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Background: Abdominal obesity, excess fat around the abdomen, is more harmful than other fat types and is a key diagnostic criterion for metabolic syndrome. It poses a growing global public health concern. This study aimed to assess the prevalence of and determinants of abdominal obesity among adults in southwest Ethiopia., Methods: A cross-sectional study involving 624 adults in Semen Bench district, southwest Ethiopia was conducted from May 23 to June 23, 2022. The data was gathered using questionnaires and anthropometric measurements. The data were analyzed using Stata version 18. A robust Poisson regression was used due to the abdominal obesity prevalence exceeding 10%. Variables with p -values < 0.25 in the bivariate analysis were included in the multivariable analysis. The adjusted prevalence ratio (APR) and 95% confidence interval were reported to indicate statistical significance and the strength of associations., Results: The prevalence of abdominal obesity was 18% (95% CI: 15-21%). After adjusting for confounding variables, the determinants of abdominal obesity included participants aged 31-50 (APR = 3.62, 95% CI: 2.67-8.95) and 51-65 (APR = 3.24, 95% CI: 2.51-8.69), being female (APR = 2.65, 95% CI: 1.63-4.98), having a low wealth index (APR = 1.46, 95% CI: 1.19-3.76), physical inactivity (APR = 1.39, 95% CI: 1.06-4.18), lack of adequate dietary diversity (APR = 3.08, 95% CI: 2.09-6.42), and food insecurity (APR = 2.84, 95% CI: 1.82-7.68)., Conclusion: The research revealed that 18% of the participants exhibited abdominal obesity. Factors such as advanced age, being female, having a low wealth index, physical inactivity, insufficient dietary diversity, and food insecurity were identified as contributors to abdominal obesity. Therefore, it is crucial to develop targeted interventions to address modifiable factors, as this can also help prevent the onset of non-communicable chronic diseases associated with abdominal obesity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Yosef, Sebeta, Tekalign, Sisay, Bekele, Tesfaw and Shifera.)

Snacking is a common dietary behaviour among adolescents contributing to more than one quarter of their total energy intake; however, the relationship between snacks and diet quality remains unclear. Hence, this study aimed to examine the characteristics of snacks among adolescents with different levels of diet quality. Dietary data collected from a nationally representative sample of Australian adolescents (12-18 years old, n = 935) using one 24-hour dietary recall in the National Nutrition and Physical Activity Survey were analysed. Snacks were defined based on participant-identified eating occasions, and diet quality was assessed using the Dietary Guideline Index for Children and Adolescents (DGI-CA). Marginal means and proportion of snack characteristics including snack frequency, snack energy density (ED), and commonly consumed foods at snack from the five food groups and discretionary foods at snack across DGI-CA tertiles (highest tertile indicating high guideline adherence) were estimated for both boys and girls using linear regression and logistic regression. Differences in means were tested using the F-test. The results showed no significant differences in the mean frequency of snacks across tertiles of DGI-CA scores. The mean ED of snacks decreased as DGI-CA scores increased in both boys (lowest tertile = 8.4, 95% CI [7.1, 10.0] kJ/g, highest tertile = 6.3 [5.4, 7.4] kJ/g) and girls (lowest tertile = 9.0 [7.8, 10.3] kJ/g, highest tertile = 5.9 [5.1, 6.9] kJ/g). As diet quality improved, the proportion of adolescents consuming discretionary (i.e., unhealthy) foods and foods from the five food group foods as snacks decreased and increased, respectively. In conclusion, adolescents with higher diet quality consumed snacks with a lower ED while lower proportion of them consume discretionary foods, and higher proportion of them consume from the five food groups. Encouraging the consumption of foods from the five food groups with lower ED as snacks presents an opportunity to enhance adolescent diet quality., (© 2024. The Author(s).)

