World Health Organization Cutoffs Research Articles

Double Burden of Malnutrition among The College Students: A Cross-Sectional Study in Bankura, India

Aim: This study aims to evaluate the nutritional status and socio-demographic factors affecting college students in Bankura, West Bengal, India. Methods: A cross-sectional study was conducted with 220 college students selected through simple random sampling with proportional allocation. Nutritional status was assessed using World Health Organization cutoff points for underweight and overweight. Statistical analyses included Student’s t-test, ANOVA for continuous variables and chi-square for categorical data with significance set at p<0.05. Further analysis applied Dunnett's post hoc test for specific group comparisons. Results: Among students aged 18-22, 27.3% were underweight and 10.9% were overweight. Binary logistic regression revealed that per capita income was significantly associated with chronic energy deficiency. The model showed significance underscoring a double burden of malnutrition linked to socio-demographic factors. Conclusion: The study highlights a high prevalence of underweight and overweight status among college students with socio-demographic factors. Family income has a significant role in chronic energy deficiency. This study underscores the need for targeted nutritional interventions in this population. Keywords: body mass index, nutritional status, malnutrition, students, socioeconomic factors, India

Diagnosis of anemia in pregnant women according to gestational weeks and world health organization criteria

Introduction: anemia during pregnancy has been associated with increased maternal and perinatal mortality, as well as complications for the baby. Objective: to analyze the factors associated with the presence of anemia in pregnant women identified using the gestational week criterion and the World Health Organization cutoff point. Methods: cross-sectional study with a sample of 990 postpartum women living in the Greater Vitória Metropolitan Region - Espírito Santo, treated in public maternity hospitals and those affiliated with the Unified Health System of the region. They were classified as anemic and non-anemic according to both criteria, which allowed the analysis of the frequencies of anemia according to sociodemographic, clinical and obstetric factors, lifestyle habits and guidance on healthy eating. The chi- square and Fisher’s exact tests were used, followed by multiple logistic regressions in the statistical analyses. Results: a significant difference was found in the prevalence of anemia during pregnancy according to the criteria used, with 29.6% according to the World Health Organization criteria and 4.6% according to the gestational week. In the method by gestational week, women with up to eight years of schooling had a greater chance of anemia when compared to women with nine years or more (ORa = 3.43; 95% CI = 1.30-9.03) and smokers had a greater chance of anemia when compared to non-smokers (ORa = 4.86; 95% CI = 1.95-12.11). In the method proposed by the World Health Organization, only smoking was associated with a greater chance of anemia (ORa = 1.76; 95% CI = 1.10-2.81). Conclusion: the findings can be applied to the management of anemia during prenatal care and help in the implementation of public policies for pregnant women.

Assessing groundwater quality in the northwestern coastal area of Sri Lanka using multivariate statistical techniques

The objective of the present study was to assess groundwater quality in the northwestern coastal region of Sri Lanka by analyzing hydrogeochemical data using multivariate techniques. The study examined the relationship between water quality and sources influencing groundwater quality and proposed useful statistical tools for water resource management. Descriptive, comparative, correlation, factor analysis (FA), and discriminant analysis (DA) were among the techniques used. The water quality in terms of electrical conductivity (EC), total dissolved solids (TDS), and dissolved nitrate and phosphate concentrations of the northwestern coastal area, where different aquifer conditions prevailed, were compared, and differences in the mean concentrations of the above parameters were identified. The study also employed ridge regression and support vector machines (SVM) to predict nitrate levels and validate the results using a 70:30 train/test split. The analysis found that the mean concentrations of EC, TDS, and HCO3- are higher in the sandy aquifer area, while Fe2+ and PO43- are higher in the regolith aquifer area. EC, TDS, PO43-, and HCO3- in the hard-rock aquifer area exceed permissible limits. Factor analysis identified four factors contributing to pollution, and a linear discriminant model classified all observations with 99.9% accuracy. The water quality index for Kalpitiya, Vanathavillu, and Katana-Negombo areas was 68.1, 99.2, and 287.9, respectively, while the World Health Organization (WHO) cutoff was 50. The use of multivariate statistical techniques demonstrated the value of analyzing hydrogeochemical data to gain valuable insights into the complex interplay of factors affecting groundwater quality. The SVM model, using a linear kernel, was identified as the best model to predict nitrate levels. A combination of statistical analyses reveals that, with the exclusion of a few wells, the groundwater in the study area is polluted and inappropriate for human consumption or culinary purposes. Nonetheless, the inhabitants persist in utilizing it as their primary source of drinking water. This study reveals the combination of statistical analyses is useful for the management of groundwater resources.

