Publications by authors named "Rihlat Said-Mohamed"

26 Publications

  • Page 1 of 1

Determinants of energy intake in Central African populations experiencing nutrition transition.

Br J Nutr 2021 Aug 19:1-10. Epub 2021 Aug 19.

UMR7206 Eco-Anthropologie, CNRS-MNHN-University Paris Diderot-Sorbonne Paris Cité, Paris, France.

Central Africa is experiencing rapid urbanisation, and this situation comes along with changes in food habits and an increased prevalence of obesity and associated health risks. Factors influencing dietary intake among the diverse African populations are not well understood. Our objective was to characterise the dietary intake and their determinants in the two main ethnic groups experiencing nutrition transition in Cameroon, the Bamiléké and the Béti. We sampled Bamiléké (381) and Béti (347) adults living in both rural and urban, collected socio-demographic variables, assessed dietary patterns by using a food portion photographs book to administrate a FFQ and a 24-h dietary recall technique and derived their BMI from measured weight and height. The dietary patterns of Bamiléké people were composed of more energy-dense foods than the Béti people, regardless of the living area. The energy intake (13·8 (sd 4·6)-15·4 (sd 4·8) MJ v. 9·7 (sd 3·5)-11·2 (sd 3·9 MJ) and the obesity (15-29 % v. 5-8 %) were therefore higher in Bamiléké than in Béti, respectively. Multivariable linear regression analyses showed strong associations of both ethnicities (4·02 MJ; P < 0·001), living area (0·21 MJ; P < 0·001) and education (0·59 MJ; P < 0·048) with energy intake, independently of each other and other socio-demographic factors. The ethnicity factor has been characterised as the more important determinant of diet. Our findings provide new insights and perspectives highlighting the importance of anthropological factors when building prevention campaigns against obesity in Central Africa.
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http://dx.doi.org/10.1017/S0007114521003159DOI Listing
August 2021

Advocating for a Collaborative Research Approach on Transgenerational Transmission of Trauma.

J Child Adolesc Trauma 2021 Jun 3:1-5. Epub 2021 Jun 3.

Department of Archaeology, University of Cambridge, Cambridge, UK.

Since Myers (1915) coined the term 'shell shock' to define the prolonged suffering of soldiers returning from the Great War, the psychological and physical result of distressing experiences, known as trauma, has been of academic interest. Transgenerational transmission of trauma effects has been recorded, demonstrating that on some level, the exposure to trauma of one generation can impact individuals of a subsequent generation (Yehuda & Lehrner, 2018). Observational studies on children of holocaust survivors formed the basis of this trajectory of research (Rakoff, 1966), and eventually this phenomenon became referred to as the transgenerational transmission of trauma (TTT). Since then, TTT has been observed in several contexts, including within families who have experienced high rates historical trauma (O'Neill et al., 2016), within regions high-frequencies of historical war and terrorism (Yehuda & Lehrner, 2018) and those who have undergone famine (Ahmed, 2010). This report aims to outline several pathways (biological, psychological, and sociological) by which trauma may be transmitted across generations. Moreover, it discusses several methods of trauma assessment and the related challenges and benefits. Lastly, this report advocates a biopsychosocial approach - an interdisciplinary model using the interplay of biological, psychological, and social-environmental factors - to research TTT. By promoting the benefits of such an interdisciplinary approach we attempt to break up silos between disciplines and encourage collaboration between academics from various backgrounds researching this topic to better serve individuals impacted by TTT.
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http://dx.doi.org/10.1007/s40653-021-00369-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172554PMC
June 2021

Association Between Household and Maternal Socioeconomic Factors with Birth Outcomes in the Democratic Republic of Congo and South Africa: A Comparative Study.

Matern Child Health J 2021 Aug 4;25(8):1296-1304. Epub 2021 May 4.

SAMRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Objective: To assess and compare the associations between household socioeconomic (SES) factors with birth outcomes (low birth weight (LBW), small-for-gestational age (SGA) and preterm birth (PTB)) in the Democratic Republic of Congo (DRC) and South Africa (SA).

Methods: Cross-sectional data of mother-newborn pairs collected in 2017 in the DRC were compared with mother-newborn pairs data from the SA Soweto first 1000-days pregnancy cohort study (2013-2016). Country-specific and pooled multivariable logistic regressions analyses assessed the associations between maternal education, marital status, and housing with LBW, SGA, and PTB adjusted for maternal anthropometry and obstetric factors.

Results: 1084 mother-newborn pairs were recruited (DRC: 256; SA: 828). The rates of LBW, PTB and SGA were, 11.5%, 17.1% and 32.8% in the DRC and 15.9%, 10.5% and 20.1% in SA. SES factors differed between countries and sex. In the DRC, being married decreased the odds of having LBW and PTB children by 86% and 80%, respectively. In SA, being a mother with secondary level of education and above was associated with 86% reduced odds of SGA. In the pooled analyses, women with secondary level of education and above had a 2.2-fold increase in odds of giving birth to a PTB newborn. Country of residence and maternal nutritional status were stronger predictors of birth outcomes than SES factors.

Conclusion For Practice: In sub-Saharan Africa, policies aiming to alleviate women's education combined with improved social support and household SES prior to and during pregnancy are critical to optimal neonatal outcomes and strategic to achieve the Sustainable Development Goals.
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http://dx.doi.org/10.1007/s10995-021-03147-xDOI Listing
August 2021

Elevated rates of horizontal gene transfer in the industrialized human microbiome.

