Search Results (30)

Background/Objectives: Aging is associated with physiological, biochemical, and psychosocial changes that can significantly affect nutritional status and overall health. In Sub-Saharan Africa (SSA), older adults face unique age-related challenges that may compromise healthy aging, yet evidence remains fragmented. This systematic review synthesized the existing literature on the nutritional status, age-related challenges, and strategies to promote healthy aging of older adults in SSA. Methods: A systematic literature search was conducted on PubMed, Scopus, ScienceDirect, and Cochrane Library to identify relevant studies published up to 10 December 2025. Results: Fifty-five studies met the inclusion criteria, with most of the studies coming from South Africa, Ghana, and Nigeria. Amongst community-dwelling populations, approximately 30–65% of the older adults were either malnourished or at risk of malnutrition, while hospital-based studies reported markedly higher burdens, with malnutrition prevalence exceeding 70% in some settings. Undernutrition, micronutrient deficiencies, and the coexistence of overweight and obesity were frequently observed, reflecting the region’s ongoing nutrition transition. Frailty emerged as the predominant age-related challenge, with prevalence ranging around 10–60%. Other common challenges included sarcopenia, reduced muscle strength, functional disability, cognitive impairment, and dysphagia, all of which were closely related to poor nutritional status, food insecurity, multimorbidity, and reduced quality of life. Few studies reported on healthy aging strategies, with the limited evidence suggesting that nutrition education, physical activity, and psychosocial interventions may enhance nutritional and functional outcomes. Conclusions: The need for context-specific, nutrition-sensitive interventions, and stronger health and social support systems is warranted to promote healthy aging in SSA older adults. Full article

Background: School feeding programs aim to improve child nutrition, and they may influence weight outcomes insofar as program modalities and household responses alter children’s total energy intake. This is especially relevant in countries facing the double burden of malnutrition, where undernutrition and micronutrient deficiencies coexist with rising overweight and obesity. This study estimates the effect of Peru’s former National School Feeding Program on obesity and excess weight among children aged 36 to 59 months under a selection-on-observables identification strategy and assesses whether impacts differ across operational modalities, particularly breakfast-only versus breakfast plus lunch and ready-to-eat rations versus foods delivered for preparation. Methods: We use repeated cross-sectional microdata from the Demographic and Health Survey (ENDES) pooled over 2014 to 2018 and link them to administrative information. The sample includes 18,959 children aged 36 to 59 months. To improve comparability, we estimate propensity score weights targeting the average treatment effect on the treated (ATT) using a machine learning generalized boosted model (GBM), and assess covariate balance using standardized mean differences and Kolmogorov–Smirnov statistics. Identification assumes conditional independence given observed covariates and overlap (common support). Main estimates rely on weighted probit models with fixed effects, progressively adding exposure duration, modality indicators, and controls. Distributional effects are examined using quantile regression on the continuous weight-for-height z-score. Results: Without differentiating modalities, beneficiary status is not associated with a statistically significant change in obesity, while pooled baseline estimates indicate a statistically significant higher probability of excess weight. Modality-specific results show that obesity declines only when Qali Warma is delivered as breakfast plus lunch through products to be prepared (approximately −1.0 percentage point in parsimonious models and −0.4 percentage points after controls). Evidence for excess weight is directionally consistent by modality but less conclusive once controls are included. Conclusions: Qali Warma’s effects on early-childhood weight outcomes depend on implementation modality. Evaluations of school feeding programs should incorporate operational heterogeneity, particularly during program redesign. Full article