Associations between socio-economic status in childhood and cardiovascular disease risk in adulthood

Cardiovascular disease (CVD) is a major national and international public health problem(1). Many factors contribute to the development of CVD including low socioeconomic status (SES), poor diet and obesity. Previous studies indicate that childhood SES may influence the development of CVD risk factors in adulthood(2). Therefore, the aim of this study was to explore associations between SES, as measured by area of residence, occupation group and population dietary quality during childhood, and CVD risk in older adults in Ireland, and to illustrate how the mapping of data from previous studies based on SES information can offer insights into health outcomes.The most recent clinical grandparent data from the Lifeways Cross-Generational Cohort Study (2001-2013)(3) were used. SES (area of residence and occupation group) data from the Lifeways grandparent data were mapped to population dietary quality from the 1948 National Nutrition Survey (NNS)(4), using the assumption that the grandparent’s current area of residence was the same as in 1948. The 1948 NNS included the assessment of individual nutritional status by a trained clinician. Clinical signs related to inadequate nutrition were recorded. Dietary quality, based on the assessment of dietary signs by the clinician, was categorised into poor, fair or good and was presented as the percentage of the population with poor, fair or good dietary quality for a given combination of occupation group and geographical area. The CVD risk variables [BMI, waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR)] in the Lifeways data were categorised based on World Health Organisation cut-offs. Blood pressure (BP) was categorised based on European Society of Hypertension/European Society of Cardiology guidelines. Relationships between the percentage of the population with poor, fair or good dietary quality in childhood and CVD risk factors were explored using Pearson’s or Spearman’s correlation as determined by the normality of data distribution. Chi-squared tests were used to investigate associations between age group, occupation group, area of residence and CVD risk factors. Binary logistic regression was used to test the predictive value of occupation group and area of residence independently on CVD risk factors.Some CVD risk factors (elevated or raised BP, a diagnosis of diabetes and/or being prescribed diabetes medications) were significantly associated with area of residence (p = <0.05).Grandparents in the Lifeways cohort from an unskilled manual background in childhood were more likely to be overweight/obese in adulthood (OR 4.67, 95% CI 1.41-15.54, p = 0.012). Inverse associations were observed between good population dietary quality in childhood and all CVD risk factors in adulthood (p <0.05).This secondary analysis of Lifeways grandparent data mapped to the 1948 NNS highlights the role childhood SES and dietary quality play in the development of CVD risk factors in adulthood and older age.

Double burden of malnutrition among young adult female (18-25 years) of West Bengal, India

Globally, malnutrition affects approximately one-third of the population, manifesting in various forms of undernutrition and overnutrition. This issue is particularly prevalent in developing countries, posing significant health concerns for female. To address this, the present study was undertaken to evaluate the nutritional status and related factors among female in Paschim Medinipur District and North 24 Pargana District of West Bengal, India. This cross-sectional study was conducted involving 337 females selected through a simple random sampling technique with proportional allocation. Data collection utilized a self-administered questionnaire. Nutritional status was determined based on the World Health Organization (WHO) cut off points for underweight and overweight. Statistical significance was set at a p<0.05. The study revealed that 16.91% of participants were underweight and 17.80% were classified as overweight or obesity. A significant association (χ2=28.400; p<0.01) was noted between monthly family income (MFI) group and nutritional status among the participants. The BMI of the participants were significantly different (F= 5.791; p<0.001) in varied MFI group. It was observed that age of the participants was significantly correlated with weight (r=0.360; p<0.01), height (r=0.294; p<0.01) and BMI (r=0.257; p<0.01). The present study clearly documented that age of the female and family income had significant influence on the nutritional status of the young adult female and more than one-third of participants were suffering from double burden of malnutrition.

Diagnostic Accuracy of Mid-Upper Arm Circumference for the Detection of Acute Malnutrition Among Children Aged 6-60 Months: A Diagnostic Accuracy Study.

