Socioeconomic status in relation to obesity and abdominal obesity in Korean adults: a focus on sex differences

Trade and investment liberalization and Asia's noncommunicable disease epidemic: a synthesis of data and existing literature

BACKGROUND

Trade and investment liberalization (trade liberalization) can promote or harm health. Undoubtedly it has contributed, although unevenly, to Asia's social and economic development over recent decades with resultant gains in life expectancy and living standards. In the absence of public health protections, however, it is also a significant upstream driver of non-communicable diseases (NCDs) including cardiovascular disease, cancer and diabetes through facilitating increased consumption of the 'risk commodities' tobacco, alcohol and ultra-processed foods, and by constraining access to NCD medicines. In this paper we describe the NCD burden in Asian countries, trends in risk commodity consumption and the processes by which trade liberalization has occurred in the region and contributed to these trends. We further establish pressing questions for future research on strengthening regulatory capacity to address trade liberalization impacts on risk commodity consumption and health.

METHODS

A semi-structured search of scholarly databases, institutional websites and internet sources for academic and grey literature. Data for descriptive statistics were sourced from Euromonitor International, the World Bank, the World Health Organization, and the World Trade Organization.

RESULTS

Consumption of tobacco, alcohol and ultra-processed foods was prevalent in the region and increasing in many countries. We find that trade liberalization can facilitate increased trade in goods, services and investments in ways that can promote risk commodity consumption, as well as constrain the available resources and capacities of governments to enact policies and programmes to mitigate such consumption. Intellectual property provisions of trade agreements may also constrain access to NCD medicines. Successive layers of the evolving global and regional trade regimes including structural adjustment, multilateral trade agreements, and preferential trade agreements have enabled transnational corporations that manufacture, market and distribute risk commodities to increasingly penetrate and promote consumption in Asian markets.

CONCLUSIONS

Trade liberalization is a significant driver of the NCD epidemic in Asia. Increased participation in trade agreements requires countries to strengthen regulatory capacity to ensure adequate protections for public health. How best to achieve this through multilateral, regional and unilateral actions is a pressing question for ongoing research.

Influences of socioeconomic factors on childhood and adolescent overweight by gender in Korea: cross-sectional analysis of nationally representative sample

Background

Childhood and adolescent overweight is a recognized public health concern as the prevalence is already high and continues to increase. The purpose of this study was to examine the relationship between socioeconomic status (SES) and overweight status by gender among Korean children and adolescents.

Methods

The data used in this study were taken from the 2009 Korean Survey on the Obesity of Youth and Children. Underweight individuals (n = 1,010) and children and adolescents whose age, height, or weight information was missing (n = 591) were excluded from the data set, resulting in a total of 8,555 subjects who were included in this analysis. Subjective SES, parental education level, parental occupational status, and family structure were used to measure parental SES. Chi-squared tests were used for univariable analysis and multiple logistic regression analysis was conducted for multivariable analysis.

Results

After adjusting for subject’s characteristics including gender, age, parental interest in weight management of children, parental body shape, economic status variables that significantly influenced childhood overweight were identified. Low economic status increased the probability of childhood overweight (odds ratio, 1.3; 95% confidence interval, 1.1-1.5).

Conclusions

There is an inverse association between parental SES variables and the overweight status of children and adolescents. Additionally, parental body shape is an important factor that influences childhood and adolescent overweight.

Association between socioeconomic status and obesity in adults: evidence from the 2001 to 2009 Korea national health and nutrition examination survey

Objectives

The present study examined relationships between socioeconomic status (SES) and obesity and body mass index (BMI) as well as the effects of health-related behavioral and psychological factors on the relationships.

Methods

A cross-sectional population-based study was conducted on Korean adults aged 20 to 79 years using data from the 2001, 2005, and 2007 to 2009 Korea National Health and Nutrition Examination Survey. Multivariate logistic and linear regression models were used to estimate odds ratios of obesity and mean differences in BMI, respectively, across SES levels after controlling for health-related behavioral and psychological factors.

Results

We observed significant gender-specific relationships of SES with obesity and BMI after adjusting for all covariates. In men, income, but not education, showed a slightly positive association with BMI (p<0.05 in 2001 and 2005). In women, education, but not income, was inversely associated with both obesity and BMI (p<0.0001 in all datasets). These relationships were attenuated with adjusting for health-related behavioral factors, not for psychological factors.

Conclusions

Results confirmed gender-specific disparities in the associations of SES with obesity and BMI among adult Korean population. Focusing on intervention for health-related behaviors may be effective to reduce social inequalities in obesity.

Associations of subjective social status with physical activity and body mass index across four Asian countries

OBJECTIVE

The aims of this study were to (1) assess physical activity and weight status differences and (2) explore the direction and shape of subjective social status (SSS) association with physical activity and weight status within four Asian countries.

METHODS

Cross section data of adult respondents from the nationally representative East Asian Social Survey were used for analyses. Logistic regression stratified by gender was conducted for the first aim, and simple and quadratic logistic regression models were used for the second.

RESULTS

SSS was significantly associated with odds of weekly or daily physical activity across all countries and genders, except for South Korean and Japanese females. Quadratic models provided significantly better fit for Chinese males (LR (d.f. = 1) = 6.51, P value <.05) and females (LR (d.f. = 1) = 7.36, P value <.01), South Korean males (LR (d.f. = 1) = 4.40, P value <.05), and Taiwanese females (LR (d.f. = 1) = 4.87, P value <.05).

CONCLUSIONS

This study provides a comparable cross Asian country measure of moderate-to-vigorous physical activity and new findings that a connection exists between SSS and physical activity. Differences of class distinction help explain the different shaped SSS relationships.

Educational attainment and obesity: a systematic review

Although previous systematic reviews considered the relationship between socioeconomic status and obesity, almost 200 peer-reviewed articles have been published since the last review on that topic, and this paper focuses specifically on education, which has different implications. The authors systematically review the peer-reviewed literature from around the world considering the association between educational attainment and obesity. Databases from public health and medicine, education, psychology, economics, and other social sciences were searched, and articles published in English, French, Portuguese and Spanish were included. This paper includes 289 articles that report on 410 populations in 91 countries. The relationship between educational attainment and obesity was modified by both gender and the country's economic development level: an inverse association was more common in studies of higher-income countries and a positive association was more common in lower-income countries, with stronger social patterning among women. Relatively few studies reported on lower-income countries, controlled for a comprehensive set of potential confounding variables and/or attempted to assess causality through the use of quasi-experimental designs. Future research should address these gaps to understand if the relationship between educational attainment and obesity may be causal, thus supporting education policy as a tool for obesity prevention.

