Research Articles Micro-nutrient related malnutrition and obesity in a university Micro-nutrient related malnutrition and obesity in a university undergraduate population and implications for non-communicable undergraduate population and implications for non-communicable diseases diseases Foluke A Olatona 1 , Sunday A Aderibigbe 2 , Eyitope O Amu 3 , Oluseye O Onabanjo 4 , Kelechi E Nnoaham 5 1 Department of Community Health & Primary Care, College of Medicine, University of Lagos, Lagos State, Nigeria, 2 Department of Epidemiology & Community Health, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria, 3 Department of Community Medicine, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, 4 Department of Nutrition and Dietetics, College of Food Science and Human Ecology, Federal University of Agriculture, Abeokuta, 5 Faculty of Health & Human Sciences, Plymouth University, Plymouth, UK Keywords: micronutrient, obesity, malnutrition 10.29392/001c.17603 Journal of Global Health Reports Vol. 4, 2020 Background Background Micronutrient deficiency and obesity are increasing globally. This study determined the prevalence of micronutrient-related malnutrition, patterns of obesity using different methods of assessment, and the predictors of obesity among the university undergraduate population in Lagos State, Nigeria. Methods Methods A multistage sampling technique was adopted to select 506 students from the three universities in Lagos State. A pre-tested, semi-structured interviewer-administered questionnaire was used to obtain data on socio-demographic and economic characteristics. Nutrient intakes were estimated from 24-hour dietary recalls, obesity was assessed through anthropometric measurements and Bio-electrical Impedance Analysis, following standard procedures. Associations between variables were tested using Chi-square, Fischer’s exact tests, and logistic regression analyses. Twenty-four-hour diet recall was analyzed using the Total Diet Assessment soft-ware. Anthropometric indices were compared with World Health Organization (WHO) standards and classified. Results Results Mean daily intake of almost all micronutrients was low except sodium which was in excess compared to the recommended dietary allowances. The prevalence of underweight was 6.6%, overweight (16.4%), and obesity (3.2%) based on body mass index (BMI). Abdominal obesity was higher than general obesity. Obesity assessed using the percentage body fat had the highest yield of 54.4% in males and 37.1% in females. Conclusions Conclusions Micronutrient-related malnutrition and central obesity were higher than reported in previous studies. Male gender, inconsistent income, and increased amount of folate were significant predictors of obesity. The students will benefit from nutrition education that emphasize the consumption of micronutrient dense foods and different methods of weight management. Malnutrition remains a significant problem worldwide, but the types of nutritional problems have changed signif- icantly over the past two decades. While under-nutrition was and is still a major threat to health and well-being in middle-and low-income countries, obesity has equally become an additional problem in such countries with in- creasing prevalence. Micronutrient disorders are a global problem affecting about 2 billion people in both developing and developed countries. They are quiet epidemics of vita- min and mineral deficiencies that affect people of all gen- ders and ages, as well as certain risk groups. In addition to causing definite disease conditions, they also worsen in- fectious and chronic diseases, significantly impacting mor- bidity, mortality, and quality of life.1 The nutrition transi- tion in sub-Saharan African countries is complex because over-nutrition associated with overweight, obesity and oth- er non-communicable diseases (NCDS) emerged before the problems of under-nutrition and micronutrient deficiencies have been solved, creating a double burden of nutrition-re- lated ill-health.2–4 Obesity has more than doubled since 1980 globally. In 2008, more than 1.4 billion adults 20 years and above were overweight. Out of these, an estimated 205 million men and 297 million women, that is more than half a billion adults were obese.5 In 2008, the global prevalence of obesity was 10% and 14% among men and women respectively com- pared with 5% and 8% in 1980. In 2014, 39% of the world’s adult population were overweight while 13% were obese.6 According to the report by the World Health Organization (WHO),7 over 26.8% and 6.5% of adults are overweight and obese respectively in Nigeria. The prevalence of overweight was 26% and 37% in men and women respectively, while the Olatona FA, Aderibigbe SA, Amu EO, Onabanjo OO, Nnoaham KE. Micro-nutrient related malnutrition and obesity in a university undergraduate population and implications for non-communicable diseases. Journal of Global Health Reports. 