Background: Anaemia, characterized by low red blood cell or haemoglobin levels, impairs oxygen transport in the body and poses a major global public health issue, particularly affecting pregnant women and children. This study focuses on identifying the factors contributing to anaemia among pregnant women receiving antenatal care (ANC) at Mizan-Tepi University Teaching Hospital (MTUTH) in southwest Ethiopia., Methods: A hospital-based unmatched case-control study was conducted from July 1 to August 30, 2022, involving 370 pregnant women (90 with anaemia and 280 without). Data collection included questionnaires, laboratory tests (Hgb and stool examination), and anthropometric measurements. SPSS version 21 was used for data analysis, with binary logistic regression identifying factors associated with anaemia. The significance level was set at a p-value <0.05 ., Results: The study achieved a 100% response rate for both cases and controls. Factors identified as determinants of anaemia among pregnant women included malaria infection (AOR = 7.83, 95% CI: 3.89-15.8), hookworm infection (AOR = 2.73, 95% CI: 1.39-5.34), short birth interval (AOR = 7.11, 95% CI: 3.59-14.2), and history of unsafe abortion (AOR = 5.40, 95% CI: 2.46-11.8)., Conclusion: This study found that malaria infection, hookworm infection, birth interval <33 months, and a history of unsafe abortion are factors contributing to anaemia in pregnant women. Strategies such as distributing insecticide-treated bed nets (ITNs) to combat malaria, improving sanitation, anthelmintic drugs, promoting family planning to prevent unwanted pregnancies and unsafe abortions, and providing preconception care can help reduce the incidence of anaemia., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Yosef, Gizachew, Fetene, Girma, Setegn, Tesfaw, Sisay and Shifera.)

The primary aim of this study was to examine the association between snack nutritional quality, overall diet quality and adiposity among Australian adolescents. The secondary aim was to assess the distribution of discretionary foods (i.e. energy-dense and nutrient-poor foods and beverages) and intakes from the five food groups at different levels of snack nutritional quality. Dietary data collected from nationally representative adolescents (12-18 years old) during a 24-h dietary recall in the National Nutrition and Physical Activity Survey were analysed ( n 784). Snacks were defined based on participant-identified eating occasions. Snack nutritional quality was assessed using the Nutrient Profiling Scoring Criterion (NPSC), whereas diet quality was evaluated using the Dietary Guideline Index for Children and Adolescents. Adiposity was assessed through BMI Z-score waist circumference and waist:height ratio (WHtR). Higher nutritional quality of snacks, as assessed by the NPSC, has been associated with higher diet quality among both boys and girls ( P < 0·001). However, there is no association between snacks nutritional quality with BMI Z-score, waist circumference and WHtR. Among both boys and girls, the consumption of fruits, vegetables and legumes/beans at snacks increased with improvement in snack nutritional quality. Conversely, the consumption of discretionary foods at snack decreased with improvement in snack nutritional quality. In conclusion, improved snack quality was associated with better diet quality in adolescents. However, there was no association between snack nutritional quality and adiposity. Future, snack nutrition quality indices should consider optimum snack characteristics related with adiposity and diet quality.

Importance: Breast cancer is the most prevalent cancer globally with tremendous disparities both within specific regions and across different contexts. The survival pattern of patients with breast cancer remains poorly understood in sub-Saharan African (SSA) countries., Objective: To investigate the survival patterns of patients with breast cancer in SSA countries and compare the variation across countries and over time., Data Sources: Embase, PubMed, Web of Science, Scopus, and ProQuest were searched from inception to December 31, 2022, with a manual search of the references., Study Selection: Cohort studies of human participants that reported 1-, 2-, 3-, 4-, 5-, and 10-year survival from diagnosis among men, women, or both with breast cancer in SSA were included., Data Extraction and Synthesis: Independent extraction of study characteristics by multiple observers was performed using open-source software, then exported to a standard spreadsheet. A random-effects model using the generalized linear mixed-effects model was used to pool data. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guideline for reporting was followed., Main Outcome and Measures: Survival time from diagnosis., Results: Forty-nine studies were included in the review with a sample size ranging from 21 to 2311 (total, 14 459; 196 [1.35%] men, 13 556 [93.75%] women, and 707 [4.90%] unspecified; mean age range, 38 to 71 years), of which 40 were summarized using meta-analysis. The pooled 1-year survival rate of patients with breast cancer in SSA was 0.79 (95% CI, 0.67-0.88); 2-year survival rate, 0.70 (95% CI, 0.57-0.80); 3-year survival rate, 0.56 (95% CI, 0.45-0.67); 4-year survival rate, 0.54 (95% CI, 0.43-0.65); and 5-year survival rate, 0.40 (95% CI, 0.32-0.49). The subgroup analysis showed that the 5-year survival rate ranged from 0.26 (95% CI, 0.06-0.65) for studies conducted earlier than 2010 to 0.47 (95% CI, 0.32-0.64) for studies conducted later than 2020. Additionally, the 5-year survival rate was lower in countries with a low human development index (HDI) (0.36 [95% CI, 0.25-0.49) compared with a middle HDI (0.46 [95% CI, 0.33-0.60]) and a high HDI (0.54 [95% CI, 0.04-0.97])., Conclusions and Relevance: In this systematic review and meta-analysis, the survival rates for patients with breast cancer in SSA were higher in countries with a high HDI compared with a low HDI. Enhancing patient survival necessitates a comprehensive approach that involves collaboration from all relevant stakeholders.

