Davaasambuu Ganmaa, Polyna Khudyakov, Uyanga Buyanjargal, Badamtsetseg Jargalsaikhan, Delgerekh Baigal, Oyunsuren Munkhjargal, Narankhuu Yansan, Sunjidmaa Bolormaa, Enkhsaikhan Lkhagvasuren, Christopher T Sempos, Sabri Bromage, Zhenqiang Wu, Batbayar Ochirbat, Batbaatar Gunchin, and Adrian R Martineau. 11/27/2018. “
Prevalence and determinants of QuantiFERON-diagnosed tuberculosis infection in 9,810 Mongolian schoolchildren.” Clinical Infectious Disease.
Publisher's VersionAbstract
BACKGROUND:
There is controversy regarding the potential influence of vitamin D deficiency, exposure to environmental tobacco smoke, BCG vaccination, season and body habitus on susceptibility to Mycobacterium tuberculosis (MTB) infection.
METHODS:
We conducted a cross-sectional analysis to identify determinants of a positive QuantiFERON®-TB Gold (QFT) assay result in children aged 6-13 years attending 18 schools in Ulaanbaatar, Mongolia. Data relating to potential risk factors for MTB infection were collected by questionnaire, physical examination and determination of serum 25-hydroxyvitamin D (25[OH]D) concentrations. Risk ratios were calculated using generalized estimating equations with adjustment for potential confounders, and population attributable fractions (PAFs) were calculated for modifiable risk factors identified.
RESULTS:
946/9,810 (9.6%) participants had a positive QFT result. QFT-positivity was independently associated with household exposure to pulmonary TB (adjusted risk ratio [aRR] 4.75, 95% CI 4.13-5.46, P<0.001; PAF 13.1%, 95% CI 11.1%-15.0%), vitamin D deficiency (aRR 1.23, 95% CI 1.08-1.40, P=0.002; PAF 5.7%, 1.9%-9.3%), exposure to environmental tobacco smoke (one indoor smoker, aRR 1.19, 95% CI 1.04-1.35; two or more indoor smokers, aRR 1.30, 95% CI 1.02-1.64; P for trend, 0.006; PAF 7.2%, 95% CI 2.2%-12.0%) and increasing age (aRR per additional year 1.14, 95% CI 1.10-1.19, P<0.001). No statistically significant independent association was seen for presence of a BCG scar, season of sampling or body mass index.
CONCLUSIONS:
Our findings underline the importance of contact tracing in TB-exposed households as a strategy to identify MTB-infected children. Vitamin D deficiency and exposure to environmental tobacco smoke may be modifiable risk factors for MTB infection.
PDF Choongwon Jeong, Shevan Wilkin, Tsend Amgalantugs, Abigail S. Bouwman, William Timothy Treal Taylor, Richard W. Hagan, Sabri Bromage, Soninkhishig Tsolmon, Christian Trachsel, Jonas Grossmann, Judith Littleton, Cheryl A. Makarewicz, John Krigbaum, Marta Burri, Ashley Scott, Ganmaa Davaasambuu, Joshua Wright, Franziska Irmer, Erdene Myagmar, Nicole Boivin, Martine Robbeets, Frank J. Rühli, Johannes Krause, Bruno Frohlich, Jessica Hendy, and Christina Warinner. 11/5/2018. “
Bronze Age population dynamics and the rise of dairy pastoralism on the eastern Eurasian steppe.” PNAS.
Publisher's VersionAbstract
Recent paleogenomic studies have shown that migrations of Western steppe herders (WSH) beginning in the Eneolithic (ca. 3300–2700 BCE) profoundly transformed the genes and cultures of Europe and central Asia. Compared with Europe, however, the eastern extent of this WSH expansion is not well defined. Here we present genomic and proteomic data from 22 directly dated Late Bronze Age burials putatively associated with early pastoralism in northern Mongolia (ca. 1380–975 BCE). Genome-wide analysis reveals that they are largely descended from a population represented by Early Bronze Age hunter-gatherers in the Baikal region, with only a limited contribution (∼7%) of WSH ancestry. At the same time, however, mass spectrometry analysis of dental calculus provides direct protein evidence of bovine, sheep, and goat milk consumption in seven of nine individuals. No individuals showed molecular evidence of lactase persistence, and only one individual exhibited evidence of >10% WSH ancestry, despite the presence of WSH populations in the nearby Altai-Sayan region for more than a millennium. Unlike the spread of Neolithic farming in Europe and the expansion of Bronze Age pastoralism on the Western steppe, our results indicate that ruminant dairy pastoralism was adopted on the Eastern steppe by local hunter-gatherers through a process of cultural transmission and minimal genetic exchange with outside groups.