2020;4:e2020091. https://orcid.org/0000-0002-7766-0117 10.29392/001c.17603 prevalence of obesity was 3% and 8.1% in men and women respectively.7 Among individuals aged 30 years and above, the prevalence of overweight and obesity together increased by 23% in men and 18% in women, while that of obesity alone increased by 47% in men and 39% in women, between 2002 and 2010, in Nigeria.8 In South West Nigeria, 29% of the University undergraduate students were overweight, 6% were obese while 13% were underweight.2 The WHO considers that more than 2 billion people worldwide suffer from micronutrient deficiencies, primarily iodine, iron, vitamin A and zinc, with important health con- sequences.9 Though all ages and both sexes are affected, children less than 5 years of age, adolescents, women of childbearing age, particularly the pregnant and lactating, refugees and victims of famine are mostly at risk.10 Among university undergraduates in Lagos, Nigeria, only 31% eat up to three times daily, only 23% eat breakfast while only 2% consumed the recommended daily allowance of fruits and vegetables.11 Overweight and obesity are associated with many dis- eases. These include hypertension, diabetes mellitus, ath- erosclerosis, certain types of cancers, chronic kidney dis- ease and increased overall cardiovascular risk.12–16 Others include asthma, osteoarthritis, and low back pain. Each 5 kg/m2 increase in BMI is associated with a 30% higher overall mortality risk and higher mortality from stroke, kid- ney disease, and diabetes mellitus in addition to reduced life expectancy by as much as ten years in those with BMI over 40 kg/m2.12 The public health implications of micronu- trient disorders are also potentially huge. They do not only cause obvious clinical manifestations, but are also respon- sible for a wide range of non-specific physiological impair- ments, leading to reduced resistance to infections, meta- bolic disorders, and delayed or impaired physical and psy- chomotor development.17 In adults, they are also associat- ed with the risk of several chronic diseases including cardio- vascular diseases (CVD), osteoporosis and cancer.18 Obesity in young people in middle income countries, has serious implications in later life8 due to its consequences. The transition to higher education involves a significant life change (in environment and resources) for many students as they often start living away from their parental home for the first time, get more freedom and make new friends.19,20 This period is accompanied with un-favorable changes in health behaviors and has been implicated as a risk period for weight gain.21 The rates of obesity have increased rapid- ly among University students globally and locally and a re- cent study among undergraduates in Nsukka Campus Nige- ria revealed a prevalence as high as 21%.22,23 Some studies have explored the prevalence of obesity among undergraduates8,11,24,25 but there is limited infor- mation on nutrient intake, the pattern of obesity using dif- ferent methods of assessment and relationships between micronutrient disorders and obesity among university un- dergraduate students in Lagos. This study, therefore, de- termined the nutrient intake, the pattern of obesity using different methods of assessment and relationships between micronutrient disorders and obesity among university un- dergraduate students in Lagos State. The result will be use- ful for policymakers in detecting areas where intervention is needed in the prevention of obesity and micronutrient deficiency. METHODS A descriptive cross-sectional design was used to obtain data from full time undergraduate students in the three Univer- sities in Lagos: University of Lagos (UNILAG), Lagos State University (LASU) and Caleb University. A multistage sampling technique was employed to select the students from the universities. All the three Universities were included. Simple random sampling was used to select four faculties from the twelve in UNILAG and LASU and one college from Caleb. Using simple random sampling tech- nique (balloting), at least one quarter of the number of de- partments was selected from each faculty making eleven (11) from UNILAG, five (5) from LASU and one from Caleb University. Using sampling proportional to size, students were se- lected across faculties, departments and levels depending on the total population of students in each faculty, depart- ment and level. Systematic random sampling technique was employed in each class to select respondents. The number required from each class was used to divide the class list to determine the sampling interval. The total number of stu- dents interviewed was five hundred and six. DATA COLLECTION Pre-tested, semi-structured interviewer administered ques- tionnaire was used to obtain data on socio demographic and economic characteristics. Mean nutrient intakes were es- timated from 24-hour dietary recalls which were conduct- ed on two days of the week (one week day and one week end day). General and abdominal obesity were assessed us- ing anthropometric measurements while percentage body fat was determined using Bio-electrical Impedance Analy- sis, following standard procedures. DATA ANALYSIS IBM SPSS StatisticsIBM SPSS Statistics (version 20) was used for data analysis. Associations between variables were tested using Chi- square and Fischer’s exact tests. Twenty-four (24) hour-diet recall was analyzed using Total Diet Assessment soft-ware. Anthropometric indices were compared with WHO stan- dards and classified. RESULTS SOCIO-DEMOGRAPHIC STATUS Their ages ranged from 15 to 41 years but the modal age group was 19-24 years while the mean age of the respon- dents was 20.3 + 3.45 years. More than half of the respon- dents (54.7%) were females and majorities were Christians’ (82.9%). Majority (47.6%) of the students had no consistent source of income or received less than N10,000 (USD 31.7) pocket money. MEAN ENERGY AND NUTRIENT INTAKE OF RESPONDENTS Mean nutrient intake of respondents were compared with FAO/WHO 2001 standards for daily recommended intakes of nutrients according to sex and age group. Most micro-nu- trients were deficient except thiamine, and zinc. Micronu- trients such as iron, calcium, potassium, folate, vitamin C, B2, B6 and B12 were inadequate while intake of sodium was higher than the recommended values for some age groups. There was no statistically significant difference between male and female mean nutrient intake for all the nutrients. (Tables (Tables 11 and and 22) ) Micro-nutrient related malnutrition and obesity in a university undergraduate population and implications for... Journal of Global Health Reports 2 Table 1. Respondents’ mean energy and mineral intake compared with RDA for sex and age group Table 1. Respondents’ mean energy and mineral intake compared with RDA for sex and age group Male Male Female Female Nutrient Nutrient Age Age in in years years Mean/Mean/ Median Median Intake Intake RDA RDA Intake Intake as % as % of of RDA RDA (%) (%) Mean/Median Mean/Median Intake Intake RDA RDA Intake Intake as % as % of of RDA RDA PP-value -value Energy (Kcal) 15-18 1543.8 ± 640.6 2800 55.1 1418.4 ± 596.6 2000 70.9 0.202 19-30 1550.2 ± 637.7 2700 57.4 1552.7 ± 625.9 2200 70.6 0.971 31-50 1452.8 ± 347.8 2600 55.9 1249.7 ± 496.5 2000 62.5 0.465 Protein(g) 15-18 49.2 ± 26.8 52 94.6 45.8 ± 21.9 46 99.6 0.379 19-30 49.3 ± 29.6 56 88.0 48.4 ± 22.8 46 105.2 0.755 31-50 54.3 ± 16.1 56 97.0 39.5 ± 19.0 46 85.9 0.220 Carbohydrate(g) 15-18 238.5 ±101.1 130 183.8 220.1 ± 87.7 130 169.2 0.219 19-30 244.3 ± 98.8 130 187.9 244.0 ± 100.6 130 187.7 0.978 31-50 225.9 ± 44.1 130 173.7 205.1 ± 61.7 130 157.7 0.548 Fibre (g) 15-18 8.1 ± 5.1 38 21.3 8.0 ± 5.0 26 30.8 0.901 19-30 8.1 ± 5.1 38 22.9 9.3 ± 7.2 25 37.2 0.089 31-50 4.6 ± 2.7 38 16.8 9.2 ± 9.1 25 36.8 0.267 Fat(g) 15-18 42.9 ±28.3 90 47.7 37.3 ± 26.2 70 53.1 0.196 19-30 39.7± 26.1 71 55.9 40.8 ± 26.4 56 72.9 0.705 31-50 33.8± 22.1 69 49.0 27.7 ± 22.0 57 48.6 0.680 Calcium(mg) 15-18 327.9 ± 225.2 1100 29.8 314.9 ± 195.2 1300 24.2 0.716 19-30 358.4± 324.3 1000 35.8 334.9 ± 198.7 1000 33.5 0.417 31-50 400.6 ± 380.7 1000 37.8 345.3 ± 192.3 1000 34.5 0.798 Sodium(mg) 15-18 967.4 (1257.5) 1500 64.5 1279.6(1473.6) 1500 85.3 0.154 19-30 1397.7 (1227.8) 1500 93.2 1378.9(1431.7) 1500 91.9 0.659 31-50 885.4 ± 770 1500 395.5 1959.7 ± 1455 1500 130.6 0.162 Potassium(mg) 15-18 991.3 ± 588.5 4700 21.1 973.7 ± 585.3 4700 20.7 0.850 19-30 839.1 (790.3) 4700 17.9 777.7 (658.4) 4700 16.6 0.377 31-50 665.0 ± 433.7 4700 14.1 618.3 ± 315.5 4700 13.1 0.859 Zinc(mg) 15-18 7.1 ± 4.56 9.7 73.2 7.6 ± 4.65 7.8 97.3 0.521 19-30 6.47 (6.41) 7 107.1 6.3 (5.09) 4.9 159.2 0.999 31-50 8.2 ± 2.64 7 117.1 6.3 ± 1.75 4.9 128.6 0.248 Iron(mg) 15-18 14.12 ± 11.68 19 74.7 14.27 ± 9.75 31 46.1 0.930 19-30 15.55 ± 10.42 14 109.3 15.12 ± 9.65 29 51.7 0.697 31-50 13.29 ± 2.37 14 92.9 12.52 ± 2.34 29 44.8 0.627 RDA – Recommended Daily Allowance OVERALL BMI CLASSIFICATION OF ALL THE RESPONDENTS According to Body Mass Index (BMIBMI) classification, most of the students (73.9%) were in the normal range of BMI. Only few of them were underweight (6.6 %), overweight (16.4%) and obese (3.2%) (Figure 1Figure 1). ). Micro-nutrient related malnutrition and obesity in a university undergraduate population and implications for... Journal of Global Health Reports 3 Table 2. Respondents’ mean vitamin intake compared with RDA for sex and age group Table 2. Respondents’ mean vitamin intake compared with RDA for sex and age group Male Male Female Female Nutrient Nutrient Age Age in in years years Mean/Mean/ Median Median Intake Intake RDA RDA Intake as Intake as % RDA% RDA (%) (%) Mean/Mean/ Median Median intake intake RDA RDA Intake as Intake as % RDA% RDA (%) (%) PP-value -value Vit A 15-18 458.1 (1433.9) 600 76.4 341.6 (1577.9) 600 56.9 0.634 (ugRE/ day) 19-30 304.9 (1290.1) 600 50.8 319.8 (1777.8) 500 64.0 0.825 31-50 875.5 (2317.7) 600 145.9 1829.9 (2047.8) 500 366.0 0.999 Vit C (mg) 15-18 25.4 (47.3) 40 63.5 15.5 (37.5) 40 38.8 0.428 19-30 16.9 (55.1) 45 37.6 16.7 (60.0) 45 37.1 0.999 31-50 1.7 (5.0) 45 3.8 2.8 (3.0) 45 6.2 0.524 Thiamine 15-18 1.17 ±0.66 1.2 97.5 1.05 ±0.67 1.1 95.5 0.257 (mg) 19-30 1.23 ± 0.65 1.2 102.5 1.30 ±0.73 1.1 118.2 0.363 31-50 1.14 ± 0.57 1.2 95.0 1.45 ± 1.10 1.1 131.8 0.570 Riboflavin 15-18 0.94 ± 0.57 1.3 72.3 0.83 ±0.50 1.0 83.0 0.195 (mg) 19-30 0.93 ± 0.54 1.3 71.5 1.01 ±0.76 1.1 91.8 0.282 31-50 1.00 ± 0.49 1.3 76.9 1.29 ± 1.07 1.1 117.3 0.571 Pyridoxine 15-18 0.64 ± 0.42 1.3 50.0 0.66 ±0.45 1.2 55.0 