The prevalence of obesity and its determinants in urban and rural aging Mexican populations

In hindsight: urban exposure explains the association between prior migration and current health of older adults in Mexico

OBJECTIVE

This study examines sex differences in the association between migration and exposure to an urban environment and overweight, hypertension and diabetes in later life.

METHODS

Interviews were conducted with 3,604 adults aged 50 and older in the Mexican Family Life Survey (MxFLS). Logistic regression analyses were used to examine the association between previous migration, urban exposure, and risk of overweight, hypertension, and diabetes.

RESULTS

Migration itself was not associated with health outcomes after controlling for urban exposure. The risk of overweight and diabetes associated with urban exposure appeared to be greater for men. Sex differences were found in the covariates that helped explain differences in health between those with high and low urban exposure.

DISCUSSION

These findings underscore the need to consider heterogeneity in health by urban exposure and by sex.

Body composition and fat distribution among older Jat females: a rural-urban comparison

The aim of the present cross-sectional study is to describe and compare age related changes in body composition and fat patterning among rural and urban Jat females of Haryana State, India. A total of 600 females (rural=300, urban=300), ranging in age from 40 to 70 years were selected by the purposive sampling method. Body weight, height, two circumferences (waist and hip) and skinfold thickness at five different sites (biceps, triceps, calf, subscapular, and supra-iliac) were taken on each participant. To study total adiposity, indices such as body mass index (BMI), grand mean thickness (GMT), total body fat and percentage fat were analyzed statistically. The fat distribution pattern was studied using waist/hip ratio, subscapular/triceps ratio and responsiveness of five skinfold sites towards accumulation of fat at different sites with advancing age. Results indicate a decline in almost every dimension including level of fatness between the mid-fourth and mid-fifth decades of life in both rural and urban females. Urban Jat females were heavier (57.36 kg vs. 56.07 kg, p>0.05) and significantly taller (1553.3mm vs. 1534.5mm, p<0.001) than their rural counterparts. Urban females also exhibited higher mean values for both the circumferences, five skinfold thicknesses as well as for lean body mass, total fat and percentage fat than the rural females. This is also evident from their higher mean values for body mass index and grand mean thickness. Waist/hip ratio values in rural and urban females showed upper body fat predominance, with urban females having relatively more abdominal fat. Results of subscapular/triceps ratio showed that rural and urban females gained proportionally similar amounts of subcutaneous fat at trunk and extremity sites until 45 years of age. Subsequently trunk skinfolds increased relatively more in thickness. The magnitude of this increase was comparatively greater in rural females up to 55 years and among urban females from 55 to 70 years. The profiles of subcutaneous fat accumulation and sensitivity of each skinfold site also revealed more fat deposition in the trunk region compared to extremities in both rural and urban females. The present study demonstrated differential rates of fat redistribution among rural and urban females.

Envelhecimento, obesidade e consumo alimentar em idosos

RESUMO Com o envelhecimento da população predominam as enfermidades crônicas e, nesse conjunto, destaca-se a obesidade, por sua prevalência sempre crescente nos diversos grupos etários, incluindo os idosos, e por suas complicações, quer de forma isolada ou associada a outros eventos mórbidos, como: hipertensão arterial, diabetes mellitus não-insulino dependente e doenças cardiovasculares, enfermidades com prevalências já elevadas entre pessoas idosas. A obesidade, considerada um problema de saúde pública, representa para o idoso um risco adi cional de importância considerável. Apesar dos múltiplos fatores que determinam o consumo alimentar, aspectos relacionados à adoção de dietas com elevado valor energético, ricas em gorduras de origem animal, açúcares, alimentos refinados e com reduzido teor de frutas, verduras e fibras, sugerem contribuição favorável à ocorrência da obesidade.

Socio-demographic, behavioral and functional characteristics of groups of community and institutionalized elderly Quechua Indians of Peru, and their association with nutritional status

Socio-demographic, behavioral, functional and anthropometric data for groups of elderly Quechua Indians of Peru were used to investigate the effects of gender and lifestyle patterns on nutritional status. Two community-dwelling samples were selected for study, representative of divergent lifestyles in terms of their combination of socio-economic, demographic and cultural contexts, plus an ad-hoc sample of institutionalized individuals with controlled food intake and reduced physical activity. Results suggest that differences in socio-demographic, behavioral and functional characteristics exist between the sexes and across settings (low- vs. highland) and lifestyles (institutionalized vs. community-dwelling; semi-urban vs. rural). These factors are likely to be related to diverging dietary and physical activity patterns, and have considerable effects on the nutritional status of the respondents.

Epidemiology of obesity and hypertension and related risk factors in Uzbekistan

OBJECTIVE

This study examined the prevalence of obesity and hypertension and associated behavioral risk factors in adult men and women in Uzbekistan. The study also examined the association between obesity and hypertension.