Background: Malnutrition in adolescents remains a significant public health issue worldwide, with undernutrition and overweight often coexisting. Accurate nutritional screening during adolescence is complicated by variability in biological maturation and class imbalance, particularly among underweight adolescents. Objective: This study aims to develop and validate machine learning models for classifying the nutritional status of adolescents, accounting for class imbalance and biological maturation, and to evaluate model stability and variable importance at different stages of peak height velocity (PHV). Methods: In this cross-sectional study, 4232 adolescents aged 11 to 18 years were recruited from nine educational institutions in Tunisia. Their nutritional status was classified according to the International Obesity Task Force (IOTF) BMI thresholds into three categories: underweight (14.4%), normal weight (68.3%), and overweight (17.2%). Ten anthropometric, behavioral, and maturation-related predictors were analyzed. Six supervised machine learning algorithms were evaluated using a 70/30 stratified split between training and test sets, with five-fold cross-validation. Class imbalance was addressed by ROSE combined with cost-sensitive learning. Model performance was assessed using accuracy, Cohen’s kappa coefficient, macro F1 score, sensitivity, specificity, and AUC. Results: The cost-sensitive Random Forest (RF) model achieved the best overall performance, with an accuracy of 0.830, a macro F1 score of 0.767, a macro-AUC of 0.921, and a macro- sensitivity of 0.743. The class-specific sensitivities were 0.70 (underweight), 0.91 (normal weight), and 0.62 (overweight), with no major misclassification between the extreme categories. Performance remained stable across the different maturation phases (accuracy from 0.823 to 0.839), with optimal discrimination in the pre-PHV (macro-AUC = 0.936; sensitivity for underweight = 0.82) and post-PHV (macro-AUC = 0.931) periods. Body mass was the main predictor (importance = 1.00), followed by waist circumference (0.34–0.53). The importance of age for classifying underweight increased significantly from the pre-PHV (0.10) to the post-PHV (0.75) period. A two-stage hierarchical model further improved underweight detection (stage 1 AUC = 0.911; sensitivity = 0.732). Conclusions: A cost-sensitive RF model, combined with ROSE, provides robust classification of adolescents’ nutritional status maturation, significantly improving underweight detection while preserving overall accuracy. This approach is particularly well-suited to public health screening in schools as a first-stage assessment that requires clinical confirmation and promotes a maturation-aware interpretation of nutritional risk among adolescents. Full article

Tuberculosis (TB) rarely occurs in isolation; most people with TB experience multiple coexisting conditions, including HIV, diabetes, undernutrition, depression, and substance use disorders, which worsen disease severity and compromise treatment outcomes. Although the World Health Organization has issued disease-specific guidance for managing key comorbidities, TB care remains largely siloed and poorly equipped to address the growing burden of multimorbidity, particularly in African health systems. In this perspective article, we propose a phased framework for multimorbidity-centered TB care. The first phase emphasizes systematic screening for common comorbidities and establishment of basic referral pathways. The second phase focuses on strengthening coordination between TB programs and existing health and social services, including task sharing and longitudinal follow-up. The third phase advances toward fully integrated, co-located, multidisciplinary models of care that embed TB services within broader multimorbidity platforms. Together, this framework offers a pragmatic roadmap for TB programs to deliver more person-centered, equitable, and efficient care, strengthen primary care systems, and accelerate progress toward ending TB as a public health threat in Africa. Full article

