To compare the responsiveness of different anthropometric indicators for measuring nutritional stress among children in developing countries.

Growth was studied within 6-month intervals in a rural Senegalese community during one dry and two rainy (hungry) seasons. Responsiveness was defined as the change divided by the standard deviation of each anthropometric indicator. Contrast was defined as the difference in responsiveness between dry and rainy seasons.

The study was conducted in Niakhar, a rural area of Senegal under demographic surveillance, with contrasted food and morbidity situations between rainy and dry seasons.

Some 5000 children under 5 years of age were monitored at 6-month intervals in 1983–1984. The present analysis was carried out on a sub-sample of children aged 6–23 months with complete measures, totalling 2803 children-intervals.

In both univariate and multivariate analysis, mid-upper arm circumference was found to be more responsive to nutritional stress than the commonly used weight-for-height Z-score (contrast = −0·64 for mid-upper arm circumference v. −0·53 for weight-for-height Z-score). Other discriminant indicators were: muscle circumference, weight-for-height, BMI and triceps skinfold. Height, head circumference and subscapular skinfold had no discriminating power for measuring the net effect of nutritional stress during the rainy season.

The use of mid-upper arm circumference for assessing nutritional stress in community surveys should be considered and preferred to other nutritional indicators. Strict standardization procedures for measuring mid-upper arm circumference are required for optimal use.

To improve estimates of vitamin A deficiency in children of pre-school age in the 2006 Uganda Demographic and Health Survey (UDHS 2006).

A cross-sectional study in which dried blood spot samples were analysed for C-reactive protein (CRP). Retinol-binding protein (RBP) had previously been analysed using a commercial enzyme immunoassay.

A population-based study in Uganda.

A systematically selected subset of the dried blood spot samples collected from children aged 6–59 months for UDHS 2006. Children were categorized into ‘normal CRP’ (Group A) and ‘raised CRP’ (Group B) using a CRP cut-off of 5 mg/l. A correction factor was calculated to adjust the Group B RBP values for the influence of the acute-phase response.

Geometric mean CRP was 6·2 (95 % CI 5·5, 7·0) mg/l, 1·6 (95 % CI 1·5, 1·8) mg/l and 17·9 (95 % CI 16·4, 19·6) mg/l in all children, in Group A and in Group B, respectively. Geometric mean RBP in all children, in Group A and in Group B was 1·18 (95 % CI 1·14, 1·22) μmol/l, 1·26 (95 % CI 1·20, 1·33) μmol/l and 1·12 (95 % CI 1·07, 1·17) μmol/l, respectively, before correction. Correction increased mean RBP in Group B to 1·26 (95 % CI 1·21, 1·31) μmol/l. The prevalence of vitamin A deficiency (RBP < 0·825 μmol/l) reduced from 18·4 % (95 % CI 17·2, 23·0 %) to 13·9 % (95 % CI 11·3, 16·5 %).

Correcting for the acute-phase response significantly reduced the prevalence of vitamin A deficiency; thus, the acute-phase response should be considered when vitamin A status is assessed using RBP in order to improve population-level estimates of vitamin A deficiency.

To assess the associations between maternal HIV infection and growth outcomes of HIV-exposed but uninfected infants and to identify other predictors for poor growth among this population.

Within a trial of de-worming during pregnancy, the cohort of offspring was followed from birth. HIV status of the mothers and their children was investigated and growth data for children were obtained at age 1 year. Length-for-age, weight-for-age and weight-for-length Z-scores were calculated for each child; Z-scores <−2 were defined as stunting, underweight and wasting, respectively.

The study was conducted in Entebbe municipality and Katabi sub-county, Uganda.

The sample consisted of 1502 children aged 1 year: HIV-unexposed (n 1380) and HIV-exposed not infected (n 122).

Prevalence of stunting, underweight and wasting was 14·2 %, 8·0 % and 3·9 %, respectively. There was evidence for an association between maternal HIV infection and odds of being underweight (adjusted OR = 2·32; 95 % CI 1·32, 4·09; P = 0·006) but no evidence for an association with stunting or with wasting. Young maternal age, low maternal education, low birth weight, early weaning and experiencing a higher number of episodes of malaria during infancy were independent predictors for stunting and underweight. A higher number of living children in the family was associated with wasting.

Maternal HIV infection was associated with being underweight in HIV-exposed uninfected infants. The success of programmes for prevention of mother-to-child HIV transmission means that an increasing number of infants will be born to HIV-infected women without acquiring HIV. Therefore, viable nutritional interventions need to be identified for this population.