PDF Ryan S.D. Calder, Sabri Bromage, and Elsie M. Sunderland. 9/7/2018. “
Risk Tradeoffs Associated with Traditional Food Advisories for Labrador Inuit.” Environmental Research.
Publisher's VersionAbstract
The traditional Inuit diet includes wild birds, fish and marine mammals, which can contain high concentrations of the neurotoxicant methylmercury (MeHg). Hydroelectric development may increase MeHg concentrations in traditional foods. Consumption advisories are often used to mitigate such risks and can result in reduced intake of traditional foods. Data from a dietary survey, MeHg exposure assessment and risk analysis for individuals in three Inuit communities in Labrador, Canada (n = 1,145) in 2014 indicate reducing traditional food intake is likely to exacerbate deficiencies in n-3 polyunsaturated fatty acids and vitamins B12 and B2. Traditional foods accounted for < 5% of per-capita calories but up to 70% of nutrients consumed. Although consumption advisories could lower neurodevelopmental risks associated with an increase in MeHg exposure (90th-percentile ∆IQ = −0.12 vs. −0.34), they may lead to greater risks of cardiovascular mortality (90th-percentile increase: +58% to +116% vs. +25%) and cancer mortality (90th-percentile increase +2% to +4% vs. no increase). Conversely, greater consumption of locally caught salmon mostly unaffected by hydroelectric flooding would lower all these risks (90th-percentile ∆IQ = +0.4; cardiovascular risk: –45%; cancer risk: –1.4%). We thus conclude that continued consumption of traditional foods is essential for Inuit health in these communities.
PDF Rajesh K. Rai, Lindsay M. Jaacks, Sabri Bromage, Anamitra Barik, Wafaie W. Fawzi, and Abhijit Chowdhury. 8/30/2018. “
Prospective cohort study of overweight and obesity among rural Indian adults: sociodemographic predictors of prevalence, incidence and remission.” BMJ Open, 8, 8, Pp. e021363.
Publisher's VersionAbstract
OBJECTIVES:
To assess sociodemographic predictors of prevalence, incidence and remission of overweight including obesity among adults (aged ≥18 years) in rural Eastern India.
DESIGN:
Prospective cohort study.
SETTING:
Birbhum Health and Demographic Surveillance System, West Bengal, India.
PARTICIPANTS:
Self-weighted sample of 24 115 adults (men: 10915, women: 13200) enrolled in 2008 were followed up for body mass index (BMI) reassessment in 2017.
PRIMARY AND SECONDARY OUTCOME MEASURES:
Measured BMI was categorised as: underweight (<18.5 kg/m2), normal weight (18.5-22.9 kg/m2) and overweight including obesity (≥23 kg/m2; hereinafter overweight). Incident overweight was defined as transition from normal weight in 2008 to overweight in 2017, whereas if overweight individuals in 2008 measured normal BMI in 2017, it was classified as remission from overweight.
RESULTS:
In 2008, 10.1% of men and 14.6% of women were overweight, whereas 17.3% of men and 24.7% of women were overweight in 2017. At the same time, in 2017, 35.6% of men and 33.3% of women were underweight. Incident overweight was 19.0% among men and 27.2% among women, whereas remission among men was higher (15.4%) than women (11.5%). Women were more likely to be overweight in 2008 and to experience incident overweight than men. For men and women, education level and wealth were positively associated with prevalence and incidence of overweight. Remission from overweight was less likely in Sainthia, a business hub in the district, as compared with Mohammad Bazar, a more rural area.
CONCLUSION:
A nutrition transition to higher risk of overweight is evident in this rural setting in India, especially among women and individuals with high socioeconomic status. At the same time, a high prevalence of underweight persists, resulting in a significant double burden. Culturally sensitive interventions that address both ends of the malnutrition spectrum should be prioritised.
PDF Sabri Bromage, Davaasambuu Ganmaa, Janet W. Rich-Edwards, Bernard Rosner, Jorick Bater, and Wafaie W. Fawzi. 8/2/2018. “
Projected effectiveness of mandatory industrial fortification of wheat flour, milk, and edible oil with multiple micronutrients among Mongolian adults.” PLoS One, 13, 8, Pp. e0201230.
