Prevalence of overweight and obesity in a Portuguese sample of adults: Results from the Azorean Physical Activity and Health Study

Predicting the association of different levels of physical activity on postoperative pulmonary complications using the international physical activity questionnaire in patients undergoing thoracoscopic lung surgery under general anaesthesia: protocol for a prospective cohort study

INTRODUCTION

Postoperative pulmonary complications (PPCs) occur frequently in patients undergoing lung surgery under general anaesthesia and are strongly associated with longer postoperative hospital stays and increased mortality. The existing literature has shown that a higher level of preoperative physical activity (PA) plays a positive role in the low incidence of postoperative complications and the quality of life in patients undergoing lung surgery. However, the association between preoperative PA levels and the incidence of PPCs has rarely been studied, particularly in thoracoscopic lung surgery. This study aims to evaluate PA levels in patients undergoing thoracoscopic lung surgery using the International Physical Activity Questionnaire and to investigate the association between PA levels and the incidence of PPCs.

METHODS AND ANALYSIS

A total of 204 participants aged 18-80 years undergoing thoracoscopic lung surgery (thoracoscopic wedge resection, thoracoscopic segmentectomy and thoracoscopic lobectomy) will be included in the study. The primary outcome is the incidence of PPCs within the first 5 postoperative days. The secondary outcomes include the number of PPCs, the incidence of PPCs 1 month postoperatively, the arterial blood levels of inflammatory markers, the incidence of postoperative adverse events within the first 5 postoperative days, extubation time, unplanned admission to the intensive care unit, postoperative length of stay and mortality 1 month postoperatively.

ETHICS AND DISSEMINATION

The study was reviewed and approved by the Research Ethics Committee of the First Affiliated Hospital of Shandong First Medical University on 31 March 2022 (YXLL-KY-2022(014)) and is registered at ClinicalTrials.gov. We plan to disseminate the data and findings of this study in international and peer-reviewed journals.

TRIAL REGISTRATION NUMBER

The trial has been prospectively registered at the clinicaltrials.gov registry (NCT05401253).

Association between alcohol intake and overweight and obesity: a systematic review and dose-response meta-analysis of 127 observational studies

Several studies have assessed the relationship between alcohol intake and overweight/obesity; however, the reported results are inconsistent. Therefore, the present systematic review and dose-response meta-analysis of observational studies was designed to investigate the association between alcohol intake and general and abdominal obesity among the adults. Literature search was conducted in the PubMed/Medline and Web of Science databases up to August 2020. Odds ratio (OR), risk ratio (RR), or hazard ratio (HR) with 95% confidence interval (95% CI) were used to pool effect size. To conduct dose-response meta-analysis, amount of alcohol intake was classified into three categories including light (<14 g/d), moderate (14-28 g/d), and heavy (>28 g/d). In the present study, 127 eligible studies were included. In cohort studies, there was no significant association between alcohol drinking and risk of overweight (OR: 0.93, 95% CI: 0.46 to 1.89), obesity (OR: 0.84, 95% CI: 0.52 to 1.37), overweight/obesity (OR: 1.15, 95% CI: 0.84 to 1.58), and abdominal obesity (OR: 1.13, 95% CI: 0.90 to 1.41). In cross-sectional studies, alcohol intake was associated with the increased odds of overweight (OR: 1.11, 95% CI: 1.05 to 1.18), overweight/obesity (OR: 1.23, 95% CI: 1.11 to 1.37), and abdominal obesity (OR: 1.19, 95% CI: 1.09 to 1.29); but not obesity (OR: 1.03, 95% CI: 0.95 to 1.12). Results of dose-response analysis indicated that heavy alcohol drinking was positively associated with odds of overweight (OR: 1.12, 95% CI: 1.01 to 1.24), overweight/obesity (OR: 1.32, 95% CI: 1.16 to 1.51), and abdominal obesity (OR: 1.25, 95% CI: 1.12 to 1.38) compared to non- or light alcohol drinking. There was no publication bias among studied on outcomes of interest. In conclusion, our results revealed alcohol drinkers, especially heavy alcohol drinkers, had increased odds of overweight, overweight/obesity, and abdominal obesity than non-alcohol drinker or light alcohol drinkers among cross-sectional studies but not cohort studies.

