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Burden, due to foodborne diseases, particularly Salmonella infection, is high in developing countries like Bangladesh. This research aimed at the molecular characterization of Salmonella spp., isolated from selected school canteen’s fast foods in Dhaka city, Bangladesh, and to evaluate the antibiotic resistance patterns of isolated foodborne pathogens. The school cafeterias were selected by the convenience sampling method. The samples were collected aseptically, and serial dilutions were made. The bacterial colonies were isolated by spread plate technique using appropriate media, and bacterial identification was carried out using gram staining and biochemical tests such as MIU, KIA, Oxidase, and Catalase test. The strain of Salmonella spp. was confirmed by molecular characterization employing the 16S rRNA gene sequencing method. The susceptibility of the isolates to various antibiotics was observed by modified Kirby-Bauer disk diffusion method. Most of the samples were found to contain an unacceptable level of a total aerobic count, which ranged from 5.6×105 to 6.1×107 and 3.4×104 to 7.2×107 for burger and sandwich samples, respectively. Significant isolates from the pathogenic strains were Salmonella spp., Shigella, Klebsiella, Proteus, E. coli, Vibrio spp., Clostridium spp., Staphylococcus spp., and others. The further molecular characterization of isolated Salmonella spp. suggests the similarity with Salmonella enterica serovar Rissen SeqrSC0091. Most isolates were resistant against Ampicillin (100%), Azithromycin (60.87%), Tetracycline (39.43%), Colistin (32.61%), while were highly sensitive to Gentamycin and Chloramphenicol. The presence of multidrug-resistant foodborne pathogens at this high level in the school cafeteria’s fast foods signifies an increased risk for the children’s health.

The experiment was carried out at the research field of Agronomy and Farming Systems Division, Bangladesh Sugarcrop Research Institute (BSRI), Ishurdi, Pabna during 2012-2013 to determine the most suitable spacing for sugarbeet cultivation in Bangladesh. The experiment was conducted with nine spacing viz. 50 cm × 20 cm, 60 cm × 20 cm, 70 cm × 20 cm, 50 cm × 25 cm, 60 cm × 25 cm, 70 cm × 25 cm, 50 cm × 30 cm, 60 cm × 30 cm and 70 cm × 30 cm in a randomized complete block design with three replications. The effects of spacing on sugarbeet plantation were observed on growth and growth contributing components (germination percentage, number of leaves plant-1, root length, shoot length, root fresh weight, shoot fresh weight, root dry weight, shoot dry weight, crop growth rate) of sugarbeet. The highest germination percentage (95.67%), number of leaves plant-1 (34.33) at 30 DAS, shoot length (54.07 cm) at 120 DAS, root fresh weight (969.47 g plant-1) at 150 DAS, shoot fresh weight (752.47 g plant-1) at 120 DAS and other growth contributing parameters were obtained with the spacing 70 cm × 30 cm. However, the maximum root length (38.97 cm) was obtained with 50 cm × 20 cm spacing. It was concluded that the wider spacing promoted the growth of individual beet, though the optimum spacing for maximum root growth of sugarbeet was 50 cm × 20 cm. Bangladesh Agron. J. 2020, 23(2): 51-58

Aims: Iodine deficiency is one of the most common micronutrient deficiencies in Bangladesh. To combat iodine deficiency disorders, universal salt iodization is mandatory in Bangladesh. The aim of our study was to determine the iodine content of both packaged and open edible table salts sold at the retailer level in different areas of Bangladesh. Study Design: The study is an experimental cross-sectional study. Place and Duration of Study: The present study was conducted in the food analysis laboratory of Department of Food Technology and Nutrition Science, Noakhali Science and Technology University from March 2019 to June 2019. A total of 90 salt samples were collected from ten retailers selected based on convenience sampling from two districts: Dhaka and Noakhali. Among the samples, 45 were packaged salts from Fifteen different brands and the rest of the 45 samples were non brand open salt. Methodology: The iodine content of iodized salt samples was determined by the iodometric titration method. Results: The mean iodine content of both types of salts is 17.801±1.973 ppm. The mean iodine contents of packaged salts and open salts are 30.691±2.679 ppm and 4.912±1.008 ppm, respectively. Only 42% of the total salt samples are adequately iodized (>20 ppm). 75% of packaged salt samples are adequately iodized and only 8% of open salt samples are adequately iodized. Conclusion: As iodine content in open table salts doesn’t meet the criteria set by the government, the sale of open salt for human consumption should be stopped.

