Effect of a Nutrition Education Intervention on Mothers’ Infant and Young Child Feeding Knowledge and Practices in the Peri-Urban Areas of Bobo-Dioulasso: Before and after Study

Background: This study assessed the effect of a nutrition education intervention aiming to improve the knowledge and practices of under 5 years children’s mothers on infant and young child feeding in peri urban areas of Bobo-Dioulasso in Burkina Faso. Methods: A total of 243 mothers of children under 5 years in the peri-urban of Bobo-Dioulasso were surveyed before and after the intervention using the FAO questionnaire for infant and young child feeding (IYCF) knowledge and practices assessment in January and October 2017. The intervention included two components consisting of a theoretical phase (counselling and discussion) and cooking demonstrations implemented for ten months. To account for the before-and-after design of the study, the McNemar’s test was used to assess the effect of the intervention on mothers’ infant and young child feeding knowledge and practices. Results: The mean age of mothers was 29 ± 6.2 years and 50.6% of the mothers were between 20 and 29 years old. All indicators used to assess the mothers’ knowledge of breastfeeding and complementary feeding significantly improved after the intervention (all p-values < 0.05). In terms of child feeding practices, half of the indicators (early breastfeeding initiation, age of complementary feeding initiation, and minimum meal frequency) significantly increased (all p = 0.001) while two indicators (minimum dietary diversity, and minimum acceptable diet) did not change (p = 0.06 and 0.67) after the intervention. Finally, continued breastfeeding, significantly declined after the intervention (73.3% vs 86.0% p = 0.001). Conclusion: The intervention improved the mothers’ knowledge on breastfeeding and complementary feeding and some child feeding practices. This study provided some evidence of an effective nutrition education intervention to increase maternal knowledge and practices.

Macroscopic Congenital Malformations at the Institute of Nutrition and Child Health (INSE)

Introduction: A congenital malformation is defined as a morphological abnormality of an organ or body region resulting from an abnormal developmental process during the formation of the embryo or fetus. Depending on their type, location and size, malformations can cause functional, psychological and aesthetic defects. The aim of this study is to document the frequency of congenital malformations, describe the characteristics of malformed newborns and their biological mothers, and identify the different types of malformations presented by newborns at the INSE. Methods: Descriptive cross-sectional study of clinically visible malformed newborns. It was carried out from January 1, 2021 to January 1, 2022 at the INSE neonatology unit. Epi info version 3.1 software was used for data entry and analysis. Results: Of a total of 2332 neonates hospitalized during the study period, 81 (3.5%) cases had at least one clinically visible congenital malformation. Nearly 84% had an age ≤ 7 days at the time of admission. The male sex was most concerned (60.5%). Newborns referred by a health facility accounted for 84%. Malformations of the digestive system accounted for 30.9% of cases, followed by those of the limbs (19.8%) and poly malformative syndrome (19.8%). Conclusion: This study shows that congenital malformations exist and are frequent in Guinea. Our results could therefore be the starting point for the future establishment of a national register of congenital malformations.

Poverty and Nutritional Health of the Child: Some Evidence from 2005 Demographic and Health Survey of Congo

The objective of this study is to identify the ways in which poverty could affect the nutritional health of the child and to analyze the strength of these links. On the whole, it appears that the relationship between poverty (measured by the wealth index) and health of the child (measured by an anthropometric index) is positive and highly significant.

Comparison of nutrition education policies and programs for children in China and other selected developed countries

A double burden of overweight/obesity and malnutrition during childhood is a major concern in China.Dietary intakes in this critical period affect children’s physical and cognitive development,and also have health consequences in later life.Therefore,establishing healthy eating habits that will endure is crucial for children.Nutrition education is an effective way in improving nutrition knowledge and attitudes,and healthy eating behaviors.Diverse forms of nutrition improvement programs that targeting children,family,teachers,and school settings have been conducted in many developed countries.However,due to the differences of genetic background,household environment as well as dietary patterns between Chinese children and children from other countries,the existing nutrition education programs for children abroad might not be appropriate for children in China.Thus,nutrition education programs that consider Chinese nutrition-related policies and food supply as well as the local educational resources are required for Chinese children.This review summarized nutrition-related policies and legislations in China and developed countries.A series of evidence-based nutrition education programs that combined educational strategies and environmental supports conducted in the Southwest China Childhood Nutrition and Growth Study were presented.These programs can serve as example models for adopting nutrition interventions to improve nutrition and health status of children in different regions of China.