Background and Aims: In recent decades, lifestyle patterns have undergone significant transformations, particularly in low- and middle-income countries (LMICs). These changes have contributed to a dual nutritional crisis characterized by the coexistence of undernutrition and overweight/obesity, commonly referred to as the Double Burden of Malnutrition (DBM). Compounding this issue is the persistent prevalence of parasitic infections, due to poor personal hygiene and sanitation practices which further exacerbate nutritional imbalances, creating what is now recognized as the Triple Burden of Malnutrition (TBM). This review aims to explore the evolving lifestyle factors that have contributed to the emergence of the DBM and to examine its intersection with parasitic infections. The focus is particularly on South Asian low- and middle-income countries, where these overlapping burdens present a significant public health challenge. By highlighting the interconnectedness of malnutrition, obesity, and parasitic diseases, this study seeks to provide a comprehensive understanding of the current nutritional landscape in South Asian LMICs and to inform future health interventions and policies. Methods: This study was conducted using published and unpublished secondary data that are available on websites and other printed materials. One of the main requirements is date, with 2013 being regarded as the initiative’s landmark. Another crucial factor is the availability of the entire article. For this study, only research publications published in English were taken into consideration. Zotero was used for compilation. The majority of the analysis was performed using percentages and ratios. A thorough evaluation of all the studies’ methodology, design, execution, and reporting was performed in order to spot any systematic flaws in this study. Results: Only 45 of the 105 full-text papers that were screened met the requirements for inclusion. Of these studies, 15 satisfied the inclusion and exclusion requirements. The results show that China, with a comparatively higher income level status, has more prevalence of overweight and obesity among children (11.5%) and women (34.6%) than India (2.1% of OWOB among children and 20.6% among women). Nepal stands behind China and India with 1.2% of OWOB among children and between them with 22.2% OWOB among women. Interestingly, among the three South Asian nations, India has the highest stunting, wasting, and underweight among children (38.4%, 21%, and 35.7%, respectively) followed by Nepal (35.8%, 9.7%, and 27%) and China (8.1%, 2%, and 2.5%). This study finds no significant difference in the prevalence of intestinal parasitic infections among OWOB and underweight populations. This review finds that the DBM along with parasitic infections has resulted in a Triple Burden of Malnutrition, which is currently a major public health issue in low- and middle-income countries in South Asia. Discussion: The various types of malnutrition were once thought of and treated as distinct public health problems, but the new understanding is that undernutrition and overnutrition are linked, and that in order for policy solutions to be successful, double-duty measures that simultaneously address multiple dimensions must be put in place. When the DBM is combined with parasite illnesses, it becomes the Triple Burden of Malnutrition, which is the primary cause of the financial burden in LMICs. China has the worst obesity problem, yet it also has more obesity-related laws and intervention programs than India and Nepal combined. All three nations, however, have failed to stop or deal with the dramatic increase in OWOB over the last 20 years. For effective implementation and results, genetic and psychological factors must also be taken into account when developing policies and programs to tackle the obesity epidemic, undernutrition, and parasite diseases. Conclusions: The prevalence of the DBM has been rising globally, with South Asia seeing a faster rate of increase. A growing DBM is favorably correlated with national economic development. In South Asian LMICs, the DBM combined with parasite diseases has resulted in a Triple Burden of Malnutrition, a debilitating illness. Full article

Background: Childhood and adolescent obesity often coexist with micronutrient deficiencies and metabolic alterations, particularly in marginalized communities. Objectives: This cross-sectional study evaluated the biochemical, anthropometric, and dietary characteristics of 55 children and adolescents (ages 4–13) from Tlaltizapán, Mexico, to identify the early metabolic risk factors associated with excess weight. Methods: Nutritional intake was assessed through six-day dietary recalls and analyzed for adequacy against the national reference values. Anthropometric and biochemical indicators—including the BMI-for-age Z-score, waist-to-height ratio (WHtR), lipid profile, and plasma amino acid levels—were stratified by age and weight status. Results: Overall, 36.4% of participants were overweight or obese. Alarmingly, 89.4% of children and 94.1% of adolescents had low HDL levels, regardless of their BMIs. Several participants with a normal BMI showed elevated WHtR, triceps skinfold, and plasma branched-chain amino acids, suggesting hidden metabolic risks. The dietary analysis revealed an excess intake of sugars, proteins, and fats, alongside insufficient fiber, vitamins, and minerals. The adolescents had poorer adherence to dietary recommendations than children. Conclusions: These findings underscore the limitations of BMI alone and support the use of WHtR, skinfolds, and biochemical markers to detect preclinical obesity. Urgent, targeted nutritional strategies are needed in semi-rural areas to address the double burden of obesity and undernutrition. Full article