Timely and accurate screening of malnutrition at the community level is essential to identifying malnourished children. The World Health Organization (WHO) guidelines classify non-oedematous acute malnutrition among children using mid-upper arm circumference (MUAC) or weight-for-height Z-score (WHZ). Study Design: A cross-sectional study. This study was conducted among children aged 6‒60 months. After necessary exclusions, 433 participants were selected using a multi-stage simple random sampling method. Using WHO guidelines for global acute malnutrition (GAM) [WHZ<-2, MUAC<12.5 cm], the sensitivity (Se), specificity (Sp), predictive values, likelihood ratios, Youden index, and receiver operating characteristic (ROC) curve were calculated for MUAC using WHZ as the criterion. Out of 433 participants, 30% were diagnosed with GAM using WHZ, while 17.6% were found malnourished using MUAC measurements. As per WHO cut-offs, the Se, Sp, positive predictive value (PPV), negative predictive value (NPV), Youden index, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) of MUAC were 48%, 96%, 83%, 81%, 0.44, 12, and 0.54, respectively. The ROC curve displayed an area under the curve of 0.86 (95% confidence interval=0.83, 0.90) for MUAC<12.5 cm. Bivariate Pearson correlation also demonstrated a positive linear relationship (R2=0.302) between the WHZ and MUAC variables. Based on the findings, 48% of the children were correctly identified by the MUAC with an 83% probability of GAM (PPV=0.83). Moreover, there was 96% Sp in non-malnourished children, with only 4% false positives. Therefore, personnel at the grassroots level can use MUAC for timely and accurate screening of children in Anganwadi centers (AWCs) due to its ease of use and simplicity.

Exploring anthropometric characteristics, weight status, and posture among preschool children in Serbia

The aim of this cross-sectional study was to determine the anthropometric characteristics, weight status, and posture of 6- and 7-year-old preschool-aged children. The sample of 922 children was divided by gender and age (monthly quartiles). Anthropometric characteristics were assessed using a battery of three variables: body height (BH), body mass (BM), and body mass index (BMI). BMI was categorized based on the World Health Organization (WHO) cutoff values, determining the degree of children’s weight status. Postural status was assessed by evaluating the following postural parameters: foot status, scoliosis, and dropped shoulders. Independent samples t-test showed no differences in anthropometric characteristics between boys and girls. According to ANOVA test, all three older groups (III, IV, and V) had significantly higher values in body height than the first two younger groups. In terms of body mass, IV and V groups had higher values than group I, and V had higher values than group II. Normal-weight children constituted 73.5%, while 14.4% were overweight and 8.8% were obese. Chi-square test revealed no difference in the degree of weight status by gender. Regarding postural status, 24.1% of children had scoliosis, 75.4% had abnormal foot status, and 59.8% had dropped shoulders. Chi-square test showed no difference between gender and postural deviations, except for foot status where boys significantly had more deviations than girls. This study contributed to diagnosing the anthropometric characteristics and posture of children and can be considered significant as the first study in this part of Serbia, serving as a starting point for future practical and research steps.

Severe nutritional anemia among hospitalized children in Central India – Descriptive study

Despite numerous efforts, pediatric nutritional anemia remains one of the most serious health issues in developing countries. Severe nutritional anemia is associated with a number of modifiable risk factors, which can be overcome if the risk factors are accurately identified and addressed for different population groups. The purpose of this descriptive study is to focus on severe nutritional anemia in hospitalized children aged 1–5 years in a tertiary care center in Central India. Hospitalized children were enrolled in the study, and demographic, socioeconomic, clinical, and laboratory data, as well as clinical and laboratory images, were reviewed. For defining severe anemia, the World Health Organization cutoff value was used. Out of total 9850 children of 1–5 years of age group admitted in hospital for 2 years, 197 children had severe nutritional anemia, indicated the incidence of 2%. Lower socioeconomic status and malnutrition were significantly correlated to severe nutritional anemia.