Background: Mid-upper arm circumference (MUAC) was recommended for screening of adolescents with obesity, although its diagnostic performance with respect to high-precision assessment of body composition remains unknown., Objective: To evaluate the diagnostic performance of MUAC in identifying obesity and metabolic syndrome in U.S. adolescents., Methods: A cross-sectional study was conducted using National Health and Nutrition Examination Survey (NHANES) data (2011-2018) of adolescents aged 12-19. We calculated the area under the receiver operating characteristic curve, sensitivity, specificity, positive and negative predictive values and likelihood ratios of MUAC in identifying obesity and metabolic syndrome., Results: In our study, data of 5496 adolescents, including 2665 females, were analysed. The prevalence of obesity was higher in boys (14%) than girls (10%), whilst metabolic syndrome was more common in males (2.6%) than females (1.7%). The area under the curve (AUC) of MUAC in identifying obesity was 0.69 in boys and 0.86 in girls, whilst the AUC of MUAC in identifying metabolic syndrome was 0.91 in boys and 0.87 in girls. The optimal MUAC cut-off for identifying adolescents with obesity was 28.3 cm in boys (sensitivity: 64.8%, specificity: 85.5%) and 30.8 cm in girls (sensitivity: 67.9%, specificity: 90.1%)., Conclusions: MUAC was a good indicator of both obesity and metabolic syndrome, with higher accuracy in girls., (© 2024 World Obesity Federation.)

Background/objective: A successful Long-Term Weight Loss (LTWL) is associated with a more favorable metabolic disease risk profile. However, evidence is limited on the association of LTWL with obesity-related complications defined by Edmonton obesity staging system (EOSS). Hence, our study aims to assess the association between LTWL thresholds and obesity-related complications defined by EOSS among the adult US population., Subjects/methods: We used data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018. Adults 18 years or older with overweight/obesity and long-term weight loss were included in the analysis. The association between long-term weight loss and obesity-related complications defined by EOSS was investigated. A multivariable logistic regression model was employed by adjusting for potential covariates., Results: A total of 22,223 adults were included in the analysis. Overall, 61.8% of participants had long-term weight loss of <5%, and 4.8% of participants had successful long-term weight loss of 20% or greater. The highest long-term weight loss threshold ( ≥ 20%) had the lowest odds of EOSS stage ≥ 2 (odds ratio [OR] = 0.60; 95% CI:0.50, 0.72; p < 0.001). The lowest LTWL threshold (5-9.9%) was relatively associated with lower odds for EOSS stage ≥ 2 [OR = 0.69 95% CI: 0.61, 0.78, p < 0.001]., Conclusions: The LTWL categories were significantly associated with lower odds of EOSS stage ≥ 2 compared to EOSS 0 or 1. Future longitudinal research assessing the association between LTWL and EOSS components is recommended., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Objective: We aimed to synthesise available evidence on the effects of community-based interventions in improving various dietary outcome measures., Design: Systematic review and meta-analysis., Setting: We searched databases including Medline, EMBASE, PSYCINFO, CINAHL and the Cochrane registry for studies reported between January 2000 and June 2022. The methodological quality of the included studies was evaluated using the Cochrane risk of bias tools for each study type. For some of the outcomes, we pooled the effect size using a random-effects meta-analysis., Participants: A total of fifty-one studies, thirty-three randomised and eighteen non-randomised, involving 100 746 participants were included., Results: Overall, thirty-seven studies found a statistically significant difference in at least one dietary outcome measure favouring the intervention group, whereas fourteen studies found no statistically significant difference. Our meta-analyses indicated that, compared with controls, interventions were effective in decreasing daily energy intake (MJ/d) (mean difference (MD): -0·25; 95 % CI: -0·37, -0·14), fat % of energy (MD: -1·01; 95 % CI: -1·76, -0·25) and saturated fat % of energy (MD: -1·54; 95 % CI: -2·01, -1·07). Furthermore, the interventions were effective in improving fibre intake (g/d) (MD: 1·08; 95 % CI: 0·39, 1·77). Effective interventions use various strategies including tailored individual lifestyle coaching, health education, health promotion activities, community engagement activities and/or structural changes., Conclusion: This review shows the potential of improving dietary patterns through community-based CVD preventive interventions. Thus, development and implementation of context-specific preventive interventions could help to minimise dietary risk factors, which in turn decrease morbidity and mortality due to CVD and other non-communicable diseases.