Cell 2021 Apr 31;184(8):2053-2067.e18. Epub 2021 Mar 31.

The Global Microbiome Conservancy, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Internal Medicine and Therapeutics, School of Medical Sciences University of Cape Coast, Cape Coast, Ghana.

Industrialization has impacted the human gut ecosystem, resulting in altered microbiome composition and diversity. Whether bacterial genomes may also adapt to the industrialization of their host populations remains largely unexplored. Here, we investigate the extent to which the rates and targets of horizontal gene transfer (HGT) vary across thousands of bacterial strains from 15 human populations spanning a range of industrialization. We show that HGTs have accumulated in the microbiome over recent host generations and that HGT occurs at high frequency within individuals. Comparison across human populations reveals that industrialized lifestyles are associated with higher HGT rates and that the functions of HGTs are related to the level of host industrialization. Our results suggest that gut bacteria continuously acquire new functionality based on host lifestyle and that high rates of HGT may be a recent development in human history linked to industrialization.
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http://dx.doi.org/10.1016/j.cell.2021.02.052DOI Listing
April 2021

Stunting in infancy, pubertal trajectories and adult body composition: the Birth to Twenty Plus cohort, South Africa.

Eur J Clin Nutr 2021 01 14;75(1):189-197. Epub 2020 Aug 14.

SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, 2193, South Africa.

Background/objectives: Childhood rapid growth and earlier puberty onset have been associated with adult obesity. However, the association between childhood stunting, pubertal timing and adult obesity is unclear. We examined whether the relationship between stunting at age 2 years (y) and body composition at 23 years is mediated by adolescent body mass index, and pubertal development, using the Birth-to-Twenty Plus cohort (South Africa).

Subjects/methods: For 1036 participants, data on anthropometrics between birth and 23 years, maternal factors, and pubertal development (Tanner scale at 9-16 years) were collected. Stunting at 2 years (height-for-age z-score < -2), 5-18 years BMI-for-age trajectories, pubertal development trajectories, and DXA-derived fat mass (FM) and fat free mass (FFM) at 23 years were determined. Data were analysed using hierarchical regressions and structural equation models.

Results: Stunting was directly associated with slower pubertal development and with shorter adult stature, but was not associated with adolescent BMI trajectories, adult FM or FFM. However, stunting was indirectly associated with adult FM and FFM through the direct associations between slower pubertal development and lower FM and between shorter height and lower FFM. BMI trajectories were independently associated with FM and FFM.

Conclusions: Being stunted in this population predicted adult body composition through slower pubertal development and shorter adult stature.
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http://dx.doi.org/10.1038/s41430-020-00716-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817521PMC
January 2021

Response of the human gut and saliva microbiome to urbanization in Cameroon.

Sci Rep 2020 02 18;10(1):2856. Epub 2020 Feb 18.

UMR7206 Eco-anthropologie, CNRS - MNHN - Université de Paris, Paris, France.

Urban populations from highly industrialized countries are characterized by a lower gut bacterial diversity as well as by changes in composition compared to rural populations from less industrialized countries. To unveil the mechanisms and factors leading to this diversity loss, it is necessary to identify the factors associated with urbanization-induced shifts at a smaller geographical scale, especially in less industrialized countries. To do so, we investigated potential associations between a variety of dietary, medical, parasitological and socio-cultural factors and the gut and saliva microbiomes of 147 individuals from three populations along an urbanization gradient in Cameroon. We found that the presence of Entamoeba sp., a commensal gut protozoan, followed by stool consistency, were major determinants of the gut microbiome diversity and composition. Interestingly, urban individuals have retained most of their gut eukaryotic and bacterial diversity despite significant changes in diet compared to the rural areas, suggesting that the loss of bacterial microbiome diversity observed in industrialized areas is likely associated with medication. Finally, we observed a weak positive correlation between the gut and the saliva microbiome diversity and composition, even though the saliva microbiome is mainly shaped by habitat-related factors.
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http://dx.doi.org/10.1038/s41598-020-59849-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028744PMC
February 2020

Understanding how maternal social and biological factors are related to fetal growth in an urban South African cohort.

J Dev Orig Health Dis 2021 02 17;12(1):79-87. Epub 2020 Feb 17.

SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

The aim of this study was to identify social and biological drivers of fetal growth by examining associations with household, preconception, and pregnancy factors in a cohort from Soweto, South Africa. Complete data and ultrasound scans were collected on 519 women between 2013 and 2016 at 6 time points during pregnancy (<14, 14-18, 19-23, 24-28, 29-33 weeks, and 34-38 weeks). Household-level factors, preconception health, baseline body mass index (BMI), and demographic data were collected at the first visit. During pregnancy, gestational weight gain (GWG; kg/week) was calculated. At 24-28 weeks of gestation, oral glucose tolerance test was used to determine gestational diabetes mellitus (GDM) status, and hypertension status was characterised. Longitudinal growth in head circumference, abdominal circumference, biparietal diameter, and femur length were modelled using the Superimposition by Translation and Rotation, a shape-invariant model which produces growth curves against gestational age. A priori identified exposure variables were then included in a series of sex-stratified hierarchical regression models for each fetal growth outcome. No household-level factors were associated with fetal growth. Maternal BMI at baseline was positively associated with all outcome parameters in males and females. Both GWG (in males and females) and GDM (in males) were significant positive predictors of abdominal growth. Males showed more responsiveness to abdominal growth, while females were more responsive to linear growth. Thus, fetal growth was largely predicted by maternal biological factors, and sexual dimorphism in the responsiveness of fetal biometry to biological exposures was evident.
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http://dx.doi.org/10.1017/S2040174420000045DOI Listing
February 2021

Assessment of environmental exposure factors on child diarrhea and systemic inflammation in the Eastern Cape.