Socioeconomic status, financial hardship and measured obesity in older adults: a cross-sectional study of the EPIC-Norfolk cohort

Background

Socioeconomic status is strongly associated with obesity. Current economic circumstances are also independently associated with self-reported weight status in Finnish civil servants. We aimed to examine three types of financial hardship in relation to measured general and central obesity in a general population of older adults, while considering conventional socioeconomic indicators.

Methods

Data from 10,137 participants (≥50 years) in the EPIC-Norfolk cohort who responded to a postal Health and Life Experiences Questionnaire (1996–2000) and attended a clinical assessment (1998–2002). Multivariable logistic regression models assessed likelihood of general obesity (BMI ≥30 kg/m²) and central obesity (women: ≥88 cm; men: ≥102 cm) calculated from measured anthropometrics.

Results

Obesity prevalence was consistently patterned by standard socioeconomic indicators, with over-50s in the lowest social class being twice as likely to be obese than those in the highest class (women OR 2.10 [CI95: 1.41—3.13]; men OR 2.36 [1.44—3.87]). After adjustment for socioeconomic status, reporting having less than enough money for one’s needs (compared to more than enough) was associated with obesity in women (OR 2.04 [1.54—2.69]) and men (OR 1.83 [1.34—2.49]). Similar associations were demonstrated between obesity and always or often not having enough money for food/clothing (women OR 1.40 [1.03—1.90]; men OR 1.81 [1.28—2.56]), compared to reporting this never occurred. The strongest independent associations were seen for obesity and reported greatest level of difficulty paying bills (women OR 2.20 [1.37—3.55]; men 2.40 [1.38—4.17]), compared to having no difficulties. Findings for central obesity were slightly higher in women and lower in men.

Conclusions

Obesity in British over-50s was more likely in study participants who reported greater financial hardship, even after education, social class and home ownership were taken into account. Public health policies need to consider the hitherto neglected role of financial hardship in older people, especially difficulty paying bills, as part of strategies to prevent or reduce obesity.

Socioeconomic status and dyslipidemia in Korean adults: the 2008-2010 Korea National Health and Nutrition Examination Survey

OBJECTIVE

This study investigated the relationship between socioeconomic status (SES) and dyslipidemia and various parameters of dyslipidemia among Korean adults.

METHODS

Data from the 2008-2010 Korea National Health and Nutrition Examination Survey were used in this study. A total of 19,041 Korean adults greater than 19years old participated in the study. The SES was assessed by monthly household income and education level. The relationship of SES to the risk of dyslipidemia was assessed with multivariate logistic regression analysis after adjusting for potential confounders.

RESULTS

The prevalence of dyslipidemia was 37.4% among Korean adults. In men, household income level was positively associated with prevalence and risks of several parameters of dyslipidemia, and education level had positive associations with the risks of dyslipidemia and parameters of dyslipidemia. However, low SES was linked to increased prevalence and risks of dyslipidemia (P for trend<0.05) and parameters of dyslipidemia in women.

CONCLUSIONS

Socioeconomic disparities in dyslipidemia were found in the Korean population. Also, there were gender differences in the relationship between SES and dyslipidemia. These disparities should be considered when performing risk calculations and screening for dyslipidemia, which will ultimately help prevent cardiovascular disease.

Prevalence of the Metabolic Syndrome among Korean Workers by Occupational Group: Fifth Korean National Health and Nutrition Examination Survey (KNHANES) 2010

OBJECTIVES

The prevalence of the metabolic syndrome has increased rapidly in South Korea over the past 10 years. However, the occurrence of the metabolic syndrome in workers grouped according to the specific type of work is not well understood in Korea. In this study, we assessed the differences in the prevalence of the metabolic syndrome by occupational group and evaluated the risk of the metabolic syndrome among occupational groups.

METHODS

From the Fifth Korean National Health and Nutrition Examination Survey (2010), 3,303 employed participants were included in this study. The unadjusted and age-adjusted prevalences of the metabolic syndrome were estimated and multiple logistic regression analysis was conducted using the presence of the metabolic syndrome as a dependent variable, and adjusting for age, education level, household income, drinking behavior, smoking status, physical activity, work hours, and work scheduling pattern.

RESULTS

Among male workers, non-manual workers had the greatest age-adjusted prevalence (26.4%, 95% CI: 22.3-30.5%) among the occupational groups. In a logistic regression analysis, male manual workers had a significantly lower odds ratio for the metabolic syndrome relative to non-manual workers (0.59, 95% CI: 0.41-0.85).

CONCLUSION

Our study demonstrated differences in the prevalence of the metabolic syndrome by occupational group and identified the greatest risk for the metabolic syndrome in male non-manual workers.

Obesity explains gender differences in the association between education level and metabolic syndrome in South Korea: the results from the Korean National Health and Nutrition Examination Survey 2010

This study aimed to examine the association of educational level with metabolic syndrome (MS) and its risk factors by gender in South Korea. A total of 6178 participants aged 20 years or older from The Fifth Korean National Health and Nutrition Examination Survey were included in this study. A generalized linear model and adjusted proportion were used to identify educational disparities in MS, its components, and its risk factors (smoking, high-risk alcohol consumption, obesity, and stress). In women, a clearly inverse association between education level and MS were observed with significant trend, and the decreasing trends of all risk factors across education quartiles were in line with the inverse association. However, the association between education level and MS was not observed with a significant trend among men. An opposite trend of risk factors across education levels was shown in men, with an increasing trend for obesity and decreasing trends for smoking and high-risk alcohol consumption. These findings demonstrate that obesity can explain gender differences in the association between education level and MS in South Korea.