Publisher's VersionAbstract
Industrial fortification of wheat flour is a potentially effective strategy for addressing micronutrient deficiencies in Mongolia, given its ubiquitous consumption and centralized production. However, Mongolia has not mandated fortification of any foods except for salt with iodine. This study modeled the effectiveness and safety of mandatory industrial fortification of wheat flour alone and in combination with edible oil and milk in reducing the prevalence of multiple micronutrient intake deficiencies among healthy non-pregnant adults in Mongolia. Six days of diet records (3 summer, 3 winter) were collected from 320 urban and rural adults across the country and analyzed for food and nutrient consumption using a purpose-built food composition table, and the Intake Monitoring and Planning Program (IMAPP) was used to project the effects of fortification on summer and winter bioavailable micronutrient intake and intake deficiency under different fortification guidelines within population subgroups defined by urban or rural locality and sex. Projections showed that flour fortification would be effective in reducing intake deficiencies of thiamin and folate, while marginal benefits of fortification with iron and riboflavin would be smaller given these nutrients' higher baseline consumption, and fortification with zinc, niacin, and vitamin B12 may be unnecessary. Fortification of flour, oil, and milk with vitamins A, D, and E at levels suggested by international guidelines would substantially reduce vitamin A intake deficiency and would increase vitamin D intake considerably, with the greatest benefits elicited by flour fortification and smaller benefits by additionally fortifying oil and milk. These results support mandatory industrial fortification of wheat flour, edible oil, and milk with iron, thiamin, riboflavin, folate, and vitamins A, D, and E in Mongolia. Considerations will be necessary to ensure the fortification of these nutrients is also effective for children, for whom the potential benefit of zinc, niacin, and vitamin B12 fortification should be assessed.
PDF Sabri Bromage, Bernard Rosner, Janet W. Rich-Edwards, Davaasambuu Ganmaa, Soninkhishig Tsolmon, Zuunnast Tserendejid, Tseye-Oidov Odbayar, Margaret Traeger, and Wafaie W. Fawzi. 5/31/2018. “
Comparison of Methods for Estimating Dietary Food and Nutrient Intakes and Intake Densities from Household Consumption and Expenditure Data in Mongolia.” Nutrients, 10, 6, Pp. E703.
Publisher's VersionAbstract
Household consumption and expenditure surveys are frequently conducted around the world and they usually include data on household food consumption, but their applicability to nutrition research is limited by their collection at the household level. Using data from Mongolia, this study evaluated four approaches for estimating diet from household surveys: direct inference from per-capita household consumption; disaggregation of household consumption using a statistical method and the "adult male equivalent" method, and direct prediction of dietary intake. Per-capita household consumption overestimated dietary energy in single- and multi-person households by factors of 2.63 and 1.89, respectively. Performance of disaggregation methods was variable across two household surveys analyzed, while the statistical method exhibited less bias in estimating intake densities (per 100 kcal) of most dietary components in both of the surveys. Increasingly complex prediction models explained 54% to 72% of in-sample variation in dietary energy, with consistent benefits incurred by inclusion of basic dietary measurements. In conclusion, in Mongolia and elsewhere, differences in how household and dietary measurements are recorded make their comparison challenging. Validity of disaggregation methods depends on household survey characteristics and the dietary components that are considered. Relatively precise prediction models of dietary intake can be achieved by integrating basic dietary assessment into household surveys.
PDF Rajesh K. Rai, Wafaie W. Fawzi, Sabri Bromage, Anamitra Barik, and Abhijit Chowdhury. 3/2018. “
Underweight among rural Indian adults: burden, and predictors of incidence and recovery.” Public Health Nutrition, 21, 4, Pp. 669-678.
Publisher's VersionAbstract
OBJECTIVE:
To study the magnitude and predictors of underweight, incident underweight and recovery from underweight among rural Indian adults.
DESIGN:
Prospective cohort study. Each participant's BMI was measured in 2008 and 2012 and categorized as underweight (BMI<18·5 kg/m2), normal (BMI=18·5-22·9 kg/m2) or overweight/obese (BMI ≥23·0 kg/m2). Incident underweight was defined as a transition from normal weight or overweight/obese in 2008 to underweight in 2012, and recovery from underweight as a transition from underweight in 2008 to normal weight in 2012. Bivariate and multivariable logistic regression analyses were employed.
SETTING:
The Birbhum Health and Demographic Surveillance System, West Bengal, India.
SUBJECTS:
Predominantly rural individuals (n 6732) aged ≥18 years enrolled in 2008 were followed up in 2012.
RESULTS:
In 2008, the prevalence of underweight was 46·5 %. From 2008 to 2012, 25·8 % of underweight persons transitioned to normal BMI, 12·9 % of normal-weight persons became underweight and 0·1 % of overweight/obese persons became underweight. Multivariable models reveal that people aged 25-49 years, educated and wealthier people, and non-smokers had lower odds of underweight in 2008 and lower odds of incident underweight. Odds of recovery from underweight were lower among people aged ≥36 years and higher among educated (Grade 6 or higher) individuals.
CONCLUSIONS:
The current study highlights a high incidence of underweight and important risk factors and modifiable predictors of underweight in rural India, which may inform the design of local nutrition interventions.
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