Factors associated with anemia among school-going adolescents aged 10–17 years in Zanzibar, Tanzania: a cross sectional study

BackgroundAnemia among adolescents (ages 10–19 years) is a leading cause of morbidity and mortality in low- and middle-income countries and carries long-term health and economic consequences. To address the issue, policymakers and programmers require evidence of the burden of anemia among adolescents in specific contexts, as well as an understanding of the factors associated with anemia in this population.MethodsWe conducted a cross-sectional survey as a baseline assessment to determine the prevalence and factors associated with anemia in secondary school students, as part of a cluster-randomized effectiveness trial testing different micronutrient supplementation strategies in addressing anemia among adolescents in Zanzibar. Between March 7th to 25th, 2022 the survey was conducted on 2,479 school-going adolescents aged 10–17 years from 42 schools on the island of Zanzibar, Tanzania. Hemoglobin concentration was measured along with the collection of socio-demographics, health, food frequency, and water, sanitation and hygiene data.ResultsBased on the World Health Organization cutoffs for anemia, 53.3% of the sample had anemia (mild, moderate, or severe). Using chi-square tests and logistic regressions, we determined that females had higher odds of anemia than males (Adjusted OR = 1.47; 95% CI: 1.24, 1.74), those in the highest wealth quintile had lower odds of anemia than those in the lowest wealth quintile (Adjusted OR = 0.7; CI: 0.54, 0.91), stunted adolescents had higher odds of anemia than non-stunted students (Adjusted OR = 1.38; 95% CI: 1.06,1.81), and those who used shared toilets had higher odds of moderate or severe anemia than those with private toilet access (Adjusted OR = 1.68; CI: 1.07, 2.64).ConclusionsThe high prevalence of anemia in this sample indicates an urgent need to address anemia among adolescents in Zanzibar, and the factors associated with anemia point to the importance of water, sanitation, and hygiene interventions in addition to dietary and nutritional support.Trial RegistrationNCT05104554, registered 03/11/2021.

Plasmodium falciparum parasite density in symptomatic and asymptomatic malaria among residents of Abuja, Nigeria

Objectives Plasmodium falciparum is prevalent in sub-Saharan Africa and constitutes the greatest public health burden relative to the four species of the parasite that infect humans. World Health Organization (WHO) uses parasite density to describe malaria severity, where 250,000 parasites/µL and 500 parasites/µL are set as the cutoff points for hyperparasitemia in low and high P. falciparum endemic regions, respectively. This classification may not be universal as different factors influence parasite density. This study evaluated the parasite densities in symptomatic and asymptomatic persons in Abuja with a view to understanding host tolerance to P. falciparum in an endemic condition. Materials and Methods This study was carried out using 246 blood samples each from symptomatic and asymptomatic volunteers, from two area councils in Abuja following WHO standard methods for Malaria microscopy. Results The result revealed symptomatic and asymptomatic groups with median axillary temperature that differed significantly (P = 0.012), parasite densities both lower that WHO cut off mark, and did not differ significantly between symptomatic and asymptomatic, among different age groups and catchment areas (P &gt; 0.05). Conclusion Parasite density does not differ in symptomatic and asymptomatic subjects in P. falciparum, which is endemic in Abuja and is lower than WHO set values.

Environmental exposure to industrial air pollution is associated with decreased male fertility