0.773 (mg) 19-30 0.67 ± 0.54 1.3 53.8 0.72 ±0.58 1.3 55.4 0.422 31-50 0.55 ± 0.25 1.3 38.5 0.41 ± 0.23 1.3 31.5 0.398 Folate (mg) 15-18 246.1 ±143.7 400 61.5 235.4 ±147.7 400 58.9 0.644 19-30 263.9 ± 163.4 400 66.0 277.3 ± 156.8 400 69.2 0.448 31-50 287.9 ± 138.3 400 72.0 248.6 ± 102.4 400 62.2 0.642 Vit B12(ug) 15-18 1.2 (1.3) 2.4 50.0 1.1 (1.3) 2.4 45.8 0.742 19-30 1.1 (1.1) 2.4 45.8 0.9 (1.1) 2.4 37.5 0.047 31-50 1.60 (3.47) 2.4 58.1 0.94 (1.34) 2.4 45.8 0.524 RDA – Recommended Daily Allowance, Vit – Vitamin PATTERN OF OBESITY USING DIFFERENT ASSESSMENT METHODS BY GENDER Body mass index showed that 3% of males and 3.3% of fe- males were obese. Based on waist circumference (WC), 1.3% of males and 8.4% of females were obese, whereas 12.3% of males and 26.5% of females were obese using Waist to Hip ratio (WHR). Prevalence of abdominal (central) obesity was significantly higher among females than males (P=0.000 for both WC and WHR). Obesity assessed using the percentage body fat had the highest yield of 54.4% in males and 37.1% in females. The difference between males and females were not statistically significant (P=0.69) (Table 3Table 3). ). Figure 1. Body Mass Index (BMI) classification of all the Figure 1. Body Mass Index (BMI) classification of all the respondents respondents Micro-nutrient related malnutrition and obesity in a university undergraduate population and implications for... Journal of Global Health Reports 4 https://www.joghr.org/article/17603-micro-nutrient-related-malnutrition-and-obesity-in-a-university-undergraduate-population-and-implications-for-non-communicable-diseases/attachment/46163.png Table 3. Pattern of obesity using different assessment methods by gender Table 3. Pattern of obesity using different assessment methods by gender Male (N=228) Male (N=228) Female (N= 275) Female (N= 275) Total Total XX² ² PP-value -value Measures of obesity Measures of obesity Normal (%) Normal (%) Overweight (%) Overweight (%) Obesity (%) Obesity (%) Normal (%) Normal (%) Overweight (%) Overweight (%) Obesity (%) Obesity (%) Overweight (%) Overweight (%) Obesity (%) Obesity (%) BMI 168 (73.7) 38 (16.7) 6 (3.0) 202 (74) 44 (16.1) 79 (3.3) 82 (16.4) 85 (3.2) 0.008 0.996 WC 215 (94.3) 10 (4.4) 3 (1.3) 188 (68.4) 64 (23.3) 23 (8.4) 74 (15) 26 (5) 49.458 0.000 WHR 200 (87.7) 28 (12.3) 187 (68) 73 (26.5) 100 (20) 15.123 0.000 Percentage body fat 104 (45.6) 124(54.4) 173 (62.9) 102 (37.1) 226 (45%) 266.8 0.69 BMI:BMI: Underweight <18.5kg/m², normal:18.5-24.99kg/m², overweight: 25-29.99kg/m² & obese> 30kg/m². Waist Circumference (WC):Waist Circumference (WC): Overweight: >94 cm(MM); >80 cm(F)F), Obesity: >102cm(M)M); >88 cm (F)F). Waist to Hip Ratio (WHR)Waist to Hip Ratio (WHR): Obesity ≥0.90 cm (M(M); ≥0.85 cm (F)F); Percentage body fatPercentage body fat: >25% in males; >30% in females Table 4. Prevalence of micro-nutrient-deficient diet or excess among the undergraduates Table 4. Prevalence of micro-nutrient-deficient diet or excess among the undergraduates Micro-nutrient Micro-nutrient Males (N= 228) Males (N= 228) Females (N=275) Females (N=275) PP-value -value RDA RDA (Mg) (Mg) Deficient/ excess micro-Deficient/ excess micro- nutrients (%) nutrients (%) RDA RDA (Mg) (Mg) Deficient/ excess micro-Deficient/ excess micro- nutrients (%) nutrients (%) Calcium deficiency 1100 225 (98.7) 1200 274 (99.6) 0.23 Iron deficiency 14 140 (61.4) 29 162 (58.9) 0.570 Zinc deficiency 7 128(56.1) 4.9 152 (55.3) 0.916 Folate deficiency 400 191 (83.8) 400 231(84) 0.958 Potassium deficiency 4700 228 (100) 4700 274(99.6) 0.100 Excess sodium 1500 97(43.0) 1500 105(38.0) 0.367 Pyridoxine deficiency 1.3 211 (92.5) 1.3 248(90.2) 0.351 Ascorbic acid deficiency 45 162 (71.1) 45 190 (69.1) 0.633 Vitamin B12 deficiency 2.4 198(86.8) 2.4 237(86.2) 0.829 Recommended Dietary AllowanceRecommended Dietary Allowance (RDA), the daily dietary intake level of a nutrient considered sufficient by the Food and Nutrition Board of the Institute of Medicine to meet the re- quirements of 97.5% of healthy individuals in each life-stage and sex group. The definition implies that the intake level would cause a harmful nutrient deficiency in just 2.5%. PREVALENCE OF MICRONUTRIENT DEFICIENT DIET AMONG UNDERGRADUATES IN LAGOS Almost all the under-graduates had vitamin B12 (86.8% M, 86.2% F), pyridoxine (92.5% M, 90.2% F) calcium (98.7% M, 99.6% F) and potassium (100% M, 99.6% F) deficient diet while almost half of them consumed excess sodium. Most of the females (58.9%) had iron deficient diet while more than half (56.1%) of the males consumed zinc deficient diet (Table 4Table 4). ). PREDICTORS OF OBESITY Males were 0.597 times more likely to develop obesity than females and students who had inconsistent amount of in- come were 2.23 times more likely to develop obesity than those who had no source of income. Moreover, for every one unit increase in folate, the likelihood of developing obesity was 1.0. DISCUSSION The average age was 20.31±3.454 with 54.7% being females and 45.3% being males. Most of the students had educated mothers and enlightened parents who lived in detached houses/duplex (23%) or bungalows (28%) or self-contained