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Total daily energy expenditure (“total expenditure”, MJ/d) reflects daily energy needs and is a critical variable in human health and physiology, yet it is unclear how daily expenditure changes over the life course. Here, we analyze a large, globally diverse database of total expenditure measured by the doubly labeled water method for males and females aged 8 days to 95 yr. We show that total expenditure is strongly related to fat free mass in a power-law manner and identify four distinct metabolic life stages. Fat free mass-adjusted daily expenditure accelerates rapidly in neonates (0-1yr) to ~46% above adult values at ~1 yr, declines slowly throughout childhood and adolescence (1-20 yr) to adult levels at ~20 yr, remains stable in adulthood (20-60 yr) even during pregnancy, and declines in older adults (60+ yr). These changes in total expenditure shed new light on human development and aging and should help shape nutrition and health strategies across the lifespan.

Background Physical activity may be a way to increase and maintain fat-free mass (FFM) in later life, similar to the prevention of fractures by increasing peak bone mass. Objectives A study is presented of the association between FFM and physical activity in relation to age. Methods In a cross-sectional study, FFM was analyzed in relation to physical activity in a large participant group as compiled in the International Atomic Energy Agency Doubly Labeled Water database. The database included 2000 participants, age 3–96 y, with measurements of total energy expenditure (TEE) and resting energy expenditure (REE) to allow calculation of physical activity level (PAL = TEE/REE), and calculation of FFM from isotope dilution. Results PAL was a main determinant of body composition at all ages. Models with age, fat mass (FM), and PAL explained 76% and 85% of the variation in FFM in females and males

Introduction 24-hour movement behaviours (physical activity, sedentary behaviour and sleep) during the early years are associated with health and developmental outcomes, prompting the WHO to develop Global guidelines for physical activity, sedentary behaviour and sleep for children under 5 years of age. Prevalence data on 24-hour movement behaviours is lacking, particularly in low-income and middle-income countries (LMICs). This paper describes the development of the SUNRISE International Study of Movement Behaviours in the Early Years protocol, designed to address this gap. Methods and analysis SUNRISE is the first international cross-sectional study that aims to determine the proportion of 3- and 4-year-old children who meet the WHO Global guidelines. The study will assess if proportions differ by gender, urban/rural location and/or socioeconomic status. Executive function, motor skills and adiposity will be assessed and potential correlates of 24-hour movement behaviours examined. Pilot research from 24 countries (14 LMICs) informed the study design and protocol. Data are collected locally by research staff from partnering institutions who are trained throughout the research process. Piloting of all measures to determine protocol acceptability and feasibility was interrupted by COVID-19 but is nearing completion. At the time of publication 41 countries are participating in the SUNRISE study. Ethics and dissemination The SUNRISE protocol has received ethics approved from the University of Wollongong, Australia, and in each country by the applicable ethics committees. Approval is also sought from any relevant government departments or organisations. The results will inform global efforts to prevent childhood obesity and ensure young children reach their health and developmental potential. Findings on the correlates of movement behaviours can guide future interventions to improve the movement behaviours in culturally specific ways. Study findings will be disseminated via publications, conference presentations and may contribute to the development of local guidelines and public health interventions. Funding Agencies|American Council on Exercise, USA; Beijing Health System High Level Talents Training Project, China [2015-3-88]; Biomedical Research Foundation, Dhaka, Bangladesh [BRF-19-01]; Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarship (CGS-M)Canadian Institutes of Health Research (CIHR); Canadian Institutes of Health Research Planning and Dissemination GrantCanadian Institutes of Health Research (CIHR) [155265]; Civilian Research Development Foundation (CRDF) Global [OISE-20-66864-1]; Department of National Planning and Monitoring, PNG Government [02704]; Early Start, University of Wollongong, Australia; Faculty of Health Sciences at the University of the Witwatersrand, Johannesburg, South Africa; Fogarty International Center (FIC) of the National Institutes of Health [D43 TW010137]; Geran Universiti Penyelidikan (GUP), Universiti Kebangsaan Malaysia [GUP-2018-142]; Global Challenges Program, University of Wollongong, Australia [888/006/497]; Harry Crossley Foundation, South Africa; National Institute of Education-Ministry of Education, Singapore [OER 04/19 TWP]; Pham Ngoc Thach University of Medicine, Vietnam [1319/QD-TDHYKPNT]; Sasakawa Sports Research Grant, Sasakawa Sports Foundation, Japan [190A2-004]; Stella de Silva Research grant from Sri Lanka College of Paediatricians, Sri Lanka; The DST-NRF Centre for Excellence in Human Development at the University of Witwatersrand, Johannesburg, South Africa; International Society of Behavioral Nutrition and Physical Activity, Pioneers Program (ISBNPA-2021); The University Research Coordination Office of the De La Salle University, Philippines [29 IR S 3TAY192021]; Universidad de La Frontera Research Directorate, Chile [DI20-0093, DFP19-0012, DI20-1002]; WHO European Office for Prevention and Control of Noncommunicable Diseases

Publisher Copyright: © 2021 The Authors Understanding the impacts of activity on energy balance is crucial. Increasing levels of activity may bring diminishing returns in energy expenditure because of compensatory responses in non-activity energy expenditures.1–3 This suggestion has profound implications for both the evolution of metabolism and human health. It implies that a long-term increase in activity does not directly translate into an increase in total energy expenditure (TEE) because other components of TEE may decrease in response—energy compensation. We used the largest dataset compiled on adult TEE and basal energy expenditure (BEE) (n = 1,754) of people living normal lives to find that energy compensation by a typical human averages 28% due to reduced BEE; this suggests that only 72% of the extra calories we burn from additional activity translates into extra calories burned that day. Moreover, the degree of energy compensation varied considerably between people of different body compositions. This association between compensation and adiposity could be due to among-individual differences in compensation: people who compensate more may be more likely to accumulate body fat. Alternatively, the process might occur within individuals: as we get fatter, our body might compensate more strongly for the calories burned during activity, making losing fat progressively more difficult. Determining the causality of the relationship between energy compensation and adiposity will be key to improving public health strategies regarding obesity.

