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Glintborg D, Ollila MM, Møller JJK, Pesonen P, Persson S, Elenis E, Rubin KH, Gissler M, Andersen MS, Sundström-Poromaa I, Piltonen T. Prospective risk of Type 2 diabetes in 99 892 Nordic women with polycystic ovary syndrome and 446 055 controls: national cohort study from Denmark, Finland, and Sweden. Hum Reprod 2024:deae124. [PMID: 38859639 DOI: 10.1093/humrep/deae124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/07/2024] [Indexed: 06/12/2024] Open
Abstract
STUDY QUESTION What is the prospective risk of Type 2 diabetes (T2D) in Nordic women with polycystic ovary syndrome (PCOS) compared to controls? SUMMARY ANSWER A diagnosis of PCOS and BMI ≥30 kg/m2 is a high-risk phenotype for a prospective risk of T2D diagnosis across Nordic countries. WHAT IS KNOWN ALREADY The risk of T2D in women with PCOS is increased. The risk of T2D is related to BMI and the magnitude of risk in normal weight women with PCOS has been discussed. However, prospective data regarding risk of T2D in population-based cohorts of women with PCOS are limited. STUDY DESIGN, SIZE, DURATION This national register-based study included women with PCOS and age-matched controls. The main study outcome was T2D diagnosis occurring after PCOS diagnosis. T2D was defined according to ICD-10 diagnosis codes and/or filled medicine prescriptions of anti-diabetic medication excluding metformin. PARTICIPANTS/MATERIALS, SETTING, METHODS The study cohort included women originating from Denmark (PCOS Denmark, N = 27 016; controls, N = 133 994), Finland (PCOS Finland, N = 20 467; controls, N = 58 051), and Sweden (PCOS Sweden, N = 52 409; controls, N = 254 010). The median age at cohort entry was 28 years in PCOS Denmark, Finland, and Sweden with a median follow-up time (interquartile range) in women with PCOS of 8.5 (4.0-14.8), 9.8 (5.1-15.1), and 6.0 (2.0-10.0) years, respectively. Cox regression analyses were adjusted for BMI and length of education. MAIN RESULTS AND THE ROLE OF CHANCE The crude hazard ratio (HR, 95% CI) for T2D diagnosis in women with PCOS was 4.28 (3.98-4.60) in Denmark, 3.40 (3.11-3.74) in Finland, and 5.68 (5.20-6.21) in Sweden. In adjusted regression analyses, BMI ≥30 vs <25 kg/m2 was associated with a 7.6- to 11.3-fold risk of T2D. In a combined meta-analysis (PCOS, N = 99 892; controls, N = 446 055), the crude HR for T2D in PCOS was 4.64 (3.40-5.87) and, after adjustment for BMI and education level, the HR was 2.92 (2.32-3.51). LIMITATIONS, REASONS FOR CAUTION Inclusion of more severe cases of PCOS in the present study design could have lead to an overestimation of risk estimates in our exposed population. However, some women in the control group would have undiagnosed PCOS, which would lead to an underestimation of T2D risk in women with PCOS. BMI data were not available for all participants. The present study should be repeated in study cohorts with higher background risks of T2D, particularly in populations of other ethnicities. WIDER IMPLICATIONS OF THE FINDINGS The prospective risk for diagnosis of T2D is increased in women with PCOS, and the risk is aggravated in women with BMI ≥30 kg/m2. STUDY FUNDING/COMPETING INTEREST(S) Funding in Denmark was from the Region of Southern Denmark, Overlægerådet, Odense University Hospital. Funding in Finland was from Novo Nordisk Foundation, Finnish Research Council and Sigrid Juselius Foundation, the National Regional Fund, Sakari Alhopuro Foundation and Finnish Diabetes Research Foundation. E.E. has received a research grant from Ferring Pharmaceuticals (payment to institution) and serves as medical advisor for Tilly AB, not related to this manuscript. The remaining authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Meri-Maija Ollila
- Research Unit of Clinical Medicine, Department of Obstetrics and Gynaecology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Jens-Jakob Kjer Møller
- OPEN-Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Paula Pesonen
- Faculty of Medicine, Infrastructure for Population Studies, University of Oulu, Oulu, Finland
| | - Sofia Persson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Evangelia Elenis
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Katrine Hass Rubin
- OPEN-Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Research unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Marianne Skovsager Andersen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Terhi Piltonen