Do declines in occupational physical activity contribute to population gains in body mass index? Tromsø Study 1974-2016

OBJECTIVE

To examine whether occupational physical activity changes predict future body mass index (BMI) changes.

METHODS

This longitudinal cohort study included adult participants attending ≥3 consecutive Tromsø Study surveys (examinations 1, 2 and 3) from 1974 to 2016 (N=11 308). If a participant attended >3 surveys, the three most recent surveys were included. Occupational physical activity change (assessed by the Saltin-Grimby Physical Activity Level Scale) was computed from the first to the second examination, categorised into persistently inactive (n=3692), persistently active (n=5560), active to inactive (n=741) and inactive to active (n=1315). BMI change was calculated from the second to the third examination (height being fixed at the second examination) and regressed on preceding occupational physical activity changes using analysis of covariance adjusted for sex, birth year, smoking, education and BMI at examination 2.

RESULTS

Overall, BMI increased by 0.84 kg/m2 (95% CI 0.82 to 0.89). Following adjustments as described previously, we observed no differences in BMI increase between the occupational physical activity change groups (Persistently Inactive: 0.81 kg/m2, 95% CI 0.75 to 0.87; Persistently Active: 0.87 kg/m2, 95% CI 0.82 to 0.92; Active to Inactive: 0.81 kg/m2, 95% CI 0.67 to 0.94; Inactive to Active: 0.91 kg/m2, 95% CI 0.81 to 1.01; p=0.25).

CONCLUSION

We observed no prospective association between occupational physical activity changes and subsequent BMI changes. Our findings do not support the hypothesis that occupational physical activity declines contributed to population BMI gains over the past decades. Public health initiatives aimed at weight gain prevention may have greater success if focusing on other aspects than occupational physical activity.

Connecting the dots between breast cancer, obesity and alcohol consumption in middle-aged women: ecological and case control studies

Background

Breast cancer (BC) incidence in Australian women aged 45 to 64 years (‘middle-aged’) has tripled in the past 50 years, along with increasing alcohol consumption and obesity in middle-age women. Alcohol and obesity have been individually associated with BC but little is known about how these factors might interact. Chronic psychological stress has been associated with, but not causally linked to, BC. Here, alcohol could represent the ‘missing link’ – reflecting self-medication. Using an exploratory cross-sectional design, we investigated inter-correlations of alcohol intake and overweight/obesity and their association with BC incidence in middle-aged women. We also explored the role of stress and various lifestyle factors in these relationships.

Methods

We analysed population data on BC incidence, alcohol consumption, overweight/obesity, and psychological stress. A case control study was conducted using an online survey. Cases (n = 80) were diagnosed with BC and controls (n = 235) were women in the same age range with no BC history. Participants reported lifestyle data (including alcohol consumption, weight history) over consecutive 10-year life periods. Data were analysed using a range of bivariate and multivariate techniques including correlation matrices, multivariate binomial regressions and multilevel logistic regression.

Results

Ecological inter-correlations were found between BC and alcohol consumption and between BC and obesity but not between other variables in the matrix. Strong pairwise correlations were found between stress and alcohol and between stress and obesity.

BMI tended to be higher in cases relative to controls across reported life history. Alcohol consumption was not associated with case-control status. Few correlations were found between lifestyle factors and stress, although smoking and alcohol consumption were correlated in some periods. Obesity occurring during the ages of 31 to 40 years emerged as an independent predictor of BC (OR 3.5 95% CI: 1.3–9.4).

Conclusions

This study provides ecological evidence correlating obesity and alcohol consumption with BC incidence. Case-control findings suggest lifetime BMI may be important with particular risk associated with obesity prior to 40 years of age. Stress was ecologically linked to alcohol and obesity but not to BC incidence and was differentially correlated with alcohol and smoking among cases and controls. Our findings support prevention efforts targeting weight in women below 40 years of age and, potentially, lifelong alcohol consumption to reduce BC risk in middle-aged women.

Association between body mass index (BMI) and vital capacity of college students of Zhuang nationality in China: a cross-section study

Objective

Our study is to evaluate the association between body mass index (BMI) and vital capacity of college students of Zhuang Nationality in China.