To assess the validity of food photographs in portion size estimation among adolescent girls in Mozambique. The study was carried out in preparation for the larger ZANE study, which used the 24 h dietary recall method.

Life-sized photographs of three portion sizes of two staple foods and three sauces were produced. Participants ate weighed portions of one staple food and one sauce. After the meal, they were asked to estimate the amount of food with the aid of the food photographs.

Zambezia Province, Mozambique.

Ninety-nine girls aged 13–18 years.

The mean differences between estimated and actual portion sizes relative to the actual portion size ranged from −19 % to 8 % for different foods. The respective mean difference for all foods combined was −5 % (95 % CI −12, 2 %). Especially larger portions of the staple foods were often underestimated. For the staple foods, between 62 % and 64 % of the participants were classified into the same thirds of the distribution of estimated and actual food consumption and for sauces, the percentages ranged from 38 % to 63 %. Bland–Altman plots showed wide limits of agreement.

Using life-sized food photographs among adolescent Mozambican girls resulted in a rather large variation in the accuracy of individuals’ estimates. The ability to rank individuals according to their consumption was, however, satisfactory for most foods. There seems to be a need to further develop and test food photographs used in different populations in Sub-Saharan Africa to improve the accuracy of portion size estimates.

To describe the burden, clinical characteristics and prognostic factors of severe malnutrition in children under the age of 5 years.

Retrospective study of hospital-based data systematically collected from January 2001 to December 2010.

Rural Mozambican district hospital.

All children aged <5 years admitted with severe malnutrition.

During the 10-year long study surveillance, 274 813 children belonging to Manhiça's Demographic Surveillance System were seen at out-patient clinics, almost half of whom (47 %) presented with some indication of malnutrition and 6 % (17 188/274 813) with severe malnutrition. Of these, only 15 % (2522/17 188) were eventually admitted. Case fatality rate of severe malnutrition was 7 % (162/2274). Bacteraemia, hypoglycaemia, oral candidiasis, prostration, oedema, pallor and acute diarrhoea were independently associated with an increased risk of in-hospital mortality, while malaria parasitaemia and breast-feeding were independently associated with a lower risk of a poor outcome. Overall minimum community-based incidence rate was 15 cases per 1000 child-years at risk and children aged 12–23 months had the highest incidence.

Severe malnutrition among admitted children in this Mozambican setting was common but frequently went undetected, despite being associated with a high risk of death. Measures to improve its recognition by clinicians responsible for the first evaluation of patients at the out-patient level are urgently needed so as to improve their likelihood of survival. Together with this, the rapid management of complications such as hypoglycaemia and concomitant co-infections such as bacteraemia, acute diarrhoea, oral candidiasis and HIV/AIDS may contribute to reverse the intolerable toll that malnutrition poses in the health of children in rural African settings.

Mali is one of the poorest countries in Africa, with 72 % of its population surviving on less than $US 1·00 per day. Health and demographic indicators are bleak. With few exceptions, studies related to the health of women in Mali have largely been under-represented. In addition, in recent years a new type of malnutrition stemming from weight gain and obesity has been observed throughout Africa. The present study aimed to (i) describe geographic and health variations of women of reproductive age, (ii) describe geographic variations of household salt iodine levels and (iii) investigate potential factors associated with women's anthropometric status and use of adequately iodized salt among households in Mali.

Demographic and Health Survey data, multistage-stratified cluster sampling methodology.

Rural and urban areas of Mali.

Non-pregnant women (n 6015) between the ages of 19 and 44 years.

Nineteen per cent of the women were overweight or obese while 11 % were underweight. Seventy-eight per cent of the households utilized adequately iodized salt. Underweight women were more prevalent in southern Mali, while obesity was more frequent in the north-east and within the major urban areas. Households located within the southern parts of Mali were more likely to utilize adequately iodized salt. Education, age, modern contraceptive use, breast-feeding status at time of the survey and household wealth index were significantly associated with the women's BMI or households’ use of adequately iodized salt.

The combined use of statistical and geographic system analysis contributes to improve targeting of interventions among vulnerable populations.

To study the associations between intakes of iodine and water chemicals and the thyroid gland status of schoolchildren living in the coastal city of Port Sudan.