Independent and supra-additive effects of alcohol consumption, cigarette smoking, and metabolic syndrome on the elevation of serum liver enzyme levels

We investigated the independent and combined effects of alcohol consumption, cigarette smoking and metabolic syndrome on abnormal liver function, i.e., the elevation of serum liver enzyme levels. Participants of a Korean population-based prospective cohort aged ≥30 years without liver disease, diabetes, or cardiovascular diseases were included. Information on alcohol consumption, smoking status, and metabolic syndrome, defined as per the criteria of the Adult Treatment Panel III, were applied to evaluate their impact on serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT). Alcohol consumption, cigarette smoking and metabolic syndrome were the significant individual factors that elevated serum liver enzyme levels. Supra-additive effects of metabolic syndrome and either alcohol consumption or cigarette smoking were also identified. The combination of heavy drinking (≥24 g/day) and metabolic syndrome conferred an effect that was higher than the sum of the two individual effects (Synergic Index (SI): AST, 2.37 [1.20-4.67]; GGT, 1.91 [1.17-3.13]). Only GGT level (odds ratio 6.04 [3.68-9.94], SI 2.33 [1.24-4.41]) was significantly elevated when the effect of moderate drinking (<24 g/day) and metabolic syndrome was combined. The combined effect of any level of alcohol consumption and cigarette smoking was also supra-additive on the elevation of GGT level with SIs of 5.57 for drinking <24 g/day and smoking ≤20 pack years, 5.12 for <24 g/day and >20 pack years, 1.80 for ≥24 g/day and ≤20 pack years, 2.03 for ≥24 g/day and >20 pack years, while only the combined effect of drinking ≥24 g/day and smoking >20 pack years elevated the AST level (SI 4.55 [3.12-6.61]). The combined effect of cigarette smoking and metabolic syndrome was not supra-additive. To prevent fatty liver disease and other related diseases, a multifactorial prevention strategy that includes limited alcohol consumption, smoking cessation and rectification of adverse metabolic profiles is required.

Gender and socioeconomic status in relation to weight perception and weight control behavior in Korean adults

AIM

In Korea, obesity is more prevalent among men and lower socioeconomic groups. To explain this obesity disparity, we compared weight perception and weight control behavior across gender and socioeconomic status (SES).

METHODS

We analyzed data from 16,260 participants aged 20 years or older in a nationally representative cross-sectional survey. SES indicators included education and income levels. Weight under-perception was defined when participants considered themselves lighter than their measured BMI status. Either no active or inappropriate weight control (i.e., trying to gain weight in obese individuals) was considered to be unhealthy patterns. Multivariate prevalence ratios were calculated using log-binomial regressions.

RESULTS

Men had a higher prevalence of weight under-perception (24.5 vs. 11.9%) and unhealthy patterns of weight control behavior (57 vs. 40%) than women. Low education level was associated with weight under-perception (ptrend = 0.022 in men, ptrend < 0.001 in women). Both education and income levels were significantly associated with patterns of weight control behavior (for education: ptrend < 0.001 in men and women; for income: ptrend = 0.047 in men, ptrend < 0.001 in women).

CONCLUSION

Weight perception and weight control behavior significantly varied by gender and SES. Public actions should be directed toward improving perception and behavior of high-risk populations.

Socioeconomic status and obesity in Abia State, South East Nigeria

BACKGROUND AND OBJECTIVES

Obesity is a major risk factor for cardiovascular disease in developed and emerging economies. There is a paucity of data from Nigeria on the association between socioeconomic status and obesity. The aim of this study is to highlight that association in Abia State, South East Nigeria.

MATERIAL AND METHODS

This was a cross-sectional survey in South East Nigeria. Participating subjects were recruited from the three senatorial zones of Abia state. A total of 2,487 adults took part in the study. The subjects were classified based on their monthly income and level of educational attainment (determinants of obesity). Monthly income was classified into three groups: low, middle, and upper income, while educational level was classified into four groups: no formal education, primary, secondary, and tertiary education. Body mass index of subjects was determined and used for defining obesity. Data on blood pressure and other anthropometric measurements were also collected using a questionnaire, modified from the World Health Organization STEPwise Approach to Chronic Disease Risk Factor Surveillance.

RESULTS

Overall, the prevalence of obesity in low, middle, and upper income groups was 12.2%, 16%, and 20%, respectively. The overall prevalence of obesity in individuals with no formal education, primary, secondary, and tertiary education was 6.3%, 14.9%, 10.5%, and 17.7%, respectively. Educational status was found to be significantly associated with obesity in women, but not in men, or in the combined group. However, level of income was observed to be significantly associated with obesity in men, women, and in the combined group.

CONCLUSION

Sociodemographic and socioeconomic factors are important determinants of obesity in our study population, and therefore may be indirectly linked to the prevalence and the outcomes of cardiovascular disease in Nigeria.

Education and obesity at age 40 among American adults

Although many have studied the association between educational attainment and obesity, studies to date have not fully examined prior common causes and possible interactions by race/ethnicity or gender. It is also not clear if the relationship between actual educational attainment and obesity is independent of the role of aspired educational attainment or expected educational attainment. The authors use generalized linear log link models to examine the association between educational attainment at age 25 and obesity (BMI≥30) at age 40 in the USA's National Longitudinal Survey of Youth 1979 cohort, adjusting for demographics, confounders, and mediators. Race/ethnicity but not gender interacted with educational attainment. In a complete case analysis, after adjusting for socioeconomic covariates from childhood, adolescence, and adulthood, among whites only, college graduates were less likely than high school graduates to be obese (RR = 0.69, 95%CI: 0.57, 0.83). The risk ratio remained similar in two sensitivity analyses when the authors adjusted for educational aspirations and educational expectations and analyzed a multiply imputed dataset to address missingness. This more nuanced understanding of the role of education after controlling for a thorough set of confounders and mediators helps advance the study of social determinants of health and risk factors for obesity.

H, Ruma D. The waist circumference measurement: a simple method for assessing the abdominal obesity

INTRODUCTION

Excess abdominal fat is an independent predictor of the risk factors and the morbidity of obesity related diseases such as type 2 diabetes, hypertension, dyslipidaemia and cardiovascular diseases. The Waist Circumference (WC) is positively correlated with the abdominal fat. Hence, the waist circumference is a valuable, convenient and a simple measurement method which can be used for identifying the individuals who are at an increased risk for the above mentioned diseases.

OBJECTIVES

To assess the abdominal obesity by measuring the waist circumference among the women who were aged 20 years and above in an urban slum of Chennai, India.To identify the socio -demographic factors which were associated with the abdominal obesity in the above study population.