A Case Study on the Impact of Mother-to-Mother Support Groups on Maternal, Infant and Young Child Nutrition and Care Practices in Habaswein and Wajir South Districts of North Eastern Kenya

Only about 25% of babies are exclusively breast fed until six months of age in developing countries though they are at a greater risk of infection and infant mortality. The Global Strategy for Maternal, Infant and Young Child Feeding (MI- YCF) Strategy developed by WHO/UNICEF in 2002 was to revitalize world attention to the impact of feeding practices on the nutritional status, growth, development, health and survival of infants and children. The data for this case study was collected through key informant interviews, observations and review of Save the Children nutrition programme reports and surveys. This information was then organized to produce a detailed description of the maternal, infant and young child nutrition programme in Habaswein and Wajir South districts or sub-counties. The maternal and infant young child nutrition (MIYCN) programme was launched in Habaswein and Wajir South districts in January 2012. The MIYCN programme followed recommendations of a Knowledge, Practice and Coverage (KPC) survey report in July 2012. To date, the programme has formed 48 Mother-to-mother Support Groups (MTMSGs), which are actively promoting the uptake of the recommended MIYCN practices in the community. MIYCN indicators have been markedly improved between July 2011 and February 2013 when surveys were conducted. The uptake of kitchen gardening has picked up significantly at Meri site and some mothers now have a changed attitude towards unskilled home deliveries and are conducting referrals for skilled births. The marked improvements in the performance of MIYCN indicators between July 2011 and February 2013 inWajir South and Habaswein districts can be partly attributed to the MIYCN programme established in January 2012. However, a randomized community trial is still required to provide conclusive results on the impact of care support groups on maternal, infant and young child feeding in this region.

Dietary fat intake of Japanese male children and its associated factors: Results of the 1995 National Nutrition Survey in Japan

Aim: To clarify the factors associated with reported dietary fat intake by Japanese male children. Methods: This study is based on the data of a nationally representative cross-sectional study in Japan. Three hundred and seventy-seven male children (age, 6 - 11 years) whose households were sampled in the 1995 Comprehensive Survey of Living Conditions of the People on Health and Welfare, and the 1995 National Nutrition Survey and whose parents were identified through record linkage between the 2 survey data sets were enrolled. Results: The final dataset in this study consisted of 377 boys with 329 of their parents. Fifty-two boys were found to be overweight (13.8%). The reported dietary fat intake was higher among the overweight boys than among the non-overweight boys. Maternal obesity was significantly associated with obesity in male children. Boys who frequently consumed foods from the “fats and lipids” group and the “meat” groups, and children from nuclear families rather than 3- generation families reported high dietary fat intake. In addition, parental fat intake was also significantly associated with fat intake of male children. Conclusions: Child and parental dietary habits along with the household status should be considered when implementing nutritional education programmes to control dietary fat intake and reduce the obesity risks of male children.

Biological Markers of Undernutrition and Risk of Complications in Children Hospitalized at the Teaching Hospital of Brazzaville

Introduction: Undernutrition is a condition frequently encountered in pediatrics. It leads to an increased morbidity and mortality regardless of the underlying condition or other risk factors such as age. In countries with limited resources such as ours, the diagnosis of undernutrition is often limited to the clinical presentation, and the contribution of biology is not often taken into account. Objectives: To establish the relationship between anthropometric parameters and biological markers in the diagnosis and classification of undernutrition and to assess the risk of infectious complications during undernutrition in children. Materials and Methods: A cross-sectional study conducted in Brazzaville among undernourished children aged 1 - 59 months between October 2018 and April 2019. Clinical diagnosis was based on WHO growth charts. The CRP, orosomucoid, albumin and transthyretin were obtained using the Cobas c311 analyzer, which enabled the calculation of Prognostic Inflammatory and Nutritional Index (PINI). The comparison of the means of the biological markers used the Student’s t-test, the risk of infectious complications the chi-square. The correlation of the diagnostic value of Z-score weight/height and PINI was also investigated. The significance level was set at 0.05. Results: Of the 95 children enrolled 63 (66.3%) were clinically severely malnourished, including 26 acute (41.3%) and 37 chronic (58.7%). The PINI revealed severe undernutrition in 85 children (89.4%) including 50 acute (58.8%) and 35 chronic (41.2%). CRP and orosomucoid were statistically higher in severe acute undernutrition (p Conclusion: Anthropometric parameters have a front-line advantage for assessing and classifying undernutrition. However, biological markers of undernutrition with PINI should be systematized in the diagnosis and management of undernutrition.