METHOD

The analysis used data from the 2002 Uzbekistan Health Examination Survey, which included a nationally representative sample of 2333 men aged 15-59 years and 5463 women aged 15-49 years. The survey measured height, weight and blood pressure and included questions on physical activity, dietary habits, tobacco smoking, alcohol use and other characteristics. The analysis was conducted using binary and multinomial logistic regression methods, separately for men and women.

RESULTS

Eating animal source protein and tobacco smoking in the past were positively associated with obesity, but there were no consistent associations with other dietary indicators, physical activity level or alcohol use. Obese men and women were about three times as likely to suffer from hypertension as those with a normal BMI (odds ratio (OR)=3.01; 95% confidence interval (CI): 1.67-5.44; P<0.001 for men and OR=2.82; 95% CI: 2.05-3.86; P<0.001 for women), independent of physical activity level, dietary habits, tobacco smoking and other factors. For men, the risk of hypertension was strongly positively associated with BMI only at BMI levels above 25 kg/m(2), but for women a positive relationship was observed at all BMI levels.

CONCLUSION

The study found a strong positive association between obesity and hypertension in adult men and women in Uzbekistan. The shape of the relationship between BMI and hypertension is different for women than for men, requiring further research to explore this relationship.

Assessment of physical education time and after-school outdoor time in elementary and middle school students in south Mexico City: the dilemma between physical fitness and the adverse health effects of outdoor pollutant exposure

Strategies to promote lifelong physical activity among children are needed to stem the adverse health consequences of inactivity. However, the health effects in growing children of long-term exposure to a polluted atmosphere are of deep concern. The atmosphere of south Mexico City (SMC) is characterized by a complex mixture of air pollutants, including ozone, particulate matter, and aldehydes. Radiological evidence suggests that small-airway disease could be present in clinically healthy, tobacco unexposed SMC children. The aim of this study was to assess, by means of a self-reported questionnaire, the physical education class times, daily outdoor after-school exposure time, and tobacco exposure in students attending public elementary and middle schools in SMC. Additionally, the time each student spent viewing television was assessed, and the authors measured each student's weight and height to determine body mass index (BMI, weight in kg divided by height in m2). The survey included 1,159 students in grades 7-9. The authors identified 2 critical periods of outdoor exposure in SMC children that coincided with significant concentrations of both ozone and particulate matter with diameters less than 10 micrometers (PM10): during school time after 11:00 A.M. and in the after-school outdoor activity period, usually extending from 1:00 P.M. to 6:00 P.M. Thirty-two percent of elementary and 61% of middle school students have physical education classes after 11:00 A.M. Students in SMC spend an average of 19.6 hr/wk outdoors in the after-school period, during which time they are engaged in light to moderate physical activities. Half of the students are exposed to tobacco smoke at home, and 7% of middle school students smoke. On the basis of BMI, 60% of students were classified as undernourished, overweight, or obese. No correlations were found between BMI and time spent viewing TV, time outdoors (on weekdays and weekends), or exposure to environmental tobacco smoke. Children and adolescents in SMC are participating in physical activities that enhance multiple components of health-related fitness. However, their activities occur outdoors, where they are exposed to high concentrations of air pollutants throughout the year. The authors believe that SMC children and adolescents must be educated, through both the school and health systems, regarding ways to obtain the necessary exercise while protecting themselves from the high concentrations of pollutants. Individuals should instruct and encourage young people to be involved in lifetime fitness activities and to eat balanced diets, if the goal is to control health-care costs, reduce disease incidence, and improve the overall quality of life of the Mexico City population.

Impact of obesity on hypogonadism in the andropause

Obesity is an issue that is increasingly affecting ageing men. With ageing, there is a decline in androgens as well. There are implications for the health of ageing men as a result of hypogonadism. Overall, there seems to be an inverse relationship between body mass index and testosterone levels, as is also demonstrated in our cross-sectional study. Obesity seems to depress the production of testosterone. It has been hypothesized that there is increased aromatization of testosterone to oestradiol and alteration of the hypothalamic-pituitary-adrenal axis in obese older men. Some hormones can affect obesity in ageing men including leptin, insulin, dehydroepiandrostenedione and growth hormone. The relationship of obesity to these hormones in ageing men will be reviewed. Testosterone replacement in ageing men can alter body composition whereby fat is exchanged for muscle. These studies will also be reviewed. Further studies in this field are recommended to evaluate long-term benefits and risks.

Total and central obesity among elderly Hispanics and the association with Type 2 diabetes

OBJECTIVE

To report the prevalence of total and central obesity in a representative sample of Puerto Rican and Dominican elders in Massachusetts, to compare them with a neighborhood-based group of non-Hispanic white elders, and to examine associations of obesity indices with the presence of type 2 diabetes.