apartments within story buildings (41.6%) but many (37.6%) of the students received less than N10, 000 (USD 30) month- ly pocket money or had no consistent source of income. Most of the nutrients and energy were deficient except carbohydrates. This study contradicts the study by Hirsh- berg where intakes of total energy surpassed guidelines26 but agrees with another study in Ghana where female re- spondents met 97 percent of energy requirement while the males met only 66 percent.27 The energy might have been deficient because many undergraduate students in Nigeria eat only two times daily and buy most of their meals from fast food restaurants.11 Since many undergraduates per- ceive inadequate funds as a reason for not eating healthy, they might have purchased small portion sizes of meals that were affordable rather than purchasing enough portion size to meet their needs.11 The low energy and high car- bohydrate intake infer that the students’ diet consisted of majorly simple carbohydrates with little energy from other sources such as protein and fat rich foods. Energy is very critical in metabolism because the transport, synthesis, and breakdown of nutrients and molecules in a cell require the use of energy.28 Adequate energy intake is also important to reserve protein for more important functions like hor- mone and enzyme production and building of tissues rather than energy generation. Protein intake was better than en- ergy especially among the females probably because many of them ate meat which contains a high amount of qualita- tive protein daily; however, some of it could have been con- verted to energy rather than fulfilling the special functions of protein. The fiber intake was not adequate. This agrees with the result of another study by Irazusta which shows only 43% of females and 51% of males met the recommendations for fiber intake.29 Adequate fiber is very important in bowel movement, weight control and prevention of NCDs general- ly.30 Iron intake was not adequate for all the age groups es- pecially among females. Majority (92%) of the females had iron deficiency. They met only 40% of their requirement while the males met 78% of their Recommended Dietary Al- lowance (RDA). Females require more iron than males in or- der to replace menstrual iron losses which make them vul- nerable to anemia and other iron deficiency disorders. Iron deficiency anaemia should be avoided among females of re- productive age because children born to such people are likely to suffer poor growth and cognition. This result is similar to the one obtained in the Ghana study above where intake of iron was low among the females.31 Zinc intake was adequate among females but not ade- quate for males who require more zinc. Almost half (49%) of the males had zinc deficiency. Its adequacy is critical to Micro-nutrient related malnutrition and obesity in a university undergraduate population and implications for... Journal of Global Health Reports 6 Table 5: Predictors of Obesity Table 5: Predictors of Obesity Variables Variables Odds Ratio Odds Ratio 95% Confidence Interval 95% Confidence Interval PP-value -value Age Age 1.01 0.949 – 1.081 0.699 Sex Sex 0.6 0.370 – 0.963 0.034* 0.034* Level of education Level of education No education Some primary 0 0 0.999 Primary 0.75 0.113 – 4.974 0.765 Some secondary 1.91 0.271 – 13.458 0.516 Secondary 0.51 0.067 – 3.913 0.518 Some tertiary 0.99 0.230 – 4.267 0.99 Tertiary 1 0.221 – 4.549 0.998 Quoranic/vocational 0.88 0.218 – 3.532 0.854 Other forms of education 0.57 0.044 – 7.567 0.673 Occupation of heads of household Occupation of heads of household Farming Petty trading 0 0 0.999 Civil servant 2.58 0.623 – 10.675 0.191 Business 0.75 0.409 – 1.393 0.369 Highly skilled professional 1.09 0.621 – 1.913 0.764 Average Income per month Average Income per month No income ₦1000-5000 0.54 0.100 – 2.923 0.475 ₦5001-₦10,000 0.57 0.182 – 1.754 0.323 ₦10,001-₦20,000 1.18 0.520 – 2.671 0.695 Above ₦20,000 1.23 0.592 – 2.558 0.577 Not consistent 2.23 1.034 – 4.789 0.041* 0.041* Micronutrients Micronutrients Calcium 1 0.999 – 1.001 0.655 Iron 1 0.960 – 1.031 0.791 Zinc 0.99 0.927 – 1.058 0.772 Folate 1 1.000 – 1.004 0.038* 0.038* Potassium 1 1.000 – 1.001 0.428 Sodium 1 1.000 – 1.000 0.498 Vit. B6 0.4 0.148 – 1.063 0.066 Vit. C 1 0.998 – 1.006 0.379 Vit. B12 0.99 0.918 – 1.075 0.868 the males’ reproductive ability. Zinc enables the male body to produce testosterone apart from other general functions such as production of enzymes and promoting immune function.32 Calcium intake was low compared to RDA (less than 50%). This is probably because the undergraduate pop- ulation did not consume enough milk or milk products daily despite its importance as a major source of dietary calci- um.33 The proportion of students who took milk and its products in other studies in similar population was low.8,34 Sodium intake was in excess for both males and females while potassium deficiency was almost universal. Almost all the under-graduates (99%) had potassium deficiency while less than half had hypernatremia This is probably a result of frequent consumption of processed foods and fast food