BackgroundCOVID-19 has seriously disrupted health services in many countries including Bangladesh. This research aimed to explore whether Rohingya (forcefully displaced Myanmar nationals) older adults in Bangladesh faced difficulties accessing medicines and routine medical care services amid this pandemic.MethodsThis cross-sectional study was conducted among 416 Rohingya older adults aged 60 years and above residing in Rohingya refugee camps situated in the Cox’s Bazar district of Bangladesh and was conducted in October 2020. A purposive sampling technique was followed, and participants’ perceived difficulties in accessing medicines and routine medical care were noted through face-to-face interviews. Binary logistic regression models determined the association between outcome and explanatory variables.ResultsOverall, one-third of the participants reported difficulties in accessing medicines and routine medical care. Significant factors associated with facing difficulties accessing medicine included feelings of loneliness (adjusted OR (AOR) 3.54, 95% CI 1.93 to 6.48), perceptions that older adults were at the highest risk of COVID-19 (AOR 3.35, 95% CI 1.61 to 6.97) and required additional care during COVID-19 (AOR 6.89, 95% CI 3.62 to 13.13). Also, the notable factors associated with difficulties in receiving routine medical care included living more than 30 min walking distance from the health centre (AOR 3.57, 95% CI 1.95 to 6.56), feelings of loneliness (AOR 2.20, 95% CI 1.25 to 3.87), perception that older adults were at the highest risk of COVID-19 (AOR 2.85, 95% CI 1.36 to 5.99) and perception that they required additional care during the pandemic (AOR 4.55, 95% CI 2.48 to 8.35).ConclusionMany Rohingya older adults faced difficulties in accessing medicines and routine medical care during this pandemic. This call for policy-makers and relevant stakeholders to re-assess emergency preparedness plans including strategies to provide continuing care.

Highlights • Geriatric health is often overlooked in developing countries like Bangladesh. • Mental health is the lowest priority domain of geriatric health. • The majority of the Bangladeshi elderly population suffers from depression symptoms. • Depression is strongly associated with geriatric malnutrition. • Depression can seriously deteriorate the quality of life for older adults., Malnutrition is the root of numerous complications ranging from physical disability to mental health problems like depression. Depending on the intensity, depression can lead to emotional fluctuations, even suicidal attempts. Geriatric health in a country like Bangladesh is often ignored, although they are a growing segment of society. This community-based cross-sectional study aimed to determine the prevalence and severity of depression and malnutrition in the elderly to evaluate the relationship between depression and malnutrition. Mini Nutritional Assessment (MNA) was used to determine nutritional status, and Geriatric Depression Scale (GDS) was used to assess depression. About 84% of the participants showed a different array of depression symptoms. The rate of malnutrition and depression is higher among the male participants. Being malnourished (OR: 4.05, 95% CI: 2.79–5.87) and people are at risk of malnutrition (OR:1.67, 95% CI:1.24–2.24) had a significantly higher risk of suffering from depression. Maintaining a good physical state, a healthy lifestyle, and a supportive family environment are among the factors that can reduce depression in the elderly population. Therefore, to fight depression, specific programs and targeted interventions focusing on physical and mental stability for the elderly at the community level can enhance awareness at the individual and family levels.

Aim This study aimed to assess the fear of COVID-19 and its associates among older Rohingya (Forcibly Displaced Myanmar Nationals or FDMNs) in Bangladesh. Method We conducted a cross-sectional survey among 416 older FDMNs aged 60 years and above living in camps of Cox’s Bazar, Bangladesh. A semi-structured questionnaire was used to collect information on participants’ socio-demographic and lifestyle characteristics, pre-existing non-communicable chronic conditions, and COVID-19 related information. Level of fear was measured using the seven-item Fear of COVID-19 Scale (FCV-19S) with the cumulative score ranged from 7 to 35. A multiple linear regression examined the factors associated with fear. Results Among 416 participants aged 60 years or above, the mean fear score was 14.8 (range 8–28) and 88.9% of the participants had low fear score. Participants who were concerned about COVID-19 (β: 0.63, 95% CI: -0.26 to 1.53) and overwhelmed by COVID-19 (β: 3.54, 95% CI: 2.54 to 4.55) were significantly more likely to be fearful of COVID-19. Other factors significantly associated with higher level of fear were lesser frequency of communication during COVID-19, difficulty in obtaining food during COVID-19, perception that older adults are at highest risk of COVID-19 and receiving COVID-19 related information from Radio/television and friends/family/neighbours. Conclusions Our study highlighted that currently there little fear of COVID-19 among the older Rohingya FDMNs. This is probably due to lack of awareness of the severity of the disease in. Dissemination of public health information relevant to COVID-19 and provision of mental health services should be intensified particularly focusing on the individual who were concerned, overwhelmed or fearful of COVID-19. However, further qualitative research is advised to find out the reasons behind this.