Methods

463 college students of Zhuang Nationality from Guangxi Medical University were selected. Basic information, body composition and vital capacity of college students were measured. According to the level of BMI, college students were divided into four groups (BMI<18.5, 18.5≤BMI<23.9, 23.9≤BMI<27.9 and BMI≥27.9). Multivariate logistic regression analysis was performed to assess the association between BMI and vital capacity.

Results

In male college students, there was no significant difference in vital capacity between the four groups (3029.54±869.25, 3347.06±784.54, 3540.00±805.35 and 3966.50±350.2, P=0.0727, respectively). Multivariate regression analysis showed that after adjusting for confounding factors, no significant association was observed between BMI and vital capacity (OR=115.02, 95% CI: -555.58∼785.63; OR=-166.58, 95% CI: -1684.56∼1351.41; OR=-484.01, 95% CI:-3504.53, 2536.51, respectively. BMI<18.5 group served as reference group). In female college students, there was also no significant difference in vital capacity between the four groups (2455.15±574.4, 2555.06±637.03, 2750.33±1224.05 and 2473.00±159.06, P=0.4011, respectively). Multivariate regression analysis showed that after adjusting for confounding factors, no significant association was observed between BMI and vital capacity (OR=-88.88, 95% CI: -333.59∼155.84; OR=20.00, 95% CI: -694.39∼734.39; OR=2.86, 95% CI: -1830.58, 1836.3, respectively. BMI<18.5 group served as reference group).

Conclusion

There was no evidence that BMI is associated with vital capacity in college students of Zhuang Nationality.

Age and gender differential relationship between employment status and body mass index among middle-aged and elderly adults: a cross-sectional study

OBJECTIVE

To determine the influence of age and gender, respectively, on the association between employment status and body mass index (BMI) in Korean adults using a large, nationally representative sample.

DESIGN

Cross-sectional study.

SETTING

South Korea.

PARTICIPANTS

7228 from fourth wave of the Korean Longitudinal Study of Aging (KLoSA), the survey's short form and year: 'KLoSA 2012'.

MAIN OUTCOME MEASURES

BMI.

RESULTS

BMI among the employed was higher than among the unemployed for those under 60. In terms of gender, employed men reported higher BMI than their unemployed counterparts, whereas employed women reported lower BMI than did unemployed women.

CONCLUSIONS

Employment status showed varying impacts on obesity by age and gender. Both unemployment at or after 60, as well as unemployment among women, is associated with increased BMI compared with unemployment among younger individuals or men, respectively.

Associations between behavioural risk factors and overweight and obesity among adults in population-based samples from 31 countries

OBJECTIVE

Concern about overweight and obesity is growing worldwide, and more research to examine behaviours associated with the risk for increased weight in adult populations is needed. The aim of this study was to estimate associations between behavioural risk factors and overweight and obesity among adults in nationally representative population samples from 20 countries in Europe, 8 countries in Asia, Australia, Chile and USA.

METHODS

This secondary analysis is based on the International Social Survey Program (ISSP), 2011-2013, Health and Health Care Module. In a cross-sectional population-based survey (N=48,741) (mean age 46.6 years, SD=17.4, age range 15-102 years) simple or multi-stage stratified random sampling was used, yielding representative samples of the adult population of respective countries. Body Mass Index was assessed by self-reported height and weight. Correlates were risk behaviours for chronic disease (smoking status, alcohol intake, consumption of fruits and vegetable (=FV), and physical activity).

RESULTS

Overall, for all 31 countries the prevalence of overweight or obesity was 44.1%, 31.7% overweight and 12.4% obese. In adjusted logistic regression models, among men and among women ex-smoking was positively associated with both overweight and obesity, while light or moderate smoking overall and among men were inversely related with obesity. Moderate alcohol use was positively associated with both overweight and obesity, while heavy alcohol use was negatively associated with overweight. The daily consumption of FV was found to be protective from both overweight and obesity, overall and for men but not for women. Physical activity was positively associated with overweight but not obesity.

CONCLUSIONS

Some risk behaviours for chronic disease appear to be associated with overweight and obesity among adults. Interventions targeting these risk behaviours may have the potential to reduce weight.