SETTINGS AND DESIGN

A community based and a cross sectional study was carried out in an urban slum of Chennai, India.

METHODS AND MATERIALS

The present study was undertaken in an urban slum of Chennai city, among the women who were aged 20 years and above. One slum was selected randomly and the households in the slum were sampled by a systematic random sampling method. A pre-designed and a pre-tested questionnaire was used to collect the information regarding the socio-demographic profile of the women. Their waist circumference was measured by using a flexible inch tape. As per the World Health Organization (WHO), the International Obesity Task Force (IOTF) and the International Association for the Study of Obesity (IASO)(2000), the following cut off values for the waist circumference were used to assess the abdominal obesity for women: WC<80cms - normal and WC ≥ 80cms-abdominal obesity.

STATISTICAL ANALYSIS

It was done by using the Statistical Package For Social Science (SPSS ), version 11.5. The prevalence was expressed in percentage and the Chi square test was used to find its association with the factors.

RESULTS

In the study population, the prevalence of abdominal obesity (WC ≥ 80 cms) was 29.8% (95% Confidence Interval [CI] 25.9-34 %). A significant association was found between the age, religion, a higher socio-economic status and the abdominal obesity. No significant association was noted between the educational status, occupation, marital status, type of family and the abdominal obesity.

CONCLUSION

Abdominal obesity among the urban slum women is on the rise. The abdominal obesity was found to be significantly higher among the slum women with increasing age and in those who belonged to the muslim religion and to a higher socio-economic status.

Sex differences in the relationship between socioeconomic status and metabolic syndrome: the Korean National Health and Nutrition Examination Survey

AIMS

To investigate sex differences in the relationship between socioeconomic status (SES) and the prevalence of metabolic syndrome (MetS) in Korean adults.

METHODS

We examined the relationship between SES, as measured by household income or education level, and the prevalence of MetS in Korean adults who participated in the 2007-2008 Korean National Health Examination and Nutrition Survey (KNHANES). The adjusted odds ratios (ORs) for MetS were calculated using multivariate logistic regression analysis across household income and education level quartiles.

RESULTS

We found significant differences between men and women in the association between SES and MetS, with a positive association for men and an inverse association for women. The adjusted OR and 95% confidence interval (95% CI) for MetS for the highest vs. lowest quartile of household income was 1.59 (1.15-2.20) in men. The adjusted ORs for MetS for the highest vs. lowest quartile of household income and education level were 0.54 (0.41-0.72) and 0.26 (0.17-0.38) in women, respectively.

CONCLUSIONS

We found sex differences in the relationship between SES and the prevalence of MetS in Korea. These findings suggest that sex-specific public health interventions that consider SES are needed for the prevention and treatment of MetS.

Fruit and Vegetable Consumption and Body Mass Index

Background: Empirical evidence on the relationship between consumption of fruits and vegetables and body weight is inconclusive. Previous studies mostly use linear regression methods to study the correlates of the conditional mean of body mass index (BMI). This approach may be less informative if the association between fruit and vegetable consumption and BMI significantly varies across the BMI distribution. Objective: The association between fruit and vegetable consumption and the BMI is examined using quantile regression. Methods: A nationally representative sample of 11,818 individuals from the Canadian Community Health Survey (2004) is used. A quantile regression model is estimated to account for the potential heterogeneous association between fruit and vegetable intake and BMI at different points of the conditional BMI distribution. The analyses are stratified by gender. Results: The multivariate analyses reveal that the association between fruit and vegetable intake and BMI is negative and statistically significant for both males and females; however, this association varies across the conditional quantiles of the BMI distribution. In particular, the estimates are larger for individuals at the higher quantiles of the distribution. The ordinary least squares (OLS) model overstates (understates) the association between FV intake and BMI at the lower (higher) half of the conditional BMI distribution. Conclusion: Findings of the standard models that assume uniform response across different quantiles of BMI distribution may be misleading. The findings of this paper suggest that increasing the intake of fruits and vegetables may be an effective dietary strategy to control weight and mitigate the risk of obesity.

The mediating effects of lifestyle factors on the relationship between socioeconomic status and self-rated health among middle-aged and older adults in Korea

Little is known about how different lifestyle factors mediate the relationship between socioeconomic status (SES) and health among middle-aged and older adults in Korea. Using data from the Korean Longitudinal Study of Aging, this study examined the direct effects of SES on self-rated health and how lifestyle factors mediate the relationships between SES and self-rated health. This study further tested whether the effects of SES and lifestyle factors differ as people age. The findings indicate that higher levels of income and education as well as not being in poverty predicted better self-rated health. Meanwhile, engaging in regular exercise and being underweight significantly mediated the relationship between education and self-rated health as well as between poverty and self-rated health. Finally, poverty and regular exercise had a greater impact on self-rated health in old age than in middle age. Implications for enhancing antipoverty policies and exercise programs are discussed.

Relationship between socioeconomic variables and obesity in Korean adolescents

BACKGROUND

Despite the importance of obesity and its association with socioeconomic status, little is known about this condition in Korean adolescents. We examined the relationship between obesity in Korean adolescents and several socioeconomic variables and compared the association of obesity with conventional and subjective indicators of socioeconomic status.

METHODS

The study comprised 60 643 Korean adolescents aged 12 to 18 years who participated in the 2007 Korea Youth Risk Behavior Web-Based Survey. The dependent variable, obesity, and the independent variables of parental education levels, family affluence scale, subjective family economic status, and subjective school achievement were collected by using a self-administered anonymous questionnaire. Data on behavioral and psychological characteristics were also collected and used as confounding factors. Multivariate logistic regression was conducted to identify associations between socioeconomic status and obesity.

RESULTS

In the descriptive analysis, adolescents with low parental education, low family affluence level, low subjective family economic status, and low subjective school achievement were more likely to be obese. However, after controlling for other risk factors in multivariate analysis, only the associations with subjective family economic status and subjective school achievement remained statistically significant.

CONCLUSIONS

Our results provide further evidence that the prevalent pattern of obesity in Korean adolescents-i.e., the inverse relationship between obesity and socioeconomic status-is similar to that in developed countries. In addition, these findings support the hypothesis that, as compared with objective socioeconomic status, subjective social status is more closely related to obesity.

