According to the World Health Organization (WHO), Pakistan is facing a rapid rise in non-communic... more According to the World Health Organization (WHO), Pakistan is facing a rapid rise in non-communicable diseases associated with lifestyle changes in urban cities. Nutrition and diet are key components of lifestyle modification factors that can help prevent and reduce the disease burden in Pakistan. Recently, dietary patterns became commonly used assessment method to examine the effects of an overall diet, representing a broader picture of food and nutrient consumption on health and disease outcome. The first paper of this dissertation identifies key dietary patterns using factor analysis, examining their relationship to sociodemographic, anthropometric and lifestyle factors among 5,491 adults from the Control of Blood Pressure and Risk Attenuation (COBRA) study in Pakistan. Three dietary patterns were identified using a culturally-derived food frequency questionnaire and were labeled as: the "fat and sweet"; the "fruit and vegetable"; and the "seafood and yogurt" patterns. The fat and sweet pattern was inversely associated with male gender and abdominal obesity, and was positively associated with being single, unmarried and between 15-39 years old. The fruit and vegetable and seafood and yogurt patterns were positively associated with increased educational status, physical activity and non-tobacco use. The second paper further examines the association between the identified dietary patterns and hypertension. Age, education, body mass index, marital status and sprinkling salt on cooked food were independently associated with hypertension in this population. Adjusted odds ratios for hypertension in the seafood and yogurt pattern scores were most protective, some protection was observed with the fruit and vegetable pattern and no significant association was seen for the fat and sweet pattern. The third paper provides an additional dimension to the relationship of dietary patterns and health outcomes by evaluating the nutritional biomarkers relevant to cardiovascular disease among the COBRA cohort who were ≥ 40 yea [...]
BACKGROUND Breakfast is an essential meal of the day that plays important role in balanced diet o... more BACKGROUND Breakfast is an essential meal of the day that plays important role in balanced diet of an individual. Studies have been conducted in developed countries; however, literature is scarce on breakfast consumption patterns among South Asian adolescents. Data about breakfast patterns may help in improving unhealthy breakfast habits and enhance the diet patterns of adolescents. METHODS This is a secondary study of a Higher Education Commission-funded project. The research participants, aged 11 to 17, were drawn from lower-middle-income secondary schools using multistage random selection. Socio-demographic and breakfast consumption were determined through interview cum questionnaire and food frequency survey. RESULTS The frequency of daily breakfast consumption was 82% among the total participants. 72.2% students considered chapatti as a primary meal for breakfast. Physically active children were less likely to skip breakfast 15.9%, whereas 27.6% were skipping breakfast less phy...
Objective: To explore the association of gender with risk factors for cardiovascular diseases amo... more Objective: To explore the association of gender with risk factors for cardiovascular diseases among adolescents. Method: The cross-sectional study was conducted 2016-2019 in low-income schools in Karachi after approval from the ethics review board of Dow University of Health Sciences, and comprised adolescents of both genders aged 11-17 years. Anthropometric measurements and lifestyle behaviours were used to generate risk profile for cardiovascular diseases. Data was analysed using SPSS 16. Results: Of the 1195 subjects, 468(39.2%) were boys and 727(60.8%) were girls. The mean age was 13.9±1.6 years. Mean family size was 5.9±3.64. Overall, 989(91.3%) participants consumed soft drinks, 44(4%) were smokers, 340(48.4%) consumed betel nut, 215(32.9%) Pan, 125(21.2%) Gutka and 9(1.7%) Bidi. Of the total, 867(83.3%) participants were physically less active than recommended, and daily screen time was >2 hours among 513(45.7%) participants. Body mass index and body fat percentage were si...
International Journal of Environmental Research and Public Health
Objective: The objective was to identify the relationship between the dietary factors related to ... more Objective: The objective was to identify the relationship between the dietary factors related to increases in the number of dental caries among an adult population group. Methods: A cross-sectional study was conducted involving adult patients and their accompanying person, aged 18 years and above (n = 1730) visiting the dental outpatient department (OPD) of a public sector tertiary healthcare institute in Karachi, Pakistan. A 39-item Food Frequency Questionnaire (FFQ) was administered to the patients, followed by a dental caries assessment using Radke’s WHO criteria. Caries assessment data were transformed into the DMFT Index (D = decayed, M = missing, F = filled teeth). Factor analysis (FA) was performed using Stata v. 11.0, followed by assessing the internal consistency of the FFQ. Multilogistic analysis was performed to explore the association between dental caries (cut-off = 5) and other independent variables, considering a p-value < 0.05 as significant. Results: The mean age...