Socio-demographic correlates of leisure time physical activity among Portuguese adults

This study aimed to identify socio-demographic correlates of leisure time physical activity among Portuguese adults. Subjects aged 31-60 years (1,076 males, 1,383 females) were categorized into two groups according to recommended physical activities ranging from ≥ 10 or < 10 MET.hours.week-1. Leisure time physical activity data was self-reported, including activities, duration of each session and frequency. Chi-square and logistic regression analyses were applied to the results. Among men, having a high socioeconomic status (OR = 1.89; 95%CI: 1.30-2.76; p = 0.001) was associated with attaining the recommended level of physical activity. For women, middle education levels were associated with physical activity (OR = 1.36; 95%CI: 1.01-1.85). Moreover, middle socioeconomic status (OR = 1.45; 95%CI: 0.80-1.91; p = 0.009) was also positively associated with meeting physical activities recommendations in the unadjusted analysis. Men and women had different patterns of socio-demographic correlates. An intervention designed to improve the levels of physical activity among Portuguese adults may take these correlates into account.

Ethnic inequalities and sex differences in body mass index among tibet minorities in China: implication for overweight and obesity risks

OBJECTIVES

In the present study, we for the first time investigated overweight and obesity level among Tibet minorities (Deng, Lhoba, Monba) living in remote villages at the south slope of Qinghai-Tibetan Plateau, China. For each ethnicity, the total number of population is less than 10 thousands in China.

METHODS

Anthropometric measurements were conducted on adult participants of three ethnicities in Tibet, China. Totally, the whole sample consists of 141 males and 163 females. Body mass index (BMI) was adopted to evaluate the overweight and obesity level.

RESULTS

Within each ethnicity, there was no significant sex difference on BMI. The general prevalence of overweight and obesity level of Lhoba ethnicity (18.42%) is higher than that of Monba (17.65%) and Deng ethnicity (6.29%). For each sex, the distribution of BMI classification was found to be significantly associated with ethnicity identity.

CONCLUSION

One possible reason for ethnic disparity among Tibet minorities in the present study is special dietary elements. Measures to prevent and cope with the problem of overweight and obesity among Tibet minorities are urgently required.

Gender differences and socioeconomic status in relation to overweight among older Korean people

Background

The ever-increasing older population and its association with serious overweight problems have garnered much attention. The correlation between being overweight and socioeconomic status factors could be helpful for understanding the inequalities among the overweight population. We examined the correlation between being overweight and some key variables, such as demographics, socioeconomic status, general health status, and health behavior in a large sample of older individuals, by each gender.

Methods

We used data from the 2008 Korean Longitudinal Study of Aging and it included 8,157 participants who were 45 years or older. To understand the relationship between the overweight participants in accordance to demographic and socioeconomic characteristics, health status, and health behaviors, a weighted chi-square test and logistic regression analysis were conducted by separating variables related to overweight, according to the genders.

Results

The number of people in the normal group was 6,347 (77.8%), while the people who were considered overweight were 1,810 (22.2%). Women (n = 4,583) constituted 52.7% of the subject, 24.9% of whom were classified as overweight. Meanwhile, 20.6% of the 47.3% (n = 3,574) of the sample who were men were classified as overweight. Participants between the ages of 45 and 64 with chronic diseases were more likely to be overweight. Men in the 4th quartile of household income were more likely to be overweight than those who were in the 1st quartile, in contrast, while unemployed women with lower education levels and urban residents were at greater risk for being overweight.

Conclusions

Among the men, health status and health behavior appeared to show a correlation with being overweight; however, among women, socioeconomic status factors were strongly related to being overweight. These findings appear to support the association of gender-specifics with the prevalence of being overweight.

Trends of BMI and prevalence of overweight and obesity in Portugal (1995-2005): a systematic review

OBJECTIVE

Locale-specific data on BMI and overweight/obesity are necessary to understand how the obesity epidemic is evolving in each setting. We aimed to describe the temporal trends of mean BMI and prevalences of overweight/obesity in studies that evaluated Portuguese adults and older people.