Vitamin D deficiency is a health problem in both developed and developing countries. The aim of this study was to determine the effect of multi-vitamin fortified milk consumption on vitamin D status among children living in the mountainous region of Morocco. Children aged 7 to 9 years (n = 239; 49% of girls vs 51% of boys) participated in a double-blind longitudinal study, where they were divided in 2 groups: a fortified group that received daily 200 mL of fortified ultra-high-temperature (UHT) milk enriched with 3 μg of vitamin D3 and a nonfortified group that received 200 mL of nonfortified UHT milk with a natural abundance of vitamin D3 (about 1.5 μg). Blood samples were collected 3 times (at baseline, then at the fourth and ninth months). The average weight, height, and z score of body mass index for age of participants were 22.8 ± 2.6 kg, 121.5 ± 5.2 cm, and –0.2 ± 0.6 kg/m2, respectively. At baseline, 47.5% of children had a concentration of 25-hydroxyvitamin D below 50 nmol/L. At the end of the study the prevalence of vitamin D

Hepatic hepcidin synthesis is stimulated by inflammation but inhibited during iron deficiency anemia (IDA). In humans, the relative strength of these opposing signals on serum hepcidin and the net effect on iron absorption and systemic iron recycling is uncertain. In this prospective, 45-day study, in young women (n=46; age 18-49 years) with or without IDA, we compared iron and inflammation markers, serum hepcidin and erythrocyte iron incorporation from 57Fe-labeled test meals, before and 8, 24 and 36 hours (h) after influenza/DPT vaccination as an acute inflammatory stimulus. Compared to baseline, at 24-36 h after vaccination: 1) interleukin-6 increased 2-3-fold in both groups (P2-fold in the non-anemic group (P, Haematologica, 104 (6), ISSN:0390-6078, ISSN:1592-8721

Background The restrictions associated with the 2020 COVID-19 pandemic has resulted in changes to young children’s daily routines and habits. The impact on their participation in movement behaviours (physical activity, sedentary screen time and sleep) is unknown. This international longitudinal study compared young children’s movement behaviours before and during the COVID-19 pandemic. Methods Parents of children aged 3–5 years, from 14 countries (8 low- and middle-income countries, LMICs) completed surveys to assess changes in movement behaviours and how these changes were associated with the COVID-19 pandemic. Surveys were completed in the 12 months up to March 2020 and again between May and June 2020 (at the height of restrictions). Physical activity (PA), sedentary screen time (SST) and sleep were assessed via parent survey. At Time 2, COVID-19 factors including level of restriction, environmental conditions, and parental stress were measured. Compliance with the World Health Organizations (WHO) Global guidelines for PA (180 min/day [≥60 min moderate- vigorous PA]), SST (≤1 h/day) and sleep (10-13 h/day) for children under 5 years of age, was determined. Results Nine hundred- forty-eight parents completed the survey at both time points. Children from LMICs were more likely to meet the PA (Adjusted Odds Ratio [AdjOR] = 2.0, 95%Confidence Interval [CI] 1.0,3.8) and SST (AdjOR = 2.2, 95%CI 1.2,3.9) guidelines than their high-income country (HIC) counterparts. Children who could go outside during COVID-19 were more likely to meet all WHO Global guidelines (AdjOR = 3.3, 95%CI 1.1,9.8) than those who were not. Children of parents with higher compared to lower stress were less likely to meet all three guidelines (AdjOR = 0.5, 95%CI 0.3,0.9). Conclusion PA and SST levels of children from LMICs have been less impacted by COVID-19 than in HICs. Ensuring children can access an outdoor space, and supporting parents’ mental health are important prerequisites for enabling pre-schoolers to practice healthy movement behaviours and meet the Global guidelines.

Salt is an essential mineral to our health that, in its sodium form, is involved in many functional processes in human body. Excessive salt consumption increases the risk of high blood pressure and cardiovascular disease (CVD). The World Health Organization (WHO) and the United Nations (UN) have identified salt reduction as one of the most cost-effective strategies to prevent the spread of non-communicable diseases. The objectives of the present study is to determine the salt status in the Moroccan population based on 24-hour dietary recall and food frequency. This descriptive cross-sectional study was conducted on 133 children and adolescents recruited from public schools in Rabat regions. The average total salt intake status was assessed by 24 h dietary recall. Food frequency questionnaire was used to evaluate children’s nutritional habits and the consumption of food rich in salt. The average total salt intake is 5264.5±2398.6mg/day. The knowledge of the study population on the health risks of excess salt, 81% of participants stated that high salt consumption is positively associated with health risks, while only 7% confirmed that there is no relationship between excess salt and health problems. For the use of iodized salt, about half (46.6%) of the study population uses iodized salt. For each variable, a significant difference is shown between the subgroups (p The current intake of salt is very high in both children and adults. Reducing salt intake is one of the most cost-effective measures to prevent CVD. A low-salt diet during childhood can prevent the development of CVD and hypertension later in life. However, there is no strategy to keep children and adults low in salt.