ObjectivesDue to low health literacy and adverse situation in the camps, there are possibilities of misconceptions related to COVID-19 among the older Rohingya (forcefully displaced Myanmar nationals or FDMNs) adults in Bangladesh. The present research aimed to assess the level of misconceptions and the factors associated with it among the older FDMNs in Bangladesh.DesignCross-sectional.SettingA selected Rohingya camp situated in Cox’s Bazar, a southeastern district of Bangladesh.ParticipantsInformation was collected from 416 conveniently selected FDMNs who were aged 60 years and above.Primary and secondary outcome measuresThe primary outcome was misconceptions related to the spread, prevention and treatment of COVID-19. Information on 14 different locally relevant misconceptions was gathered, each was scored as one, and obtained a cumulative score, ranging from 0 to 14, with a higher score indicating a higher level of misconceptions. A multiple linear regression model explored the factors associated with misconceptions.ResultsThe participants had an average of five misconceptions. The most prevalent misconceptions were: everyone should wear personal protective equipment when outside (84.6%) and its prevention by nutritious food (62.5%) and drinking water (59.3%). Other notable misconceptions included the spread of COVID-19 through mosquito bites (42%) and its transmissions only to the non/less religious person (31.4%). In regression analyses, memory or concentration problems, communication frequency with social networks, pre-existing conditions and receiving information from health workers were significantly associated with higher COVID-19 misconceptions. These misconceptions were less likely among those overwhelmed by COVID-19, having COVID-19 diagnosed friends or family members and receiving information from friends and family.ConclusionsOverall, we found that misconceptions were prevalent among the older FDMNs in Bangladesh. The associations have important implications for programmes to prevent and manage COVID-19 in these settings. Health workers need to be adequately trained to provide clear communication and counter misconceptions.

Introduction Obesity and higher BMI is one of the leading comorbidities to increase the risk of COVID-19 severity. This paper presents a systematic review and meta-analysis estimating the effects of overweight and obesity on COVID-19 disease severity. Method Two electronic databases (Medline and Cochrane library) and one grey literature database (Grey Literature Report) were searched. The risks of bias of the selected studies were assessed by using the Navigation Guide method for human data. Both random and fixed effect meta-analyses were determined using Review Manager (RevMan) software version 5.4. Results After initial screening, 12 studies were fulfilled the eligibility criteria, comprising a total of 405359 patients, and included in the systematic review. The pooled risk of COVID-19 severity was 1.31 times higher based on both fixed and random effect model among those overweight patients, I2 0% and 2.09 and 2.41 times higher based on fixed and random effect respectively among obese patients, I2 42% compared to healthy individuals. Conclusion Overweight and obesity are found to be risk factors for disease severity of COVID-19 patients. However, further assessment of metabolic parameters is required to estimate the risk factors of COVID-19 patients and understanding the mechanism between COVID-19 and body mass index.

The global pandemic of COVID-19 is posing the biggest threat to humanity through its ubiquitous effect of unfathomable magnitude. Although COVID-19 is a viral disease, there might be an association between different comorbidities and the occurrence of the disease. Our study aims to determine the association between the COVID-19 infection and pre-existing comorbidities such as asthma, diabetes, liver disease, lung disease, heart disease, kidney disease, hypertension, and obesity through a web-based self-reported survey. Univariate and multivariate logistic regression analyses were done using these risk factors as independent variables. A total of 780,961 participants from 183 different countries and territories participated in this study. Among them, 1516 participants were diagnosed with COVID-19 prior to this study. A significant risk association was observed for age above 60 years, female gender, as well as different pre-existing disease conditions such as diabetes, kidney disease, liver disease, and heart diseases. Asthma and diabetes were the major dominant comorbidities among patients, and patients with existing diabetes were more likely to develop the disease than others who did not diagnose as diseased. Therefore, older adults, females, as well as people with comorbidities such as diabetes mellitus, heart disease, kidney disease, and liver disease are the most vulnerable population for COVID-19. However, further studies should be carried out to explain the pathway of these risk associations.