To understand how chronic exposure to industrial air pollution is associated with male fertility through semen parameters. Retrospective cohort study. Men in the Subfertility, Health, and Assisted Reproduction cohort who underwent a semen analysis in the two largest healthcare systems in Utah from 2005-2017 with ≥1 measured semen parameter (N = 21,563). Residential histories for each man were constructed using locations from administrative records linked through the Utah Population Database. Industrial facilities with air emissions of nine endocrine-disrupting compound chemical classes were identified from the Environmental Protection Agency Risk-Screening Environmental Indicators microdata. Chemical levels were linked with residential histories for the 5 years before each semen analysis. Semen analyses were classified as azoospermic or oligozoospermic (< 15 M/mL) using World Health Organization cutoffs for concentration. Bulk semen parameters such as concentration, total count, ejaculate volume, total motility, total motile count, and total progressive motile count were also measured. Multivariable regression models with robust standard errors were used to associate exposure quartiles for each of the nine chemical classes with each semen parameter, adjusting for age, race, and ethnicity, as well as neighborhood socioeconomic disadvantage. After adjustment for demographic covariates, several chemical classes were associated with azoospermia and decreased total motility and volume. For exposure in the 4th relative to 1st quartile, significant associations were observed for acrylonitrile (βtotal motility = -0.87 pp), aromatic hydrocarbons (odds ratio [OR]azoospermia = 1.53; βvolume = -0.14 mL), dioxins (ORazoospermia = 1.31; βvolume = -0.09 mL; βtotal motility = -2.65 pp), heavy metals (βtotal motility = -2.78pp), organic solvents (ORazoospermia = 1.75; βvolume = -0.10 mL), organochlorines (ORazoospermia = 2.09; βvolume = -0.12 mL), phthalates (ORazoospermia = 1.44; βvolume = -0.09 mL; βtotal motility = -1.21 pp), and silver particles (ORazoospermia = 1.64; βvolume = -0.11 mL). All semen parameters significantly decreased with increasing socioeconomic disadvantage. Men who lived in the most disadvantaged areas had concentration, volume, and total motility of 6.70 M/mL, 0.13 mL, and 1.79 pp lower, respectively. Count, motile count, and total progressive motile count all decreased by 30-34 M. Several significant associations between chronic low-level environmental exposure to endocrine-disrupting compound air pollution from industrial sources and semen parameters were observed. The strongest associations were seen for increased odds of azoospermia and declines in total motility and volume. More research is needed to further explore additional social and exposure factors as well as expand on the risk posed to male reproductive health by the studied chemicals.

Mediterranean Diet Adherence and Physical Activity Level in Adolescents During the Lockdown in the COVID-19 Pandemic: A Cross-sectional Study in Greek Island of Rhodes

Background: Nutrition is involved in various ways in the 17 distinct SDGs of United Nations Agenda 2030. The COVID-19 pandemic is testing the world threatening health, nutrition, education, and social protection. Objective: The objective of this study was to assess the adolescents’ adherence to the Mediterranean diet that attended senior high school in the Greek city of Rhodes during the lockdown period. Methods: In this cross-sectional, observational study the sample of the research was 227 students aged 11-15 years old, that self-reported their weight and height and completed validated questionnaires for their nutritional attitudes. Results: The percentages of students who were overweight/obese were 22.5% of the total sample (17.2% overweight and 5.3% obese) according to the IOTF (International Obesity Taskforce) cutoffs and 30.4% (21.6% overweight and 8.8% obese) according to the WHO (World Health Organization) cutoffs. The average KIDMED score of the sample was medium (6.00) and the adherence to the Mediterranean diet of the sample needs improvement. Conclusion: Results support a shift from traditional Mediterranean diet to more unhealthy eating patterns. Adolescents' limited physical activity mainly on weekdays was reported, and further research could examine the role of distant education for this behavior. Policies and strategies targeting the students’ population are essential for adolescents’ nutrition education and the improvement of their dietary habits toward the sustainable Mediterranean diet, during the specific circumstances of covid pandemic.

The combined effect of air and transportation noise pollution on atherosclerotic inflammation and risk of cardiovascular disease events

Air pollution and noise exposures individually associate with major adverse cardiovascular events (MACE) via a mechanism involving arterial inflammation (ArtI); however, their combined impact on ArtI and MACE remains unknown. We tested whether dual (vs. one or neither) exposure associates with greater ArtI and MACE risk and whether MACE risk is mediated via ArtI. Individuals (N=474) without active cancer or known cardiovascular disease with clinical 18F-FDG-PET/CT imaging were followed for 5 years for MACE. ArtI was measured. Average air pollution (particulate matter≤2.5μm, PM2.5) and transportation noise exposure were determined at individual residences. Higher exposures were defined as noise >55 dBA (World Health Organization cutoff) and PM2.5 ≥sample median. At baseline, 46%, 46%, and 8% were exposed to high levels of neither, one, or both pollutants; 39 experienced MACE over a median 4.1 years. Exposure to an increasing number of pollutants associated with higher ArtI (standardized β [95% CI: .195 [.052, .339], P=.008) and MACE (HR [95% CI]: 2.897 [1.818-4.615], P<.001). In path analysis, ArtI partially mediated the relationship between pollutant exposures and MACE (P<.05). Air pollution and transportation noise exposures contribute incrementally to ArtI and MACE. The mechanism linking dual exposure to MACE involves ArtI.