Objective: The aim of this study was to identify the best anthropometric indices for predicting metabolic syndrome in US adolescents., Methods: A cross-sectional study analyzed data of adolescents ages 10 to 19 y using the National Health and Nutrition Examination Survey 2011 to 2018 data. The receiver operating characteristic areas under the curve (AUCs) of waist circumference z score, body roundness index, body mass index, and A Body Shape Index in identifying predicting metabolic syndrome were assessed. Furthermore, sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios of all anthropometric indices were calculated., Results: A total of 5496 adolescents were included in the analysis. Waist circumference z score had an AUC of 0.90 (95% CI, 0.89-0.91), sensitivity of 95.0% (95% CI, 89.4-98.1), and specificity of 74.8% (95% CI, 73.6, 76.0). Body roundness index had an AUC of 0.88 (95% CI, 0.87-0.89), sensitivity of 96.7% (95% CI, 91.7-99.1), and specificity of 75.2% (95% CI, 74.1-76.4). Body mass index z score had an AUC of 0.83 (95% CI, 0.81-0.85), sensitivity of 97.5% (95% CI, 92.9-99.5), and specificity of 68.2% (95% CI, 66.9-69.4). A Body Shape Index had an AUC of 0.59 (95% CI, 0.56-0.61), sensitivity of 75.0% (95% CI, 66.3-82.5), and specificity of 50.9% (95% CI, 49.5-52.2)., Conclusions: Our study found waist circumference z score and body roundness index were the best predictors of predicting metabolic syndrome compared with body mass index z score and A Body Shape Index in both boys and girls. We recommend that future studies develop global cutoff points for these anthropometric indices and examine their performance in a multi-country setting., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Not all COVID-19 deaths are officially reported, and particularly in low-income and humanitarian settings, the magnitude of reporting gaps remains sparsely characterized. Alternative data sources, including burial site worker reports, satellite imagery of cemeteries, and social media-conducted surveys of infection may offer solutions. By merging these data with independently conducted, representative serological studies within a mathematical modeling framework, we aim to better understand the range of underreporting using examples from three major cities: Addis Ababa (Ethiopia), Aden (Yemen), and Khartoum (Sudan) during 2020. We estimate that 69 to 100%, 0.8 to 8.0%, and 3.0 to 6.0% of COVID-19 deaths were reported in each setting, respectively. In future epidemics, and in settings where vital registration systems are limited, using multiple alternative data sources could provide critically needed, improved estimates of epidemic impact. However, ultimately, these systems are needed to ensure that, in contrast to COVID-19, the impact of future pandemics or other drivers of mortality is reported and understood worldwide.

Cancer incidence is relatively low in sub-Saharan Africa (SSA), however, prognosis is expected to be poor in comparison with high-income countries. Comprehensive evidence is limited on the survival pattern of colorectal cancer patients in the region. We conducted a systematic review and meta-analysis to investigate the pattern of colorectal cancer survival in the region and to identify variation across countries and over time. We searched international databases MEDLINE, Scopus, Embase, Web of Science, ProQuest, CINAHL, and Google Scholar to retrieve studies that estimated survival from colorectal cancer in SSA countries from inception to December 31, 2021 without language restriction. Due to between-study heterogeneity, we performed a random-effects meta-analysis to pool survival rates. To identify study-level sources of variation, we performed subgroup analysis and meta-regression. Results are reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guideline and the protocol was registered in PROSPERO database (CRD42021246935). 23 studies involving 10,031 patients were included in the review, of which, 20 were included in the meta-analysis. The meta-analysis results showed that the pooled 1-, 2-, 3-, 4-, and 5-year survival rates in SSA were 0.74 (95% CI, 0.66-0.81), 0.50 (95% CI, 0.41-0.58), 0.36 (95% CI, 0.27-0.47), 0.31 (95% CI, 0.22-0.42), and 0.28 (95% CI, 0.19-0.38) respectively. Subgroup analyses indicated that the survival rate varied according to year of study, in which those conducted in recent decades showed relatively better survival. The 5-year survival was higher in middle-income SSA countries (0.31; 95%CI: 0.17-0.49) than low-income countries (0.20; 95%CI: 0.11-0.35), however, the difference was not statistically significant. In conclusion, survival from colorectal cancer is low in sub-Saharan Africa compared to other regions. Thus, intervention strategies to improve screening, early diagnosis and treatment of colorectal cancer should be developed and implemented to improve survival in the region., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Dietary diversity in children may be influenced not only by individual circumstances but also by the features of the community in which they live. Our study aimed to assess community and individual-level determinants of minimum dietary diversity among children aged 6-23 months in Ethiopia. We included 2960 children aged 6-23 months from the recent Ethiopia Demographic and Health Survey. A minimum dietary diversity was defined as the consumption of at least five food groups out of the eight reference food groups within 24 h by children aged 6-23 months. Multilevel logistic regression was used to investigate the drivers of minimum dietary diversity in Ethiopian children aged 6-23 months. About 12⋅5 % of children met the bare minimum of dietary diversification. Age of the child (9-11 months AOR, 3⋅3 (95 % CI 1⋅8, 5⋅6), 12-17 months AOR, 4⋅0 (95 % CI 2⋅4, 6⋅7), 18-23 months AOR, 3⋅5 (95 % CI 2⋅0, 5⋅8)), caregiver listening radio at least once a week AOR, 1⋅6 (95 % CI 1⋅1, 2⋅4) and wealth quantiles (Second AOR, 1⋅8 (95 % CI 1⋅1, 3⋅1), Fourth AOR, 2⋅9 (95 % CI 1⋅6, 5⋅2) and Highest AOR, 2⋅2 (95 % CI 1⋅1, 4⋅2)) were individual characteristics associated with dietary diversity. Place of residence was the only community-level characteristic associated with children's dietary diversity (Rural AOR, 0⋅4 (95 % CI 0⋅2, 0⋅6)). The minimum dietary diversity among Ethiopian children is suboptimal. Nutrition programmes aimed at enhancing dietary diversity should be strengthened in this population, particularly for those from poor families and residing in rural areas., (© The Author(s) 2022.)