- Research Unit of Clinical Medicine, Department of Obstetrics and Gynaecology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
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García-Mayor J, Moreno-Llamas A, De la Cruz-Sánchez E. How socioeconomic status affects weight status through health-related lifestyles: a latent class analysis. Eur J Cardiovasc Nurs 2023; 22:730-744. [PMID: 36316287 DOI: 10.1093/eurjcn/zvac101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 10/12/2023]
Abstract
AIMS Obesity levels have increased worldwide with serious public health concerns. However, weight status is related to socioeconomic status (SES), which may also influence health-related lifestyles. Here, we study the association between SES and obesity mediated by diet and physical activity. METHODS AND RESULTS Using cross-sectional data from 2006, 2011, 2014, and 2017 Spanish health surveys (the final sample consisted of 61 768 adults aged between 18 and 64 years), we conducted a latent class analysis to estimate health-related lifestyle clusters (based on dietary patterns and physical activity) and mediation analyses to evaluate the association of SES and obesity through the clustering of health-related lifestyles. In both men and women, SES was inversely related to obesity (P < 0.001) and positively related to healthier lifestyle classes (P < 0.001). Obesity was inversely related to healthier lifestyle classes (P < 0.001). A small-although significant-proportion mediated by the clustering of lifestyles was found as follows: 4.9%, 95% CI (6.6%, 3.2%) in men and 2.3%, 95% CI (3.4%, 1.3%) in women for educational attainment, 5.3%, 95% CI (7.2%, 3.6%) in men and 2.0%, 95% CI (2.9%, 1.1%) in women for occupational social class, and 4.9%, 95% CI (6.5%, 3.1%) and 1.9%, 95% CI (2.9%, 1.1%) combining the above two SES indicators. CONCLUSIONS SES is related to obesity through clustering health-related lifestyles, with greater emphasis on men. However, the complex relationship between SES and weight status also suggests other indicators that contribute to the social gradient of obesity.
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Affiliation(s)
- Jesús García-Mayor
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, C/Santa Alicia s/n, Murcia 30720, Spain
| | - Antonio Moreno-Llamas
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, C/Santa Alicia s/n, Murcia 30720, Spain
| | - Ernesto De la Cruz-Sánchez
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, C/Santa Alicia s/n, Murcia 30720, Spain
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Norrbäck M, Neovius M, Ottosson J, Näslund I, Bruze G. Earnings and work loss from 5 years before to 5 years after bariatric surgery: A cohort study. PLoS One 2023; 18:e0285379. [PMID: 37200271 DOI: 10.1371/journal.pone.0285379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/21/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND The personal economic impact of bariatric surgery is not well-described. OBJECTIVES To examine earnings and work loss from 5 years before to 5 years after bariatric surgery compared with the general population. SETTING Nationwide matched cohort study in the Swedish health care system. METHODS Patients undergoing primary bariatric surgery (n = 15,828) and an equal number of comparators from the Swedish general population were identified and matched on age, sex, place of residence, and educational level. Annual taxable earnings (primary outcome) and annual work loss (secondary outcome combining months with sick leave and disability pension) were retrieved from Statistics Sweden. Participants were included in the analysis until the year of study end, emigration or death. RESULTS From 5 years before to 5 years after bariatric surgery, earnings increased for patients overall and in subgroups defined by education level and sex, while work loss remained relatively constant. Bariatric patients and matched comparators from the general population increased their earnings in a near parallel fashion, from 5 years before (mean difference -$3,489 [95%CI -3,918 to -3,060]) to 5 years after surgery (-$4,164 [-4,709 to -3,619]). Work loss was relatively stable within both groups but with large absolute differences both at 5 years before (1.09 months, [95%CI 1.01 to 1.17]) and 5 years after surgery (1.25 months, [1.11 to 1.40]). CONCLUSIONS Five years after treatment, bariatric surgery had not reduced the gap in earnings and work loss between surgery patients and matched comparators from the general population.