restaurants while consuming inadequate fruits and vegeta- bles. Diets based on processed foods are high in sodium and low in potassium.25 This finding agrees with the study by Burke et al among undergraduates in University of New Hampshire in United States which discovered that more than 90% of college students exceeded sodium recommen- dations.35 High level of sodium and low level of potassium intake are risk factors for hypertension in many people and it is recommended that sodium intake should be limited while potassium should be increased.36 Research has shown that the problem with hypertension is not just high level of sodium but the balance between sodium and potassium. Higher potassium intake has been found to result in blood pressure lowering in the overall population with more pro- nounced effects in patients with hypertension or consum- ing a high sodium diet.31 Unfortunately, less than one third Micro-nutrient related malnutrition and obesity in a university undergraduate population and implications for... Journal of Global Health Reports 7 of Nigerians consume adequate amount of fruits and veg- etables which are rich in Potassium. This result is similar to another one in Ghana, where about two-thirds had normal BMIs and a third were either overweight, obese or underweight.31 The prevalence of gen- eral overweight & obesity in this study was lower than ob- tained among undergraduates in South Western Nigeria generally (29%, 6%) and in a Central University in the West Bank (25%, 7.2%).8,37 The prevalence of abdominal obesity was significantly higher among females compared to males using waist circumference and waist to hip ratio (p=0.000). The percentage body fat assessed using bio-electrical im- pedance analysis yielded the highest rate of obesity which was higher among males though the difference was not sta- tistically significant. LIMITATIONS Ideally, it would have been better to obtain and use blood samples to demonstrate objectively the measure of defi- ciency or excess of micronutrients; however, 24-hour diet recall was used as a proximate. There could have been a challenge with accuracy of recall and extrapolating mi- cronutrient deficiency from two days nutrient intake could have yielded some degree of inaccuracy. CONCLUSIONS Mean nutrient intake was lower than RDA for most mi- cronutrients except thiamine and sodium ,which were too high. Micronutrient-related malnutrition and central obesi- ty were higher than reported in previous studies. Male gen- der, inconsistent income and increased amount of folate were significant predictors of obesity. Nutrition and lifestyle education programs targeting behavioral change should be instituted in universities through the school cur- riculum. Whole foods such as legumes, milk, fruits and veg- etables which can also supply iron, calcium, potassium, fo- late and other micronutrients and control weight gain are recommended for the undergraduates. ACKNOWLEDGEMENTS The authors wish to acknowledge the Deans of Students af- fairs of the three universities for granting permission to col- lect data. ETHICS APPROVAL AND CONSENT TO PARTICIPATE The study was conducted according to the guidelines laid down in the Declaration of Helsinki. Ethical approval was obtained from the Health Research and Ethics Committee of the Lagos University Teaching Hospital (Ref No: ADM/ DCST/HREC/APP/179 and Lagos State University Teaching Hospital (Ref No: LREC/10/06/630). Informed written con- sent was obtained from all students as well as parental con- sent from those who were younger than eighteen (18) years of age before conducting the study, and confidentiality was maintained. AVAILABILITY OF DATA AND MATERIAL The datasets used and analyzed during the current study are available from the corresponding author on reasonable re- quest. FUNDING None AUTHORSHIP CONTRIBUTIONS: FO, SA, EA, OO conceptualized and designed the study. F.O acquired and interpreted the data. FO, SA, EA and KN draft- ed the manuscript and critically revised it for important intellectual content. KN was a major contributor in writ- ing the manuscript. All authors read and approved the final manuscript. COMPETING INTERESTS The authors completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available upon request from the corresponding author), and declare no conflicts of interest. CORRESPONDENCE TO: Dr. Foluke A. Olatona Department of Community Health and Primary Care College of Medicine, University of Lagos, Nigeria Submitted: March 09, 2020 GMT, Accepted: October 10, 2020 GMT This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC- BY-4.0). View this license’s legal deed at http://creativecommons.org/licenses/by/4.0 and legal code at http://creativecom- mons.org/licenses/by/4.0/legalcode for more information. Micro-nutrient related malnutrition and obesity in a university undergraduate population and implications for... Journal of Global Health Reports 8 http://www.icmje.org/coi_disclosure.pdf REFERENCES 1. Tulchinsky TH. Micronutrient deficiency conditions: Global health issues. Public Health Rev. 2010;32(1):243-255. doi:10.1007/bf03391600 2. Otemuyiwa IO, Adewusi SRA. Food Choice and Meal Consumption Pattern Among Undergraduate Students In Two Universities In Southwestern Nigeria. Journal of Nutrition Health. 