Background: Excessive sodium intake is linked to high blood pressure. Estimating sodium intake is difficult. The 24-h urine collection is currently the recommended method for estimating intake but cumbersome for large population studies. Predictive model to estimate sodium intake based on single spot urine were developed, but showed inconsistency when used in extern populations. This study aims to develop a specific model for estimating sodium excretion over 24 hours for the Moroccan population. Methods: 371 participants in the urinary validation sub-study of the STEP-wise survey-Morocco 2017-2018 provided a valid 24-hour urine collection and spot urine specimens. Participant were randomly assigned to the training (n=183) and the validation data set (n=188). Results: A prediction model for 24-hour sodium excretion was developed. Adjusted R2 was 0.258. In the validation data set, correlation was 0.431 [95%CI; 0.258-0.580], and the adjusted R2 was 0.190. The Bland-Altman plot showed a nonsignificant small mean bias of -18 mg (95%CI, -213 to 177) in predicting 24-h urinary sodium excretion at the group level. At the individual level, limits of agreement were wide. Conclusion: This new model developed from a single spot urine could be used to predict the average 24-h sodium excretion of Moroccan adults.

Purpose Iodine deficiency has several adverse effects on human growth and development and it is categorized collectively as iodine deficiency disorders (IDDs). Recent estimations showed that 29.8 per cent of school-age children have insufficient iodine intake. Salt iodization is widely accepted as the best method for increasing iodine intake. In 1995, Morocco adopted the universal salt iodization strategy to reduce iodine deficiency and consequently prevent and control IDDs. This study aims to determine the benefit of this strategy on schoolchildren and adolescent by assessing iodine intake and evaluating iodine deficiency. Design/methodology/approach This transversal study was conducted on 131 children and adolescents. Iodine intake was assessed using a food frequency questionnaire. Iodine status was evaluated on 24-h urine samples and the creatinine excretion was used to validate completeness of urine collection. Findings The medians of urinary iodine excretion and concentration were 77 µg/day and 96 µg/L, respectively. Overall, 72.5 per cent are deficient, so mild and moderate iodine deficiencies were reported in 58 per cent and 14.5 per cent, respectively, and no child exhibited severe deficiency. A significant difference was reported between iodine deficiency and, sex and age; iodine deficiency was more pronounced in boys and children under eight years. In this study, iodine status in deficient children does not change with the consumption pattern of dairy products and eggs, and results showed no significant association (p > 0.05). However, fish consumption was significantly associated to urinary iodine concentration = 100 µg/L (p = 0.044). Average UIC in school-aged children is still inadequate and consumption of foods high in iodine remains very insufficient. Therefore, additional efforts must focus on nutritional education of Moroccan school-aged children. Originality/value In the author’s knowledge, this is the first study evaluating schoolchildren iodine status by 24-h iodine collection; the study reported association of iodine deficiency with dietary habit concerning sources of food rich on iodine.

Background. Regular physical activity in childhood and adolescent plays an important role in reducing the risk of cardiovascular health diseases, diabetes, and obesity in adulthood. However, little is known about physical activity levels (PA) and sedentary time among children and adolescents in Morocco. Objective. To examine gender, type of day, and age grade differences in objectively measured sedentary time, physical activity levels, and physical activity guideline attainment among children and adolescents in Morocco. Method. 172 children/adolescents (mean age = 10.92 ± 1.55 years, 49.4% are boys) were recruited for this study and wore a tri-axial accelerometer (GT3X+) for 7 consecutive days. Time spent in sedentary, PA levels, and daily steps were measured and compared according to gender, age grade, and the type of day (weekdays/weekends). Results. In weekdays children/adolescents spent more time in sedentary than weekends (p < 0.001). Boys were eight times more likely to meet the recommendation for at least 60 min of moderate to vigorous physical activity per day than girls (OR: 8.569; 95% [CI]: 4.23–17.32), p < 0.001. Conclusion. These findings highlight the need for effective and sustainable strategies and programs aiming to promote physical activity and to reduce sedentary behavior among children and adolescents in Morocco.