Background Depression is globally a crucial communal psychiatric disorder, which is more common in older adults. The situation is considerably worse among millions of older (forcibly displaced Myanmar nationals or FDMNs) Rohingya adults, and the coronavirus disease-2019 (COVID-19) pandemic may exacerbate the already existing precarious situation. The present study investigated depressive symptoms and their associated factors in older adult Rohingya FDMNs in Cox Bazar, Bangladesh, during the COVID-19 pandemic. Method A total of 416 older adults aged 60 years and above residing in Rohingya camps situated in the South Eastern part of Bangladesh were interviewed using a 15-item Geriatric Depression Scale (GDS-15) in Bengali language. Chi-square test was performed to compare the prevalence of depressive symptoms within different categories of a variable and a binary logistic regression model was performed to determine the factors associated with depressive symptoms. Results More than 41% of Rohingya older adults had depressive symptoms (DS). Socio-demographic and economic factors such as living alone, dependency on family for living, poor memory, feelings of being left out, difficulty in getting medicine and routine medical care during COVID-19, perception that older adults are at highest risk of COVID-19 and pre-existing non-communicable chronic conditions were found to be significantly associated with developing DS. Higher DS was also evident among older female Rohingya FDMNs. Conclusion DS are highly prevalent in older Rohingya FDMNs during COVID-19. The findings of the present study call for immediate arrangement of mental health care services and highlight policy implications to ensure the well-being of older FDMNs.

IntroductionCOVID-19 pandemic has caused havoc worldwide, and different comorbidities have been seen to exacerbate the condition. Obesity is one of the leading comorbidities, which is associated with many other diseases. In this paper, we present a systematic review and meta-analysis estimating the effects of overweight and obesity on COVID-19 disease severity.MethodologyTwo electronic databases (Medline and Cochrane library) and one grey literature database (Grey Literature Report) were searched using the following keywords: overweight, obesity, body mass index, respiratory disease, coronavirus, COVID-19. The risks of bias of the selected studies were assessed by using the Navigation Guide method for human data. Both random and fixed effect meta-analysis were determined using Review Manager (RevMan) software version 5.4.ResultsAfter initial screening, 12 studies (7 cohort studies, four case-control studies, and one cross-sectional study) were fulfilled the eligibility criteria, comprising a total of 405359 patients and included in the systematic review. The pooled risk of disease severity was 1.31 times higher based on both fixed and random effect model among those overweight patients,I20% and 2.09 and 2.41 times higher based on fixed and random effect respectively among obese patients,I242% compared to healthy individuals.ConclusionOverweight and obesity are common risk factors for disease severity of COVID-19 patients. However, further assessment of metabolic parameters included BMI, waist-hip ratio, and insulin levels, are required to estimate the risk factors of COVID-19 patients and understanding the mechanism between COVID-19 and body mass index.

BackgroundThe average life expectancy of the Bangladeshi population has been rising over the last decade due to the economic growth along with improved medicare. Although the increased number of geriatric people and their health is a matter of great concern, this issue remains unnoticed here.ObjectivesTo assess the nutritional status of the functionality and to analyze the association between nutritional status and functional ability of the selected Bangladeshi geriatric population.MethodsA community-based cross-sectional study was conducted among 400 participants, covering Chittagong, Noakhali, Comilla, and Jessore district of Bangladesh from December 2019 to February 2020. A standard and pretested questionnaire containing Mini Nutritional Assessment (MNA), Tinetti Performance Oriented Mobility Assessment (POMA), Activities of daily living scale (ADL), Lawton-Brody Instrumental Activities of Daily Living Scale (IADL), was used.ResultsAccording to our study, The prevalence of malnutrition and people at risk of malnutrition have been 25.4% and 58.8%, respectively. In the case of functionality, 63.3% of subjects have high falling risk, and 61.8% of subjects can independently do their daily activities while 38.3% are dependent. Furthermore, almost 80% of people are dependent in terms of doing living skills. High risk of falling (OR=10.823; 95% CI: 5.846-20.37; pConclusionsGeriatric malnutrition can accelerate disability conditions, which can lead to early functional aging and subsequent loss in the quality of life.