Objectives To assess the nutritional status & lifestyle behaviors and see the response of nutriti... more Objectives To assess the nutritional status & lifestyle behaviors and see the response of nutrition education delivery by smartphone technology among school going adolescents. Methods A cross-sectional analytical study design was conducted on total of 150 adolescents (aged 14–19 years) from private schools of Karachi (East) using multi-staged random sampling. Data was collected on adolescent's socio-demographics, lifestyle behaviors, nutritional status and dietary behaviors. Based on the need for providing the health and nutrition literacy to our adolescent population through m-health, the smartphone app by the name of ‘Health and Nutrition Daily guidelines for Youth” ‘HANDY’ was developed for the project. Also, a brochure was designed which included the same information as the app, representing the conventional form of education. Participants were divided into two groups – Control group was provided information through brochures and the Intervention group was given brochures an...
Journal of the Dow University of Health Sciences, 2015
The fundamental role played by good nutrition in enabling personal, social and economic developme... more The fundamental role played by good nutrition in enabling personal, social and economic development is now widely recognized as presenting an important global challenge that has to be addressed if major national and international problems are to be resolved in the coming decades.
Hypertension affects 33% of the adult population in Pakistan. Various studies have shown the crit... more Hypertension affects 33% of the adult population in Pakistan. Various studies have shown the critical role of specific dietary patterns in the prevention and management of hypertension. However, the dietary determinants of hypertension in Pakistan remain unknown. In this study we aimed to identify dietary patterns from baseline food frequency data and assess their associations with hypertension in 5491 subjects from the Control of Hypertension and Risk Attenuation (COBRA) study, 2004. Factor analysis was used to identify the “fat and sweet”, “fruit and vegetable” and “seafood and yogurt” patterns with 20% variance in food intake. Associations between dietary patterns and subject characteristics were assessed using ANOVA and chi square tests. Odds of hypertension were higher in women and increased with age and BMI in both genders (&lt;0.001). When adjusted for covariates, the seafood and yogurt (OR= 0.72: 95% CI: 0.61,0.84; p‐value &lt;0.001) and fruit and vegetable (OR =0.89: 95% CI: 0.80,0.99; p‐value= 0.039) patterns were inversely related with hypertension, whereas no significant association was seen for the fat and sweet pattern. Our findings suggests that specific dietary patterns may have a role in regulating blood pressure in this population, however, more prospective studies are needed.
Nutritional assessment was carried out on fifty haemodialyzed patients by demographic, anthropome... more Nutritional assessment was carried out on fifty haemodialyzed patients by demographic, anthropometric, biochemical and dietary indices. The mean age of the patients was 49 years with a male to female ratio of 2.3:1. The duration of dialysis ranged from 6 to 40 months with a mean of 25 months. Fifty percent of the patients were moderately nourished based on their body weight 44%, body mass index 40% and mid-arm circumference 66%. Seventy percent patients had albumin and total proteins within the normal range. Blood urea nitrogen, creatinine, cholesterol, potassium and phosphorus did not significantly change from the previous reports. The calorie and protein intake in 60-70% cases was less than recommended. Overall there was a tendency to calorie and to a lesser degree protein malnutrition in our patients. It is suggested that preventing malnutrition by economical, aggressive and ongoing dietary intervention may minimize malnutrition in haemodialyzed patients.
Introduction Vulnerability to malnutrition is very high with low-income women and their children ... more Introduction Vulnerability to malnutrition is very high with low-income women and their children in rural Balochistan with contributing factors including lack of awareness about proper nutrition, low literacy, scarcity of vegetables and fruit, and low purchasing power of households. The Food and Agriculture Organization’s kitchen garden program provides resources to improve nutrition and health knowledge and promote healthy eating practices. The objective of this study was to assess nutrition and health awareness, knowledge, attitudes, behavioural intentions/behaviours (AKAB) of women who attended the kitchen garden program and trainings. Materials and methods A community based cross-sectional survey (N = 209) using a two-stage cluster sampling method was used to select households with survey participants being mothers with children under five years of age. A pretested questionnaire was administered via face-to-face surveys by trained enumerators in two districts of Balochistan prov...