Overweight, obesity, and metabolic syndrome in adults and children in South Korea: a review of the literature

Overweight, obesity, and metabolic syndrome are increasing in South Korea dramatically. This review of the literature summarizes published studies on the prevalence of overweight, obesity, and metabolic syndrome in South Korean adults and children; summarizes studies related to obesity management and prevention in South Korean adults and children; and identifies gaps in the literature for further research. A PubMed, CINAHL, and Google Scholar search identified articles published between January 1, 2000, and June 30, 2010, using the following key search terms: overweight, obesity, adult, children, adolescent, metabolic syndrome, prevention, and South Korea. Inclusion criteria included articles published in English or Korean, and primary or secondary research that measured the prevalence and characteristics of overweight and obesity or described a management or prevention program. Twelve articles met the inclusion criteria and were categorized into either adult or child studies. In adults, the prevalence of overweight and obesity has increased as South Korea has moved from an agricultural to a modern society. In children, there were associations between infant feeding patterns, familial relationships, and dietary and physical activity patterns. There were few programs to manage or prevent overweight. Further research is needed to develop effective strategies to prevent and manage overweight and obesity in adults and children, using family-based interventions that include multigenerational family members.

Determinants of body weight status in Malaysia: an ethnic comparison

OBJECTIVE

To investigate the roles of sociodemographic and health lifestyle factors in affecting body mass index (BMI) across ethnic groups in Malaysia.

METHODS

Data are obtained from 2,436 observations from the Malaysia Non-Communicable Disease Surveillance-1. The multi-ethnic sample is segmented into Malay, Chinese, and Indian/other ethnicities. Ordered probit analysis is conducted and marginal effects of sociodemographic and health lifestyle variables on BMI calculated.

RESULTS

Malays between 41 and 58 years are more likely to be overweight or obese than their 31-40 years counterparts, while the opposite is true among Chinese. Retirees of Chinese and Indian/other ethnicities are less likely to be obese and more likely to have normal BMI than those between 31 and 40 years. Primary educated Chinese are more likely to be overweight or obese, while tertiary-educated Malays are less likely to suffer from similar weight issues as compared to those with only junior high school education. Affluent Malays and Chinese are more likely to be overweight than their low-middle income cohorts. Family illness history is likely to cause overweightness or obesity, irrespective of ethnicity. Malay cigarette smokers have lower overweight and obesity probabilities than non-cigarette smokers.

CONCLUSIONS

There exists a need for flexible policies to address cross-ethnic differences in the sociodemographic and health-lifestyle covariates of BMI.

Barriers and catalysts of nutrition literacy among elderly Japanese people

Improving skills for accessing and utilizing diet/nutrition information is important for preventing non-communicable diseases and frailty among elderly people. With the rapidly increasing number of elderly people in the world, promoting nutrition literacy among them is a pivotal health policy for maintaining and promoting health. This article describes the barriers and catalysts of nutrition literacy among elderly Japanese people (aged ≥75 years). A cross-sectional analysis of the responses to a questionnaire administered to 678 study participants (men = 347, women = 331) was conducted. Logistic regression analysis revealed that more men had limited nutrition literacy than did women. After stratification by gender, the limited nutrition literacy group was associated with cognitive difficulty in men and women, visual impairment in men and hearing impairment in women. Lower education level and economic status were associated with limited nutrition literacy among women. Adjusted odds ratios (ORs) controlling for age, education level and economic status, as well as cognitive, visual and hearing function, indicated that informational support [OR = 5.59, 95% confidence interval (95% CI) = 1.28-24.49] and diet/nutrition information obtained from friends of the participants (OR = 2.16, 95% CI = 1.11-4.20) were both associated with adequate nutrition literacy among men, whereas diet/nutrition information from health professionals (OR = 3.96, 95% CI = 1.97-7.95) had a significant relation with adequate nutrition literacy among women. Moreover, in the adequate nutrition literacy group, men were more likely to be overweight (OR = 2.17, 95% CI = 1.20-3.91). These findings suggested that cognitive and sensory functions should be taken into account when diet information is provided to older adults. Enhancement of social networks is also a key point in improving nutrition literacy. An effective intervention to improve nutrition literacy in elderly people, particular old men, warrants further investigation.

General and abdominal obesity in South Korea, 1998-2007: gender and socioeconomic differences

OBJECTIVE

To examine national trends in prevalence and socioeconomic inequalities in both general (measured by body mass index) and abdominal obesity (measured by waist circumference) by gender and socioeconomic position (SEP) indicators.

METHODS

Data were from four rounds of nationally representative cross-sectional surveys for Korean men and women aged 25-64 (6,286 in 1998, 4,839 in 2001, 4,181 in 2005, and 2,006 in 2007). We calculated age-adjusted prevalence rates of overweight and abdominal obesity by gender and SEP indicators (education, occupational class, employment status and income) and examined trends of prevalence and its inequalities.

RESULTS

Overweight and abdominal obesity has significantly increased in Korean men (P for linear trend <0.01), not in women. For men, high SEP was associated with overweight and abdominal obesity, but the magnitude of socioeconomic differences in obesity measures generally remained unchanged during the study period. Among women, low SEP was associated with overweight. Interestingly, increasing inequalities in abdominal obesity according to education and income were found in women.

CONCLUSIONS

Clear gender differences were noted in (1) time trends of overweight and abdominal obesity, (2) relationships between the obesity measures and various SEP indicators, and (3) linear time trends of socioeconomic differentials in obesity.

Impact of education on obesity and blood pressure in developing countries: A study on the Ibos of Nigeria

BACKGROUND

Increase in the prevalence of hypertension, obesity and obesity related diseases has become significant cause of disability and premature death in both developing and newly developed countries, with over bearing demand on national health budgets.

AIM

To evaluate the impact of various levels of education on obesity and blood pressure.

MATERIALS AND METHOD

325 male and 254 female Nigerians of ages 20-80 years of the Ibo ethnicity through random sampling, were selected for this study. The participants were broken into three major groups based on their educational levels; primary, secondary and tertiary levels. systolic and diastolic blood pressure (SBP & DBP) levels, body mass index (BMI), waist hip ratio (WHR), waist height ratio (WHtR), waist circumference (WC),various skin fold thicknesses, and other anthropometric parameters were measured.