To compare the World Health Organization (WHO) body mass index (BMI)-for-age definition of obesity against measured body fatness in African children.In a prospective multicentre study over 2013 to 2017, we recruited 1516 participants aged 8 to 11 years old from urban areas of eight countries (Ghana, Kenya, Mauritius, Morocco, Namibia, Senegal, Tunisia and United Republic of Tanzania). We measured height and weight and calculated BMI-for-age using WHO standards. We measured body fatness using the deuterium dilution method and defined excessive body fat percentage as 25% in boys and 30% in girls. We calculated the sensitivity and specificity of BMI z-score +2.00 standard deviations (SD) and used receiver operating characteristic analysis and the Youden index to determine the optimal BMI z-score cut-off for classifying excessive fatness.The prevalence of excessive fatness was over three times higher than BMI-for-age-defined obesity: 29.1% (95% CI: 26.8 to 31.4; 441 children) versus 8.8% (95% CI: 7.5 to 10.4; 134 children). The sensitivity of BMI z-score +2.00 SD was low (29.7%, 95% CI: 25.5 to 34.2) and specificity was high (99.7%, 95% CI: 99.2 to 99.9). The receiver operating characteristic analysis found that a BMI z-score +0.58 SD would optimize sensitivity, and at this cut-off the area under the curve was 0.86, sensitivity 71.9% (95% CI: 67.4 to 76.0) and specificity 91.1% (95% CI: 89.2 to 92.7).While BMI remains a practical tool for obesity surveillance, it underestimates excessive fatness and this should be considered when planning future African responses to the childhood obesity pandemic.Comparer la définition de l'obésité de l'Organisation mondiale de la Santé basée sur l'indice de masse corporelle (IMC) selon l'âge à la masse grasse mesurée chez les enfants africains.Dans le cadre d'une étude prospective multicentrique menée entre 2013 et 2017, nous avons recruté 1516 participants âgés de 8 à 11 ans dans des zones urbaines situées dans huit pays (Ghana, Kenya, Maroc, Maurice, Namibie, République-Unie de Tanzanie, Sénégal et Tunisie). Nous avons mesuré leur taille et leur poids et calculé leur IMC par rapport à leur âge en utilisant les normes de l'OMS. Nous avons mesuré la masse grasse à l'aide de la méthode de dilution du deutérium, et défini le taux de masse grasse excessive comme étant 25% pour les garçons et 30% pour les filles. Nous avons calculé la sensibilité et la spécificité du Z-score de l'IMC+2,00 écarts types (ET) et utilisé une analyse de la fonction d'efficacité du récepteur et l’indice de Youden afin de déterminer la valeur limite optimale du Z-score de l'IMC pour classifier la masse grasse excessive.La prévalence de la masse grasse excessive était plus de trois fois supérieure à la prévalence de l'obésité définie en fonction de l'IMC selon l'âge: 29,1% (IC à 95%: 26,8-31,4; 441 enfants) contre 8,8% (IC à 95%: 7,5-10,4; 134 enfants). La sensibilité du Z-score de l'IMC +2,00 ET était faible (29,7%, IC à 95%: 25,5-34,2), tandis que la spécificité était élevée (99,7%, IC à 95%: 99,2-99,9). L'analyse de la fonction d'efficacité du récepteur a révélé qu'un Z-score de l'IMC de +0,58 ED optimiserait la sensibilité, et qu'à cette valeur limite, l'aire sous la courbe était de 0,86, la sensibilité de 71,9% (IC à 95%: 67,4-76,0) et la spécificité de 91,1% (IC à 95%: 89,2-92,7).Si l'IMC reste est un outil pratique pour surveiller l'obésité, il sous-évalue la masse grasse excessive. Cela doit être pris en compte lors de la planification des futures mesures africaines de lutte contre la pandémie d'obésité chez l'enfant.Comparar la definición de obesidad por edad del índice de masa corporal (IMC) de la Organización Mundial de la Salud (OMS) con la grasa corporal medida en niños africanos.En un estudio prospectivo multicéntrico realizado entre 2013 y 2017, se reclutaron 1516 participantes de edades comprendidas entre los 8 y los 11 años de zonas urbanas de ocho países (Ghana, Kenya, Marruecos, Mauricio, Namibia, República Unida de Tanzania, Senegal y Túnez). Se midieron la altura y el peso y calculamos el IMC por edad utilizando los estándares de la OMS. Se midió la grasa corporal mediante el método de dilución de deuterio y se definió el porcentaje de grasa corporal excesiva como25 % en los niños y30 % en las niñas. Se calculó la sensibilidad y especificidad del IMC con desviaciones estándar (DE) de los valores Z de+2,00 y se utilizó el análisis de las características operativas del receptor y el índice Youden para determinar el límite óptimo del IMC z-score para clasificar el exceso de grasa.La prevalencia de la obesidad excesiva fue más de tres veces superior a la obesidad definida por el IMC por edad: 29,1 % (IC del 95 %: 26,8 a 31,4; 441 niños) en comparación con un 8,8 % (IC del 95 %: 7,5 a 10,4; 134 niños). La sensibilidad del IMC con DE de los valores Z+2,00 fue baja (29,7 %, IC del 95 %: 25,5 a 34,2) y la especificidad fue alta (99,7 %, IC del 95 %: 99,2 a 99,9). El análisis de las características operativas del receptor encontró que un IMC z-score +0,58 DE optimizaría la sensibilidad, y en este corte el área bajo la curva era de 0,86, con una sensibilidad del 71,9 % (IC del 95 %: 67,4 a 76,0) y una especificidad del 91,1 % (IC del 95 %: 89,2 a 92,7).Aunque el IMC sigue siendo una herramienta práctica para la monitorización de la obesidad, subestima el exceso de grasa y esto debería tenerse en cuenta a la hora de planificar las futuras respuestas africanas a la pandemia de obesidad infantil.