Accuracy of Mid-Upper Arm Circumference for Detecting Acute Malnutrition in Children Aged 6-59 Months in an Urban Slum in Bangladesh: A Cross-Sectional Analysis.

Background The weight-for-height z-score (WHZ) is considered the gold standard for detecting acute malnutrition in children. However, an accurate assessment of WHZ can often be challenging, especially in community settings. Mid-upper arm circumference (MUAC) is a simple and easy-to-perform method to identify children with acute malnutrition. The objective of the study was to evaluate the accuracy of MUAC in detecting acute malnutrition compared to WHZ among children aged 6-59 months in Bangladesh. Methods We used anthropometric data for 239 children aged 6-59 months from a cross-sectional study conducted in 2013 in an urban slum in Dhaka, Bangladesh. The sensitivity and specificity of MUAC to detect acute malnutrition were calculated, considering WHZ as the gold standard. Results The mean age of the children was 29.4 ± 12.7 months, with a male-to-female ratio of 1:1.2. The prevalence of acute malnutrition was 17.1% and 22.5% based on WHZ and MUAC, respectively. The total area under the receiver operating characteristic curve was 0.816. For detecting acute malnutrition, the sensitivity of MUAC was 61.0% and the specificity was 85.4% for the World Health Organization (WHO) recommended cutoff of <125 mm. Using the Youden index, the best MUAC cutoff point to detect acute malnutrition was <128 mm with a sensitivity of 75.6% and a specificity of 74.7%. Conclusions Our study demonstrated a low sensitivity of MUAC to identify acute malnutrition at the WHO cutoff of <125 mm. The cutoff could be increased to <128 mm to capture more children with acute malnutrition.

Under-nutrition and its determinants among school-aged children in northwest Ethiopia

Malnutrition among children has lifelong implications, its outcomes not only cover the whole life but also transfer from one generation to another generation. Most studies conducted before focused on undernutrition in pregnant mothers and children less than 5 years of age, whereas school-age children are often omitted from health and nutrition surveys or surveillance. In Northwest Ethiopia, particularly in the study area, the community levels nutritional status of school-age is not well studied and documented. Therefore, this study aimed to assess the prevalence and determinants of the under-nutritional status of school-age children in Gondar Zuria District, Northwest Ethiopia. A community-based cross-sectional study design was employed with 364 respondents from January to April 2020. Data entered using Epi Data software version 3.1. Standard deviation scores were obtained by the world health organization Anthro Plus software to determine the nutritional status of children, and further analysis was done by using STATA version 14 software. Adjusted odds ratio with its corresponding 95 % confidence interval was used to declare statistically significant variables. The prevalence of overall under-nutrition was 71.98% (95%, CI: 67%-76%) from which, 43.13% (95%, CI: 38%-48%) were stunted, 40.93% (95%, CI: 35%-46%) were under-weight, and 35.44% (95%, CI: 30%-40%) were wasted. Child age [AOR = 0.30, 95% CI (0.13-0.68)], food insecurity [AOR = 2.24, 95% CI (1.03-4.83)], good knowledge of mother/care giver [AOR = 0.40, 95% CI (0.17-0.92)], having larger family size (Tzioumis and Adair, 2014; Wolde etal., 2015; Mohammed etal., 2019) [6-8] [AOR = 2.92, 95% CI (1.29-6.58)], and unprotected drinking water sources [AOR = 2.84, 95% CI (1.00-8.06)] were the predictors of under-nutrition. According to the world health organization cut-offs, the prevalence of overall under-nutrition in the study area was very high. Child age, food insecurity, knowledge of mother/caregiver, having a larger family size, and unprotected drinking water sources were the predictors of under-nutrition. The district offices should give attention to the improvement of the food security status of the community, and give priority to the availability and accessibility of drinking water sources, particularly pipe water sources. Special attention to older age groups of children is important to control the prevalence of under-nutrition.