RESULT

For all the indicators of subcutaneous fat, general obesity, and central obesity, largest mean deposition was noted to be highest in the lowest education group and least in the highest education group. Mean blood pressure parameters were also highest in the least education group. While fat deposition was noted to be highest in all the females of all the groups, the males showed larger mean BP values. Education was noted to have a significant inverse relationship with most of the fat indicators and blood pressure parameters and cardiovascular disease risk highest in the least education groups.

CONCLUSION

Education showed a significant impact on obesity and blood pressure and could be one of the major tools to reduce the high prevalence of obesity, hypertension and other obesity associated diseases.

Prevalence of the metabolic syndrome and its components in relation to socioeconomic status among Jamaican young adults: a cross-sectional study

BACKGROUND

The metabolic syndrome has a high prevalence in many countries and has been associated with socioeconomic status (SES). This study aimed to estimate the prevalence of the metabolic syndrome and its components among Jamaican young adults and evaluate its association with parental SES.

METHODS

A subset of the participants from the 1986 Jamaica Birth Cohort was evaluated at ages 18-20 years between 2005 and 2007. Trained research nurses obtained blood pressure and anthropometric measurements and collected a venous blood sample for measurement of lipids and glucose. Prevalence of the metabolic syndrome and its components were estimated using the 2009 Consensus Criteria from the International Diabetes Federation, National Heart Lung and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society, and International Association for the Study of Obesity. SES was assessed by questionnaire using occupation of household head, highest education of parent/guardian, and housing tenure of parent/guardian. Analysis yielded means and proportions for metabolic syndrome variables and covariates. Associations with levels of SES variables were obtained using analysis of variance. Multivariable analysis was conducted using logistic regression models.

RESULTS

Data from 839 participants (378 males; 461 females) were analyzed. Prevalence of the metabolic syndrome was 1.2% (95% confidence interval [95%CI] 0.5%-1.9%). Prevalence was higher in females (1.7% vs. 0.5%). Prevalence of the components [male: female] were: central obesity, 16.0% [5.3:24.7]; elevated blood pressure, 6.7% [10.8:3.3]; elevated glucose, 1.2% [2.1:0.4]; low HDL, 46.8% [28.8:61.6]; high triglycerides, 0.6% [0.5:0.6]. There were no significant differences in the prevalence of the metabolic syndrome for any of the SES measures used possibly due to lack of statistical power. Prevalence of central obesity was inversely associated with occupation (highly skilled 12.4%, skilled 13.5%, semi-skilled/unskilled 21.8%, p = 0.013) and education (tertiary 12.5%, secondary 14.1%, primary/all-age 28.4%, p = 0.002). In sex-specific multivariate logistic regression adjusted for hip circumference, central obesity remained associated with occupation and education for women only.

CONCLUSION

Prevalence of the metabolic syndrome is low, but central obesity and low HDL are present in 16% and 47% of Jamaican youth, respectively. Central obesity is inversely associated with occupation and education in females.

Factors related to obesity among Iranian men: results from the National Health Survey

OBJECTIVE

To our knowledge, only a few Iranian studies have investigated factors associated with obesity among men. The aims of the present study were to explore the associations between sociodemographic factors, smoking and obesity in Iranian men and compare these associations between Iranian men and women.

DESIGN

We used data from the National Health Survey in Iran. A generalised estimating equations model included 11,697 men and 14,854 women aged 20-69 years (12,850 households). Body weight and height were objectively measured. BMI was calculated as kg/m2, and subjects were classified into obese (BMI >or= 30 kg/m2) and non-obese (BMI < 30 kg/m2).

RESULTS

Among men, adjusted obesity OR were 0.62 (95 % CI 0.52, 0.74), 1.09 (95 % CI 0.90, 1.32), 1.003 (95 % CI 1.00, 1.007) and 0.57 (95 % CI 0.40, 0.81) for smokers, married, economic index and active workforce groups, respectively. Using low education as the reference group, the obesity OR for men were 1.06 (95 % CI 0.89, 1.26) and 0.75 (95 % CI 0.57, 0.99) for the moderate and high education groups, respectively. Using rural as the reference group, the obesity OR was 1.87 (95 % CI 1.56, 2.26) for urban men.

CONCLUSIONS

Our findings may point towards a better understanding of the social and cultural mechanisms of obesity in Iranian men. The above sociodemographic factors are large contributors to obesity and provide the greatest opportunity for actions and interventions designed for prevention and treatment.

Associations between multiple indicators of socioeconomic status and obesity in young adult Filipinos vary by gender, urbanicity, and indicator used

More research is needed on the socio-environmental determinants of obesity in lower- and middle-income countries. We used generalized estimating equations to evaluate the cross-sectional effect of urban residence and multiple individual-level indicators of socioeconomic status (SES) on the odds of overweight or central adiposity in a birth cohort of young adult (mean age 21.5 y) Filipino males (n = 987) and females (n = 819) enrolled in the Cebu Longitudinal Health and Nutrition Survey. Overweight was defined as BMI >/=25 kg/m(2) and central adiposity was defined as a waist circumference >85 cm for males or >80 cm for females. Community-level urbanicity was measured on a continuous scale. Multiple indicators of SES included assets, income, education, and marital status. In the final multivariable models, assets and being married were positively related to overweight and central adiposity in males (P < 0.05), but being married was the only predictor of these outcomes in females. However, once the modifying effects of urban residence were accounted for, assets were positively related to overweight and central adiposity among the most rural women, but not in more urban women. Our results are consistent with a growing body of literature that suggests the relationship between SES and obesity is positive in lower-income contexts and inverse in higher-income contexts, particularly in females. The pattern of relationships we observed suggests that as the Philippines continues to develop economically, the public health impact of obesity will increase similarly to what has been observed in countries further along in their economic transition.

Social Change and Socioeconomic Disparities in Health over the Life Course in China: A Cohort Analysis

This article examines social stratification in individual health trajectories for multiple cohorts in the context of China's dramatically changing macro-social environment. Using data from the China Health and Nutrition Survey, we find significant socioeconomic status (SES) differences in the mean level of health and that these SES differentials generally diverge over the life course. We also find strong cohort variations in SES disparities in the mean levels of health and health trajectories. The effect of education on health slightly decreases across successive cohorts. By contrast, the income gap in health trajectories diverges for earlier cohorts but converges for most recent cohorts. Both effects are more pronounced in rural areas. Given that these cohort effects are opposite those reported in recent U.S. studies, we discuss China's unique social, economic, and political settings. We highlight the association between SES and health behaviors, China's stage of epidemiologic transition, and the changing power of the state government and its implications for health care.