مقارنة بين السمنة المقيسة في الأطفال الأفارقة، وتعريف البدانة القائم على مؤشر كتلة الجسم (BMI) بالنسبة للسن، والتابع لمنظمة الصحة العالمية.في دراسة استباقية متعددة المراكز خلال الفترة من 2013 إلى 2017، قمنا بتسجيل 1516 مشاركًا تتراوح أعمارهم بين 8 إلى 11 عامًا من المناطق الحضرية في ثماني بلدان (السنغال، والمغرب، وتونس، وجمهورية تنزانيا المتحدة، وغانا، وكينيا، وموريشيوس، وناميبيا).قمنا بقياس الطول والوزن وحساب مؤشر كتلة الجسم (BMI) بالنسبة للسن، باستخدام معايير منظمة الصحة العالمية.قمنا بقياس سمنة الجسم باستخدام طريقة تخفيف الديوتيريوم، وحددنا النسبة المئوية للدهون الزائدة في الجسم لتكون أكثر من 25٪ في الأولاد، وأكثر من 30٪ في البنات.قمنا بحساب حساسية وخصوصية المحصلة المعيارية لمؤشر كتلة الجسم لتكن أكبر من +2.00 بالنسبة للانحرافات المعيارية (SD)، واستعنا بتحليل خصائص التشغيل للمستقبٍل ومؤشر يودنلتحديد الحد الأمثل للمحصلة المعيارية لمؤشر كتلة الجسم، بهدف تصنيف السمنة المفرطة.كان انتشار السمنة المفرطة أعلى أكثر من ثلاث مرات من السمنة التي يحددها مؤشر كتلة الجسم بالنسبة للسن: 29.1٪ (فاصل الثقة 95٪: 26.8 إلى 31.4؛ 441 طفلاً) مقابل 8.8٪ (فاصل الثقة 95٪: 7.5 إلى 10.4، 134 طفلاً).كانت حساسية الانحراف المعياري (SD) - الأكبر من +2.00 بالنسبة للمحصلة المعيارية لمؤشر كتلة الجسم- منخفضة، (29.7٪، بفاصل ثقة 95٪: 25.5 إلى 34.2) وكانت الخصوصية عالية (99.7٪، بفاصل ثقة 95٪: 99.2 إلى 99.9).اكتشف تحليل خصائص التشغيل للمستقبٍل أن الانحراف المعياري بنسبة +0.58 - للمحصلة المعيارية لمؤشر كتلة الجسم- سوف يُحسن من الحساسية، وأنه عند هذا الحد كانت المساحة تحت المنحنى 0.86، وكانت الحساسية 71.9٪ (فاصل ثقة 95٪: 67.4 إلى 76.0)، وخصوصية 91.1٪ (فاصل ثقة 95٪: 89.2 إلى 92.7).بينما يظل مؤشر كتلة الجسم أداة عملية لمراقبة السمنة، إلا أنه يقلل من السمنة المفرطة، ويجب وضع ذلك في الاعتبار عند التخطيط لاستجابات أفريقية مستقبلية لوباء البدانة في مرحلة الطفولة.将世卫组织 (WHO) 年龄别身体质量指数 (BMI-for-age) 对肥胖的定义与所测量的非洲儿童体脂率进行对比。.在 2013 年至 2017 年的一项前瞻性、多中心的研究中，我们从 8 个国家的城市地区（加纳，肯尼亚，摩洛哥，毛里求斯，纳米比亚，塞内加尔，突尼斯和坦桑尼亚联合共和国）招募了 1516 名 8 至 11 岁的参与者。我们使用 WHO 标准测量了参与者的身高和体重，并计算了年龄别身体质量指数。我们使用重水同位素法测量了参与者的体脂，并定义过度肥胖百分位数为男孩 25％，女孩 30％。我们计算了 BMI z 评分 +2.00 标准差 (SD) 的敏感性和特异性，并使用受试者工作特征分析和约登指数来确定过度肥胖分类的最佳 BMI z 评分的界限值。.过度肥胖的患病率比年龄别身体质量指数所定义的肥胖高出三倍以上：29.1％（95％ 置信区间，CI：26.8 至 31.4；441 名儿童）与 8.8％（95％ 置信区间，CI：7.5 至 10.4；134 名儿童）。BMI z 评分 +2.00 标准差 (SD) 的敏感性低（29.7％，95％ 置信区间，CI：25.5 至 34.2），特异性高（99.7％，95％ 置信区间，CI：99.2 至 99.9）。受试者工作特征分析发现 BMI z 评分 +0.58 标准差 (SD) 将优化敏感性，并在此界限值时，曲线下区域为 0.86，敏感性为 71.9％（95％ 置信区间，CI：67.4 至 76.0），特异性为 91.1％（95％ 置信区间，CI：89.2 至 92.7）。.虽然身体质量指数 (BMI) 仍然是肥胖监测的实用工具，但它低估了过度肥胖的患病率，因此，在规划未来非洲应对儿童肥胖率快速上升的情况时应慎重考虑。.Сравнение определения ожирения, принятого Всемирной организацией здравоохранения (ВОЗ) на основании значения «индекс массы тела (ИМТ)-возраст», с измеренными величинами упитанности африканских детей.В перспективном многоцентровом исследовании в период с 2013 по 2017 год приняли участие 1516 участников в возрасте от 8 до 11 лет из городских районов восьми стран (Гана, Кения, Маврикий, Марокко, Намибия, Объединенная Республика Танзания, Сенегал и Тунис). Детей взвешивали и измеряли их рост, после чего вычисляли показатель «ИМТ-возраст» согласно стандартам ВОЗ. Также измерялось содержание жировой ткани в организме методом дейтериевого разбавления; содержание жировой ткани считалось избыточным, если оно превышало 25% у мальчиков и 30% у девочек. Авторы вычислили чувствительность и специфичность z-оценки ИМТ + 2,00 стандартного отклонения (СО) и воспользовались методом анализа характеристических показателей правильности обнаружения сигналов индексом Юдена для определения оптимального порога z-оценки по ИМТ в вопросе классификации наличия избытка жировой ткани.Распространенность избытка жировой ткани более чем в три раза превышала частоту ожирения, определяемую показателем «ИМТ-возраст»: 29,1% (95%-й ДИ: 26,8–31,4; 441 ребенок) в сравнении с 8,8% (95%-й ДИ: 7,5–10,4; 134 ребенка). Чувствительность z-оценки ИМТ + 2,00 СО была низкой (29,7%, 95%-й ДИ: 25,5–34,2), а специфичность — высокой (99,7%, 95%-й ДИ: 99,2–99,9). Анализ характеристических особенностей правильности обнаружения сигналов позволил обнаружить, что оптимизация чувствительности возможна при использовании z-оценки ИМТ + 0,58 СО и что при этом пороговом значении площадь под кривой составляла 0,86, чувствительность — 71,9% (95%-й ДИ: 67,4–76,0), а специфичность — 91,1% (95%-й ДИ: 89,2–92,7).Несмотря на то что измерение ИМТ остается практическим средством выявления ожирения, оно недооценивает содержание избыточной жировой ткани в организме, и это следует учитывать при планировании мероприятий по борьбе с пандемией детского ожирения в Африке.