In our previous nationwide study on goitre, it was observed that the prevalence of goitre was high in Port Sudan city despite high urinary iodine excretion. A cross-sectional study including schoolchildren aged 6–12 years was designed. Measurements determined the prevalence of goitre, urinary iodine concentration and thiocyanate secretion in casual urine samples, serum levels of thyroxine, triiodothyronine, thyroid-stimulating hormone and thyroglobulin, as well as the levels of Cl–, F–, Ca2+, Mg2+ and total hardness of drinking water.

Schoolchildren (n 654) aged 6–12 years.

Port Sudan city is located at the western bank of the Red Sea. The city is surrounded by a mountainous area known as the Red Sea Hills. It is the main sea port in the Sudan, inhabited by ethnically and socio-economically heterogeneous populations.

The prevalence of goitre in Port Sudan was 34·86 % while the median urinary iodine concentration was 46·4 μg/dl. Out of thirty-one pupils from Port Sudan, twenty-four (77·42 %) were found to have urinary iodine concentration greater than 30 μg/dl and twelve (38·71 %) had different degrees of biochemical hypothyroidism. Excessive concentrations of Cl–, Ca2+, Mg2+ and water hardness (369·2, 116·48, 60·21 and 539·0 mg/l, respectively) were detected in drinking water samples collected from Port Sudan that exceeded levels permitted by the WHO.

The coastal city of Port Sudan is a goitre-endemic area. In contrast to other Sudanese cities in which endemic goitre is related to iodine deficiency, goitre in Port Sudan is associated with iodine excess. Water chemicals seemed to have no effects on thyroid status.

To examine the effects of three different school snacks on morbidity outcomes.

Twelve schools were randomized to either one of three feeding groups or a Control group. There were three schools per group in this cluster randomized trial. Children in feeding group schools received school snacks of a local plant-based dish, githeri, with meat, milk or extra oil added. The oil used was later found to be fortified with retinol. Physical status, food intake and morbidity outcomes were assessed longitudinally over two years.

Rural Embu District, Kenya, an area with high prevalence of vitamin A deficiency.

Standard 1 schoolchildren (n 902; analytic sample) enrolled in two cohorts from the same schools one year apart.

The Meat and Plain Githeri (i.e. githeri + oil) groups showed the greatest declines in the probability of a morbidity outcome (PMO) for total and severe illnesses, malaria, poor appetite, reduced activity, fever and chills. The Meat group showed significantly greater declines in PMO for gastroenteritis (mainly diarrhoea) and typhoid compared with the Control group, for jaundice compared with the Plain Githeri group, and for skin infection compared with the Milk group. The Milk group showed the greatest decline in PMO for upper respiratory infection. For nearly all morbidity outcomes the Control group had the highest PMO and the least decline over time.

The intervention study showed beneficial effects of both animal-source foods and of vitamin A-fortified oil on morbidity status.

Simulating the probable impact of grain amaranth and highly absorbable, low-Fe micronutrient powder (MNP) on Fe status in a potential target population is an essential step in choosing and developing an appropriate actual intervention.

We simulated the potential effect of fortifying maize porridge with grain amaranth or MNP on the prevalence of inadequate Fe intake and Fe deficiency using data from two cross-sectional surveys. In the first survey (2008), dietary intake data were collected by two 24 h recalls (n 197). Biochemical data (n 70) were collected in the second survey (2010). A simulation with daily consumption for 80 d of non-fortified maize porridge (60 g of maize flour), amaranth-enriched porridge (80 g of grain amaranth–maize flour, 70:30 ratio) or maize porridge fortified with MNP (2·5 mg Fe as NaFeEDTA) was done.

Mwingi District, Kenya.

Pre-school children aged 12–23 months.

Prevalence of anaemia, Fe deficiency and Fe-deficiency anaemia was 49 %, 46 % and 24 %, respectively. Consumption of non-fortified, amaranth-enriched and MNP-fortified maize porridge was estimated to provide a median daily Fe intake of 8·6 mg, 17·5 mg and 11·1 mg, respectively. The prevalence of inadequate Fe intake was reduced to 35 % in the amaranth-enriched porridge group and 45 % in the MNP-fortified porridge group, while ferritin concentration was increased in both (by 1·82 (95 % CI 1·42, 2·34) μg/l and 1·80 (95 % CI 1·40, 2·31) μg/l, respectively; P < 0·005) compared with the non-fortified maize porridge group, resulting in a decreased prevalence of Fe deficiency (27 %) in the two fortification groups.

Addition of grain amaranth or low-Fe MNP to maize-based porridge has potential to improve Fe intake and status in pre-school children.