Socio-spatial patterns of neighborhood effects on adult obesity in Taiwan: a multi-level model

Obesity, one of the most significant health problems now facing developed countries, has been increasing steadily in Taiwan. This study addresses how neighborhood factors affect individual obesity by simultaneously examining individual-level socioeconomic status and neighborhood-level characteristics using a multi-level approach combined with a spatial analysis. The data are from Taiwan's 2001 Social Development Survey on Health and Safety; a representative sample of 27,593 adults over 262 townships (i.e. neighborhoods). A spatial autocorrelation model is employed to investigate the spatial clustering of neighborhood affluence. A two-level Generalized Hierarchical Linear Model (GHLM) is used to combine neighborhood-level (level-2) characteristics (i.e., spatial patterns of neighborhood affluence and ethnic composition), and individual-level SES position (level-1) to examine the factors associated with adult obesity risk. Three principal findings were obtained. First, individual obesity risk is significantly higher in spatially clustered neighborhoods of economic affluence. Neighborhood factors associated with obesity are likely to operate over a wide geographical area and are not limited to conditions in the immediate residential neighborhood. Second, aboriginal people living adjacent to the most affluent cluster in northern Taiwan have elevated obesity risk, revealing possible spatial diffusion and ethnic acculturation. Third, adult obesity is, however, associated with socioeconomically disadvantaged groups in different neighborhood contexts. These findings suggest that accounting for spatial interdependencies among neighborhoods enhances the accuracy of estimated neighborhood effects on obesity.

Cost-effectiveness of a community-based obesity control programme

We evaluated two 12-week long community-based obesity control programmes in Korea. One was a visiting-type programme (V-type) (n = 515) administered by a public health centre and the other was a remote-type programme (R-type) (n = 410) utilizing an Internet website and mobile phones with a short message service. The total cost for the intention-to-treat subjects was US$116,993 in the V-type programme and $24,555 in the R-type programme. In the per-protocol subjects, 66% of V-type participants (n = 117) achieved the target bodyweight reduction (5%) and 13% of R-type participants (n = 15). In the per-protocol subjects, the cost per person was $227 (V-type) and $60 (R-type). The cost per person achieving the target weight reduction was $975 (V-type) and $1637 (R-type). The average amount that participants were willing to pay was $71 (V-type) and $21 (R-type). The cost-effectiveness of the visiting-type community-based, short-duration obesity control programme was higher than the remote-type programme.

Socioeconomic status, sex, and obesity in a large national cohort of 15-87-year-old open university students in Thailand

BACKGROUND

As obesity increases, middle-income countries are undergoing a health-risk transition. We examine the association between socioeconomic status (SES) and emerging obesity in Thailand, and ascertain if an inverse relationship between SES and obesity has appeared.

METHODS

The data derived from 87 134 individuals (54% female; median age, 29 years) in a national cohort of distance-learning Open University students aged 15-87 years and living throughout Thailand. We calculated adjusted odds ratios for associations of SES with obesity (body mass index, >or=25) across 3 age groups by sex, after controlling for marital status, age, and urbanization.

RESULTS

Obesity increased with age and was more prevalent among males than females (22.7% vs 9.9%); more females were underweight (21.8% vs 6.2%). Annual income was 2000 to 3000 US dollars for most participants. High SES, defined by education, income, household assets, and housing type, associated strongly with obesity-positively for males and inversely for females-especially for participants younger than 40 years. The OR for obesity associated with income was as high as 1.54 for males and as low as 0.68 for females (P for trend <0.001).

CONCLUSIONS

Our national Thai cohort has passed a tipping point and assumed a pattern seen in developed countries, ie, an inverse association between SES and obesity in females. We expect the overall population of Thailand to follow this pattern, as education spreads and incomes rise. A public health problem of underweight females could emerge. Recognition of these patterns is important for programs combating obesity. Many middle income countries are undergoing similar transitions.

Association of educational level with risk of obesity and abdominal obesity in Iranian adults

BACKGROUND

The impact of education on obesity may vary according to population and geographic region. The objective of the present study was to determine the association between education and obesity.

METHODS

A cross-sectional study of 3600 subjects aged 20-70 years was conducted by using a cluster sampling technique in an adult population residing in the north of Iran, in 2004. Weight, height, waist and hip circumference were measured and data concerning education level, demographic characteristics and physical activities were collected by interview. Logistic regression analysis was used to estimate the association between education and general obesity (body mass index >or=30) as well as abdominal obesity (waist circumference >88 cm in women and 102 cm in men).

RESULTS

The adjusted odds ratio (OR) for general obesity at education level of high school and college compared with illiterate and primary level was 0.55 [95% confidence interval (CI): 0.43-0.71]. A greater negative association was observed for education at university level (OR = 0.32, 95% CI: 0.22-0.47) irrespective to sex. However, with regard to abdominal obesity, after controlling for confounding factors, the adjusted OR for education at university level remained significant only in women but not in men.

CONCLUSION

The findings of this study indicate that education level is inversely associated with general obesity in both sexes but with abdominal obesity only in women.

The association between socioeconomic status and overweight/obesity in a Malay population in Singapore

In developed countries in the West, lower socioeconomic status (SES) is associated with a higher prevalence of overweight/obesity. The authors examined the association between SES defined by education and income and overweight/obesity in a population-based cohort of 2807 individuals of Malay ethnicity (age 40-80 years, 51% women) in Singapore. The prevalence of overweight/ obesity (body mass index > or =25 kg/m(2)) in men and women was 50.4% and 65.1%, respectively. In women, the prevalence of overweight/obesity increased with lower levels of education and income. Compared with the higher categories of SES, the odds ratio (95% confidence interval) of overweight/obesity in women was 1.42 (1.06-1.89) for education and 2.08 (1.33-3.26) for income. In contrast, in men, the prevalence of overweight/obesity decreased with lower levels of education and income (P interaction by gender <.05 for all SES variables). Lower SES was positively associated with overweight/obesity in Malay women, and the association was in the opposite direction in Malay men.

