Human milk is considered to be the ideal food for infants. Accurate, representative, and up-to-date nutrient composition data of human milk are crucial for the management of infant feeding, assessment of infant and maternal nutritional needs, and as a guide for developing infant formula. Currently in the United States, the nutrient profiles of human milk can be found in the USDA National Nutrient Database for Standard Reference, and in books or review articles. Nonetheless, these resources all suffer major drawbacks, such as being outdated, incomplete profiles, limited sources of data, and uncertain data quality. Furthermore, no nutrient profile was developed specifically for the US population. The purposes of this review were to summarize the current knowledge of human milk nutrient composition from studies conducted in the United States and Canada, and to identify the knowledge gaps and research needs. The literature review was conducted to cover the years 1980–2017, and 28 research papers were found containing original data on macronutrients and micronutrients. Most of these 28 studies were published before 1990 and mainly examined samples from small groups of generally healthy lactating women. The experimental designs, including sampling, storage, and analytic methods, varied substantially between the different studies. Data of several components from these 28 studies showed some consistency for 1–6 mo postpartum, especially for protein, fat, lactose, energy, and certain minerals (e.g., calcium). The data for 7–12 mo postpartum and for other nutrients are very scarce. Comprehensive studies are required to provide current and complete nutrient information on human milk in the United States.

Background: Global Health Estimates 2015 has shown the stroke as second leading global cause of death and 3rd leading global cause for DALYs for year 2015. The objectives of this study were to determine the frequency, distribution and determinants of hypertension in adult stroke population of D.I.Khan Division, Pakistan. Materials & Methods: This cross-sectional study was conducted in Department of Community Medicine, Gomal Medical College, D.I.Khan, Pakistan from February 1, 2017 to April 30, 2017. A sample 217 was selected with margin of error 5.59%, 90%CL and 50% prevalence of hypertension in 200,000 adults at risk of stroke population through consecutive sampling. All indoor adult patients of stroke were eligible. Sex, age groups, and residence and presence of hypertension were variables. Frequency and distribution of hypertension were analyzed by count and percentage. Hypotheses for distribution were substantiated by chi-square goodness-of-fit and of association by chi-square test of association. Results: Out of 217 patients with stroke, 123 (56.7%) were men and 94 (43.3%) were women, 86 (39.6%) were≤60 years and 131 (60.4%) were>60 years, and 105 (48.4%) were urban and 112 (51.6%) were rural. Frequency of hypertension was 132/217 (60.83%). Out of 132 patients with hypertension, men were 74 (34.10%), women 58 (26.73%), age group≤60 years 46 (21.20%), >60 years 86 (39.63%), urban 72 (33.18%) and rural 60 (27.65%). Presence of hypertension was associated to residence (p=.023) but not to sex (p=.817) and age groups (p=.072). Conclusion: Frequency of hypertension in adult stroke population of D.I.Khan Division, Pakistan was found to be similar as expected. Frequency was more in men, in older age group (of>60years) and in urban population. The presence of hypertension in adult stroke population of D.I.Khan Division was associated to residence but not to sex and age groups.

Objective: The purpose of the present paper is to examine the prevalence of metabolic syndrome (MetS) and its components using the harmonized definition in an interviewed sub-sample of diverse, low-income, adult South Asians (SA) of both sexes residing in Maryland. We also wanted to derive a BMI cut-off value that was highly correlated with the recommended waist circumference (WC) that we could apply to a larger sample of SA Americans for whom only BMI values were available from clinic files. We also examined differences in MetS prevalence among various Asian ethnic groups (defined by country of origin) and the clustering pattern of their MetS components. Design: Clinical data extraction on subjects (n 1002) and interviewees (n 401) were used in a cross-sectional study of SA Americans. Setting: Two community health centres in Montgomery and Baltimore County, MD, USA. Subjects: SA adult males and females (n 1403) aged 20-68 years. Results: The prevalence of MetS using harmonized WC cut-offs (90 cm in men and 80 cm in women) was 47 % in men and 54 % in women. Using a BMI of 23·0 kg/m 2 gave a similar prevalence of MetS for males (48 %) and females (47 %). Of the five MetS components, the prevalence pattern differed among the ethnic groups, particularly for SA Indians. Conclusions: The prevalence of MetS in a diverse, low-income, SA American immigrant group using the harmonized definition was 51 %. Derived lowered BMI cut-off of 23·0 kg/m 2 should be used by clinicians in studies on SA when WC values are not available for detecting metabolic risk. SA Indians had a higher prevalence of abnormal TAG and blood glucose values compared with other SA, and therefore results for SA Indians should not be generalized to all SA ethnic groups.