To investigate the nutritional impact of a community-based programme that focused on social cohesion and action.

The change in nutritional status of children aged 12–60 months was examined over a period of 3 years in Makueni District in Eastern Province of Kenya in six communities in which an intervention programme of Participatory Learning and Action was introduced and in ten communities in which only basic preparations were made but no intervention was started.

The intervention was part of the Government of Kenya Community Based Nutrition Programme and was supported by the Government of Denmark.

Children aged 12–60 months.

Among communities without intervention there were similar levels of underweight (mean Z-score: −1·63 v. −1·50 (NS); % with Z-score < –2: 36·6 % v. 34·5 % (NS)) and stunting (mean Z-score: −2·0 v. −1·99 (NS); % with Z-score < –2: 44·3 % and 47·4 % (NS)) at baseline and after 3 years. By contrast, among communities who had received interventions, there were significant improvements after 3 years in the levels of underweight (mean Z-score: −1·66 v. −1·37 (P < 0·02); % with Z-score < –2: 42·9 % v. 31·4 % (P < 0·035)) and stunting (mean Z-score: −2·05 v. −1·59 (P < 0·05); % with Z-score < –2: 52·7 % v. 39·7 % (P < 0·02)).

The results indicate considerable potential for using Participatory Learning and Action as a community-based approach to effectively address child undernutrition. It is suggested that these interventions are developed, implemented and evaluated more widely as a mean of tackling childhood undernutrition and improving child survival and development.

The objective of the present study was to evaluate the effect of settlement on the nutrition and health status of pastoral women of reproductive age.

A cross-sectional survey that included a 24 h dietary recall was administered to 224 randomly selected Gabra women. Height and weight were used to compute BMI. Whole capillary blood was used to measure Hb. Additional capillary blood was collected on filter paper and dried blood spots were analysed for transferritin receptor, C-reactive protein and α1-acid glycoprotein. Descriptive statistics were used to analyse population characteristics. The t test and the χ2 test were used to determine population differences. Multiple criteria models were used to determine the prevalence of Fe deficiency, anaemia and inflammation.

Settled and semi-settled women in Kalacha Location in Marsabit County, Kenya.

Non-pregnant women aged 15–49 years.

Fe repletion was observed in 43 % of settled and 40 % of semi-settled women. Fe-deficiency erythropoiesis in was found in 18 % of settled and 20 % of semi-settled women, whereas 15 % of settled compared with 25 % of semi-settled women were suffering from Fe-deficiency anaemia. Anaemia due to chronic diseases was more prevalent in semi-settled women than in settled women, and more common than Fe-deficiency anaemia.

Settled women were significantly less anaemic than semi-settled women, but had similarly high levels of chronic energy deficiency. While anaemia and Fe deficiency were more pronounced in semi-settled than settled women, anaemia of chronic disease and chronic infection were highly prevalent in both communities. Policies should be put in place to improve overall nutrition among pastoral women.

To examine household food insecurity and coping mechanisms in two relatively politically stable states of South Sudan.

Cross-sectional assessment including structured interviews and focus group discussions with food aid programme beneficiaries and staff. Structured interview findings were analysed with descriptive statistics using the statistical software package STATA version 11.

Rural households in four payams (sub-county administrative districts) benefiting from a multi-year assistance programme funded by the US Agency for International Development. The study was conducted in January 2012, six months after independence.

Study subjects included eighty mothers of children aged 6–23 months in structured interviews and eight focus groups, each with six to ten participants, of mothers of children aged 6–23 months.

Ninety-three per cent of households surveyed in Warrap and 100 % of households in Northern Bahr el Ghazal states were severely food access insecure. Nearly all households (97·5 %) surveyed in both states reported there were months in 2011 without enough food to eat. The majority of households (88 %) reported sometimes or often going to bed hungry in the month preceding the study. A number of coping mechanisms were used when households did not have enough food, including reduced meal size, skipping meals, selling assets and engaging in some kind business in order to generate money to buy food.

Given the highly volatile political, economic and humanitarian situation in South Sudan, the priorities of the international community are understandably focused on securing greater stability in South Sudan and preventing humanitarian needs from escalating significantly. There is a need, however, for simultaneous emphasis on food assistance and longer-term development strategies throughout South Sudan, particularly in areas of agriculture, livelihoods and food security.

The present study was done to confirm the relationship between changes in food patterns and nutrition transition in three South-East Asian countries, namely the Philippines, Malaysia and Indonesia.