BACKGROUND The global pandemic of COVID-19 is posing the biggest threat to humanity through its ubiquitous effect of unfathomable magnitude. It has been responsible for over four hundred thousand death worldwide to date. There has been evidence that various comorbidities have a higher risk associated with case fatality. OBJECTIVE Although COVID-19 is a viral disease, there might be an association between different comorbidities and the occurrence of the disease. Our study aims to determine the association between the COVID-19 infection and pre-existing comorbidities such as asthma, diabetes, liver disease, lung disease, heart disease, kidney disease, hypertension, and obesity through a web-based self-reported survey. METHODS Sociodemographic and medical history data on different comorbidities were collected by a web-based self-reported survey between 25th March 2020 to 4th June 2020 by the Nexoid United Kingdom. Univariate and multivariate logistic regression analyses were done using these risk factors as independent variables. RESULTS A total of 780,961 participants from 183 different countries and territories participated in this study. Among them, 1516 participants were diagnosed with COVID-19 prior to this study. A significant risk association was observed for age above 60 years, female gender as well as different pre-existing disease conditions such as diabetes, kidney disease, liver disease, and heart diseases. Asthma and diabetes were the major dominant comorbidities among patients, and patients with existing diabetes were 1.464 (AOR: 1.464; 95% CI: 1.228-1.744) times more likely to develop the disease than others who did not diagnose as diseased. CONCLUSIONS Older adults, female as well as people with comorbidities such as diabetes mellitus, heart disease, kidney disease, and liver disease, are the most vulnerable population for COVID-19. However, further studies should be carried out to explain the pathway of these risk associations. CLINICALTRIAL

BackgroundThe global pandemic of COVID-19 is posing the biggest threat to humanity through its ubiquitous effect of unfathomable magnitude. It has been responsible for over four hundred thousand death worldwide to date. There has been evidence that various comorbidities have a higher risk associated with case fatality. Although COVID-19 is a viral disease, there might be an association between different comorbidities and the occurrence of the disease.MethodSociodemographic and medical history data on different comorbidities such as asthma, diabetes, liver disease, lung disease, heart disease, kidney disease, hypertension, and obesity were collected by a web-based self-reported survey between 25th March 2020 to 4th June 2020 by the Nexoid United Kingdom. Univariate and multivariate logistic regression analyses were done using these risk factors as independent variables.ResultA total of 780,961 participants from 183 different countries and territories participated in this study. Among them, 1516 participants were diagnosed with COVID-19 prior to this study. A significant risk association was observed for age above 60 years, female gender as well as different pre-existing disease conditions such as diabetes, kidney disease, liver disease, and heart diseases. Asthma and diabetes were the major dominant comorbidities among patients, and patients with existing diabetes were 1.464 (AOR: 1.464; 95% CI: 1.228-1.744), more likely to develop the disease than others who did not diagnose as diseased.ConclusionOlder adults, female as well as people with comorbidities such as diabetes mellitus, heart disease, kidney disease, and liver disease, are the most vulnerable population for COVID-19. However, further studies should be carried out to explain the pathway of these risk associations.