Background Adequate nutrition is a public health priority, particularly in low-income rural commu... more Background Adequate nutrition is a public health priority, particularly in low-income rural communities where there is a high prevalence of malnutrition and stunting. Baluchistan is an arid desert and mountainous Province with the worst health indicators in Pakistan. The objective of this study was to identify current knowledge, attitudes and practices of vulnerable women with young children residing in remote areas of Balochistan and assess their information needs to guide the development of a BCC nutrition strategy materials and activities to support a Kitchen Gardens Project. Methods The needs assessment incorporated formative research via eight focus group discussions with demand and supply-side program beneficiaries (n = 124) to assess current nutrition knowledge, attitudes and beliefs toward kitchen gardens and proposed nutrition resources. Semi-structured interviews (n = 16) were also conducted with key stakeholders. A literature review supported the development of discussion...
Dietary pattern analysis is an epidemiological method designed to consider the complexity of food... more Dietary pattern analysis is an epidemiological method designed to consider the complexity of food preferences and diet patterns of populations. Few studies from South Asia have used this methodology to describe population food intake. Our objective was to identify dietary patterns and understand their associ-ations with sociodemographic, anthropometric and life-style factors among low-income Pakistani urban adults. Dietary information was collected by a thirty-three-item FFQ and dietary patterns were derived by principal component analyses in 5491 subjects enrolled in the Control of Blood Pressure and Risk Attenuation (COBRA) study. Three dietary patterns were identified: a fat and sweet pattern characterised by fried snacks/foods, desserts, organ meats, bakery products, Pakistani bread and food purchased from outside the home; a fruit and vegetable pattern including fruits, juices, raw and cooked vegetables, lean meat and low-fat milk; and a seafood and yogurt pattern identified by...
Background In Pakistan, this is a catastrophe for 44% children combating with stunted growth; the... more Background In Pakistan, this is a catastrophe for 44% children combating with stunted growth; the third highest percentage of stunted children in the world and further 1 million children are underweight. Fifteen percent of children are wasted and half of them are anemic, and almost one-third of the children have iron deficiency anemia. The study aimed to collate all contributing factors that have been reported in the PDHS-2012-13 survey for child malnutrition. Methods Pakistan Demographic and Health Survey, 2012-13 data was used (n = 1967). Forty five factors were extracted from PDHS 2012-13 and factor analysis was performed to reduce these factors into similar potential factors by using principle component (PC) decomposition. Malnutrition status of children of age < 5 years was assessed by using three indices: height-for-age, weight-for-height, and weight for age. To examine the associations between derived factors and childhood malnutrition, binary logistic regression was used....
JPMA. The Journal of the Pakistan Medical Association, Sep 1, 2016
Nutrition transition is a shift in eating and disease patterns towards diet-nutrition-related non... more Nutrition transition is a shift in eating and disease patterns towards diet-nutrition-related non-communicable diseases (NR-NCDs). This shift in many developing countries has been accompanied with changes in behaviours, lifestyles, diets, physical inactivity, smoking and alcohol consumption. In addition to the burden of under-nutrition, nutrition transition has caused a sudden rise in overweight/obesity-related chronic diseases in developing countries. Little research has been done in Pakistan to explore nutrition transition, and its associated nutrition challenges. The current study attempted to investigate the socio-economic, environmental and demographic determinants of rise in obesity among women of reproductive years (15-49 years) in Pakistan. A review of related published literature for a period of 10 years (2005-2015) was carried out. Also, data from National Nutrition Survey (NNS-2011) and Pakistan Demographic and Health Survey (PDHS 2012-13) was reviewed and used to supplem...
JPMA. The Journal of the Pakistan Medical Association, 1995
Compliance with fluid and dietary instructions is a critically significant factor in the health a... more Compliance with fluid and dietary instructions is a critically significant factor in the health and well-being of haemodialysis patients. Serial measurement of serum potassium (K) and interdialytic weight gain (IWG) were carried out in 50 haemodialysis patients at the Kidney Centre over a period of one month. Sixty-two percent were males. Ages ranged from 19-69 years (mean 49 years). Duration on dialysis varied from 6 months to 9 years. Patients with an IWG > 1.5 Kg and/or serum K+ > 5.5 m Eq/L were defined as non-compliant. Thirty-two patients (64%) were non-compliant in either diet or fluid. In 13 of these cases, both serum K and IWG were elevated. In the remaining 19, only one value was high. Predictors of non-compliance to diet and fluid regimens were older age (81%), males (68%), less education (75%), single (90%) depression (59%) and not feeling responsible for one's own well-being (85%). Attempts to improve compliance should be aimed by exposing the non-compliant gr...