This was a cross-sectional study conducted between August 2008 and August 2009 using three methods: interviews, focus group discussions and analyses of government reports.

The study was conducted in rural and urban areas in Manila and Calabanga (Philippines), Selangor and Kuala Selangor (Malaysia), and Padang, Pariaman Tanah Datar and Limapuluh Kota (West Sumatra, Indonesia).

Adults aged 18 to 77 years.

The results showed that Filipinos, Malaysians and Indonesians have retained many aspects of their traditional diets. In fact, most participants in the study considered Western-style and franchise fast foods as snack or recreational foods to be consumed once in a while only. However, a significant difference was noted between urban and rural areas in food varieties consumed. Participants in urban areas consumed more varieties of traditional foods owing to their availability and the participants’ food purchasing power. Although traditional food patterns were maintained by most of the participants, more sugar and vegetable oils were consumed and added to the traditional recipes.

The rapid nutrition transition in this region may be due, instead, to increasing food availability and food purchasing power, rather than to a shift in food preferences towards modern Western foods.

To assess whether nutritional deficiency increases susceptibility to arsenic-related health effects.

Assessment of nutrition was based on a 24 h recall method of all dietary constituents.

Epidemiological cross-sectional study was conducted in an arsenic-endemic area of West Bengal with groundwater arsenic contamination.

The study was composed of two groups – Group 1 (cases, n 108) exhibiting skin lesions and Group 2 (exposed controls, n 100) not exhibiting skin lesions – age- and sex-matched and having similar arsenic exposure through drinking water and arsenic levels in urine and hair.

Both groups belonged to low socio-economic strata (Group 1 significantly poorer, P < 0·01) and had low BMI (prevalence of BMI < 18·5 kg/m2: in 38 % in Group 1 and 27 % in Group 2). Energy intake was below the Recommended Daily Allowance (set by the Indian Council of Medical Research) in males and females in both groups. Increased risk of arsenical skin lesions was found for those in the lowest quintile of protein intake (v. highest quintile: OR = 4·60, 95 % CI 1·36, 15·50 in males; OR = 5·62, 95 % CI 1·19, 34·57 in females). Significantly lower intakes of energy, protein, thiamin, niacin, Mg, Zn and choline were observed in both males and females of Group 1 compared with Group 2. Significantly lower intakes of carbohydrate, riboflavin, niacin and Cu were also observed in female cases with skin lesions compared with non-cases.

Deficiencies of Zn, Mg and Cu, in addition to protein, B vitamins and choline, are found to be associated with arsenical skin lesions in West Bengal.

We aimed to test the fetal overnutrition hypothesis by comparing the associations of maternal and paternal adiposity (sum of skinfolds) with adiposity and cardiovascular risk factors in children.

Children from a prospective birth cohort had anthropometry, fat percentage (bio-impedance), plasma glucose, insulin and lipid concentrations and blood pressure measured at 9·5 years of age. Detailed anthropometric measurements were recorded for mothers (at 30 ± 2 weeks’ gestation) and fathers (5 years following the index pregnancy).

Holdsworth Memorial Hospital, Mysore, India.

Children (n 504), born to mothers with normal glucose tolerance during pregnancy.

Twenty-eight per cent of mothers and 38 % of fathers were overweight/obese (BMI ≥ 25·0 kg/m2), but only 4 % of the children were overweight/obese (WHO age- and sex-specific BMI ≥ 18·2 kg/m2). The children's adiposity (BMI, sum of skinfolds, fat percentage and waist circumference), fasting insulin concentration and insulin resistance increased with increasing maternal and paternal sum of skinfolds adjusted for the child's sex, age and socio-economic status. Maternal and paternal effects were similar. The associations with fasting insulin and insulin resistance were attenuated after adjusting for the child's current adiposity.

In this population, both maternal and paternal adiposity equally predict adiposity and insulin resistance in the children. This suggests that shared family environment and lifestyle, or genetic/epigenetic factors, influence child adiposity. Our findings do not support the hypothesis that there is an intra-uterine overnutrition effect of maternal adiposity in non-diabetic pregnancies, although we cannot rule out such an effect in cases of extreme maternal obesity, which is rare in our population.

To document the scale-up of India's Adolescent Girls’ Anaemia Control Programme following a knowledge-centred framework for scaling up nutrition interventions and to identify the critical elements of and lessons learned from a decade of programme experience for the control of anaemia in adolescent girls.

