at their child, while decreasing the chance of exclusive breastfeeding. Improving HL could contribute to the implementation of recommended ECAP behaviours in families, especially to the reduction of allergen-avoiding behaviours.

The association between poverty and longitudinal patterns of adverse childhood experiences across childhood and adolescence: Findings from a prospective population-based cohort study in the UK

BackgroundAdverse childhood experiences (ACEs) affect up to half the general population, they are known to co-occur, and are particularly common among those experiencing poverty. Yet, there are limited studies examining specific patterns of ACE co-occurrence considering their developmental timing. ObjectiveTo examine the longitudinal co-occurrence patterns of ACEs across childhood and adolescence, and to examine the role of poverty in predicting these. Participants and settingThe sample was 8859 children from the Avon Longitudinal Study of Parents and Children, a longitudinal prospective population-based UK birth cohort. MethodsRepeated measures of ten ACEs were available, occurring in early childhood (birth-5 years), mid-childhood (6–10 years), and adolescence (11–16 years). Latent class analysis was used to identify groups of children with similar developmental patterns of ACEs. Multinomial regression was used to examine the association between poverty during pregnancy and ACE classes. ResultsSixteen percent of parents experienced poverty. A five-class latent model was selected: “Low ACEs” (72·0 %), “Early and mid-childhood household disharmony” (10·6 %), “Persistent parental mental health problems” (9·7 %), “Early childhood abuse and parental mental health problems” (5·0 %), and “Mid-childhood and adolescence ACEs” (2·6 %). Poverty was associated with a higher likelihood of being in each of the ACE classes compared to the low ACEs reference class. The largest effect size was seen for the “Early and mid-childhood household disharmony” class (OR 4·70, 95 % CI 3·68–6·00). ConclusionsA multifactorial approach to preventing ACEs is needed – including support for parents facing financial and material hardship, at-risk families, and timely interventions for those experiencing ACEs.

Differences between sexes in STEMI treatment and outcomes with contemporary primary PCI.

Historically, differences in timely reperfusion and outcomes have been described in females who suffer ST-segment elevation myocardial infarction (STEMI). However, there have been improvements in the treatment of STEMI patients with contemporary Percutaneous Coronary Intervention (PCI) strategies. Comparisons between sexes were performed on STEMI patients treated with primary PCI over a 4-year period (January 1, 2017-December 31, 2020) from the Queensland Cardiac Outcomes Registry. Primary outcomes were 30-day and 1-year cardiovascular mortality. Secondary outcomes were STEMI performance measures. The total and direct effects of gender on mortality outcomes were estimated using logistic and multinomial logistic regression models. Overall, 2747 (76% male) were included. Females were on average older (65.9 vs. 61.9 years; p < 0.001), had longer total ischemic time (69 min vs. 52 min; p < 0.001) and less achievement of STEMI performance targets (<90 min) (50% vs. 58%; p < 0.001). There was no evidence for a total (odds ratio [OR] 1.3 (95% confidence interval [CI]: 0.8-2.2; p = 0.35) or direct (adjusted OR 1.2 (95% CI: 0.7-2.1; p = 0.58) effect of female sex on 30-day mortality. One-year mortality was higher in females (6.9% vs. 4.4%; p = 0.014) with total effect estimates consistent with increased risk of cardiovascular mortality (Incidence rate ratio [IRR]: 1.5; 95% CI: 1.0-2.3; p = 0.059) and noncardiovascular mortality (IRR: 2.1; 95% CI: 0.9-4.7; p = 0.077) in females. However, direct (adjusted) effect estimates of cardiovascular mortality (IRR: 1.0; 95% CI: 0.6-1.6; p = 0.94) indicated sex differences were explained by confounders and mediators. Small sex differences in STEMI performance measures still exist; however, with contemporary primary PCI strategies, sex is not associated with cardiovascular mortality at 30 days or 1 year.