Background: Rohingya (Forcefully Displaced Myanmar Nationals or FDMNs) in Bangladesh are at increased risk of 2019 coronavirus disease (COVID-19), especially the older population. Given low health literacy among the FDMNs and the adverse situation of their residential camps, there are possibilities of misinformation related to COVID-19 among the older FDMNs who are at greater risk. Therefore, the present research aimed to assess the level of misconceptions and the factors associated with it among the older FDMNs in Bangladesh. Methods: This cross-sectional study was conducted among 416 FDMNs, aged 60 years and above, from a Rohingya camp situated in Cox’s Bazar, a South-Eastern district of Bangladesh. We collected information on 14 different locally relevant misconceptions related to the spread, prevention, and treatment of COVID-19, scored each misconception as one, and obtained a cumulative score of the 14-items, ranging from 0 to 14, with a higher score indicating a higher level of misconceptions. With backward selection based on the Akaike information criterion, a multiple linear regression model explored the factors associated with misconceptions. Findings: The participants had an average of five misconceptions. The most prevalent misconceptions were related to the prevention of COVID-19, i.e., everyone should wear personal protective equipment when outside (86.6%), and its prevention by nutritious food (62.5%) and drinking water (59.3%). Other notable misconceptions included the spread of COVID-19 through mosquito bites (42%) and its transmissions only to the non/less-religious person (31.5%). In regression analyses, memory or concentration problems, communication frequency with social networks, pre-existing conditions, and receiving information from health workers were significantly associated with higher COVID-19 misconceptions. These misconceptions were less likely among those overwhelmed by the pandemic, having COVID-19 diagnosed friends or family members, and receiving information from friends and family. Interpretation: Overall, we found that misconceptions were prevalent among the older FDMNs in Bangladesh. The associations have important implications for programs to prevent and manage COVID-19 in these settings. Health workers need to be adequately trained to provide clear communication and counter misconceptions. Funding: No funding was received for this study. Declaration of Interests: The authors have no conflict of interest to disclose. Ethics Approval Statement: The institutional review board of the Institute of Health Economics, University of Dhaka, Bangladesh, approved the study protocol. Informed written consent was sought from the participants (thumb impressions from those who could not read and write) before administering the survey. Participation was voluntary, and participants did not receive any compensation. Written approval was also sought from the Office of the Refugee Relief and Repatriation Commissioner (RRRC) prior to accessing the camps and conducting the survey.

This study explored the perceived change in tobacco use during the COVID-19 pandemic and its associated factors among older adults residing in Rohingya refugee camps, also referred to as Forcibly Displaced Myanmar Nationals in Bangladesh. The study followed a cross-sectional design and was conducted in October 2020 among 416 older adults aged 60 years and above. A purposive sampling technique was applied to identify eligible participants, and face-to-face interviews were conducted using a pre-tested semi-structured questionnaire to collect the data. Participants were asked if they noted any change in their tobacco use patterns (smoking or smokeless tobacco) during the COVID-19 pandemic compared to pre-pandemic. Binary logistic regression models determined the factors associated with the perceived change in tobacco use. More than one in five participants (22.4%) were current tobacco users, of whom 40.8% reported a perceived increase in tobacco use during the COVID-19 pandemic. Adjusted analysis revealed that participants who were concerned about COVID-19 had significantly (p < 0.05) lower odds of perceived increase in tobacco use (aOR = 0.22, 95% CI: 0.06–0.73), while older adults who were overwhelmed by COVID-19 (aOR = 0.26, 95% CI: 0.06–1.18) and communicated less frequently with others during the pandemic than before (aOR = 0.19, 95% CI: 0.03–1.20) had marginally significantly (p < 0.1) lower odds of perceived increase in tobacco use during this pandemic. Relevant stakeholders, policymakers, and practitioners need to focus on strengthening awareness-raising initiatives as part of an emergency preparedness plan to control tobacco use during such a crisis period.

Background: The prevalence of non-communicable diseases is rising in Dhaka City, Bangladesh. Obesity is one of the significant risk factors for many non-communicable diseases. This research aimed to investigate the current prevalence of overweight and obesity among children in selected schools in Dhaka City through anthropometric evaluation, as well as to assess the correlation of various environmental determinants such as physical activity, dietary behavior, lifestyle habits, are associated with increased risk of obesity in children.Methods: This school-based cross-sectional study was conducted among 106 participants (50 male and 56 female participants) aged 6-14 years selected by convenience sampling from four randomly selected primary schools of different regions of Dhaka city. A pre-tested questionnaire was used to collect data.Results: The prevalence of overweight and obesity among school-going children 24.5%, 68% respectively. Factors associated with being obese included type of game (χ2=34.036; p=0.001), total playtime (χ2=17.788; p=0.000), TV and computer watch time (χ2=27.321; p=0.007), spend money to buy fast food (χ2=26.451; p=0.002), eating days fast food in a week (χ2=24.825; p=0.003), type of tiffin (χ2=19.757; p=0.072).Conclusions: Less playtime, longer watching TV and computer, and eating more fast food are major risk factors for overweight and obesity among school-going children in Dhaka city. Interventions are needed to increase awareness of child overweight weight and obesity risk factors to decrease the prevalence of overweight and obesity.