2012;21(4):233-245. doi:10.1177/0260106013510994 3. World Health Organization. Diet and Physical Activities. Prevention of Diseases; 2011. 4. Abdulkarim AA, Otuneye AT, Ahmed P, Shattima DR. Adolescent malnutrition: Prevalence and pattern in Abuja Municipal Area Council, Nigeria. Nig J Paed. 2014;41(2):99–103. doi:10.4314/njp.v41i2.4 5. World Health Organization. Physical Status: The Use and Interpretation of Anthropometry. Geneva, Switzerland: World Health Organization; 1995:854. 6. World Health Organization. WHO Global Strategy on Diet, Physical Activity and Health. 2014. 7. World Health Organization. Physical Status: The use and interpretation of anthropometry: Report of A WHO Expert Committee:2008. WHO technical series 859. 8. Ono T, Guthold R, Strong K. WHO Global Comparable Estimates: Global Infobase data for saving lives. 2005. https://apps.who.int/infobase/Inde x.aspx. 9. World Health Organization. World Health Report, 2000. Geneva: World Health Organization; 2000. 10. Dairo MD, Ige OK. Supplementation of micronutrient in community micronutrient deficiency prevention programmes. Annals of Ibadan Postgraduate Medicine. 2009;7(1):6-9. 11. Olatona FA, Onabanjo OO, Ugbaja RN, Nnoaham KE, Adelekan DA. Dietary habits and metabolic risk factors for non-communicable diseases in a university undergraduate population. J Health Popul Nutr. 2018;37(1):21. doi:10.1186/s41043-018-0152-2 12. Bray GA. Complications of obesity. Ann Intern Med. 1985;103(6 Pt 2):1052-1062. doi:10.7326/0003-4 819-103-6-1052 13. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: A systematic review and meta-analysis. JAMA. 2013;309(1):71-82. doi:10.1001/jama.2012.113 905 14. Must A, McKeown NM, Groot LJ, Beck-Peccoz P, Chrousos G, Dungan K, et al. The Disease Burden Associated with Overweight and Obesity. Endotext. South Dartmouth, MA: MDText.com, Inc.;2000-2012 15. Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J. Body-mass index and cause-specific mortality in 900 000 adults: Collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083-1096. doi:10.1016/s0140-6736(0 9)60318-4 16. Wilson PWF, D’Agostino RB, Sullivan L, Parise H, Kannel WB. Overweight and obesity as determinants of cardiovascular risk: The Framingham experience. Arch Intern Med. 2002;162(16):1867-1872. doi:10.100 1/archinte.162.16.1867 17. Allen L, de Benoist B, Dary O, Hurrell R. Guidelines on Food Fortification with Micronutrients. World Health Organization and Food and Agricultural Organization of the United Nations. Geneva: World Health Organization; 2006. 18. Fairfield KM, Fletcher RH. Vitamins for chronic disease prevention in adults: Scientific review. JAMA. 2002;287(23):3116-3126. doi:10.1001/jama.287.23.31 16 19. Crombie AP, Ilich JZ, Dutton GR, Panton LB, Abood DA. The Freshman Weight Gain Phenomenon Revisited. Nutrition Review. 2009;67(2):83-94. doi:1 0.1111/j.1753-4887.2008.00143.x 20. Arnett JJ. Emerging adulthood: A theory of development from the late teens through the twenties. TheAmerican Journal of Psychiatry. 2000;55(5):469-480. doi:10.1037/0003-066x.55.5.469 21. Deforche B, Dyck DV, Deliens T, Bourdeaudhuij ID. Changes In Weight, Physical Activity, Sedentary Behaviour And Dietary Intake During The Transition To Higher Education: A Prospective Study. Int J Behav Nutr Phys Act. 2015;12(1):16. doi:10.1186/s12966-01 5-0173-9 Micro-nutrient related malnutrition and obesity in a university undergraduate population and implications for... Journal of Global Health Reports 9 https://doi.org/10.1007/bf03391600 https://doi.org/10.1177/0260106013510994 https://doi.org/10.4314/njp.v41i2.4 https://apps.who.int/infobase/Index.aspx https://apps.who.int/infobase/Index.aspx https://doi.org/10.1186/s41043-018-0152-2 https://doi.org/10.7326/0003-4819-103-6-1052 https://doi.org/10.7326/0003-4819-103-6-1052 https://doi.org/10.1001/jama.2012.113905 https://doi.org/10.1001/jama.2012.113905 https://doi.org/10.1016/s0140-6736(09)60318-4 https://doi.org/10.1016/s0140-6736(09)60318-4 https://doi.org/10.1001/archinte.162.16.1867 https://doi.org/10.1001/archinte.162.16.1867 https://doi.org/10.1001/jama.287.23.3116 https://doi.org/10.1001/jama.287.23.3116 https://doi.org/10.1111/j.1753-4887.2008.00143.x https://doi.org/10.1111/j.1753-4887.2008.00143.x https://doi.org/10.1037/0003-066x.55.5.469 https://doi.org/10.1186/s12966-015-0173-9 https://doi.org/10.1186/s12966-015-0173-9 22. Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, et al. Prevalence of Obesity, Diabetes, And Obesity-Related Health Risk Factors. Journal of the American Medical Association. 2003;289:76-79. 23. Onyechi UA, Okolo AC. Prevalence of Obesity Among Undergraduate Students, Living In Halls Of Residence, University Of Nigeria, Nsukka Campus, Enugu State. Anim Res Int. 2008;5(3):928 – 931 928. d oi:10.4314/ari.v5i3.48764 24. Adu OB, Falade AM, Nwalutu EJ, Elemo BO, Magbagbeola OA. Nutritional Status of Undergraduates In A Nigerian University In South- West Nigeria. International Journal of Medicine and Medical Sciences. 2009;(8):318-324. 