Water Res 2020 Feb 1;169:115244. Epub 2019 Nov 1.

DST-NRF Centre of Excellence for Food Security, University of the Western Cape, South Africa.

Poor environmental technologies and gastrointestinal illnesses have been hypothesized to be a primary cause to the lack of impact of child health programs on child stunting rates (low height-for-age) in South Africa. This study assessed correlations between environmental exposures (water source, water treatment, sanitation, refuse), diarrheal occurrences, and systemic inflammation proxies among female and male children under five years of age in the Eastern Cape. A conceptual model was hypothesized using structural equation (SE) modeling and two sex-specific (female and male) datasets were subsequently generated from the data and applied to the hypothesized SE model. Results suggested that environmental exposure variables associated with diarrhea and systemic inflammation proxies were different between females and males. For diarrheal occurrences among females, an increase in local authority management of refuse (compared to household management) (0.161, p-value (p) = 0.007), sharing sanitation facilities (0.060, p = 0.023), and a decrease in the frequency of the treatment of drinking water (-0.043, p = 0.025) were correlated with an increase in diarrhea. For males, an increase in household use of flush toilets (as compared to ventilated pit latrines) was correlated with an increase in diarrhea (0.113, p = 0.027). For systemic inflammation among both sexes, an increase in household use of water pumped into the premises (as compared to a public water tap) and an increase in diarrheal occurrences were correlated with an increase in systemic inflammation. The data support an increased focus on sex and gender specific factors among field practitioners and policy makers working in the environmental health field in South Africa.
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http://dx.doi.org/10.1016/j.watres.2019.115244DOI Listing
February 2020

The association between household socio-economic status, maternal socio-demographic characteristics and adverse birth and infant growth outcomes in sub-Saharan Africa: a systematic review.

J Dev Orig Health Dis 2020 08 25;11(4):317-334. Epub 2019 Oct 25.

MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa.

Adverse birth outcomes and infant undernutrition remain the leading causes of morbidity and mortality in sub-Saharan Africa (SSA). Impaired infant growth and development, which often begins during foetal development, may persist during the first 2 years of life and has been associated with higher risks of cardiometabolic diseases. This systematic review assessed the associations between maternal demographic characteristics and household socio-economic status (SES), and preterm birth (PTB), small for gestational age, low birth weight (LBW), stunting, wasting and underweight in children under 2 years of age in SSA countries. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we searched for publications in three electronic databases (PubMed, Scopus and ScienceDirect). Eleven studies on children under 2 years of age, in four SSA regions, published in English between 1990 and 2018, were included. All the studies were observational in design (cross-sectional or cohort studies). Maternal education was the most commonly explored exposure. Most studies (63.3%) focused on undernutrition during the first 2 years of life: LBW, PTB and stunting. Lower maternal education, maternal unemployment and lower household wealth index were the SES factors most commonly associated with adverse birth outcomes and infant undernutrition. Maternal marital status was not associated with any infant outcomes. The definitions of the SES varied, which may explain discrepancies between studies. Nutrition intervention programs in SSA need to promote education and poverty alleviation in women at reproductive age, starting from pre-pregnancy, to optimise infant growth and development and prevent the increase in the prevalence of cardiometabolic diseases.
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http://dx.doi.org/10.1017/S2040174419000680DOI Listing
August 2020

Early-life exposures and cardiovascular disease risk among Ghanaian migrant and home populations: the RODAM study.

J Dev Orig Health Dis 2020 06 26;11(3):250-263. Epub 2019 Sep 26.

Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.

Early-life environmental and nutritional exposures are considered to contribute to the differences in cardiovascular disease (CVD) burden. Among sub-Saharan African populations, the association between markers of early-life exposures such as leg length and sitting height and CVD risk is yet to be investigated. This study assessed the association between leg length, sitting height, and estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk among Ghanaian-born populations in Europe and Ghana. We constructed sex-specific quintiles for sitting height and leg length for 3250 participants aged 40-70 years (mean age 52 years; men 39.6%; women 60.4%) in the cross-sectional multicenter Research on Diabetes and Obesity among African Migrants study. Ten-year risk of ASCVD was estimated using the Pooled Cohort Equations; risk ≥7.5% was defined as "elevated" CVD risk. Prevalence ratios (PR) were estimated to determine the associations between sitting height, leg length, and estimated 10-year ASCVD risk. For both men and women, mean sitting height and leg length were highest in Europe and lowest in rural Ghana. Sitting height was inversely associated with 10-year ASCVD risk among all women (PR for 1 standard deviation increase of sitting height: 0.75; 95% confidence interval: 0.67, 0.85). Among men, an inverse association between sitting height and 10-year ASCVD risk was significant on adjustment for study site, adult, and parental education but attenuated when further adjusted for height. No association was found between leg length and estimated 10-year ASCVD risk. Early-life and childhood exposures that influence sitting height could be the important determinants of ASCVD risk in this adult population.
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http://dx.doi.org/10.1017/S2040174419000527DOI Listing
June 2020

Sanitation and diarrhoea in infancy and CRP level at 18 years: the birth-to-twenty plus cohort.