Physical activity and nutrition attitudes in obese Hispanic children with non-alcoholic steatohepatitis

AIM:To assess nutrition,physical activity and health-ful knowledge in obese children with biopsy-proven nonalcoholic steatohepatitis(NASH or NA)compared to children without liver disease.METHODS:Children with biopsy-proven NASH comprised the NASH group.Age,sex and ethnicity matched control groups consisted of obese(OB)and lean(CO) children with no liver disease.Subjects were adminis-tered the School Physical Activity and Nutrition Survey and one blood draw was obtained.RESULTS:Fifty-seven patients were enrolled with a mean age of 12.1±2.1 years,and all were Hispanic.Even though the OB and NA had a similar increased body mass index(%),35%of the NA group always read nutrition labels compared to none in the OB(P<0.05),and more NA children felt their diet is"less healthy".NA consumed the least amount of fruits with only 25%having≥1 fruit/d vs 45%in OB and 64.7% in CO(P<0.05 NA vs CO).Only 15%of NA subjects performed light exercise vs 35%and 59%of OB and CO groups,respectively(P=0.02).The mean physical activity score was lowest in the NA group(P<0.05).Amongst the subjects with NASH,we found that 100% of patients with grade 2 or 3 fibrosis had a sedentary score>2 compared to only 63.6%of those with grade 1 or no fibrosis(P<0.05).CONCLUSION:Children with NASH had increased sedentary behavior,decreased activity,and fruit intake.Larger studies may determine the benefit of changing these behaviors as treatment for NASH.

Research Progress on Nutritional Requirements of Carp

Carp is a temperate freshwater fish native to Asia,distributed in all regions of the world except Australia and South America.With the improvement of comprehensive and healthy breeding technology of carp,the unit yield has been greatly increased mainly due to the exten-sive use of compound feed.In this study,the nutritional requirements of carp were summarized from the aspects of protein,amino acids,fat,carbohydrate,calcium and phosphorus,vitamins and taurine.This study provides a certain theoretical reference for scientific formula of carp feed.

小学生营养促进Child-to-Child模式的应用效果评价

目的 评价C T C模式在我省小学生营养教育中的效果 ,促进小学生营养教育。方法 采用问卷调查、召开座谈会、个人访谈等形式 ,对实验效果进行评定。结果 干预组学生营养知识平均得分提高了75 0 % ,与营养有关的认识与态度平均得分提高了 18 8% ,行为平均得分提高了 6 9% ;辐射组三、四、五年级学生“知识”、“认识和态度”也有显著提高 ,但行为改变不明显。结论 :C T C模式不仅可用于学生营养教育 。

Barriers to Optimal Maternal and Child Feeding Practices in Pastoralist Areas of Somali Region, Eastern Ethiopia: A Qualitative Study

Maternal and child nutrition is critical for child health and survival. Appropriate feeding practices are of fundamental importance for health, nutrition, survival and development of infants and children. In pastoral areas of Ethiopia, barriers related to culture, knowledge, social norms, beliefs, behaviors, decision making in the household and burden of other responsibilities contribute to nutritional status of women and children to deteriorate. Policies and strategies are recommending assessment of barriers for designing programs and interventions to improve maternal and child nutrition practices. This study is aimed to assess barriers of optimal maternal and child feeding practices in Pastoralist areas of Somali region, Eastern Ethiopia. A qualitative community based research method was used involving 17 focus group discussions and 20 in-depth interviews with mothers, grandmothers, health professionals and religious leaders from three districts. Data from FGDs and interviews were transcribed and coded. The agreed upon codes were synthesized and grouped into exhaustive categories. The categories were then merged into themes representing the most common barriers on maternal and child feeding practice that emerged from the FGDs and interviews. We found that traditional beliefs, myths, culture custodian influence, low accessibility and availability of nutritional foods, pattern and burden of other responsibilities, poor knowledge and health seeking behavior, perceived milk insufficiency as main barriers for optimal maternal and child feeding practices. Barriers on optimal maternal and child feeding are very common in the study areas. More work needs to be done to strengthen community-based nutrition with strong social behavioral change communication with emphasis on age-specific counselling on maternal and child nutrition at health facilities, during antenatal and early postnatal visits in the study areas through different media channels, particularly, Somali Region TV and FMs to promote optimal nutrition in the region.