25. Kaplan NM. Primary Hypertension: Pathogenesis. In: Kaplan NM, ed. Kaplan’s Clinical Hypertension. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2006:50-121. 26. Hirshberg SE, Fernandes J, Melanson KJ, Dwiggins JL, Dimond ES, Lofgren IE. Dietary Sugars Predict Chronic Disease Risk Factors In College Students. Topics in Clinical Nutrition. 2011;26(4):324-334. do i:10.1097/tin.0b013e318237d026 27. Nti CA, Pecku E, Opare-Obisaw C. Nutrition knowledge, meal patterns and nutritional status of energy drink users in a Ghanaian University. Journal of Human Ecology. 2015;49(1-2):1-7. doi:10.1080/097 09274.2015.11906818 28. Boundless. The Role of Energy and Metabolism.” Boundless Biology Boundless, 26 May. https://www.b oundless.com/biology/textbooks/boundless-biology.T extbook/metabolism-6/energy-and-metabolism-68/th e-role-of-energy-and-metabolism-2016;341-11478/m etabolism-341-11478/. Accessed February 1, 2017. 29. Irazusta A, Hoyos I, Irazusta J, Ruiz F, Díaz E, Gil J. Increased cardiovascular risk associated with poor nutritional habits in first-year university students. Nutrition Research. 2007;27(7):387-394. doi:10.1016/ j.nutres.2007.05.007 30. Anderson JW, Baird P, Davis RH, et al. Health Benefits of Dietary Fiber. Nutrition Reviews. 2009;67(4):188-205. doi:10.1111/j.1753-4887.2009.00 189.x 31. Aburto NJ, Hanson S, Gutierrez H, Hooper L, Elliott P, Cappuccio FP. Effect of increased potassium intake on cardiovascular risk factors and disease: Systematic review and meta-analyses. BMJ. 2013;346(apr03 3):f1378-f1378. doi:10.1136/bmj.f137 8 32. Frederickson CJ, Koh J-Y, Bush AI. The Neurobiology of Zinc in Health and Disease. Nat Rev Neurosci. 2005;6(6):449-462. doi:10.1038/nrn1671 33. Olatona FA, Sosanya A, Sholeye OO, Obrutu OE, Nnoaham KE. Knowledge of fruits and vegetables, consumption pattern and associated factors among adults in Lagos State, Nigeria. Research Journal of Health Sciences. 2018;6(2):50. doi:10.4314/rejhs.v6i 2.2 34. Mohammad A, Neda A, Mohsen E, Kazem R. Nutrition Knowledge, The Attitude and Practices of College Students. Facta Universitatis Series: Physical Education and Sport. 2011;9(3):349-357. 35. Burke JD, Reilly RA, Morrell JS, Lofgren IE. The University of New Hampshire’s Young Adult Health Risk Screening Initiative. Journal of American Dietetics Association. 2009;109(10):1751-1758. doi:1 0.1016/j.jada.2009.07.005 36. Adrogué HJ, Madias NE. Sodium and Potassium in the Pathogenesis of Hypertension. N Engl J Med. 2007;356(19):1966-1978. doi:10.1056/nejmra064486 37. Yasin IT, Nagham AY, Wiam TK, Lama O, Abu R, Ahmad BR, et al. Prevalence and Risk Factors of Obesity and Hypertension Among Students at A Central University in The West Bank. Libyan Journal of Medicine. 2012;7:10. doi:10.3402/ljm.v7i0.19222 Micro-nutrient related malnutrition and obesity in a university undergraduate population and implications for... Journal of Global Health Reports 10 https://doi.org/10.4314/ari.v5i3.48764 https://doi.org/10.4314/ari.v5i3.48764 https://doi.org/10.1097/tin.0b013e318237d026 https://doi.org/10.1097/tin.0b013e318237d026 https://doi.org/10.1080/09709274.2015.11906818 https://doi.org/10.1080/09709274.2015.11906818 https://www.boundless.com/biology/textbooks/boundless-biology.Textbook/metabolism-6/energy-and-metabolism-68/the-role-of-energy-and-metabolism-2016;341-11478/metabolism-341-11478/ https://www.boundless.com/biology/textbooks/boundless-biology.Textbook/metabolism-6/energy-and-metabolism-68/the-role-of-energy-and-metabolism-2016;341-11478/metabolism-341-11478/ https://www.boundless.com/biology/textbooks/boundless-biology.Textbook/metabolism-6/energy-and-metabolism-68/the-role-of-energy-and-metabolism-2016;341-11478/metabolism-341-11478/ https://www.boundless.com/biology/textbooks/boundless-biology.Textbook/metabolism-6/energy-and-metabolism-68/the-role-of-energy-and-metabolism-2016;341-11478/metabolism-341-11478/ https://www.boundless.com/biology/textbooks/boundless-biology.Textbook/metabolism-6/energy-and-metabolism-68/the-role-of-energy-and-metabolism-2016;341-11478/metabolism-341-11478/ https://doi.org/10.1016/j.nutres.2007.05.007 https://doi.org/10.1016/j.nutres.2007.05.007 https://doi.org/10.1111/j.1753-4887.2009.00189.x https://doi.org/10.1111/j.1753-4887.2009.00189.x https://doi.org/10.1136/bmj.f1378 https://doi.org/10.1136/bmj.f1378 https://doi.org/10.1038/nrn1671 https://doi.org/10.4314/rejhs.v6i2.2 https://doi.org/10.4314/rejhs.v6i2.2 https://doi.org/10.1016/j.jada.2009.07.005 https://doi.org/10.1016/j.jada.2009.07.005 https://doi.org/10.1056/nejmra064486 https://doi.org/10.3402/ljm.v7i0.19222 Background Methods Results Conclusions METHODS Data collection Data analysis RESULTS Socio-demographic status Mean energy and nutrient intake of respondents Overall BMI classification of all the respondents Pattern of obesity using different assessment methods by gender Prevalence of micronutrient deficient diet among undergraduates in Lagos Predictors of obesity DISCUSSION Limitations CONCLUSIONS Acknowledgements Ethics approval and consent to participate Availability of data and material Funding Authorship contributions: Competing interests Correspondence to: References