JPMA. The Journal of the Pakistan Medical Association, 1994
Nutritional assessment was carried out on fifty haemodialyzed patients by demographic, anthropome... more Nutritional assessment was carried out on fifty haemodialyzed patients by demographic, anthropometric, biochemical and dietary indices. The mean age of the patients was 49 years with a male to female ratio of 2.3:1. The duration of dialysis ranged from 6 to 40 months with a mean of 25 months. Fifty percent of the patients were moderately nourished based on their body weight 44%, body mass index 40% and mid-arm circumference 66%. Seventy percent patients had albumin and total proteins within the normal range. Blood urea nitrogen, creatinine, cholesterol, potassium and phosphorus did not significantly change from the previous reports. The calorie and protein intake in 60-70% cases was less than recommended. Overall there was a tendency to calorie and to a lesser degree protein malnutrition in our patients. It is suggested that preventing malnutrition by economical, aggressive and ongoing dietary intervention may minimize malnutrition in haemodialyzed patients.
Dietary pattern analysis is an epidemiological method designed to consider the complexity of food... more Dietary pattern analysis is an epidemiological method designed to consider the complexity of food preferences and diet patterns of populations. Few studies from South Asia have used this methodology to describe population food intake. Our objective was to identify dietary patterns and understand their associations with sociodemographic, anthropometric and life-style factors among low-income Pakistani urban adults. Dietary information was collected by a thirty-three-item FFQ and dietary patterns were derived by principal component analyses in 5491 subjects enrolled in the Control of Blood Pressure and Risk Attenuation (COBRA) study. Three dietary patterns were identified: a fat and sweet pattern characterised by fried snacks/foods, desserts, organ meats, bakery products, Pakistani bread and food purchased from outside the home; a fruit and vegetable pattern including fruits, juices, raw and cooked vegetables, lean meat and low-fat milk; and a seafood and yogurt pattern identified by ...
According to the World Health Organization (WHO), Pakistan is facing a rapid rise in non-communic... more According to the World Health Organization (WHO), Pakistan is facing a rapid rise in non-communicable diseases associated with lifestyle changes in urban cities. Nutrition and diet are key components of lifestyle modification factors that can help prevent and reduce the disease burden in Pakistan. Recently, dietary patterns became commonly used assessment method to examine the effects of an overall diet, representing a broader picture of food and nutrient consumption on health and disease outcome. The first paper of this dissertation identifies key dietary patterns using factor analysis, examining their relationship to sociodemographic, anthropometric and lifestyle factors among 5,491 adults from the Control of Blood Pressure and Risk Attenuation (COBRA) study in Pakistan. Three dietary patterns were identified using a culturally-derived food frequency questionnaire and were labeled as: the "fat and sweet"; the "fruit and vegetable"; and the "seafood and yogurt" patterns. The fat and sweet pattern was inversely associated with male gender and abdominal obesity, and was positively associated with being single, unmarried and between 15-39 years old. The fruit and vegetable and seafood and yogurt patterns were positively associated with increased educational status, physical activity and non-tobacco use. The second paper further examines the association between the identified dietary patterns and hypertension. Age, education, body mass index, marital status and sprinkling salt on cooked food were independently associated with hypertension in this population. Adjusted odds ratios for hypertension in the seafood and yogurt pattern scores were most protective, some protection was observed with the fruit and vegetable pattern and no significant association was seen for the fat and sweet pattern. The third paper provides an additional dimension to the relationship of dietary patterns and health outcomes by evaluating the nutritional biomarkers relevant to cardiovascular disease among the COBRA cohort who were ≥ 40 yea [...]
BACKGROUND Breakfast is an essential meal of the day that plays important role in balanced diet o... more BACKGROUND Breakfast is an essential meal of the day that plays important role in balanced diet of an individual. Studies have been conducted in developed countries; however, literature is scarce on breakfast consumption patterns among South Asian adolescents. Data about breakfast patterns may help in improving unhealthy breakfast habits and enhance the diet patterns of adolescents. METHODS This is a secondary study of a Higher Education Commission-funded project. The research participants, aged 11 to 17, were drawn from lower-middle-income secondary schools using multistage random selection. Socio-demographic and breakfast consumption were determined through interview cum questionnaire and food frequency survey. RESULTS The frequency of daily breakfast consumption was 82% among the total participants. 72.2% students considered chapatti as a primary meal for breakfast. Physically active children were less likely to skip breakfast 15.9%, whereas 27.6% were skipping breakfast less phy...