Predictors of inadequate gestational weight gain according to iom recommendations and intergrowth-21st standards: the araraquara cohort study

BackgroundGestational weight gain (GWG) is a critical factor for maternal and fetal health.ObjectiveTo identify maternal predictors of inadequate GWG according to the 2009 Institute of Medicine (IOM) recommendations and Intergrowth-21st standards.MethodsA prospective epidemiological cohort study conducted from 2017 to 2023 in southeastern Brazil assessed 1,557 women at three different stages of pregnancy (≤ 18, 20–26, and 30–36 weeks of gestation) and at delivery. Sociodemographic, obstetric, lifestyle, nutritional, and maternal morbidity characteristics were collected, along with biochemical parameters.ResultsAmong the participants, 38.7% had GWG above IOM recommendations, while 67.5% had GWG above the Intergrowth-21st standards. Multinomial logistic regression analysis showed that women with pre-pregnancy obesity and women with the highest body fat percentage had, respectively, a 95% (OR = 1.95; 95% CI: 1.08–3.51) and 1% (OR = 1.01; 95% CI: 1.01–1.05) higher chance of GWG above IOM recommendations. Pregnant women in the lowest tertile of height, smokers, number of previous pregnancies, and women living in crowded homes had, respectively, a 57% (OR = 0.57; 95% CI: 0.41–0.80), 36% (OR = 0.64; 95% CI: 0.37–0.86), 35% (OR = 0.65; 95% CI: 0.43–0.97), and 14% (OR = 0.86; 95% CI: 0.59–0.86) lower chance of GWG above IOM recommendations. Women with diabetes were 2.53 times more likely (OR = 2.53; 95% CI: 1.32–4.83) to have GWG below IOM recommendations. Using the Intergrowth-21st standards, women with the highest body fat percentage had a 12% (OR = 1.12; 95% CI: 1.02–1.24) higher chance of GWG above the 90th percentile. Pregnant women in the lowest tertile of height were 2.82 times more likely (OR = 2.82; 95% CI: 1.08–8.13) and women with the lowest hemoglobin concentrations had a 41% lower chance (OR = 0.59; 95% CI: 0.39–0.88) of having GWG below the 10th percentile. While both guidelines identified body fat percentage and pre-pregnancy obesity as significant predictors of excessive GWG, the Intergrowth-21st standards captured a higher percentage of women exceeding GWG limits.ConclusionThe findings underscore the importance of comparing two instruments for assessing the adequacy of GWG. The IOM and Intergrowth-21st standards provide complementary insights, which can help implement targeted interventions for specific groups of women based on their nutritional and socioeconomic status, lifestyle, and obstetric factors to prevent pregnancy-related complications.

Cardiometabolic multimorbidity in Mexican adults: a cross-sectional analysis of a national survey.

Cardiometabolic multimorbidity is a rising phenomenon that has been barely explored in middle-income countries such as Mexico. This study aimed to estimate the prevalence, associated factors, and patterns of cardiometabolic multimorbidity (2 and 3+ diseases) in Mexican adults (≥20 years old) by age group. A cross-sectional and secondary analysis of Mexico's National Health and Nutrition Survey 2018-2019 was conducted. Information on eight diseases and other sociodemographic and health/lifestyle characteristics was obtained through self-reporting. Descriptive analyses were performed, and multinomial logistic regression models were calculated to identify the variables associated with cardiometabolic multimorbidity. Factor analysis and latent classes were estimated to determine disease patterns. The prevalence of cardiometabolic multimorbidity for the total population study was 27.6% (13.7% for people with 2 diseases and 13.9% for people with 3+ diseases). By age group, the prevalence of 2+ diseases was 12.5% in the age group of 20-39 years, 35.2% in the age group of 40-59 years, and 44.5% in the age group of 60 years and older. The variables of depressive symptomatology and having functional limitations (1+) were statistically associated with cardiometabolic multimorbidity in almost all age groups. Patterns of cardiometabolic multimorbidity varied among adults in different age groups. Understanding the behavior of cardiometabolic multimorbidity at various stages of adulthood is a resource that could be used to design and implement intervention strategies. Such strategies should correspond to the population's sociodemographic, health, and lifestyle characteristics and the specific disease patterns of each age group.