Objective Assortative mating for adiposity increases the genetic burden on offspring, but its causes remain unclear. One hypothesis is that people who have high adiposity find other people with obesity more physically attractive than lean people. Methods The attractiveness of sets of images of males and females who varied in adiposity were rated by opposite sex subjects (559 males and 340 females) across 12 countries. Results There was tremendous individual variability in attractiveness ratings. For female attractiveness, most males favored the leanest subjects, but others favored intermediate fatness, some were indifferent to body composition, and others rated the subjects with obesity as most attractive. For male images rated by females, the patterns were more complex. Most females favored subjects with low levels of adiposity (but not the lowest level), whereas others were indifferent to body fatness or rated the images depicting individuals with obesity as the most attractive. These patterns were unrelated to rater BMI. Among Caucasian males who rated the images of the thinnest females as being more attractive, the magnitude of the effect depended on rater BMI, indicating limited "mutual attraction." Conclusions Individual variations in ratings of physical attractiveness were broadly unrelated to rater BMI and suggest that mutual attraction is an unlikely explanation for assortative mating for obesity.

Calcium is an important mineral playing a vital role to maintain bone health. Calcium intake is considered as one of the most important determinants to assess the calcium status and to evaluate the calcium deficiency in the human body. Our study aims at estimating calcium intake in a sample of children and adolescent to be used in the global strategy to reduce calcium deficiency disorders in Morocco. Thus, 131 children and adolescents were recruited from public schools at Rabat and its regions in the framework of a descriptive cross-sectional study. For each participant, anthropometric parameters were measured. Calcium status was assessed by 24 h dietary recall. Food frequency questionnaire was used to evaluate children’s nutritional habits and to assess the consumption of calcium-rich food. Overall, the mean calcium intake was 522.0 ± 297.0 mg/day, and 85.5% of subjects highlighted calcium deficiency, with no significant difference between boys and girls. Calcium intake was significantly different according to age groups, and high consumption of calcium was found in subjects aged from 14 to 18 years (776.86 ±290.07 mg/day), giving evidence of the low calcium status of the studied population. Daily food intake and food frequency analysis showed that bread, vegetables, and fruits are the most consumed food and the main source of daily calcium intake. Consumption of dairy products, considered as the best source of calcium, is lower and represents only 14% of total calcium intake. Our study clearly showed that calcium status is very lower in Moroccan children and adolescents and a large proportion of this population have inadequate calcium intake. Hence, there’s an urgent need of specific strategies, including children sensitisation and nutritional education, to increase calcium intake and therefore reduce calcium deficiency disorders impacting the whole body during childhood and in adult age.

Background: Exclusive breastfeeding during the first six months of an infant&rsquo, s life is an important factor for their optimal growth and health. Breastfeeding also has maternal benefits and can assist with postpartum weight loss. As shown by previous studies, postpartum weight retention can contribute to obesity. Objective: To quantify the human milk and evaluate the effect of breastfeeding on maternal weight loss during the 12 months postpartum. Method: This study included 70-mother&ndash, baby pairs. Infants&rsquo, intake of human milk and water from other sources, as well as the body composition of the mothers, were measured at the 1st, 3rd, 6th, 9th and 12th month postpartum by using the deuterium oxide dose-to-mother technique. Results: There was a significant change in the mothers&rsquo, body composition between the first and twelfth months in exclusive breastfeeding women compared to not-exclusive ones. Similarly, the difference between the quantities of human milk intake was highly significant in exclusive breastfeeding women compared to women who were not exclusively breastfeeding. Conclusion: Our results showed that exclusive breastfeeding for twelve months has a significant effect on postpartum weight loss among Moroccan women and that it is an effective way to control overweight and obesity among lactating women.

Background: Physical activity (PA) is an important agent in the prevention of chronic diseases such as obesity. Objectives: To provide preliminary data on PA among school children and to correlate the PA with weight status. Material and Methods: A total of 40 children aged between 8 and 11 years and attending Tunisian schools were recruited. The body composition was determined by using the deuterium oxide dilution technique. PA was determined by the PAQ-C (PA Questionnaire for Older Children). An objective monitoring of PA and sedentary time was achieved by using ActiGraph GT3X + accelerometers. Results: PAQ-C data demonstrate that 20% of the sample had light PA levels and 80% had moderate PA levels. Times spent in sedentary (62.37%) and light (30.80%) activities were higher than that spent in moderate and vigorous (6.83%) activities. Furthermore, almost half of the sample spent more than 60 min per day in moderate-to-vigorous intensity PA (MVPA). The average MVPA was significantly higher in normal weight than overweight and obese groups (67.68 ± 20.98 vs. 49.07 ± 19.09, p = 0.007). The proportion of overweight children who spent more than 60 min per day in MVPA was significantly higher than that of normal-weight (60.9 vs. 29.4%; p = 0.049). Conclusion: This study indicates that half of school children comply with the health-based guidelines for PA and sedentary behavior. Our findings also suggest that obesity was associated with decrease in PA in Tunisian children.

Objective: To carry out an inventory on the availability, challenges, and needs of dietary assessment (DA) methods in Africa as a pre-requisite to provide evidence, and set directions (strategies) for implementing common dietary methods and support web-research infrastructure across countries. Methods: The inventory was performed within the framework of the " Africa's Study on Physical Activity and Dietary Assessment Methods" (AS-PADAM) project. It involves international institutional and African networks. An inventory questionnaire was developed and disseminated through the networks. Eighteen countries responded to the dietary inventory questionnaire. Results: Various DA tools were reported in Africa; 24-Hour Dietary Recall and Food Frequency Questionnaire were the most commonly used tools. Few tools were validated and tested for reliability. Face-to-face interview was the common method of administration. No computerized software or other new (web) technologies were reported. No tools were standardized across countries. Conclusions: The lack of comparable DA methods across represented countries is a major obstacle to implement comprehensive and joint nutrition-related programmes for surveillance, programme evaluation, research, and prevention. There is a need to develop new or adapt existing DA methods across countries by employing related research infrastructure that has been validated and standardized in other settings, with the view to standardizing methods for wider use.