RESEARCH METHODS AND PROCEDURES

We examined the prevalence of overweight, obesity, and central obesity in 596 Hispanics of Caribbean origin, ages 60 to 92 years, and 239 non-Hispanic whites, and tested linear and logistic regression models to determine associations among body mass index (BMI), waist circumference (WC), and diabetes.

RESULTS

Obesity (BMI > or = 30 kg/m(2)) was prevalent among all ethnic groups, ranging from 17% to 29% for Dominican and Puerto Rican men, respectively, and from 29% to 40% for non-Hispanic white and Dominican women, respectively. These differences were not statistically significant. Among Hispanic men and women, diabetes was prevalent across all BMI and WC categories but tended to be greatest among those with BMI of 25 to 29 kg/m(2) (41% to 43%). In contrast, diabetes was most prevalent in the obese group (36% to 45%) of non-Hispanic whites. Both BMI and WC were associated with the presence of diabetes, but the coefficients were greater for non-Hispanic whites than for Hispanics.

DISCUSSION

Caribbean Hispanics and non-Hispanic whites living in the same Massachusetts localities had high prevalences of overweight and obesity. Total and central obesity exerted a differential effect on the presence of diabetes among ethnic groups; for Hispanics, diabetes was prevalent even among non-obese individuals, whereas for non-Hispanic white women, the prevalence of diabetes was strongly associated with total and central obesity. Additional research is needed to investigate the factors associated with the differential effect of obesity on the prevalence of type 2 diabetes among Hispanic and non-Hispanic white elders.

Obesity trends in Latin America: transiting from under- to overweight

Latin America is undergoing a rapid demographic and nutritional transition. A recent WHO/PAHO survey on obesity in the region revealed an increasing trend in obesity as countries emerge from poverty, especially in urban areas. In contrast, in middle income countries, obesity tends to decline as income increases; this is especially so in women. Dietary changes and increasing inactivity are considered the crucial contributory factors that explain this rise. The end result is a progressive rise in overweight and obesity, especially in low income groups who improve their income and buy high fat/high carbohydrate energy-dense foods. Intake of these foods increases to the detriment of grains, fruits and vegetables. Most aboriginal populations of the Americas have changed their diet and physical activity patterns to fit an industrialized country model. They now derive most of their diet from Western foods and live sedentary and physically inactive lives. Under these circumstances they develop high rates of obesity, insulin resistance and type 2 diabetes. Supplementary feeding programs are common in the region; the number of beneficiaries significantly exceeds the malnourished. Weight-for-age definition of undernutrition without assessment of length will overestimate the dimension of malnutrition and neglect the identification of stunted overweight children. Providing food to low income stunted populations may be beneficial for some, although it may be detrimental for others, inducing obesity especially in urban areas. Defining the right combination of foods/nutrients, education and lifestyle interventions that are required to optimize nutrition and health is a present imperative.

Hyperinsulinemia and abdominal obesity are more prevalent in non-diabetic subjects with family history of type 2 diabetes

BACKGROUND

This study was undertaken in order to identify the relationships between family history of type 2 diabetes and cardiovascular risk factors in non-diabetic Mexican individuals.

METHODS

The design was a cross-sectional, population-based study stratified by age and sex. Participants consisted of 189 non-diabetic volunteers 30-64 years of age, both males and non-pregnant females randomly selected from a middle income neighborhood in Durango, Mexico and distributed into two groups, with and without family history of type 2 diabetes mellitus. Hypertensive subjects were excluded. Body mass index (BMI) and waist-to-hip ratio (WHR) were assessed. Hematocrit, both fasting and 2-h post 75-g glucose load insulin, and glucose levels, lipid profile, serum albumin, and proteinuria were measured.

RESULTS

Ninety-four (49.7%) individuals with family history of type 2 diabetes, and 95 (50.3%) in the control group were included. The prevalence of obesity was greater among women with family history of diabetes, 39 (73.6%) vs. 27 (50.0%) of the control group, p = 0.02. Adiposity tended to be centrally distributed in 86 subjects, of whom 22 (25. 6%) males and 54 (62.8%) females were in the group with family history of diabetes and four (4.6%) males and six (7.0%) females in the control group, p <0.000. Multivariate logistic regression analysis showed a strong relationship between family history of type 2 diabetes with both abdominal obesity (odds ratio [OR] 4.2, CI 95% 1.9-10.1, p <0.05) and fasting hyperinsulinemia (OR 3.1, CI 95% 1. 4-11.2, p <0.05).

CONCLUSION

In the absence of additional risk factors such as diabetes and hypertension, there is a strong relationship between family history of diabetes with hyperinsulinemia and abdominal obesity in middle-aged Mexican individuals.