Ann Hum Biol 2019 Aug 18;46(5):415-424. Epub 2019 Sep 18.

SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.

Cardiometabolic disease is associated with chronic low-grade inflammation. While low birthweight, childhood stunting and rapid weight gain predict higher adult high-sensitivity C-reactive protein (hs-CRP) concentrations, associations between childhood infections and adulthood CRP are inconsistent. To assess the associations between sanitation, diarrhoea and a combined score of both from birth to age 2 years and hs-CRP at age 18 years, independently of early life nutrition and adult adiposity. This study collected data on sanitation and diarrhoea episodes from birth to 2 years on 756 participants of the Birth-to-Twenty Plus cohort, a birth cohort initiated in South Africa in 1990, and calculated a combined score of both variables. Anthropometry was measured at 2 years and 18 years and hs-CRP at 18 years. Of the participants, 29.5% had no access to indoor flush sanitation and 38.2% experienced ≥1 diarrhoea episode between birth and 2 years. Not having access to indoor flush sanitation and experiencing ≥1 diarrhoea episodes were associated with 1.50 mg/L and 1.52 mg/L higher hs-CRP, respectively. Prevalence of both burdens in infancy was associated with a 2.18 mg/L higher hs-CRP. In this population, poor sanitation and diarrhoea in early life predict elevated CRP in young adulthood, independently of early life nutrition and adiposity.
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http://dx.doi.org/10.1080/03014460.2019.1657496DOI Listing
August 2019

Body composition and physical activity as mediators in the relationship between socioeconomic status and blood pressure in young South African women: a structural equation model analysis.

BMJ Open 2018 12 19;8(12):e023404. Epub 2018 Dec 19.

MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Objectives: Varying hypertension prevalence across different socioeconomic strata within a population has been well reported. However, the causal factors and pathways across different settings are less clear, especially in sub-Saharan Africa. Therefore, this study aimed to compare blood pressure (BP) levels and investigate the extent to which socioeconomic status (SES) is associated with BP, in rural and urban South Africa women.

Setting: Rural and urban South Africa.

Design: Cross-sectional.

Participants: Cross-sectional data on SES, total moderate and vigorous physical activity (MVPA), anthropometric and BP were collected on rural (n=509) and urban (n=510) young black women (18-23 years age). Pregnant and mentally or physically disabled women were excluded from the study.

Results: The prevalence of combined overweight and obesity (46.5% vs 38.8%) and elevated BP (27.0% vs 9.3%) was higher in urban than rural women, respectively. Results from the structural equation modelling showed significant direct positive effects of body mass index (BMI) on systolic BP (SBP) in rural, urban and pooled datasets. Negative direct effects of SES on SBP and positive total effects of SES on SBP were observed in the rural and pooled datasets, respectively. In rural young women, SES had direct positive effects on BMI and was negatively associated with MVPA in urban and pooled analyses. BMI mediated the positive total effects association between SES and SBP in pooled analyses (ß 0.46; 95% CI 0.15 to 0.76).

Conclusions: Though South Africa is undergoing nutritional and epidemiological transitions, the prevalence of elevated BP still varies between rural and urban young women. The association between SES and SBP varies considerably in economically diverse populations with BMI being the most significant mediator. There is a need to tailor prevention strategies to take into account optimising BMI when designing strategies to reduce future risk of hypertension in young women.
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http://dx.doi.org/10.1136/bmjopen-2018-023404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6303607PMC
December 2018

Rural-urban variations in age at menarche, adult height, leg-length and abdominal adiposity in black South African women in transitioning South Africa.

Ann Hum Biol 2018 Mar 20;45(2):123-132. Epub 2018 Mar 20.

a MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics , School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand , Johannesburg , South Africa.

Background: The pre-pubertal socioeconomic environment may be an important determinant of age at menarche, adult height, body proportions and adiposity: traits closely linked to adolescent and adult health.

Aims: This study explored differences in age at menarche, adult height, relative leg-length and waist circumference between rural and urban black South African young adult women, who are at different stages of the nutrition and epidemiologic transitions.

Subjects And Methods: We compared 18-23 year-old black South African women, 482 urban-dwelling from Soweto and 509 from the rural Mpumalanga province. Age at menarche, obstetric history and household socio-demographic and economic information were recorded using interview-administered questionnaires. Height, sitting-height, hip and waist circumference were measured using standardised techniques.

Results: Urban and rural black South African women differed in their age at menarche (at ages 12.7 and 14.5 years, respectively). In urban women, a one-year increase in age at menarche was associated with a 0.65 cm and 0.16% increase in height and relative leg-length ratio, respectively. In both settings, earlier age at menarche and shorter relative leg-length were independently associated with an increase in waist circumference.

Conclusions: In black South African women, the earlier onset of puberty, and consequently an earlier growth cessation process, may lead to central fat mass accumulation in adulthood.
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http://dx.doi.org/10.1080/03014460.2018.1442497DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5964443PMC
March 2018

The associations between adult body composition and abdominal adiposity outcomes, and relative weight gain and linear growth from birth to age 22 in the Birth to Twenty Plus cohort, South Africa.

PLoS One 2018 16;13(1):e0190483. Epub 2018 Jan 16.

MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.

Background: The growing prevalence of overweight and obesity in low- or middle-income countries precipitates the need to examine early life predictors of adiposity.

Objectives: To examine growth trajectories from birth, and associations with adult body composition in the Birth to Twenty Plus Cohort, Soweto, South Africa.

Methods: Complete data at year 22 was available for 1088 participants (536 males and 537 females). Conditional weight and height indices were generated indicative of relative rate of growth between years 0-2, 2-5, 5-8, 8-18, and 18-22. Whole body composition was measured at year 22 (range 21-25 years) using dual energy x-ray absorptiometry (DXA). Total fat free soft tissue mass (FFSTM), fat mass, and abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were recorded.

Results: Birth weight was positively associated with FFSTM and fat mass at year 22 (β = 0.11, p<0.01 and β = 0.10, p<0.01 respectively). Relative weight gain from birth to year 22 was positively associated with FFSTM, fat mass, VAT, and SAT at year 22. Relative linear growth from birth to year 22 was positively associated with FFSTM at year 22. Relative linear growth from birth to year 2 was positively associated with VAT at year 22. Being born small for gestational age and being stunted at age 2 years were inversely associated with FFSTM at year 22.

Conclusions: The importance of optimal birth weight and growth tempos during early life for later life body composition, and the detrimental effects of pre- and postnatal growth restriction are clear; yet contemporary weight-gain most strongly predicted adult body composition. Thus interventions should target body composition trajectories during childhood and prevent excessive weight gain in early adulthood.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190483PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770024PMC
February 2018

Examining the relationships between body image, eating attitudes, BMI, and physical activity in rural and urban South African young adult females using structural equation modeling.

PLoS One 2017 16;12(11):e0187508. Epub 2017 Nov 16.

MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.

The persistence of food insecurity, malnutrition, increasing adiposity, and decreasing physical activity, heightens the need to understand relationships between body image satisfaction, eating attitudes, BMI and physical activity levels in South Africa. Females aged 18-23 years were recruited from rural (n = 509) and urban (n = 510) settings. Body image satisfaction was measured using Stunkard's silhouettes, and the 26-item Eating Attitudes questionnaire (EAT-26) was used to evaluate participants' risk of disordered eating. Minutes per week of moderate to vigorous physical activity (MVPA) was assessed using the Global Physical Activity Questionnaire (GPAQ). Significant linear correlates were included in a series of regressions run separately for urban and rural participants. Structural equation modeling (SEM) was used to test the relationships between variables. Urban females were more likely to be overweight and obese than rural females (p = 0.02), and had a greater desire to be thinner (p = 0.02). In both groups, being overweight or obese was positively associated with a desire to be thinner (p<0.01), and negatively associated with a desire to be fatter (p<0.01). Having a disordered eating attitude was associated with body image dissatisfaction in the urban group (β = 1.27, p<0.01, CI: 0.38; 2.16), but only with a desire to be fatter in the rural group (β = 0.63, p = 0.04, CI: 0.03; 1.23). In the SEM model, body image dissatisfaction was associated with disordered eating (β = 0.63), as well as higher MVPA participation (p<0.01). These factors were directly associated with a decreased risk of disordered eating attitude, and with a decreased desire to be thinner. Findings indicate a shift in both settings towards more Westernised ideals. Physical activity may provide a means to promote a healthy body image, while reducing the risk of disordered eating. Given the high prevalence of overweight and obesity in both rural and urban women, this study provides insights for future interventions aimed at decreasing adiposity in a healthy way.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187508PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5690598PMC
December 2017

Life History theory hypotheses on child growth: Potential implications for short and long-term child growth, development and health.

Am J Phys Anthropol 2018 01 26;165(1):4-19. Epub 2017 Oct 26.

Department of Paediatrics and Child Health, MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng 2193, South Africa.

Life history theory integrates ecological, physiological, and molecular layers within an evolutionary framework to understand organisms' strategies to optimize survival and reproduction. Two life history hypotheses and their implications for child growth, development, and health (illustrated in the South African context) are reviewed here. One hypothesis suggests that there is an energy trade-off between linear growth and brain growth. Undernutrition in infancy and childhood may trigger adaptive physiological mechanisms prioritizing the brain at the expense of body growth. Another hypothesis is that the period from conception to infancy is a critical window of developmental plasticity of linear growth, the duration of which may vary between and within populations. The transition from infancy to childhood may mark the end of a critical window of opportunity for improving child growth. Both hypotheses emphasize the developmental plasticity of linear growth and the potential determinants of growth variability (including the role of parent-offspring conflict in maternal resources allocation). Implications of these hypotheses in populations with high burdens of undernutrition and infections are discussed. In South Africa, HIV/AIDS during pregnancy (associated with adverse birth outcomes, short duration of breastfeeding, and social consequences) may lead to a shortened window of developmental plasticity of growth. Furthermore, undernutrition and infectious diseases in children living in South Africa, a country undergoing a rapid nutrition transition, may have adverse consequences on individuals' cognitive abilities and risks of cardio-metabolic diseases. Studies are needed to identify physiological mechanisms underlying energy allocation between biological functions and their potential impacts on health.
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http://dx.doi.org/10.1002/ajpa.23340DOI Listing
January 2018

Understanding the Relationship between Socio-Economic Status, Physical Activity and Sedentary Behaviour, and Adiposity in Young Adult South African Women Using Structural Equation Modelling.