Anthropometry based nutritional status of unmarried adolescent girls (15-19 Y) of urban Vadodara, Gujarat, India

: The word ‘adolescence’ is derived from the Latin verb ‘adolescere’, which means “grow to maturity.” The World Health Organization (WHO) defines adolescents as young people aged 10-19 years. There are about 1.2 billion adolescents, a fifth of the world’s population. Nutrition is key to unlocking the potential of investment in the health of women, children and adolescents. After obtaining necessary permission from Vadodara Mahanagar Seva Sadan 250 unmarried adolescent girls aged 15-19 years were enrolled in the study. Data on Socio-Economic background (SES) for enrolled girls’ families, Weight and Height was collected using pre-tested semi structured questionnaire. Thinness was assessed using age and sex specific WHO cut-offs for BMI for age (5-19Y). Stunting was identified using WHO cut-offs for Height for age criteria. Mean age of the adolescent girls was 16.3 years. 62% of the adolescent girls were attending school. 70% of adolescent girls were belonging to reserve category (SC/ST/OBC). It was found that 15.2 % and 6.4% of the girls were moderately and severely thin respectively. Only 13.2 % adolescent girls had normal BMI for age. Prevalence of stunting was 80.8%. Thinness and stuntingin unmarried adolescent girls (15-19 years) of urban area is a cause of concern.

Necrosis is an independent predictor of disease-free and overall survival in pancreatic well-differentiated neuroendocrine tumours (NETs): a proposal to include it in grading systems

Pancreatic neuroendocrine tumours (NETs) are currently graded using the World Health Organization (WHO) 2019 system, which is based solely on mitotic count and Ki-67 proliferative index. Although necrosis is a well recognised adverse prognostic feature that is included in the grading systems of NETs of certain types such as pulmonary carcinoid and medullary thyroid carcinoma, there is currently insufficient evidence to support its inclusion in the grading of pancreatic NETs. Therefore, we sought to investigate the prognostic significance of tumour necrosis in our cohort of resected pancreatic NETs, with a view to providing evidence to support its incorporation into the WHO grading scheme. Under our proposal, pancreatic NETs without necrosis would continue to be graded based solely on mitotic count and Ki-67 index using the established WHO cut-offs, while NETs with tumour necrosis would be classified as grade 3, irrespective of proliferative activity. Using this system in our cohort of 110 resected pancreatic NETs, overall survival (OS) was 250, 198, and 151 months (p=0.039) and disease-free survival (DFS) was 180 months, 117 months, and 38 months (p<0.0001) for grades 1, 2, and 3, respectively. In contrast, there was no significant difference in OS (p=0.231) or DFS (p=0.058) between low grade (grade 1) and intermediate-high grade (grade 2/3) tumours using the current WHO system which does not consider necrosis. Interobserver concordance for assessment of necrosis was excellent. In conclusion, necrosis is an independent predictor of OS and DFS for pancreatic NETs, and our findings strongly support its addition to the grading scheme for this tumour.

Prevalence of iodine deficiency among Moroccan women of reproductive age

BackgroundIodine deficiency disorders (IDD) affects nearly 1.9 million people worldwide. Iodine deficiency (ID) remains a public health concern not only for pregnant women, but for women of reproductive age (WRA) as well. This study was planned to evaluate the iodine status and the prevalence of iodine deficiency in a nationally representative sample of Moroccan WRA according to their socio-economic data and living areas.MethodsThis study is a cross-sectional national survey conducted on 1652 WRA aged between 18 and 49 years. Iodine status was assessed by the evaluation of the urinary iodine concentration (UIC) on spot urinary samples, using the Sandell-Kolthoff reaction, and by the estimation of iodine-rich food consumption, using a food frequency questionnaire. The World Health Organization cutoff of a median UIC of < 100 μg/l was used to define ID in the population.ResultsThe median UIC [20th- 80th] was 71.3 μg/l [37.5–123.1] and 71% of participants had UIC < 100 μg/L, indicating insufficient iodine status and mild iodine deficiency. WRA from urban and rural areas showed an UIC median of 75.94 μg/l [41.16–129.97] and 63.40 μg/l [33.81–111.68], respectively. Furthermore, ID prevalence was significantly higher in rural areas (75.6%) as compared to urban areas (67.9%) (p < 0.05). Food frequency questionnaires analyses highlighted that dairy products are the most commonly consumed iodine-rich food, reported to be consumed daily by 43.1% of WRA. Of particular interest, 83.5% of WRA reported a weekly consumption of fish.ConclusionID is still a public health problem in Morocco highlighting the necessity to implement effective national program, including efficient salt iodization, effective nutritional education and awareness, to control iodine deficiency and prevent IDD development.