Background/Objectives: Anemia and undernutrition are severe public health concerns in Ethiopia. These are the two most common nutritional disorders in pregnant women and frequently coexist. However, to our knowledge, there is little evidence of the coexistence of anemia and undernutrition among pregnant women. Therefore, this study aimed to examine the prevalence of coexisting anemia and undernutrition (CAU) and associated factors among pregnant women. Methods: A community-based cross-sectional study was conducted from 1 to 25 June 2024, on 515 pregnant women in the Hawela Lida district of Sidama, Ethiopia. We utilized a multi-stage sampling method to choose eligible study participants. A pre-tested and structured questionnaire was used to collect data via the online Open Data Kit mobile tool. We controlled the effect of confounders and clustering by using a multi-level mixed-effect modified Poisson regression analysis model. Results: The prevalence of CAU among pregnant women was 25.4% (95% CI: 21.9–28.9). The prevalence of CAU was associated with household food insecurity (adjusted prevalence ratio [APR]: 2.17; 95% CI: 1.43–3.28), training on model family (APR: 0.66; 95% CI: 0.45–0.96), inadequate dietary diversity (APR: 1.51; 95% CI: 1.18–1.95), and having poor knowledge of nutrition (APR: 1.55; 95% CI: 1.06–2.26) at individual levels. Low community-level women’s autonomy (APR: 6.19; 95% CI: 3.42–11.22) and community-level road accessibility (APR: 0.65; 95% CI: 0.43–0.98) were the identified determinants of CAU at the community level. Conclusions: One in four pregnant women had CAU in the study area. Household food insecurity, inadequate dietary diversity, and poor nutrition knowledge were associated with an increased likelihood of CAU, while participation in model family training and improved road accessibility were associated with reduced CAU. We have also indicated that low community-level women’s autonomy significantly increased the risk of CAU. Therefore, inter-sectorial collaboration should be required to comprehensively address CAU’s determinants at different levels. Additionally, any CAU prevention and intervention programs should provide model family training explicitly targeting women with poor nutritional knowledge and low autonomy in healthcare decision-making. Full article

Children with Down syndrome often face significant feeding difficulties and health comorbidities that may contribute to undernutrition or obesity. This study assessed dietary habits and nutritional status among 104 children with Down syndrome in Croatia, representing 11.5% of this population. Results showed that over 30% of children aged 1 to 15 were overweight. Over 60% never consumed whole grain bread, while more than 50% avoided fish, nuts, or seeds. Despite rural families more frequently producing their own food (meat p = 0.009; fruits/vegetables p = 0.035), no significant improvement was observed in the children’s diets compared to their urban counterparts. Urban children consumed milk (p = 0.008) and fermented dairy (p = 0.005) more often. Children of university-educated mothers had higher vegetable (p = 0.031), meat (p = 0.025), olive oil (p = 0.003), and nut (p = 0.029) consumption, and a lower intake of processed meats (p = 0.008) and salty snacks (p = 0.040). Families spending less than 50% of income on food also showed significantly healthier dietary patterns. Feeding difficulties in children with Down syndrome are commonly associated with sensory sensitivities, oral-motor impairments, and comorbid medical conditions. These challenges are often intensified by parental anxiety, delayed introduction of diverse foods, and inadequate professional support. Collectively, these factors contribute to selective eating, poor nutrient intake, and disordered eating behaviors. This study underscores the need for individualized nutritional interventions that address the unique physiological and sensory requirements of both children and adults with Down syndrome. Effective strategies should extend beyond general dietary recommendations to include early exposure to a variety of food textures, specialized feeding support, and the management of coexisting health conditions. Family education and engagement play a crucial role in achieving positive nutritional outcomes. Empowering parents and caregivers—especially those in socioeconomically disadvantaged or rural communities—can facilitate the alignment of food accessibility with healthy dietary practices. The findings of this research offer valuable guidance for the development and implementation of national strategies aimed at enhancing the nutrition and long-term health of individuals with Down syndrome. Full article