Objective: To explore the association of gender with risk factors for cardiovascular diseases amo... more Objective: To explore the association of gender with risk factors for cardiovascular diseases among adolescents. Method: The cross-sectional study was conducted 2016-2019 in low-income schools in Karachi after approval from the ethics review board of Dow University of Health Sciences, and comprised adolescents of both genders aged 11-17 years. Anthropometric measurements and lifestyle behaviours were used to generate risk profile for cardiovascular diseases. Data was analysed using SPSS 16. Results: Of the 1195 subjects, 468(39.2%) were boys and 727(60.8%) were girls. The mean age was 13.9±1.6 years. Mean family size was 5.9±3.64. Overall, 989(91.3%) participants consumed soft drinks, 44(4%) were smokers, 340(48.4%) consumed betel nut, 215(32.9%) Pan, 125(21.2%) Gutka and 9(1.7%) Bidi. Of the total, 867(83.3%) participants were physically less active than recommended, and daily screen time was >2 hours among 513(45.7%) participants. Body mass index and body fat percentage were si...
International Journal of Environmental Research and Public Health
Objective: The objective was to identify the relationship between the dietary factors related to ... more Objective: The objective was to identify the relationship between the dietary factors related to increases in the number of dental caries among an adult population group. Methods: A cross-sectional study was conducted involving adult patients and their accompanying person, aged 18 years and above (n = 1730) visiting the dental outpatient department (OPD) of a public sector tertiary healthcare institute in Karachi, Pakistan. A 39-item Food Frequency Questionnaire (FFQ) was administered to the patients, followed by a dental caries assessment using Radke’s WHO criteria. Caries assessment data were transformed into the DMFT Index (D = decayed, M = missing, F = filled teeth). Factor analysis (FA) was performed using Stata v. 11.0, followed by assessing the internal consistency of the FFQ. Multilogistic analysis was performed to explore the association between dental caries (cut-off = 5) and other independent variables, considering a p-value < 0.05 as significant. Results: The mean age...
Objectives To assess the nutritional status & lifestyle behaviors and see the response of nutriti... more Objectives To assess the nutritional status & lifestyle behaviors and see the response of nutrition education delivery by smartphone technology among school going adolescents. Methods A cross-sectional analytical study design was conducted on total of 150 adolescents (aged 14–19 years) from private schools of Karachi (East) using multi-staged random sampling. Data was collected on adolescent's socio-demographics, lifestyle behaviors, nutritional status and dietary behaviors. Based on the need for providing the health and nutrition literacy to our adolescent population through m-health, the smartphone app by the name of ‘Health and Nutrition Daily guidelines for Youth” ‘HANDY’ was developed for the project. Also, a brochure was designed which included the same information as the app, representing the conventional form of education. Participants were divided into two groups – Control group was provided information through brochures and the Intervention group was given brochures an...
Journal of the Dow University of Health Sciences, 2015
The fundamental role played by good nutrition in enabling personal, social and economic developme... more The fundamental role played by good nutrition in enabling personal, social and economic development is now widely recognized as presenting an important global challenge that has to be addressed if major national and international problems are to be resolved in the coming decades.
Hypertension affects 33% of the adult population in Pakistan. Various studies have shown the crit... more Hypertension affects 33% of the adult population in Pakistan. Various studies have shown the critical role of specific dietary patterns in the prevention and management of hypertension. However, the dietary determinants of hypertension in Pakistan remain unknown. In this study we aimed to identify dietary patterns from baseline food frequency data and assess their associations with hypertension in 5491 subjects from the Control of Hypertension and Risk Attenuation (COBRA) study, 2004. Factor analysis was used to identify the “fat and sweet”, “fruit and vegetable” and “seafood and yogurt” patterns with 20% variance in food intake. Associations between dietary patterns and subject characteristics were assessed using ANOVA and chi square tests. Odds of hypertension were higher in women and increased with age and BMI in both genders (&lt;0.001). When adjusted for covariates, the seafood and yogurt (OR= 0.72: 95% CI: 0.61,0.84; p‐value &lt;0.001) and fruit and vegetable (OR =0.89: 95% CI: 0.80,0.99; p‐value= 0.039) patterns were inversely related with hypertension, whereas no significant association was seen for the fat and sweet pattern. Our findings suggests that specific dietary patterns may have a role in regulating blood pressure in this population, however, more prospective studies are needed.