Therapeutic methods for diarrhea in children

DEFINITIONAcute diarrhoea is defined as passage of loose or waterystools at least three times in a 24 h period.When loosestools contain blood,it is called bloody diarrhoea(dysentery).It is the consistency of the stools which ismost important rather than the frequency.Breast-fed babiesoften pass'pasty'stools frequently which is not diarrhoea.The raother can often tell accurately whether child hasdiarrhoea or not.

Prevalence of hypertension and its associations with body composition across Chinese and American children and adolescents

Background The age of onset of hypertension(HTN)is decreasing,and obesity is a significant risk factor.The prevalence and racial disparities in pediatric HTN and the association between body composition and blood pressure are insufficiently studied.This study aimed to evaluate the prevalence of HTN in Chinese and American children and adolescents and to assess the relationship between various body composition indices and HTN.Methods Seven thousand,five hundred and seventy-three Chinese and 6239 American children and adolescents aged 8–18 years from the 2013–2015 China Child and Adolescent Cardiovascular Health study and the 2011–2018 National Health and Nutrition Examination Surveys were analyzed.Blood pressure and body composition(fat and muscle)were measured by trained staff.The crude prevalence and age-standardized prevalence rate(ASPR)of primary HTN and its subtypes[isolated systolic hypertension(ISH)and isolated diastolic hypertension(IDH)]were calculated based on 2017 American Academy of Pediatrics guidelines.Multivariable-adjusted linear regression coefficients and odds ratios(ORs)were calculated to assess the associations of body composition indicators with HTN,ISH and IDH.Results The ASPR of HTN was 18.5%in China(CN)and 4.6%in the United States(US),whereas the obesity prevalence was 7.4%and 18.6%,and the population attributable risk of HTN caused by overweight and obesity was higher in the US than in CN.Increased fat mass,muscle mass and body fat percentage mass were associated with a higher risk of HTN in both countries.The percent of muscle body mass had a protective effect on HTN and ISH in both countries[HTN(CN:OR=0.83,95%CI=0.78–0.88;US:OR=0.72,95%CI=0.64–0.81);ISH(CN:OR=0.87,95%CI=0.80–0.94;US:OR=0.71,95%CI=0.62–0.81)],and the protective effect was more common among children and adolescents with high levels of physical activity.Conclusions The burden of HTN in Chinese children and adolescents was substantial and much greater than that in the US,and the contribution of obesity to HTN was higher in the US than in CN.Augmenting the proportion of muscle mass in body composition has a protective effect against HTN in both populations.Optimizing body composition positively influences blood pressure in children and adolescents,particularly those with high-level physical activity.

Nutritional requirements of meat-type and egg-type ducks: what do we know?

The demand for duck meat, duck eggs, and associated products is increasing each year. Classic and modern selection programs have been applied to enhance the economic traits of ducks to satisfy the requirements of consumers and enhance the incomes of producers. The nutritional requirements of unselected ducks may not be adequate, however, to fulfill the potential productivity performance of modern birds, including both meat-type and egg-type ducks. In particular, an imbalanced diet is associated with low productive performance and signs of nutritional deficiency（if insufficient nutrients are supplied）, as well as with high feed costs and manure problems that reflect flock health and welfare（if excessive nutrients are supplied）. Thus, the main aim of this review is to summarize the results of previous studies that estimated the nutrient requirements of meat-type and egg-type ducks in order to evaluate current knowledge and to identify further issues that need to be addressed. In addition,the results obtained in previous studies are compared in order to understand how to lower commercial feed costs,fulfill the genetic potential of selected ducks, protect the environment from pollution, and satisfy the welfare and health needs of ducks.