Body mass index, waist to hip ratio and waist/height in adult Polish women in relation to their education, place of residence, smoking and alcohol consumption

Obesity is a complex, multifactorial disorder that develops from genotype and environmental interactions. The aim of this study is to describe the variability of body mass index (BMI), waist to hip ratio (WHR) and waist to height (W/Ht) in adult Polish women, and to determine relationships between these variables and factors such as education, place of residence, smoking and alcohol drinking. The tested group consisted of 10,254 women aged 25-95 years, who voluntarily filled in questionnaires and participated in anthropometric measurements (body height and mass, waist and hip circumferences). The BMI, WHR and W/Ht values were calculated based on these measurements. The participants were differentiated in terms of education, residence and lifestyle (smoking, alcohol drinking). Chi-squared test, product-moment correlations, ANOVA, multiple correspondence analysis (MCA) and logistic regression with backward elimination were used to evaluate associations between social and lifestyle factors and BMI, WHR and W/Ht. The results confirm (1) the relationship between low social status and the risk of overweight and obesity as observed in developed countries; (2) higher susceptibility to environmental factors such as education, place of residence, smoking and alcohol drinking in younger (premenopausal) women; (3) the usefulness of simple and practical anthropometric indicators such as WHR and W/Ht for the identification of the higher risk of future metabolic diseases in obese people and those with a normal body mass.

Prevalence of obesity and metabolic syndrome in Korean adults

We studied the prevalence and trend of obesity and metabolic syndrome in Korean adults aged at least 20 years using Korean National Health Examination and Nutrition Survey data from 1998 and 2001. The prevalence of body mass index (BMI) > or = 25 kg m(-2) among Korean adults in 2001 was 32.9% in men and 27.4% in women, and the number of Korean men with BMI > or = 25 kg m(-2) has increased markedly since 1998. A significant positive association between obesity and socioeconomic status was found in Korean men, whereas a significant negative association was identified in Korean women. The prevalence rates of waist circumference (WC) > or = 90 cm in men and WC > or = 85 cm in women were 23.4% and 23.1% in 2001 respectively. The prevalence of metabolic syndrome among Korean adults was 15-30% according to various criteria of metabolic syndrome. Future studies are needed to determine the changes in prevalence of obesity and contributing factors for obesity in Koreans.

[Health inequalities in Korea: current conditions and implications]

OBJECTIVES

The aim of this study is to summarize the current conditions and implications of health inequalities in South Korea.

METHODS

Through a literature review of empirical studies and supplementary analysis of the data presented in the 1998, 2001, and 2005 KNHANEs, we evaluated the extent and trends of socioeconomic inequalities in both health risk factors, such as smoking, physical activity, and obesity, and outcomes, such as total mortality, subjective poor health status by self-reports and metabolic syndrome. Relative risks and odds ratios were used to measure differences across socioeconomic groups, and the relative index of inequality was used to evaluate the changes in inequalities over time.

RESULTS

We found clear inequalities to various degrees in most health indicators. While little change was observed in mortality differences over time, the socioeconomic gaps in risk factors and morbidity have been widening, with much larger differences among the younger population.

CONCLUSIONS

Socioeconomic inequalities are pervasive across various health indicators, and some of them are increasing. The trends in socioeconomic inequalities in health should be carefully monitored, and comprehensive measures to alleviate health inequalities are needed, especially for young populations.

Socioeconomic status and overweight/obesity in an adult Chinese population in Singapore

BACKGROUND

Studies from industrialized Western countries have reported an inverse association between socioeconomic status and overweight/obesity. In contrast, few studies from newly industrialized countries in Asia have examined this association. In this context, we examined the association between socioeconomic status and overweight/obesity by gender in Chinese adults in Singapore.

METHODS

A population-based cross sectional study of 942 participants (57.3% women, 40-81 years) residing in the Tanjong Pagar district of Singapore was conducted. Education, income, and housing type were used as socioeconomic status indicators. Main outcome-of-interest was the presence of overweight/obesity (n=313), classified by body mass index as overweight (25-29.9 kg/m²), or obese (≥30 kg/m²)

RESULTS

The prevalence of overweight/obesity was 33% in men and 34% in women. In men, SES indicators were not associated with overweight/obesity. In women, SES indicators were found to be inversely associated with overweight/ obesity. Compared to women with secondary/higher education, the odds ratio (OR) (95% confidence interval [CI]) of overweight/obesity in women with primary/lower education was 2.5 (1.5-4.0). Compared to women earning > Singapore dollar (SGD) 1,000 per month, the OR (95% CI) of overweight/obesity among women earning ≤SGD 1,000 was 2.5 (1.4-4.5). Compared to women living in large size public apartments or private houses, the OR (95% CI) of overweight/obesity in women living in small/medium size public apartments was 1.8 (1.2-2.7).

CONCLUSIONS

Lower socioeconomic status, defined by education, income, and housing type was associated with overweight/obesity in Chinese Singaporean women.

Prevalence of obesity in preschool Greek children, in relation to parental characteristics and region of residence

BACKGROUND

The aim of this retrospective cohort study was to record the prevalence of overweight and obesity in relation to parental education level, parental body mass index and region of residence, in preschool children in Greece.

METHODS

A total of 2374 children (1218 males and 1156 females) aged 1-5 years, stratified by parental educational level (Census 1999), were examined from 105 nurseries in five counties, from April 2003 to July 2004, Weight (kg) and height (cm) were obtained and BMI (kg/m2) was calculated. Both the US Centers for Disease Control (CDC) and the International Obesity Task Force (IOTF) methods were used to classify each child as "normal", "at risk of overweight" and "overweight". Parental demographic characteristics, such as age and educational level and parental anthropometrical data, such as stature and body weight, were also recorded with the use of a specifically designed questionnaire.

RESULTS

The overall estimates of at risk of overweight and overweight using the CDC method was 31.9%, 10.6 percentage points higher than the IOTF estimate of 21.3% and this difference was significant (p < 0.001). Children with one obese parent had 91% greater odds for being overweight compared to those with no obese parent, while the likelihood for being overweight was 2.38 times greater for children with two obese parents in the multivariate model.

CONCLUSION

Both methods used to assess prevalence of obesity have demonstrated that a high percentage of the preschool children in our sample were overweight. Parental body mass index was also shown to be an obesity risk factor in very young children.