Even though the total SA American population is increasing rapidly, there is a paucity of information on the relationship between diet quality, acculturation and health outcomes such as Metabolic Syndrome (MetS) in the low-income South Asian (SA) sub-population. Our goal was to examine diet quality, degree of acculturation and their potential influence on MetS in a diverse sample of SA Americans. A convenience sample of 401 adult SA men and women were studied using a cross-sectional study design. Volunteers from two low-income community health clinics in Maryland were interviewed by questionnaires. MetS, defined by the consensus harmonized definition by the presence of ≥ 3 of the 5 abnormal indicators, was studied. An interviewer obtained an automated self-administered 24-hour Recall (ASA24) and an acculturation index (using a previously validated (SL-ASIA). SA had a composite HEI2010 score of 68 suggesting an overall need for diet improvements. Males had a higher diet quality (mean HEI2010 score) than females. Males with MetS had lower diet quality (68) than males without MetS (73). The converse was true for females (68 vs. 65). Americanized (more acculturated) subjects had a higher diet quality compared to less acculturated SA. Small differences were found in diet quality scores among SA adults from different countries. Less acculturated females, had a higher percentage of MetS and lower diet quality compared to males. These results suggest that interventions are needed in males and females who were less acculturated because they may have greater MetS and lower diet quality compared to more Americanized SA.

Metabolic syndrome (MetS) is characterized by the accumulation of cardiovascular risk factors among men and women worldwide. The use of very long‐chain polyunsaturated fatty acids (VLC PUFA) could potentially benefit individuals with MetS. The goal was to better understand the relationship between MetS and VLC PUFA in South Asian (SA) Americans who experience an elevated risk for heart disease. We analyzed a cross section of South Asian (SA) using the automated self‐administered 24‐hr recall (ASA24) and clinic data in a low‐income SA in Maryland. We found no correlation between MetS indicators (high‐density lipoprotein (HDL) cholesterol, triglycerides, fasting blood glucose, diastolic blood pressure, and waist circumference (WC)) and dietary n‐3 PUFA (eicosapentaenoic, docosapentaenoic acids). However, dietary n‐6 VLC PUFA (arachidonic acid [AA]) was associated with cholesterol and fasting blood glucose levels. SA with MetS did not have a significantly low level of dietary VLC PUFA intake, and there were no SA group differences in the intake of VLC PUFA but there were significant gender differences. Dietary practices in SA may contribute to increased proinflammatory markers and play a role in elevated MetS components.

Pastoralism is widely practiced in arid lands and is the primary means of livelihood for approximately 268 million people across Africa. Environmental, interpersonal, and transactional variables such as vegetation and water availability, conflict, ethnic tensions, and private/public land delineation influence the movements of these populations. The challenges of climate change and conflict are widely felt by nomadic pastoralists in Somalia, where resources are scarce, natural disasters are increasingly common, and protracted conflict has plagued communities for decades. Bereft of real-time data, researchers and programmatic personnel often turn to post hoc analysis to understand the interaction between climate, conflict, and migration, and design programs to address the needs of nomadic pastoralists. By designing an Agent-Based Model to simulate the movement of nomadic pastoralists based on typologically-diverse, historical data of environmental, interpersonal, and transactional variables in Somaliland and Puntland between 2008 and 2018, this study explores how pastoralists respond to changing environments. Through subsequent application of spatial analysis such as choropleth maps, kernel density mapping, and standard deviational ellipses, we characterize the resultant pastoralist population distribution in response to these variables. Outcomes demonstrate a large scale spatio-temporal trend of pastoralists migrating to the southeast of the study area with high density areas in the south of Nugaal, the northwest of Sool, and along the Ethiopian border. While minimal inter-seasonal variability is seen, multiple analyses support the consolidation of pastoralists to specifically favorable regions. Exploration of the large-scale population, climate, and conflict trends allows for cogent narratives and associative hypotheses regarding the pastoralist migration during the study period. While this model produces compelling associations between pastoralist movements and terrestrial and conflict variables, it relies heavily on assumptions and incomplete data that are not necessarily representative of realities on the ground. Given the paucity of data regarding pastoralist decision-making and migration, validation remains challenging.

The objective of this study was to estimate the prevalence of Metabolic Syndrome (MetS) and its risk components and then compare differences in the risk components among low-income, uninsured Central and South American recent immigrants to the USA. This cross-sectional survey sampled 1,042 adult patients from a medical clinic in metropolitan Washington, DC. The overall prevalence of the MetS was 26.9% estimated using the modified harmonized definition. The most common abnormal metabolic indicator for women was an elevated BMI ≥ 30 kg/m2 (36.1%), while, for men, it was an elevated triglyceride level (46.5%). The risk of abnormal MetS indicators increased steadily with increasing BMI. The abnormal indicator combination identifying the most subjects with the MetS included the following: high triglycerides, low HDL cholesterol, and obesity. MetS rates were highest among subjects from El Salvador and Honduras, 31.3% and 28.0%, respectively, and lowest among subjects from Bolivia (21.7%). Dyslipidemia and high BMI increased the likelihood of having the MetS, which is consistent with studies on Mexican Americans in the San Antonio Heart Study and studies within Central and South American countries. This study adds new baseline epidemiological data for largely understudied, low-income, and mostly recent immigrant groups.

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