Association between sleep duration and overweight/obesity among Chinese children and adolescents:a longitudinal study

Background:To determine the associations between sleep duration and overweight/obesity in Chinese children and adolescents.Methods:This longitudinal study analyzed 3,126 children and adolescents aged 7 to 18 years who had participated in the China Health and Nutrition Survey during 2004-2011.Sleep duration was classified into<9 h,9-10 h,and>10 h for children aged 7-12 years,and<8 h,8-9 h,and>9 h for adolescents aged 13-18 years.Results:After adjusting for confounder,short sleep duration was associated with overweight/obesity for girls aged 7-12 years(β=4.32,95%confidence interval=1.27 to 7.37,P=0.006)and boys aged 13-18 years(β=3.38,95%confidence interval=2.01 to 4.74,P<0.001).No statistically significant association was found among the other 2 groups.Meanwhile,long sleep duration was not statistically significant at any age.Conclusion:The association between short sleep duration and overweight/obesity to be dependent on both age and gender.

Evaluation of Malnutrition in Infants Aged 0 - 59 Months in the Suburbs of Dakar

Introduction: Child malnutrition is a major public health concern worldwide, particularly in low- and middle-income countries. The latest report from Senegal’s Continuous Demographic and Health Survey revealed that 18% of children in Senegal were stunted (chronic malnutrition), 8% were wasted (acute malnutrition) and 14% were underweight. Thus, this study aimed to assess the characteristics associated with malnutrition in children according to their nutritional status. Methods: This descriptive transverse study was conducted at the Pediatric Social Institute of Pikine/Guediawaye and the National Hospital Center of Pikine, in Senegal between October and December 2019. A total of 94 children were recruited, with the consent of their legal tutors. Descriptive and multivariate analyses of the factors associated with malnutrition were performed. The z-scores for the indices of nutrition were determined with WHO Anthro® software version 3.2.2. All the data analyses were performed using R software version 4.2.2. Result: From the 94 children recruited, 51.06% were female, with a sex ratio (male/female) of 0.96. Acute malnutrition was recorded in 62.77% of cases, chronic malnutrition in41.49%, and underweight in 71.27%. Linear regression analysis showed that many factors, such as the female gender [OR = 1.82 CI (1.02 - 3.3), P-value = 0.04], consanguinity [OR = 2.84 CI (1.14 - 7.65), P-value = 0.03], low birth weight [OR = 4.83 CI (2.15 - 12.89), P-value = 0.0004], were associated with acute malnutrition. Low birth weight (<2.5 kg) [OR = 10.66 CI (3.82 - 44.39) P-value < 0.0001], non-exclusive breastfeeding [OR = 3 CI (1.40 - 7.13)] P-value = 0.007], dietary diversification before six months [OR = 2.04 CI (1.23 - 3.51), P-value = 0.007] and others factors were associated with underweight. The most frequently recorded clinical signs are weight loss (30.85%), fever (23.40%), diarrhea (34.04%), and anemia (70.21%). Conclusion: Problems associated with malnutrition are multifactorial. Dietary diversification, consanguinity, and low birth weight are factors associated with malnutrition in children in Senegal. Thus, special attention must be paid to this problem because of its impact on child survival. .

Dietary requirements of synthesizable amino acids by animals:a paradigm shift in protein nutrition

Amino acids are building blocks for proteins in all animals. Based on growth or nitrogen balance, amino acids were traditionally classified as nutritionally essential or nonessential for mammals, birds and fish. It was assumed that all the ＂nutritionally nonessential amino acids （NEAA）＂ were synthesized sufficiently in the body to meet the needs for maximal growth and optimal health. However, careful analysis of the scientific literature reveals that over the past century there has not been compelling experimental evidence to support this assumption. NEAA （e.g., glutamine, glutamate, proline, glycine and arginine） play important roles in regulating gene expression, cell signaling, antioxidative responses, fertility, neurotransmission, and immunity. Additionally, glutamate, glutamine and aspartate are major metabolic fuels for the small intestine to maintain its digestive function and to protect the integrity of the intestinal mucosa. Thus, diets for animals must contain all NEAA to optimize their survival, growth, development, reproduction, and health. Furthermore, NEAA should be taken into consideration in revising the ＂ideal protein＂ concept that is currently used to formulate swine and poultry diets. Adequate provision of all amino acids （including NEAA） in diets enhances the efficiency of animal production. In this regard, amino acids should not be classified as nutritionally essential or nonessential in animal or human nutrition. The new Texas A＆M University＇s optimal ratios of dietary amino acids for swine and chickens are expected to beneficially reduce dietary protein content and improve the efficiency of their nutrient utilization, growth, and production performance.

