The co-occurrence of anemia and cardiometabolic disease risk demonstrates sex-specific sociodemographic patterning in an urbanizing rural region of southern India

Jones, Andrew D.; Hayter, Arabella; Baker, Christopher P.; Prabhakaran, Poornima; Gupta, Vipin; Kulkarni, Bharati; Smith, George Davey; Ben-Shlomo, Yoav; Krishna, K. V. Radha; Kumar, Parvinder; Kinra, Sanjay

doi:10.1038/ejcn.2015.177

Cited by 18 publications

(21 citation statements)

References 46 publications

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“…The burdens of moderate and severe anemia among the sample population were considerably higher than national figures (15.0% and 1.8%, respectively), underscoring the severity of anemia as a public health concern in the study region [ 3 ]. While there is a dearth of prevalence data on anemia among men in India, our study found one of the highest recorded prevalence estimates in India, considerably higher than the national rural average (24%) [ 3 ] and other regional populations in South India [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 71%

Burden and Determinants of Anemia in a Rural Population in South India: A Cross-Sectional Study

Little

Zivot

Humphries

et al. 2018

Anemia

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Background/Objectives To determine the prevalence and determinants of blood haemoglobin level and mild, moderate, and severe anemia in a sample of adults from rural Tamil Nadu, India. Subjects/Methods We recruited a sample of men and nonpregnant women aged 20 years and older. Clinical health measures included blood haemoglobin concentration and body mass index. We assessed associations between anemia outcomes and sociodemographic and dietary factors using linear and logistic regression modeling. Results A total of 753 individuals (412 women and 341 men) participated in this study. The prevalence of anemia was 57.2% among women and 39.3% among men (P<0.001). Prevalence of anemia increased with age among men (P<0.001) but not women (P>0.05). Iron intake was low; 11.7% women and 24.1% of men reported iron intakes above recommended dietary allowances (P<0.001). Factors (OR (95% CI)) associated with mild or moderate anemia among women included television ownership (0.27 (0.13, 0.58)), livestock ownership (0.46 (0.28, 0.75)), refined grain consumption (1.32 (1.02, 1.72)), meat consumption (0.84 (0.71, 0.99)), and commercial agriculture production (mild: 4.6 (1.1, 18.8); moderate: 6.8 (1.98, 23.1)). Factors associated with mild, moderate, or severe anemia among men included rurality (0.50 (0.25, 0.99)), sugar consumption (1.04 (1.01, 1.06)), egg consumption (0.80 (0.65, 0.99)), and high caste (7.3 (1.02, 52.3)). Conclusion Both women and men in this region may be particularly vulnerable to anemia, and future research must expand beyond dietary risk factors to examine the impacts of sociodemographic and environmental factors.

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Section: Discussionmentioning

confidence: 71%

Burden and Determinants of Anemia in a Rural Population in South India: A Cross-Sectional Study

Little

Zivot

Humphries

et al. 2018

Anemia

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“…Given the higher prevalence of both overweight and anemia among women as compared to female adolescents, it is not surprising that the prevalence of the individual‐level double burden among women far exceeded that of female adolescents. Despite the fact that the odds of anemia and overweight appear to be independent of one another in this population, the high prevalence of their co‐occurrence among women of reproductive age—analogous to other regions with a high prevalence of the individual‐level double burden of malnutrition (Gartner et al, ; Jones et al, )—suggests the need for policy and programmatic responses that address both forms of malnutrition in this demographic group.…”

Section: Discussionmentioning

confidence: 83%

Household food insecurity in Mexico is associated with the co‐occurrence of overweight and anemia among women of reproductive age, but not female adolescents

Jones

Mundo‐Rosas²,

Cantoral

et al. 2016

Maternal & Child Nutrition

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We aimed to determine the association between household food insecurity (HFI) and the co-occurrence of overweight and anemia among women of reproductive age in the Mexican population. We analyzed data on 4,039 nonpregnant female adolescents (15-19 years) and 10,760 nonpregnant adult women of reproductive age (20-49 years) from the 2012 National Health and Nutrition Survey of Mexico. The survey uses a two-stage sampling design, stratified by rural and urban regions. The Latin American and Caribbean Food Security Scale was used to assess HFI. We assessed overweight and obesity in women based on World Health Organization classifications for body mass index, and BMI-for-age Z-scores for female adolescents, and defined anemia as an altitude-adjusted hemoglobin (Hb) concentration < 120 g/L based on measurement of capillary Hb concentrations. In multiple logistic regression models adjusting for potential confounding covariates, HFI was not associated with the co-occurrence of anemia and overweight among female adolescents. The adjusted odds of women of reproductive age from mildly and moderately food-insecure households, respectively, experiencing concurrent anemia and overweight were 48% (OR: 1.48; 95% CI: 1.15, 1.91) and 49% (OR: 1.49; 95% CI: 1.08, 2.06) higher than among women from food-secure households. Severe HFI was not associated with concurrent overweight and anemia among female adolescents or women. HFI may be a shared mechanism for dual forms of malnutrition within the same individual, simultaneously contributing to overconsumption and dietary inadequacy.