Nutritional assessment was carried out on fifty haemodialyzed patients by demographic, anthropome... more Nutritional assessment was carried out on fifty haemodialyzed patients by demographic, anthropometric, biochemical and dietary indices. The mean age of the patients was 49 years with a male to female ratio of 2.3:1. The duration of dialysis ranged from 6 to 40 months with a mean of 25 months. Fifty percent of the patients were moderately nourished based on their body weight 44%, body mass index 40% and mid-arm circumference 66%. Seventy percent patients had albumin and total proteins within the normal range. Blood urea nitrogen, creatinine, cholesterol, potassium and phosphorus did not significantly change from the previous reports. The calorie and protein intake in 60-70% cases was less than recommended. Overall there was a tendency to calorie and to a lesser degree protein malnutrition in our patients. It is suggested that preventing malnutrition by economical, aggressive and ongoing dietary intervention may minimize malnutrition in haemodialyzed patients.
Introduction Vulnerability to malnutrition is very high with low-income women and their children ... more Introduction Vulnerability to malnutrition is very high with low-income women and their children in rural Balochistan with contributing factors including lack of awareness about proper nutrition, low literacy, scarcity of vegetables and fruit, and low purchasing power of households. The Food and Agriculture Organization’s kitchen garden program provides resources to improve nutrition and health knowledge and promote healthy eating practices. The objective of this study was to assess nutrition and health awareness, knowledge, attitudes, behavioural intentions/behaviours (AKAB) of women who attended the kitchen garden program and trainings. Materials and methods A community based cross-sectional survey (N = 209) using a two-stage cluster sampling method was used to select households with survey participants being mothers with children under five years of age. A pretested questionnaire was administered via face-to-face surveys by trained enumerators in two districts of Balochistan prov...
Background Adequate nutrition is a public health priority, particularly in low-income rural commu... more Background Adequate nutrition is a public health priority, particularly in low-income rural communities where there is a high prevalence of malnutrition and stunting. Baluchistan is an arid desert and mountainous Province with the worst health indicators in Pakistan. The objective of this study was to identify current knowledge, attitudes and practices of vulnerable women with young children residing in remote areas of Balochistan and assess their information needs to guide the development of a BCC nutrition strategy materials and activities to support a Kitchen Gardens Project. Methods The needs assessment incorporated formative research via eight focus group discussions with demand and supply-side program beneficiaries (n = 124) to assess current nutrition knowledge, attitudes and beliefs toward kitchen gardens and proposed nutrition resources. Semi-structured interviews (n = 16) were also conducted with key stakeholders. A literature review supported the development of discussion...
Dietary pattern analysis is an epidemiological method designed to consider the complexity of food... more Dietary pattern analysis is an epidemiological method designed to consider the complexity of food preferences and diet patterns of populations. Few studies from South Asia have used this methodology to describe population food intake. Our objective was to identify dietary patterns and understand their associ-ations with sociodemographic, anthropometric and life-style factors among low-income Pakistani urban adults. Dietary information was collected by a thirty-three-item FFQ and dietary patterns were derived by principal component analyses in 5491 subjects enrolled in the Control of Blood Pressure and Risk Attenuation (COBRA) study. Three dietary patterns were identified: a fat and sweet pattern characterised by fried snacks/foods, desserts, organ meats, bakery products, Pakistani bread and food purchased from outside the home; a fruit and vegetable pattern including fruits, juices, raw and cooked vegetables, lean meat and low-fat milk; and a seafood and yogurt pattern identified by...
Background In Pakistan, this is a catastrophe for 44% children combating with stunted growth; the... more Background In Pakistan, this is a catastrophe for 44% children combating with stunted growth; the third highest percentage of stunted children in the world and further 1 million children are underweight. Fifteen percent of children are wasted and half of them are anemic, and almost one-third of the children have iron deficiency anemia. The study aimed to collate all contributing factors that have been reported in the PDHS-2012-13 survey for child malnutrition. Methods Pakistan Demographic and Health Survey, 2012-13 data was used (n = 1967). Forty five factors were extracted from PDHS 2012-13 and factor analysis was performed to reduce these factors into similar potential factors by using principle component (PC) decomposition. Malnutrition status of children of age < 5 years was assessed by using three indices: height-for-age, weight-for-height, and weight for age. To examine the associations between derived factors and childhood malnutrition, binary logistic regression was used....