We reviewed all articles, programme and project reports, and baseline and endline assessments published between 1995 and 2012 regarding the control of anaemia through intermittent iron and folic acid supplementation; key programme specialists and managers were interviewed to complete or verify information wherever needed.

India.

Adolescent girls.

The scale-up of India's Adolescent Girls’ Anaemia Control Programme followed a knowledge-centred programme cycle comprising five phases: Evidence, Innovation, Evaluation, Replication and Universalization. By the end of 2011, the programme was being rolled out in thirteen states and was reaching 27·6 million adolescent girls of whom 16·3 million were school-going girls and 11·3 million were out-of-school girls. Building on the critical elements of and lessons learned from the programme, the Government of India launched in 2012 the national Weekly Iron and Folic Acid Supplementation (WIFS) programme to universalize the benefits of anaemia control to the overall population of Indian adolescents.

The Adolescent Girls’ Anaemia Control Programme in India provides a good example of how a knowledge-centred approach can successfully guide the scaling up of public health nutrition interventions and facilitate intersectoral convergence among different government departments and development partners to break the inter-generational cycle of undernutrition and deprivation.

Dietary Fe deficiency has a high incidence in Pakistani children and may be associated with increased gastrointestinal absorption of trace metals such as Mn. Therefore, children residing in heavily polluted cities like Karachi may be prone to Mn toxicity. The present study investigated blood Mn concentrations in Karachi children of different Fe statuses.

A prospective observational study was conducted where children were classified into different categories of Fe status – normal Fe, borderline Fe deficiency, Fe deficiency and Fe-deficiency anaemia – using WHO criteria supported by measurements of soluble transferrin receptors. Blood Mn was determined for children in each category using graphite atomic absorption spectroscopy.

Three hospital outpatient departments in Karachi, Pakistan.

A total of 269 children (156 males, 113 females) aged 6–60 months from low-income families of Karachi.

Blood Mn concentrations were significantly higher in children with Fe-deficiency anaemia and Fe deficiency compared with those of normal Fe status (both P < 0·01). Blood concentrations of soluble transferrin receptors were higher in children with Fe-deficiency anaemia compared with those of borderline or normal Fe status (both P < 0·05).

These findings report for the first time high blood Mn concentrations in Fe-deficient children of this age group. There is therefore an urgent need to identify and remove environmental exposure to Mn in combination with health strategies aimed at eradicating childhood Fe deficiency.

To evaluate patterns of physical activity (PA), the prevalence of physical inactivity and the relationships between PA and sociodemographic, clinical and biochemical parameters among Sri Lankan adults.

Descriptive cross-sectional study.

Nationally representative population-based survey conducted in Sri Lanka.

Data on PA and associated details were obtained from 5000 adults. PA was assessed using the International Physical Activity Questionnaire (short-form). A binary logistic regression analysis was performed using the dichotomous variable ‘health-enhancing PA’ (0 = ‘active’, 1 = ‘inactive’).

Sample size was 4485. Mean age was 46·1 (sd 15·1) years, 39·5 % were males. The mean weekly total MET (metabolic equivalents of task) minutes of PA among the study population was 4703 (sd 4369). Males (5464 (sd 5452)) had a significantly higher weekly total MET minutes than females (4205 (sd 3394); P < 0·001). Rural adults (5175 (sd 4583)) were significantly more active than urban adults (2956 (sd 2847); P < 0·001). Tamils had the highest mean weekly total MET minutes among ethnicities. Those with tertiary education had lowest mean weekly total MET minutes. In all adults 60·0 % were in the ‘highly active’ category, while only 11·0 % were ‘inactive’ (males 14·6 %, females 8·7 %; P < 0·001). Of the ‘highly active’ adults, 85·8 % were residing in rural areas. Results of the binary logistic regression analysis indicated that female gender (OR = 2·1), age >70 years (OR = 3·8), urban living (OR = 2·5), Muslim ethnicity (OR = 2·7), tertiary education (OR = 3·6), obesity (OR = 1·8), diabetes (OR = 1·6), hypertension (OR = 1·2) and metabolic syndrome (OR = 1·3) were all associated with significantly increased odds of being physically ‘inactive’.

The majority of Sri Lankan adults were ‘highly active’ physically. Female gender, older age, urban living, Muslim ethnicity and tertiary education were all significant predictors of physical inactivity. Physical inactivity was associated with obesity, diabetes, hypertension and metabolic syndrome.