Background: Nearly half of under-five deaths are linked to undernutrition. Most evidence on undernutrition relies on conventional anthropometric measures. Conventional anthropometric measures fail to capture its overlapping forms and are limited in providing the true burden and distinct disaggregated patterns of undernutrition. Using the Composite Index of Anthropometric Failure (CIAF), this study aims to provide updated regional and country-level pooled prevalence estimates of the overall burden and various single and coexisting patterns of undernutrition among children in Sub-Saharan Africa (SSA). Methods: We systematically searched Medline, CINAHL, Web of Science, Scopus, and Google Scholar for studies published between January 2006 and October 2023. Studies reporting the prevalence of aggregated CIAF or any of the disaggregated forms of CIAF (stunting only, wasting only, underweight only, stunting-underweight, wasting-underweight, and stunting-wasting-underweight) based on the 2006 World Health Organisation (WHO) growth standard were included. Data extraction was performed by two reviewers, and discrepancies were resolved by consensus. Pooled prevalences of various categories of undernutrition were estimated using a random effect model meta-analysis. Subgroup analysis and meta-regression were performed to identify possible sources of heterogeneity among the included studies. Publication bias was checked using the Asymmetry funnel plot and Egger’s test. The protocol was registered on PROSPERO (CRD42023458796). Result: This systematic review and meta-analysis identified 3898 published studies from the database search, of which 26 were included. In SSA, the overall pooled prevalence of undernutrition among children was 37.45% (95% Confidence Interval (CI): 31.97, 42.92). Of these, 10% (95% CI: 8.02, 11.98) of children experienced at least one coexisting form, and 25.5% (95% CI: 16.78, 33.72) experienced at least one single form of undernutrition. Stunting only [22.32% (95% CI: 18.26, 26.39)] was the most prevalent disaggregated pattern of undernutrition, followed by the coexistence of stunting with underweight [10.15% (95% CI: 8.17, 12.13)]. Conclusions: Over one in three children in SSA experienced at least one form of undernutrition. Nearly one-third of these undernourished children were affected by multiple forms of undernutrition. The high prevalence of coexisting undernutrition indicates the need to develop multi-indicator nutrition strategies that could simultaneously address the various dimensions of undernutrition in children. Full article

Introduction: Undernutrition in low- and middle-income countries (LMICs) remains a leading public health challenge. It accounts for one-third of the under-five mortality rate in sub-Saharan Africa (SSA). This study applied the composite index of anthropometric failure (CIAF) to assess the prevalence of various standalone and coexisting forms of undernutrition and identify associated risk factors. Methods: Nationally representative demographic health survey (DHS) data from 26 SSA countries were used. A multilevel multinomial logistic regression analysis was conducted considering the hierarchical nature of DHS data and more than two categories of outcome variable. Four models were fitted and the model with the highest log-likelihood and lowest deviance was chosen as the best-fitted model. The adjusted relative risk ratio (aRRR) with its corresponding 95% confidence interval (CI) was presented as a measure of the effect. Results: The overall prevalence of undernutrition among under-five children in SSA was 34.59% (95% CI: 34.35–34.82). Additionally, 20.49% (95% CI: 20.30–20.69) and 14.09% (95% CI: 13.92–14.26) of under-five children had standalone and coexisting undernutrition, respectively. The mother’s educational level and household wealth status were the most significant shared drivers for standalone and coexisting undernutrition. On the other hand, child and health service factors were differentiating factors between standalone and coexisting undernutrition. Age of the child, sex of the child, type of birth, birth weight, adherence to age-appropriate feeding, antenatal care visit (ANC), place of delivery, and maternal educational status were the most significant determinants of various undernutrition forms in 0–23-month-old children. For 24–59-month-old children, age of the child, sex of the child, type of birth, household wealth status, and maternal education were identified as the main determinants of different forms of undernutrition. Conclusions: Our analysis revealed that distal factors were shared risk factors among standalone and coexisting forms of undernutrition. However, proximal and intermediate factors varied in the type and strength of the association between standalone and coexisting undernutrition. This implies that holistic and category-specific strategies are needed to significantly reduce undernutrition among under-five children in SSA. Full article