JPMA. The Journal of the Pakistan Medical Association, Sep 1, 2016
Nutrition transition is a shift in eating and disease patterns towards diet-nutrition-related non... more Nutrition transition is a shift in eating and disease patterns towards diet-nutrition-related non-communicable diseases (NR-NCDs). This shift in many developing countries has been accompanied with changes in behaviours, lifestyles, diets, physical inactivity, smoking and alcohol consumption. In addition to the burden of under-nutrition, nutrition transition has caused a sudden rise in overweight/obesity-related chronic diseases in developing countries. Little research has been done in Pakistan to explore nutrition transition, and its associated nutrition challenges. The current study attempted to investigate the socio-economic, environmental and demographic determinants of rise in obesity among women of reproductive years (15-49 years) in Pakistan. A review of related published literature for a period of 10 years (2005-2015) was carried out. Also, data from National Nutrition Survey (NNS-2011) and Pakistan Demographic and Health Survey (PDHS 2012-13) was reviewed and used to supplem...
JPMA. The Journal of the Pakistan Medical Association, 1995
Compliance with fluid and dietary instructions is a critically significant factor in the health a... more Compliance with fluid and dietary instructions is a critically significant factor in the health and well-being of haemodialysis patients. Serial measurement of serum potassium (K) and interdialytic weight gain (IWG) were carried out in 50 haemodialysis patients at the Kidney Centre over a period of one month. Sixty-two percent were males. Ages ranged from 19-69 years (mean 49 years). Duration on dialysis varied from 6 months to 9 years. Patients with an IWG > 1.5 Kg and/or serum K+ > 5.5 m Eq/L were defined as non-compliant. Thirty-two patients (64%) were non-compliant in either diet or fluid. In 13 of these cases, both serum K and IWG were elevated. In the remaining 19, only one value was high. Predictors of non-compliance to diet and fluid regimens were older age (81%), males (68%), less education (75%), single (90%) depression (59%) and not feeling responsible for one's own well-being (85%). Attempts to improve compliance should be aimed by exposing the non-compliant gr...
JPMA. The Journal of the Pakistan Medical Association, 1994
Nutritional assessment was carried out on fifty haemodialyzed patients by demographic, anthropome... more Nutritional assessment was carried out on fifty haemodialyzed patients by demographic, anthropometric, biochemical and dietary indices. The mean age of the patients was 49 years with a male to female ratio of 2.3:1. The duration of dialysis ranged from 6 to 40 months with a mean of 25 months. Fifty percent of the patients were moderately nourished based on their body weight 44%, body mass index 40% and mid-arm circumference 66%. Seventy percent patients had albumin and total proteins within the normal range. Blood urea nitrogen, creatinine, cholesterol, potassium and phosphorus did not significantly change from the previous reports. The calorie and protein intake in 60-70% cases was less than recommended. Overall there was a tendency to calorie and to a lesser degree protein malnutrition in our patients. It is suggested that preventing malnutrition by economical, aggressive and ongoing dietary intervention may minimize malnutrition in haemodialyzed patients.
Dietary pattern analysis is an epidemiological method designed to consider the complexity of food... more Dietary pattern analysis is an epidemiological method designed to consider the complexity of food preferences and diet patterns of populations. Few studies from South Asia have used this methodology to describe population food intake. Our objective was to identify dietary patterns and understand their associations with sociodemographic, anthropometric and life-style factors among low-income Pakistani urban adults. Dietary information was collected by a thirty-three-item FFQ and dietary patterns were derived by principal component analyses in 5491 subjects enrolled in the Control of Blood Pressure and Risk Attenuation (COBRA) study. Three dietary patterns were identified: a fat and sweet pattern characterised by fried snacks/foods, desserts, organ meats, bakery products, Pakistani bread and food purchased from outside the home; a fruit and vegetable pattern including fruits, juices, raw and cooked vegetables, lean meat and low-fat milk; and a seafood and yogurt pattern identified by ...
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