This study aimed to estimate the prevalence of hypertension among a group of adolescents and to assess the relationship of systolic and diastolic blood pressure (SBP, DBP) with body fat mass (BFM), body mass index (BMI) and waist circumference (WC). A total of 167 subjects aged 11-17 years were recruited, 29.3% and 12.6% were overweight and obese respectively. BMI, WC, SBP and DBP were determined using standardized equipment. BFM was estimated by the deuterium oxide dilution. Hypertension (HT) and prehypertension (pre-HT) were observed in 17.4% and 9.6%, of the study population, respectively. The prevalence of HT and pre-HT was significantly higher in boys and in overweight-obese groups (p = 0.044; p = 0.003 respectively). Both SBP and DBP were significantly higher in overweight-obese compared to healthy-weight groups (p < 0.001; p = 0.002 respectively). SBP was significantly higher in boys than girls (p = 0.013). With some exceptions, SBP and DBP were significantly correlated with BMI, WC and BFM in the study population and different weight-status groups of both genders. The relationship of blood pressure with BMI appeared to be more significant than with WC and BFM. The prevalence of hypertension was higher in boys than girls and in overweight-obese than healthy-weight adolescents. Overall SBP and DBP were associated with BFM, BMI and WC. However, the strong association between these variables was seen in girls, and the greater risk of developing hypertension could be associated with increasing BMI.

The aim of the study is to evaluate the prevalence of iron deficiency anaemia (IDA) after a wheat flour fortification program with electrolytic elemental iron in Morocco. Two surveys were conducted after introduction of fortified wheat flour. The target population was women aged 15–49 years and preschool children aged between 2 and 5 years. A total of 1,258 and 1,237 children aged between 2 and 5 years, and 1,497 and 1,537 women of childbearing age have been involved, respectively, in the first and second investigation using a sentinel system. Ferritin and C-reactive-protein analyses were determined in a sub-sample of 268 and 130 women who were selected in May 2006 and January 2008, respectively and, in a subsample of 146 and 201 preschool children who were recruited in May 2006 and January 2008, respectively. The prevalence of anaemia in women was 31.5 and 33.3 % in May 2006 and January 2008, respectively. The prevalence of IDA was 63.9 and 59.1 % in May 2006 and January 2008, respectively. The prevalence of anaemia among preschool children was 47.8 and 37.5 % in May 2006 and January 2008, respectively. The prevalence of IDA in preschool children was 16.7 and 16 % in May 2006 and January 2008, respectively. The flour fortification programme with electrolytic elemental iron in Morocco had no apparent beneficial effect on the prevalence of IDA among women of childbearing age and preschool children.

Iodine is required for the production of the thyroid hormones essential for the growth and development of the brain. All forms of iodine deficiency (ID) affect the mental development of the child. Our study aims to assess the impact of ID on the intellectual development of Moroccan schoolchildren and to evaluate the effect of consumption of fortified milk on reducing ID. In a double-blind controlled trial conducted on schoolchildren, children were divided into two groups to receive fortified milk (30% of cover of RDI iodine) or nonfortified milk for 9 months. Urinary iodine was analyzed using the Sandell-Kolthoff reaction, a dynamic cognitive test using Raven’s Standard Progressive Matrices to assess learning potential was performed at baseline and end line, and anthropometric assessment was done only at baseline. The study included schoolchildren who were severely iodine deficient. The prevalence of malnutrition was high in both groups; in this study, we found improvements in iodine status and in cognitive abilities among Moroccan schoolchildren. Our study showed that the consumption of fortified milk led to a clear improvement in iodine status and also appeared to have a favorable effect on the cognitive ability of Moroccan schoolchildren in a rural mountainous region.

Anaemia is a public health problem in Morocco. To limit this problem, Morocco developed a national programme based on fortification of flour with electrolytic elemental iron. To evaluate the programme's impact on the prevalence of anaemia in children between 2 and 5 years, 4 surveys were conducted, between 2006 and 2008, throughout the country. The results showed a significant improvement in the mean rate of haemoglobin accompanied by a significant decrease in the prevalence of anaemia. This improvement appears to be the result of several mutually reinforcing actions in addition to the fortification of flour with iron, including the promotion of a diversified diet rich in micronutrients and the promotion of public health measures.

Background : Although high-performance liquid chromatography (HPLC) is the commonly used method for the analysis of retinol in biological samples, simple and rapid test kits are available. Objectives : This study compared a rapid test kit (ICHECK Fluoro®) to HPLC for the assessment of serum retinol concentrations. Methods : For the analysis by HPLC, sample preparation included standard deproteinization and extraction phases. The analysis by ICHECK was performed by injecting serum into IEX reagent vials (n=89) and mixing manually for separation. After precipitation of the proteins, the vial was introduced into the chamber of the ICHECK Fluoro and analysed at 0 min (ICHECK0min) and 15 min later (ICHECK15min). Bland and Altman approach was applied to test the agreement between HPLC and ICHECK. Results : Mean HPLC, ICHECK0min and ICHECK15min values were 421.2±106.0 μg/L, 423.1±118.3 μg/L and 413.2±107.6 μg/L, respectively. Retinol concentrations significantly decreased in the IEX solution over time (p