Background and objective: Paediatric malnutrition has a synergistic relationship with diarrhoea. In children under two years of age, diarrhoea occurs in more than half of malnutrition cases and is associated with increased duration of illness, increased length of hospital stays, increased morbidity, and mortality. A well-established relationship exists between diarrhoeal and various standalone forms of malnutrition, but their association with coexisting forms of malnutrition (CFM) has not yet been investigated. Thus, this study assessed the association of CFM with diarrhoea among Pakistani children using datasets retrieved from Demographic Health & Survey and UNICEF. Study design: A pooled analysis of datasets of Pakistan Demographic & Health Surveys (PDHS) and Multiple Indicator Cluster Surveys (MICS) from the year 2010 to 2018 was conducted. Methods: Data of 70,723 children aged below two years were analysed after excluding those with incomplete anthropometry and outliers. Findings: Of the total study population, this study reported the presence of either diarrhoea or malnutrition or both in over half of Pakistani children aged between 0 and 23.9 months. Both standalone forms of undernutrition and coexisting forms of undernutrition were significantly associated with increased odds of diarrhoea by 1.07 (1.02 to 1.12) and 1.21 (1.16 to 1.27) times. The practice of breastfeeding, secondary/higher level of maternal education, and improvement in socioeconomic status reduced the risk of diarrhoea, while the children aged between 6 and 23.9 months residing in urban areas showed a high risk of diarrhoea. Conclusions: The presence of any type of undernutrition, i.e., standalone and/or coexisting forms were associated with increased risk of diarrhoeal diseases in children. An improvement in socioeconomic status, adherence to the continuation of breastfeeding, and maternal education are keys to reducing the burden of diarrhoea among children. Full article

The dietary patterns and quality of diets of women of reproductive age (WRA) significantly affect their health and that of their children. The suboptimal diet among women can lead to issues such as intrauterine growth retardation, low birth weight, premature birth, and malnutrition. To examine the dietary patterns and nutrient intake of WRA in the indigenous communities of the Attappady tribal block in Kerala, we conducted a cross-sectional study in 20 randomly selected villages in 2022. The study involved 24 h dietary recall surveys, anthropometric measurements, and estimation of hemoglobin concentration to assess nutrient intake and nutritional status. A total of 446 women aged 15–49 from 423 households participated, with 92 households included in the diet survey. The findings indicated that the diet was primarily based on cereals and root-based starchy staples, with low consumption of dairy products, fruits, and vegetables. The estimated intakes of major nutrients, except for protein, were lower than the recommended dietary allowance (RDA). Nearly 50% of the WRA were malnourished. About 32% of non-pregnant and non-lactating (NPNL) women and 40% of lactating mothers suffered from chronic energy deficiency (BMI < 18.5 kg/m²). Conversely, 13.4% of NPNL women and 15% of lactating mothers were overweight or obese (BMI ≥ 25 kg/m²). A total of 12.5% of adolescent girls aged 15–19 were thin (BAZ < −2 SD), and 10.5% were overweight or obese (BAZ > +1 SD). Since the co-existence of micronutrient deficiencies and undernutrition is rooted in the socio-cultural aspects of indigenous tribes, a culturally sensitive nutrition intervention model would be appropriate for the better health and wellbeing of women in the community. Full article