Int J Environ Res Public Health 2017 10 23;14(10). Epub 2017 Oct 23.

MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa.

Socio-economic status (SES) is an important predictor of obesity, but how it is associated with differences in physical activity and sedentary behaviour is less clear. This cross-sectional study examined the association between SES (sum of household assets), physical activity and sedentary time, and how they predict adiposity. Socio-demographic, anthropometric, and physical activity data on rural ( = 509) and urban ( = 510) South African women (18-23 years) were collected. Overweight and obesity prevalence, and sedentary time, were higher; and moderate-vigorous intensity physical activity (MVPA) was lower, in the urban sample. Structural equation models (SEMs) were constructed for BMI and waist circumference. In the urban sample SES had a direct inverse effect on MVPA (ß; 95% CI, -41.69; -73.40 to -9.98), while in the rural sample SES had a direct effect on BMI (ß; 95% CI, 0.306; 0.03 to 0.59). In the pooled sample, SES had a direct inverse effect on MVPA (ß; 95% CI, -144; -170.34 to -119.04), and MVPA was directly associated with BMI (ß; 95% CI, 0.04; 0.01 to 0.08). The influence of SES, and the role of physical activity and sedentary time on adiposity differs between the urban and rural samples, and the importance of other environmental and behavioural factors must be considered in the development of obesity and the design of effective interventions.
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http://dx.doi.org/10.3390/ijerph14101271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664772PMC
October 2017

Understanding and acting on the developmental origins of health and disease in Africa would improve health across generations.

Glob Health Action 2017 ;10(1):1334985

p DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA) , University of Stellenbosch , Stellenbosch , South Africa.

Data from many high- and low- or middle-income countries have linked exposures during key developmental periods (in particular pregnancy and infancy) to later health and disease. Africa faces substantial challenges with persisting infectious disease and now burgeoning non-communicable disease.This paper opens the debate to the value of strengthening the developmental origins of health and disease (DOHaD) research focus in Africa to tackle critical public health challenges across the life-course. We argue that the application of DOHaD science in Africa to advance life-course prevention programmes can aid the achievement of the Sustainable Development Goals, and assist in improving health across generations. To increase DOHaD research and its application in Africa, we need to mobilise multisectoral partners, utilise existing data and expertise on the continent, and foster a new generation of young African scientists engrossed in DOHaD.
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http://dx.doi.org/10.1080/16549716.2017.1334985DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5533158PMC
September 2018

Nutrition Transition and Biocultural Determinants of Obesity among Cameroonian Migrants in Urban Cameroon and France.

Int J Environ Res Public Health 2017 06 29;14(7). Epub 2017 Jun 29.

Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7206, Eco-Anthropologie et Ethnobiologie, Musée de l'Homme, Muséum National d'Histoire Naturelle, 17 place du Trocadéro, 75016 Paris, France.

Native of rural West Cameroon, the Bamiléké population is traditionally predisposed to obesity. Bamiléké who migrated to urban areas additionally experience the nutrition transition. We investigated the biocultural determinants of obesity in Bamiléké who migrated to urban Cameroon (Yaoundé), or urban France (Paris). We conducted qualitative interviews ( = 36; 18 men) and a quantitative survey ( = 627; 266 men) of adults using two-stage sampling strategy, to determine the association of dietary intake, physical activity and body weight norms with obesity of Bamiléké populations in these three socio-ecological areas (rural Cameroon: = 258; urban Cameroon: = 319; urban France: = 50). The Bamiléké valued overweight and traditional energy-dense diets in rural and urban Cameroon. Physical activity levels were lower, consumption of processed energy-dense food was frequent and obesity levels higher in new migrants living in urban Cameroon and France. Female sex, age, duration of residence in urban areas, lower physical activity and valorisation of overweight were independently associated with obesity status. This work argues in favour of local and global health policies that account for the origin and the migration trajectories to prevent obesity in migrants.
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http://dx.doi.org/10.3390/ijerph14070696DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5551134PMC
June 2017

The (Possibly Negative) Effects of Physical Activity on Executive Functions: Implications of the Changing Metabolic Costs of Brain Development.

J Phys Act Health 2016 09 16;13(9):1017-22. Epub 2016 Aug 16.

Background: An area of growth in physical activity research has involved investigating effects of physical activity on children's executive functions. Many of these efforts seek to increase the energy expenditure of young children as a healthy and low-cost way to affect physical, health, and cognitive outcomes.

Methods: We review theory and research from neuroscience and evolutionary biology, which suggest that interventions seeking to increase the energy expenditure of young children must also consider the energetic trade-offs that occur to accommodate changing metabolic costs of brain development.

Results: According to Life History Theory, and supported by recent evidence, the high relative energy-cost of early brain development requires that other energy-demanding functions of development (ie, physical growth, activity) be curtailed. This is important for interventions seeking to dramatically increase the energy expenditure of young children who have little excess energy available, with potentially negative cognitive consequences. Less energy-demanding physical activities, in contrast, may yield psychosocial and cognitive benefits while not overburdening an underweight child's already scarce energy supply.

Conclusions: While further research is required to establish the extent to which increases in energy-demanding physical activities may compromise or displace energy available for brain development, we argue that action cannot await these findings.
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http://dx.doi.org/10.1123/jpah.2015-0687DOI Listing
September 2016

Development and validation of two food portion photograph books to assess dietary intake among adults and children in Central Africa.