Background: Folate is essential for the synthesis and integrity of DNA, normal cell formation, and body growth. Folate deficiency among women of reproductive age (WRA) increases the risk of poor birth outcomes including neural tube defect (NTD)-affected pregnancies. Folate status is largely dependent on dietary intakes., Objectives: We aimed to explore the spatial distribution of biomarkers of folate status and their association with farming systems among nonpregnant WRA in Ethiopia., Methods: Serum and RBC folate concentration data were derived from the Ethiopia National Micronutrient Survey of 2015. The spatial dependencies of folate concentration of WRA were investigated and its relation with the dominant local farming system was explored., Results: The median serum folate and RBC folate concentrations were 12.3 nmol/L and 567.3 nmol/L, respectively. The national prevalence of folate deficiency using homocysteine concentration as a metabolic indicator based on serum and RBC folate concentration was 11.6% and 5.7%, respectively. The majority of women (77.9%) had low RBC folate concentrations consistent with increased risk of NTD-affected pregnancies. Folate nutrition was spatially dependent at distances of ≤ 300 km. A marked variability in folate concentration was observed between farming systems: greater RBC folate concentration (median: 1036 nmol/L) was found among women from the Lake Tana fish-based system, whereas the lowest RBC folate concentration (median: 386.7 nmol/L) was observed in the highland sorghum chat mixed system., Conclusions: The majority (78%) of WRA in Ethiopia had low folate status potentially increasing the risk of NTD-affected pregnancies. These findings may help national and subnational nutrition intervention strategies to target the most affected areas in the country., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Objective: This study aimed to synthesise the existing evidence on the performance of mid-upper arm circumference (MUAC) to identify children and adolescents with overweight and obesity., Design: Systematic review and meta-analysis., Setting: We searched PubMed, EMBASE, SCOPUS, Cochrane Library, Web of Science, CINAHL and Google scholar databases from their inception to December 10, 2021, for relevant studies. There were no restrictions regarding the language of publication. Studies reporting measures for the diagnostic performance of MUAC compared with a reference standard for diagnosing overweight and obesity in children and adolescents aged 2-19 years were included., Participants: A total of 54 381 children and adolescents from twenty-one studies were reviewed; ten studies contributed to meta-analyses., Results: In boys, MUAC showed a pooled AUC of 0·92 (95 % CI 0·89, 0·94), sensitivity of 84·4 (95 % CI 84·6, 90·8) and a specificity of 86·0 (95 % CI 79·2, 90·8), when compared against BMI z-score, defined overweight and obesity. As for girls, MUAC showed a pooled AUC of 0·93 (95 % CI 0·90, 0·95), sensitivity of 86·4 (95 % CI 79·8, 91·0), specificity of 86·6 (95 % CI 82·2, 90·1) when compared against overweight and obesity defined using BMI z-scores., Conclusion: In comparison with BMI, MUAC has an excellent performance to identify overweight and obesity in children and adolescents. However, no sufficient evidence on the performance of MUAC compared with gold standard measures of adiposity. Future research should compare performance of MUAC to the 'golden standard' measure of excess adiposity.