(1) Background: The double burden of malnutrition (DBM) is an emerging public health concern among children and adolescents in developing countries. This study investigated the prevalence and factors associated with being underweight and overweight among adolescents. (2) Methods: This cross-sectional study was conducted among 423 adolescents across 10 high schools in Harare. A questionnaire was used to collect data and weight for height-z-scores were used to compute body mass index. Pearson’s Chi-Square and multinomial logistic regression were used to test for associations and explore factors associated with being underweight or overweight at (p < 0.05). (3) Results: The median and IQR range for the participants was 16 (14–19) years. There were more girls 53.2%, than boys 46.8% (p = 0.002), and more 14–16-year-olds 54.1%, than 17–19-year-olds (p = 0.070). More boys 10% than girls 9.1% were underweight, whereas more girls 21.8% than boys 9.3% were overweight and obese (p = 0.002). By age, more 14–16-year -olds were underweight 12.7% than 17–19-year-olds 5.9%, whereas more 17–19-year-olds 16.2% were overweight than 14–16-year-olds (p = 0.070). Significant factors associated with being underweight were inadequate balanced nutrition knowledge [OR = 1.49 (0.139–0.997), p = 0.049], being in the 14–16 years age group [OR = 2.56 (1.137–5.779), p = 0.023], having formally employed [OR = 2.34 (1.008–5.428), p = 0.048] and unemployed [OR = 5.17 (1.263–21.116), p = 0.022] household heads. Significant factors associated with overweight were being a girl [OR = 0.32 (0.168–2.561), p < 0.001, and having formally employed household heads [OR = 2.00 (1.044–1.206), p = 0.037]. The employment status of the household head (being formally employed) was the only factor which associated with both underweight and overweight statuses. (4) Conclusions: Although underweight and overweight statuses co-exist, among adolescents, those who are overweight appear to be more than those who are underweight. Significant factors associated with being underweight were inadequate nutrition knowledge, being 14–16 years old, and having formally employed or unemployed parents. While being a girl and having formally employed parents were significant determinants of the overweight status. This paper calls for more awareness of DBM and context-specific interventions targeting obesity in a country where undernutrition has been traditionally prioritized at policy and program levels. Full article

Background: The coexistence of malnutrition due to over- and under-nutrition in the Peruvian Amazon increases chronic diseases and cardiovascular risk. Methods: A cross-sectional study of a male population where anthropometric, clinical, and demographic variables were obtained to create a binary logistic regression predictive model of cardiovascular risk. Results: We compared two methods with good predictive results, finally choosing Model 4 (r² = 0.57, sensitivity 73.68%, specificity 95.35%, Youden index 0.69, and validity index 94.21), with non-invasive variables such as blood pressure (p < 0.001), hip circumference (p < 0.001), and FINDRISC test result (p < 0.05); Conclusions: We developed a cheap, fast, and non-invasive tool to determine cardiovascular risk in the population of this endemic area. Full article

The World Health Organization’s (WHO) Eastern Mediterranean Region (EMR) is suffering from a double burden of malnutrition in which undernutrition coexists with rising rates of overweight and obesity. Although the countries of the EMR vary greatly in terms of income level, living conditions and health challenges, the nutrition status is often discussed only by using either regional or country-specific estimates. This analytical review studies the nutrition situation of the EMR during the past 20 years by dividing the region into four groups based on their income level—the low-income group (Afghanistan, Somalia, Sudan, Syria, and Yemen), the lower-middle-income group (Djibouti, Egypt, Iran, Morocco, Pakistan, Palestine, and Tunisia), the upper-middle-income group (Iraq, Jordan, Lebanon, and Libya) and the high-income group (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates)—and by comparing and describing the estimates of the most important nutrition indicators, including stunting, wasting, overweight, obesity, anaemia, and early initiation and exclusive breastfeeding. The findings reveal that the trends of stunting and wasting were decreasing in all EMR income groups, while the percentages of overweight and obesity predominantly increased in all age groups across the income groups, with the only exception in the low-income group where a decreasing trend among children under five years existed. The income level was directly associated with the prevalence rates of overweight and obesity among other age groups except children under five, while an inverse association was observed regarding stunting and anaemia. Upper-middle-income country group showed the highest prevalence rate of overweight among children under five. Most countries of the EMR revealed below-desired rates of early initiation and exclusive breastfeeding. Changes in dietary patterns, nutrition transition, global and local crises, and nutrition policies are among the major explanatory factors for the findings. The scarcity of updated data remains a challenge in the region. Countries need support in filling the data gaps and implementing recommended policies and programmes to address the double burden of malnutrition. Full article