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“…External comparison of this specific issue of double burden inequalities with other countries is difficult as published data are scarce. In India, the subjects of the Hyderabad Nutrition Trial nevertheless also featured a higher prevalence of the double burden of overweight and anaemia among women v. men (9 % v. 1 %, respectively), although at much lower overall level mainly due to the much lower overall prevalence of overweight (32) . In our setting, gender differences in malnutrition measured from the point of view of this double burden resulted in much higher values than when each type of malnutrition was measured separately.…”

Section: Discussionmentioning

confidence: 97%

“…As our main interest was in gender inequality measures, the gender × covariate interactions terms were then detailed by assessing the variation of the women v. men RPR inequality measure according to the categories of the covariates (i.e. assessing the modifying effect of covariates on the associations between gender and health outcomes) (8,31) , rather than the other possible symmetric interpretation of the same interaction terms (assessing the modifying effect of gender on the relationship between health outcomes and covariates) (32) . Adjusted RPR were estimated based on marginal estimates of probabilities computed at the mean value of all other covariates using the margins command in Stata.…”

Section: Double Burden Of Malnutritionmentioning

confidence: 99%

Gender inequalities in excess adiposity and anaemia combine in a large double burden of malnutrition gap detrimental to women in an urban area in North Africa

Traissac

Ati

Gartner

et al. 2016

Public Health Nutr.

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Objective: The nutrition transition has exacerbated the gender gap in health in the Middle East and North Africa region as the increase in excess adiposity has been much higher among women than men. This is not exclusive of the persistence of anaemia, generally also more prevalent among women. We assessed the magnitude and sociodemographic factors associated with gender inequality vis-à-vis the double burden of excess adiposity and anaemia. Design: Cross-sectional study, stratified two-stage cluster sample. BMI (= weight/ height 2 ) ≥25·0 kg/m 2 defined overweight and BMI ≥ 30·0 kg/m 2 obesity. Anaemia was defined as Hb <120 g/l for women, <130 g/l for men. Gender inequalities vis-à-vis the within-subject coexistence of excess adiposity and anaemia were assessed by women v. men relative prevalence ratios (RPR). Their variation with sociodemographic characteristics used models including gender × covariate interactions. Setting: Greater Tunis area in 2009-2010. Subjects: Adults aged 20-49 years (women, n 1689; men, n 930). Results: Gender inequalities in excess adiposity were high (e.g. overweight: women 64·9 % v. men 48·4 %; RPR = 2·1; 95 % CI 1·6, 2·7) and much higher for anaemia (women 38·0 % v. men 7·2 %; RPR = 8·2; 95 % CI 5·5, 12·4). They were striking for overweight and anaemia (women 24·1 % v. men 3·4 %; RPR = 16·2; 95 % CI 10·3, 25·4). Gender inequalities in overweight adjusted for covariates increased with age but decreased with professional activity and household wealth score; gender inequality in anaemia or overweight and anaemia was more uniformly distributed. Conclusions: Women were much more at risk than men, from both over-and undernutrition perspectives. Both the underlying gender-related and sex-linked biological determinants of this remarkable double burden of malnutrition inequality must be addressed to promote gender equity in health.

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The co-occurrence of anemia and cardiometabolic disease risk demonstrates sex-specific sociodemographic patterning in an urbanizing rural region of southern India

Cited by 18 publications

References 46 publications

Burden and Determinants of Anemia in a Rural Population in South India: A Cross-Sectional Study

Burden and Determinants of Anemia in a Rural Population in South India: A Cross-Sectional Study

Household food insecurity in Mexico is associated with the co‐occurrence of overweight and anemia among women of reproductive age, but not female adolescents

Gender inequalities in excess adiposity and anaemia combine in a large double burden of malnutrition gap detrimental to women in an urban area in North Africa

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