Nutritional support in chronic liver disease and cirrhotics

The liver is a major organ and an essential componentin maintaining an appropriate nutritional status in healthy individuals through metabolism of protein, carbohydrates, and fat. In individuals with chronic liver disease(CLD), along with a number of other essen-tial functions that the liver serves, its role in nutrition maintenance is severely impaired. Common causes of CLD include hepatitis C, alcoholic liver disease, and non-alcoholic liver disease. Amongst this population, the most common manifestation of impaired nutritional maintenance is protein-calorie malnutrition. Aside from inherent abnormalities in metabolism, such as malab-sorption and maldigestion, CLD can be associated with anorexia as well as increased metabolic requirements, all of which contribute to a state of malnutrition. Given the systemic implications and impact on prognosis of malnutrition, proper nutritional assessment is essential and can be achieved through a thorough history and physical, as well as biochemical investigations and anthropometry as needed. Following an appropriate assessment of a patient's nutritional status, an approach to management can be decided upon and is based on the extent of malnutrition which directly reflects the severity of disease. Management options can be grossly separated into enteral and parenteral nutrition. The former is usually sufficient in the form of oral supplements in less severe cases of malnutrition, but as the CLD worsens, parenteral nutrition becomes necessary. With appropriate assessment and early intervention, many of the complications of CLD can be avoided, and ultimately better outcomes can be achieved.

Effects of nutritional and psychological status in gastrointestinal cancer patients on tolerance of treatment

AIM: To assess the effects of poor nutritional and psychological status on tolerance of cancer treatment and the recovery of physical performance status in patients with gastrointestinal cancer. METHODS: An epidemiological survey with respect to nutritional and psychological status in patients with gastrointestinal cancer was conducted among 182 operated patients in four provincial-level hospitals from December 2005 to June 2006. The food frequency survey method, state-trait anxiety inventory (STAI) and depression status inventory (DSI) were used to obtain information about the diet and psychological status in the patients. Nutritional status in the participants was reflected by serum albumin (Alb), hemoglobin (HB) and body mass index (BMI). RESULTS: Alb, protein intake and anxiety were associated with the severity of side effects of treatment. The adjusted relative risk (RR) for Alb, protein intake and anxiety was 3.30 (95% CI: 1.08, 10.10, P = 0.03), 3.25 (95% CI: 1.06, 9.90, P = 0.04) and 1.48 (95% CI: 1.29, 1.70, P < 0.0001), respectively. Moreover, calorie intake, HB and depression were associated with the recovery of physical performance status in the patients. Adjusted relative risk was 2.12 (95% CI: 1.09, 4.03, P = 0.028), 2.05 (95% CI: 1.08, 3.88, P =0.026) and 1.07 (95% CI: 1.02, 1.12, P = 0.007), respectively. CONCLUSION: Both poor nutrition status and psychological status are independent risk factors for severe side effects of cancer treatment, and have impact on the recovery of physical performance status in patients after treatment.

The Association of Mercury and ALT with Obesity in Korean Adults Using Data from the Korea National Health and Nutrition Examination Survey for 11 Years(KNHANES 2005,2008-2017)

The association between heavy metals in the blood and obesity has been examined in many studies.However,inconsistencies have been observed in the results of these studies.The present study was conducted using data from 119,181 participants of the Korea National Health and Nutrition Examination Survey(KNHANES)for 11 years in 2005 and between 2008 and 2017.The subjects with missing heavy metal blood tests,health interview data,and health examination data were excluded from the study.The study population comprised 1,844 individuals(972 men,and 872 women)who were eligible for inclusion.It was found that obesity and abdominal obesity were associated with an increase in both blood mercury(P<0.001)and alanine aminotransferase(ALT)(P<0.001).After adjusting the confounding factors,those with concurrent high levels of ALT and the highest tertile of mercury showed an increased risk of obesity(odds ratio 4.46,95%confidence interval 2.23-8.90,P<0.001)as well as abdominal obesity(odds ratio 5.36,95%confidence interval 2.57-11.17,P<0.001).The interrelationship of mercury and ALT with the parameters of body mass index(P for interaction=0.009)and waist circumference(P for interaction=0.012),respectively,have been observed to be significant,suggesting that the reciprocal relationship could contribute to obesity and abdominal obesity.