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Affiliation(s)
- Mattias Norrbäck
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Martin Neovius
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Johan Ottosson
- Faculty of Medicine and Health, Department of Surgery, Örebro University, Örebro, Sweden
| | - Ingmar Näslund
- Faculty of Medicine and Health, Department of Surgery, Örebro University, Örebro, Sweden
| | - Gustaf Bruze
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
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Tudor C. The Nexus between Pollution and Obesity and the Magnifying Role of Media Consumption: International Evidence from GMM Systems Estimates. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10260. [PMID: 36011894 PMCID: PMC9407853 DOI: 10.3390/ijerph191610260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
The aim of this paper is to uncover the associations between air pollution, media consumption, and the prevalence of obesity. Based on data availability, this study draws on an unbalanced panel of 28 countries and develops and extracts relationships through robust System-General Method of Moments (Sys-GMM) estimators that account for the dynamic nature and high persistence of the variables of interest. In light of previous findings, economic development, trade openness, and government consumption are included as controls in the dynamic panel models. The estimation results consistently indicate that pollution is a strong determinant of obesity, a link that remains robust through the alternative proxies for pollution (i.e., total greenhouse gas emissions (GHG) and carbon (CO2) intensity of energy generation). However, CO2 intensity shows the strongest association with obesity. Furthermore, the findings indicate that media consumption is an independent and significant driver of obesity, whilst its inclusion among regressors further magnifies the impact and significance of the pollution factor. Moreover, the combined effect of media consumption and pollution significantly contributes to spurring obesity in all model specifications. Thus, a vicious cycle emerges between air pollution, media consumption, and obesity, with synergistic detrimental health effects. The current findings highlight the importance of continuing and consistent efforts to mitigate pollution and reach related low-carbon policy targets. Moreover, for the sustainable reduction and prevention of obesity, these efforts should be complemented by policy interventions and public campaigns aimed at "healthy" media consumption, such as encouraging regular physical exercise and healthy nutrition.
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Affiliation(s)
- Cristiana Tudor
- International Business and Economics Department, The Bucharest University of Economic Studies, 010374 Bucharest, Romania
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Glintborg D, Rubin KH, Kristensen SBM, Lidegaard Ø, T’Sjoen G, Burgwal A, Hilden M, Andersen MS. Socioeconomic status in Danish transgender persons: a nationwide register-based cohort study. Endocr Connect 2021; 10:1155-1166. [PMID: 34414901 PMCID: PMC8494405 DOI: 10.1530/ec-21-0119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Gender dysphoria could be associated with low socioeconomic status (SES). SES could be modified by age, ethnic background, and medical morbidity. AIM To determine SES in a national study population including transgender persons in Denmark. METHODS National register-based cohort study in Danish transgender persons and age-matched controls. The transgender study cohort included persons with ICD-10 diagnosis code of 'gender identity disorder' and/or persons with legal sex change and persons who fulfiled the inclusion criteria during 2000-2018. The main outcome measure was SES including personal income, occupational status, and education. RESULTS The cohort included 2770 transgender persons and 27,700 controls. In the transgender study cohort, 1437 were assigned male at birth (AMAB), median age (interquartile range, IQR) 26.0 (17.3) years, and 1333 were assigned female at birth (AFAB), median age 22.5 (10.3) years. Adjusting for age and sex, the relative risk ratio (RRR) of low vs high personal income was 5.6 (95% CI: 4.9; 6.3) in transgender persons compared to controls. The RRR of low vs high income was 6.9 (5.8; 8.3) in persons AMAB compared to control males and 4.7 (3.9; 5.6) in persons AFAB compared to control females. The RRR of low vs high income was 3.7 (3.2; 4.3) in transgender persons of Danish origin compared to controls. The Charlson comorbidity index was comparable in transgender persons vs controls. CONCLUSIONS Being transgender was negatively associated with SES. In transgender persons, the risk of low vs high income could be more pronounced in transgender persons of foreign origin.
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Affiliation(s)
- Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Correspondence should be addressed to D Glintborg:
| | - Katrine Hass Rubin
- Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Simon Bang Mohr Kristensen
- Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Øjvind Lidegaard
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Guy T’Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - Aisa Burgwal
- Department of Endocrinology and Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - Malene Hilden
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Gender Identity, Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Skovsager Andersen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Narita K, Amiya E. Social and environmental risks as contributors to the clinical course of heart failure. Heart Fail Rev 2021; 27:1001-1016. [PMID: 33945055 DOI: 10.1007/s10741-021-10116-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 11/28/2022]
Abstract
Heart failure is a major contributor to healthcare expenditures. Many clinical risk factors for the development and exacerbation of heart failure had been reported, including diabetes, renal dysfunction, and respiratory disease. In addition to these clinical parameters, the effects of social factors, such as occupation or lifestyle, and environmental factors may have a great impact on disease development and progression of heart failure. However, the current understanding of social and environmental factors as contributors to the clinical course of heart failure is insufficient. To present the knowledge of these factors to date, this comprehensive review of the literature sought to identify the major contributors to heart failure within this context. Social factors for the risk of heart failure included occupation and lifestyle, specifically in terms of the effects of specific occupations, occupational exposure to toxicities, work style, and sleep deprivation. Socioeconomic factors focused on income and education level, social status, the neighborhood environment, and marital status. Environmental factors included traffic and noise, air pollution, and other climate factors. In addition, psychological stress and behavior traits were investigated. The development of heart failure may be closely related to these factors; therefore, these data should be summarized for the context to improve their effects on patients with heart failure. The present study reviews the literature to summarize these influences.