Br J Nutr 2016 Mar 20;115(5):895-902. Epub 2016 Jan 20.

1Muséum National d'Histoire Naturelle,Centre National de la Recherche Scientifique,Université Paris 7 Diderot,Sorbonne Paris Cite,Sorbonne Universités,Unité Eco-Anthropologie et Ethnobiologie (UMR 7206),Musée de l,17 place du Trocadéro,75016 Paris,France.

Owing to nutritional transition in Cameroon, one in two adults is overweight and one in five is obese, and 8·1% of children are overweight and 2·1% are obese. Given this phenomenon, dietary intake assessment is needed to establish appropriate preventive nutrition-sensitive strategies. Our aim was to develop and test the validity of two food portion photograph books (FPPB) to be used as visual aids for adults and children taking part in a 24-h dietary recall. To design FPPB, interviews and focus group discussions were undertaken with women to obtain consensus on the local categorisation of foods. For each cooked and weighed food, three photographs of the average small, medium and large serving portion sizes were taken, and four intermediary portion sizes were calculated. To validate the FPPB, a sample of adults (361) and children (224) were asked, at meal times, to self-serve a food portion prepared in the household and the portion sizes were weighed; 24 h after the measurement, the same subjects were shown the appropriate FPPB and were asked to indicate the food and the portion they consumed. In adults, of the 821 portions tested, 77% were accurately estimated, whereas in children 74% of the 556 portions tested were accurately estimated. For both groups, the small- and medium-sized portions were frequently selected and accurately estimated (>70%). Our findings suggest that the adult and children's FPPB can be used in Cameroon to estimate food portion sizes, and thus nutritional intake in the frame of the 24-h dietary recall.
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http://dx.doi.org/10.1017/S0007114515005401DOI Listing
March 2016

Development and Validation of the Body Size Scale for Assessing Body Weight Perception in African Populations.

PLoS One 2015 4;10(11):e0138983. Epub 2015 Nov 4.

CNRS, UMR 7206 «Eco-anthropologie et Ethnobiologie», Musée de l'Homme, Muséum National d'Histoire Naturelle, Paris, France.

Background: The social valorisation of overweight in African populations could promote high-risk eating behaviours and therefore become a risk factor of obesity. However, existing scales to assess body image are usually not accurate enough to allow comparative studies of body weight perception in different African populations. This study aimed to develop and validate the Body Size Scale (BSS) to estimate African body weight perception.

Methods: Anthropometric measures of 80 Cameroonians and 81 Senegalese were used to evaluate three criteria of adiposity: body mass index (BMI), overall percentage of fat, and endomorphy (fat component of the somatotype). To develop the BSS, the participants were photographed in full face and profile positions. Models were selected for their representativeness of the wide variability in adiposity with a progressive increase along the scale. Then, for the validation protocol, participants self-administered the BSS to assess self-perceived current body size (CBS), desired body size (DBS) and provide a "body self-satisfaction index." This protocol included construct validity, test-retest reliability and convergent validity and was carried out with three independent samples of respectively 201, 103 and 1115 Cameroonians.

Results: The BSS comprises two sex-specific scales of photos of 9 models each, and ordered by increasing adiposity. Most participants were able to correctly order the BSS by increasing adiposity, using three different words to define body size. Test-retest reliability was consistent in estimating CBS, DBS and the "body self-satisfaction index." The CBS was highly correlated to the objective BMI, and two different indexes assessed with the BSS were consistent with declarations obtained in interviews.

Conclusion: The BSS is the first scale with photos of real African models taken in both full face and profile and representing a wide and representative variability in adiposity. The validation protocol proved its reliability for estimating body weight perception in Africans.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0138983PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4633130PMC
June 2016

Has the prevalence of stunting in South African children changed in 40 years? A systematic review.

BMC Public Health 2015 Jun 5;15:534. Epub 2015 Jun 5.

MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown 2193, Johannesburg, South Africa.

Background: In the last 20 years, South Africa has experienced political, economic, and demographic transitions accompanied by an epidemiological transition. Like several sub-Saharan countries, the South African population is facing both under-and over-nutrition, and nutrition and lifestyle related chronic disease while the burden of infectious disease remains high. It is critical to understand these trends overtime in order to highlights the pitfalls and successful measures initiatives taken in the efforts to tackle malnutrition. The objective of this systematic review is to investigate the changes in the prevalence of stunting, a chronic form of undernutrition, in South Africa over 40 years, and to derive lessons from the South African experience, a country in an advanced process of transition in sub-Saharan Africa.

Methods: We undertook a systematic review of publications selected from PubMed, Science Direct and Scopus. We included studies and surveys published between 1970 and 2013 if they reported the prevalence of stunting (low height-for-age) in children under-6 years of age living in South Africa. We excluded studies conducted in health facility outpatients or hospital wards, or children with known chronic and acute infectious diseases. We extracted Date of data collection, study setting, ethnicity, age, sex, sample size, growth references/standards, diagnostic criteria for stunting and prevalence of stunting from each study.

Results: Over the last decade, the national prevalence of stunting has decreased. However, between and within provincial, age and ethnic group disparities remain. Unlike other countries in sub-Saharan Africa, no sex or rural/urban differences were found in preschool children. However, the analysis of long-term trends and identification of vulnerable groups is complicated by the use of different growth references/standards and sampling methods.