DESIGN

Systematic review, conducted via a PubMed search up to January 2011 and independent reference screening and data extraction. Twenty-one eligible studies were identified. Data were extracted from the published reports and obtained from the authors of seven of the largest studies. Adjusted ecological estimates of mean BMI and prevalences of overweight/obesity were computed by linear regression.

RESULTS

Between 1995 and 2005, when using data obtained from anthropometric measurements, overweight prevalence increased by 3·2 % and 3·5 % and obesity prevalence by 7·4 % and 1·3 % among women and men, respectively, while mean BMI did not vary meaningfully. When using self-reported information, mean BMI increased by 0·8 kg/m2 and 0·9 kg/m2, overweight prevalence by 3·5 % and 3·7 % and obesity prevalence by 5·8 % and 5·5 % among women and men, respectively. Results from the 20-year-old conscripts (1960-2000) showed a marked increase in these outcomes in the last decades.

CONCLUSIONS

Our results show an important increase in overweight/obesity in younger ages. The trends in the indicators derived from self-reported data suggest an increase in awareness of the importance of overweight/obesity among the population.

Metabolic risk factors, physical activity and physical fitness in Azorean adolescents: a cross-sectional study

Background

The prevalence of metabolic syndrome has increased over the last few decades in adolescents and has become an important health challenge worldwide. This study analyzed the relationships between metabolic risk factors (MRF) and physical activity (PA) and physical fitness (PF) in a sample of Azorean adolescents.

Methods

A cross-sectional school-based study was conducted on 417 adolescents (243 girls) aged 15-18 from the Azorean Islands, Portugal. Height, weight, waist circumference, fasting glucose, HDL-cholesterol, triglycerides, and blood pressure were measured. A sum of MRF was computed, and adolescents were classified into three groups: no MRF, one MRF and two or more MRF. PA was assessed by a sealed pedometer. PF was assessed using five tests from the Fitnessgram Test Battery. Dietary intake was obtained using a semi-quantitative food frequency questionnaire.

Results

Mean daily steps for girls and boys were 7427 ± 2725 and 7916 ± 3936, respectively. Fifty-nine percent of the adolescents showed at least one MRF and 57.6% were under the healthy zone in the 20 m Shuttle Run Test. Ordinal logistic regression analysis showed that after adjusting for sex, body mass index, socio-economic status and adherence to a Mediterranean diet, adolescents who were in the highest quartile of the pedometer step/counts (≥9423 steps/day) and those who achieved the healthy zone in five tests were less likely to have one or more MRF (OR = 0.56;95%CI:0.33-0.95; OR = 0.55;95%CI:0.31-0.98, respectively).

Conclusions

Daily step counts and PF levels were negatively associated with having one or more MRF among Azorean adolescents. Our findings emphasize the importance of promoting and increasing regular PA and PF to reduce the public health burden of chronic diseases associated with a sedentary lifestyle.

Sitting time and body mass index, in a Portuguese sample of men: results from the Azorean Physical Activity and Health Study (APAHS)

The aim of this study was to verify the relation between body mass index (BMI) and sitting time in a sample of 4,091 Azorean men. BMI was calculated from self-reported weight and height. Total physical activity (PA) time and total sitting time were assessed with the IPAQ (short version). Linear Regression analysis showed that total sitting time (hours/day) was positively associated with BMI (B = 0.078; p < 0.001) after adjustments for age, meal frequency, alcohol and tobacco consumptions, island of residence, education level and total PA time. Although the cross sectional design precludes us from establishing causality, our findings emphasize the importance of reducing sedentary behavior to decrease the risk of obesity.

Walking and body mass index in a Portuguese sample of adults: a multilevel analysis

Physical inactivity is an important risk factor for many chronic diseases. The purpose of this study was to investigate the cross-sectional associations between walking and body mass index (BMI). This study comprised 9991 adults (5723 women), aged 37.8+/-9.5 years, from the 2004 Azorean Physical Activity and Health Study. Walking was assessed with the International Physical Activity Questionnaire, and expressed as minutes per week. BMI was calculated from self-reported weight and height. A series of multilevel linear regression models were fitted to assess regression coefficients and s.e. predicting BMI. Results show that, in both genders, and after adjustments for potential confounders, walking was not a significant predictor of BMI. Therefore, our analysis does not extend the findings of earlier studies as it shows no significant associations between walking and BMI, after adjustments for potential confounders. Nevertheless, among Azoreans walking should be encouraged, as walking has other health benefits, beyond controlling obesity.