In vitro effects of aqueous extract of unfermented rooibos on human spermatozoa.

The inability to conceive is a baleful experience for thousands of couples worldwide. Among different well‐known reproductive techniques, medicinal plants have been utilized to treat male infertility. Medicinal plants, provide a therapeutic alternative, which is available and affordable for infertile couples. We investigated the direct effect of unfermented rooibos aqueous extract on human spermatozoa. Semen samples (n = 50) collected from donors and patients consulting for fertility were reassigned as normal (n = 22) and abnormal (n = 28) samples based on the outcome of the baseline semen analysis, using the World Health Organization (WHO) cut off value. Semen samples were allowed to liquefy and subsequently washed with human tubular fluid in bovine serum albumin medium. The samples were then treated with aqueous extracts of unfermented rooibos (0, 0.15, 1.5, 15, 150 μg/ml) at 37°C for 1 h and assessed thereafter. Sperm motility, vitality, DNA fragmentation, intracellular reactive oxygen species and mitochondrial membrane potential in both groups remained unchanged (p > 0.05). However, aqueous extract of unfermented rooibos (only at 1.5 μg/ml) significantly increased capacitation and acrosome reaction in the abnormal sample group (p > 0.05). Unfermented rooibos aqueous extract had no deleterious impact on human spermatozoa's function and might be attributed to its antioxidant properties.

Prognostic value of anemia in patients with ST-elevation myocardial infarction

Abstract Introduction Haemoglobin (Hb) levels are an important outcome predictor in several diseases. Purpose We aimed to evaluate Hb at hospital admission in patients with ST-segment elevation myocardial infarction (STEMI) as a predictor of in-hospital complications, mortality and heart failure (HF) during follow-up. Methods We retrospectively studied consecutive STEMI patients treated with primary percutaneous coronary intervention between January 2010 and December 2016. Clinical data was retrieved by review of patients' clinical records. Severity of anaemia was defined according World Health Organization cut-offs. Results Of 864 patients with mean age of 63±13 years, 646 (75%) were male. Mean Hb at hospital admission was 14±2g/dL, 682 (81%) with normal Hb, 118 (14%) with mild anaemia, 45 (5%) with moderate anaemia and 2 (0.2%) with severe anaemia. Female gender, smoking, diabetes, hypertension, previous myocardial infarction and peripheral artery disease were associated to higher incidence of anaemia at hospital admission. Anaemia was also associated to Killip-Kimball (KK) class ≥II at hospital admission. They also had higher incidence of in-hospital stroke, advanced atrioventricular block, gastrointestinal bleeding and blood transfusion. In-hospital mortality was 9%, higher patients with anaemia (13% vs 7%, p=0.022). Median follow-up was 43 (26–66) months. All-cause mortality was 14%, higher in patients with anaemia (27% vs 11%, p&amp;lt;0.001, Log rank test p&amp;lt;0.001). In multivariate analysis, age (HR 1.1, 95% CI 1.0–1.1), diabetes (HR 1.9, 95% CI 1.1–3.4), left ventricular ejection fraction (LVEF) at discharge (if &amp;lt;50%, HR 3.4, 95% CI 1.6–7.2), and anaemia at admission (HR 1.8, 95% CI 1.0–3.2) were independent predictors of all-cause death during follow-up. Incidence of de novo HF, clinical worsening or hospitalization was 18%, higher in patients with anaemia (27% vs 17%, p=0.007, Log rank test p=0.007). In multivariate analysis, age (HR 1.1, 95% CI 1.0–1.1), KK class (if II, HR 2.1, 95% CI 1.3–3.5; if III, HR 4.0, 95% CI 1.8–8.9; if IV, HR 2.1, 95% CI 1.2–3.9), body mass index (if obese, HR 2.5, 95 CI 1.4–4.4) and LVEF at discharge (if &amp;lt;50%, HR 4.2, 95% CI 2.2–7.7), but not anaemia at admission (p=0.633) were independent predictors HF. Conclusion In our contemporary cohort of STEMI patients, the presence of anaemia at hospital admission was not only associated to in-hospital complications, but also all-cause mortality during follow-up. Funding Acknowledgement Type of funding sources: None.