Iron deficiency constitutes a major public health problem in Morocco, mainly among women and children. The aim of our paper is to assess the efficacy of consumption of multiple micronutrients (MMN) fortified milk on iron status of Moroccan schoolchildren living in rural region. Children (N=195), aged 7 to 9 y, were recruited from schools and divided into two groups: the nonfortified group (NFG) received daily a nonfortified Ultra-High-Temperature (UHT) milk and the fortified group received (FG) daily UHT milk fortified with multiple micronutrients including iron sulfate. Blood samples were collected at baseline (T0) and after 9 months (T9). Hemoglobin (Hb) was measuredin situby Hemocue device; ferritin and C Reactive Protein were assessed in serum using ELISA and nephelometry techniques, respectively. Results were considered significant when thepvalue was p=0.037). Despite the low prevalence of iron deficiency anemia (1.9%); more than 50% of children in our sample suffered from iron deficiency at baseline. The consumption of fortified milk reduced the prevalence of iron deficiency by 27% in schoolchildren living in high altitude rural region of Morocco.Clinical Trial Registration.Our study is registered in the Pan African Clinical Trial Registry with the identification numberPACTR201410000896410.

ObjectiveThe study aimed to detail the lifestyle (physical activity and dietary habits) of Moroccan adolescents.DesignCross-sectional study undertaken in the framework of the ATLS (Arab Teens Lifestyle Study).SettingPhysical activity and dietary habits were determined using a validated questionnaire in public secondary schools.SubjectsA total of 669 adolescents aged 15·0–19·9 years were randomly recruited from Kenitra, Morocco.ResultsPhysical activity patterns and intensity differed between genders. As anticipated, male adolescents were more active than female adolescents across a typical week and engaged in more vigorous-intensity physical activity than female adolescents, who spent more time than male adolescents in moderate-intensity physical activity. Of particular concern was that one in five of the adolescents surveyed was inactive, with almost 45 % of the sample reporting television viewing for more than 2 h/d and 38 % engaged in computer use for a similar period. From a dietary perspective, most adolescents reported that they do not take breakfast or consume milk and dairy products, fruits and vegetables on a daily basis. In contrast, most reported consumption of doughnuts, cakes, candy and chocolate more than three times per week and approximately 50 % consumed sugary drinks more than three times per week.ConclusionsBased on a continuation of the self-reported lifestyle behaviours, adolescents in the present study are at risk of developing chronic diseases. Education programmes are urgently needed to assist in the promotion of a healthy lifestyle and reduce the likelihood of overweight and obesity and related health risks among young people.

Liposarcoma is the most common malignant deep soft-tissue tumor in adults. however, primitive cutaneous liposarcoma is very rare. We report the observation of a patient who presents a liposarcoma of the thumb.

Background: The prevalence of obesity and related diseases such as metabolic syndrome (MetS) are increasing in young populations over the world, especially in developing countries. This study aimed to estimate the prevalence of MetS and its individual components, and to assess their association with both overweight/obesity and excess body fat. Methods: This study included 192 adolescents (77 boys and 115 girls) aged 11 to 17 years. Blood pressure and anthropometric measurements were done using standardized techniques. Fasting blood samples were taken for determination of glucose and lipids levels. Percent body fat was estimated using deuterium oxide. The international diabetes federation criteria were applied for the diagnosis of MetS. Results: The prevalence of MetS among overweight/obese adolescents was 18.6% while it was not observed in their normal weight counterparts. The most common abnormality found in the study population was reduced HDLcholesterol (26.6%) followed by elevated fasting blood glucose (22.4%) and high waist circumference (19.3%). Among overweight/obese groups, the rates of individuals with raised TG and reduced HDL-cholesterol were significantly higher in boys than girls (35.0% vs. 15.2%, p=0.044; and 32.5% vs. 13.0%, p=0.038, respectively). Compared to normal-weight adolescents, overweight/obese subjects had higher odds of having at least two MetS components (OR=5.37, 95%CI: 2.72-10.59), or at least three MetS components (OR=11.80, 95%CI: 3.40-41.03). Excess body fat showed similar degrees of association with clustering MetS components. Conclusions: The prevalence of MetS and its individual components was quite high among the study population, particularly among overweight/obese adolescents. MetS components were strongly associated with both overweight/ obesity and excess body fat. MetS and its components might be best predicted by obesity indexes, determined according to age and body mass index in adolescents, than accurate percent body fat.

Objectives. The study aimed to assess the relationship between body fat and each of body mass index (BMI) and waist circumference (WC), and to test the effectiveness of fat mass (FM), percent of body fat (PBF), BMI, and WC in predicting high levels of fasting blood glucose (FBG).Methods. A total of 167 adolescents aged 11–17 years were recruited from Rabat region. BMI and WC were determined using standard equipments. FM and PBF were derived from isotope dilution technique. FBG was determined by the hexokinase method.Results. Regardless of the weight status, BMI showed a strong positive correlation with FM and PBF in both genders. WC was significantly correlated with FM in boys and girls, and with PBF in different groups of girls and boys of the study sample. However, there was no significant relationship between WC and PBF in normal weight and overweight-obese groups of boys. FBG was highly correlated with FM and PBF in girls of the study sample and in overweight-obese girls. Similar significant relationship between FBG and both BMI and WC was observed in overweight-obese girls, while there was no significant association between FBG and other variables in boys and normal-weight girls.Conclusion. BMI and WC were closely associated with FM and PBF, respectively. However, the degree of these associations depends on gender and weight status. BMI may provide a better proxy estimate of overall adiposity than WC; nevertheless, both of them would appear to be a reasonable surrogate for FM and PBF as screening tools to identify adolescents at risk of developing excess body fat and high level of FBG.