Conclusion: Despite economic growth, political and social transitions, and national nutritional programs, stunting remains stubbornly persistent and prevalent in South Africa. A multi-sectoral and public health approach is needed to: (i) better monitor stunting over time, (ii) combat malnutrition during the first thousand days of life through continued efforts to improve maternal nutrition during pregnancy and infant feeding practices.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456716PMC
http://dx.doi.org/10.1186/s12889-015-1844-9DOI Listing
June 2015

Africa in transition: growth trends in children and implications for nutrition.

Ann Nutr Metab 2014 22;64 Suppl 2:8-13. Epub 2014 Oct 22.

MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

The aims of this paper were to: (1) review the literature and examine contemporary child growth in terms of stunting prevalence across Africa; (2) discuss child stunting within the context of economic growth and adult obesity, and (3) elucidate the implications for child nutrition. It is evident that stunting in under-5-year-old children still plagues Africa and has not decreased as expected in line with the concomitant improvement in economic development over the past decade. Persisting and possibly widening inequality ensures that not all segments of the population, in particular the most vulnerable, benefit equally from economic growth. Of concern is the association between the increasing economic progress across Africa and the rising adult obesity, especially amongst females. More and more African countries are now afflicted with a double burden of malnutrition. The implication for child nutrition is that African countries need not only apply a multisectoral approach to accelerate the reduction in stunting levels, but also to arrest and prevent obesity.
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http://dx.doi.org/10.1159/000365122DOI Listing
July 2015

Is overweight in stunted preschool children in Cameroon related to reductions in fat oxidation, resting energy expenditure and physical activity?

PLoS One 2012 11;7(6):e39007. Epub 2012 Jun 11.

UMR 7206 Eco-anthropologie et Ethnobiologie, Centre National de la Recherche Scientifique, Muséum national d'Histoire naturelle, Paris Diderot University, Paris, France.

Background: Recent studies suggest that early modifications in metabolic pathways and behaviour, leading to energy conservation and reduced linear growth, could represent adaptations to nutritional constraints during foetal life and infancy. Impaired fat oxidation, low resting energy expenditure and reduced physical activity, resulting from these adaptations, could facilitate fat storage and development of overweight in growth-retarded children that consume more energy-dense food. This study aims at assessing whether: (1) dual-burden preschool children (simultaneously stunted and overweight) of Yaounde (Cameroon) have low birth-weight (indicator of foetal undernutrition) and reductions in fat oxidation, resting energy expenditure (REE) and physical activity, (2) fat oxidation, REE and physical activity are associated with foetal growth.

Methodology/principal Findings: 162 children (24-72 months) were considered: 22 stunted-overweight (SO), 40 stunted (S), 41 overweight (O), and 59 non stunted-non overweight (NSNO). Nutritional status and body composition were assessed using anthropometry and multifrequency bioimpedance analysis. Fasting respiratory quotient (RQ) and REE were measured by indirect calorimetry. Physical activity was determined using accelerometers, food questionnaires were used for diet assessment and birth-weight was noted. Mean RQs and REE (weight adjusted) did not differ between stunted children (SO and S) and non-stunted children (O and NSNO). SO and S children spent more time in sedentary activities than O children (p = 0.01 and p = 0.02, respectively) and less time in moderate-to-vigorous activities than NSNO children (p = 0.05 and p = 0.04, respectively). SO children's diet was less diverse (p = 0.01) with less animal products (p = 0.006). Multiple linear regressions model revealed that birth-weight is predictive of RQ (β = 0.237, p<0.01, R(2) = 0.08).

Conclusions/significance: This study showed that growth retardation in stunted-overweight children could be associated with postnatal nutritional deficiencies. Overweight in stunted children could be associated with reduced physical activity in the context of nutrition transition. High birth-weight was a predictor of reduced lipid oxidation, a risk factor of fat deposition.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0039007PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372472PMC
November 2012

Determinants of overweight associated with stunting in preschool children of Yaounde, Cameroon.

Ann Hum Biol 2009 Mar-Apr;36(2):146-61

CNRS/MNHN, Paris, France.

Background: Nutrition transition in developing countries has been associated with higher prevalence of overweight.

Aim: The study aimed to identify the factors associated with concurrent stunting and overweight in urban preschool children of Yaounde, Cameroon.

Subjects And Methods: 169 preschool children of both sexes were recruited according to their nutritional status: Stunted, overweight, stunted-overweight, and non-stunted-non-overweight. Factors associated with concurrent stunting and overweight were investigated through interviewer-administered questionnaires. A binary logistic regression model was used to determine the relation between nutritional statuses and associated factors.

Results: A low-income family and a low maternal educational level are independent risk factors for a child to be stunted-overweight [odds ratios (95% CI): 3.81 (13.32-1.08), 2.90 (7.82-1.07), respectively]. Mother under-evaluation of child's weight is a factor associated with stunting-overweight and overweight in children [odds ratios (95% CI): 3.42 (8.72-1.33), 6.52 (18.09-2.34), respectively]. Being overweight is also related to higher birth weight. Unlike stunted children, stunted-overweight children live with both their parents and have an older mother. Short maternal stature and mother's over-evaluation of her child's height are independent factors associated with stunting.

Conclusion: Poor preschool children of Yaounde are facing concomitant stunting and overweight. More studies are needed to better assess the impact of maternal factors.
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http://dx.doi.org/10.1080/03014460802660526DOI Listing
May 2009
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