Socio-demographic and perceived environmental correlates of walking in Portuguese adults--a multilevel analysis

Several studies have identified associations between walking levels and socio-demographic and environmental variables. The aim of the present study was to describe walking patterns and examine associations between socio-demographic characteristics and perceived environmental attributes with walking among adults living in the Azorean Archipelago (Portugal). In all, 7330 adult participants (4104 women), aged 38.1 +/- 9.3 years, of the 2004 Azorean Physical Activity and Health Study answered the Environmental Module and the short version of the International Physical Activity Questionnaire. Among the Azoreans, the environmental dimension "infrastructures, access to destinations, social environment and aesthetics" and moderate to vigorous physical activity were positively associated with walking levels; and smoking, sitting time and being married were negatively related, regardless of gender, age or education level. Through the cross-sectional nature of this study, our results suggest that targeted programs for Azoreans aimed to increase walking levels should consider that infrastructures, access to destinations, social environment and aesthetics seem to act synergistically and associate positively with walking behaviour.

Cost-utility of a walking programme for moderately depressed, obese, or overweight elderly women in primary care: a randomised controlled trial

Background

There is a considerable public health burden due to physical inactivity, because it is a major independent risk factor for several diseases (e.g., type 2 diabetes, cardiovascular disease, moderate mood disorders neurotic diseases such as depression, etc.). This study assesses the cost utility of the adding a supervised walking programme to the standard "best primary care" for overweight, moderately obese, or moderately depressed elderly women.

Methods

One-hundred six participants were randomly assigned to an interventional group (n = 55) or a control group (n = 51). The intervention consisted of an invitation, from a general practitioner, to participate in a 6-month walking-based, supervised exercise program with three 50-minute sessions per week. The main outcome measures were the healthcare costs from the Health System perspective and quality adjusted life years (QALYs) using EuroQol (EQ-5D.)

Results

Of the patients invited to participate in the program, 79% were successfully recruited, and 86% of the participants in the exercise group completed the programme. Over 6 months, the mean treatment cost per patient in the exercise group was €41 more than "best care". The mean incremental QALY of intervention was 0.132 (95% CI: 0.104–0.286). Each extra QALY gained by the exercise programme relative to best care cost €311 (95% CI, €143–€394). The cost effectiveness acceptability curves showed a 90% probability that the addition of the walking programme is the best strategy if the ceiling of inversion is €350/QALY.

Conclusion

The invitation strategy and exercise programme resulted in a high rate of participation and is a feasible and cost-effective addition to best care. The programme is a cost-effective resource for helping patients to increase their physical activity, according to the recommendations of general practitioners. Moreover, the present study could help decision makers enhance the preventive role of primary care and optimize health care resources.

Trial Registration

[ISRCTN98931797]

Physical activity and perceived environmental attributes in a sample of Portuguese adults: results from the Azorean Physical Activity and Health study

OBJECTIVES

The aim of the present study was to determine whether the relation of perceived neighbourhood attributes to reported Physical Activity (PA) levels in Azorean adults varied by gender and body mass index (BMI).

METHODS

7330 adult participants (4104 women), aged 38.1+/-9.3 years, from the 2004 Azorean Physical Activity and Health Study. They answered the Environmental Module and the short version of the International Physical Activity Questionnaire (IPAQ). Height and weight were self-reported.

RESULTS

After adjustments for age, BMI, education level and island of residence, the dimension Infrastructures, Access to destinations, Social environment and Aesthetics was positively associated with moderate PA level and Health-Enhancing Physical Activity (HEPA) level, only in women. When participants were categorized by BMI status, the same dimension was a significant predictor for moderate PA level in normal weight men and women, and for HEPA level only in overweight/obese women, after controlling for age, education level and island of residence.

CONCLUSIONS

The dimension Infrastructures, Access to destinations, Social environment and Aesthetics was predictors of higher PA levels in Azorean adults. Targeted programs for Azoreans to increase PA levels should consider that this set of environmental features seem to act synergistically and are positively associated with PA.