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Affiliation(s)
- Koichi Narita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, 113-8655, Tokyo, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, 113-8655, Tokyo, Japan. .,Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, 113-8655, Tokyo, Japan.
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Earnings and employment for women after bariatric surgery: a matched cohort study. Int J Obes (Lond) 2021; 45:766-775. [PMID: 33495524 DOI: 10.1038/s41366-021-00737-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 10/27/2020] [Accepted: 01/04/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND/OBJECTIVES Bariatric surgery induces durable weight loss and improves health and quality of life. Less is known about how bariatric surgery affects labour market outcomes. This study examined the development of earnings and employment status among women with obesity who underwent bariatric surgery versus matched comparators. SUBJECTS/METHODS This study included two cohorts of women in Sweden who gave birth between 1992 and 2014: a cohort with bariatric patients and their full sisters (sister cohort) and a cohort with bariatric patients and comparators matched on BMI, education, birth year, and previous cardiovascular, psychiatric, and musculoskeletal inpatient care diagnoses (BMI-matched cohort). Taxable annual earnings were retrieved from the Swedish Income Tax Register from 2 years before to 5 years after surgery. Employment status was measured dichotomously (employed/not employed) based on earnings data. Adjusted mean and prevalence differences were estimated for earnings and employment by ordinary least squares regression. RESULTS The sister cohort included 1400 patient-sister pairs. At baseline, patients and their sisters were of similar age (38.3 vs. 38.6 years) but had different BMI (37.3 vs. 26.7 kg/m2). The BMI-matched cohort included 2967 patient-comparator pairs with similar age (36.1 vs. 36.2 years) and BMI (37.1 vs. 37.0 kg/m2) before surgery. During follow-up, similar developments of earnings and employment status were observed between bariatric patients and the comparators in both cohorts. When comparing absolute levels of earnings in the sister cohort, the difference in earnings at 2 years before surgery [mean difference -$4137 (95% CI -5245 to -3028)] was similar to the difference in earnings at 5 years after surgery [-$5620 (-7024 to -4215)]. Similar results were found in the BMI-matched cohort, but of smaller magnitude. CONCLUSIONS Bariatric surgery had little influence on the development of annual earnings and employment for women with obesity in Sweden over 5 years after surgery.
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Väisänen D, Kallings LV, Andersson G, Wallin P, Hemmingsson E, Ekblom-Bak E. Lifestyle-associated health risk indicators across a wide range of occupational groups: a cross-sectional analysis in 72,855 workers. BMC Public Health 2020; 20:1656. [PMID: 33148214 PMCID: PMC7641800 DOI: 10.1186/s12889-020-09755-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/23/2020] [Indexed: 11/20/2022] Open
Abstract
Background Identify and compare health risk indicators for common chronic diseases between different occupational groups. Methods A total of 72,855 participants (41% women) participating in an occupational health service screening in 2014–2019 were included. Occupation was defined by the Swedish Standard Classification of Occupation, and divided into nine major and additionally eight sub-major groups. These were analysed separately, as white- and blue-collar occupations and as low- and high-skilled occupations. Seven health risk indicators were self-reported: exercise, physical work situation, sitting at work and leisure, smoking, diet, and perceived health, whereas cardiorespiratory fitness, BMI and blood pressure were measured. These were further dichotomized (yes/no) and as clustering of risk indicators (≥3 vs. <3). Results The greatest variation in OR across sub-major and major occupational groups were seen for daily smoking (OR = 0.68 to OR = 5.12), physically demanding work (OR = 0.55 to OR = 45.74) and high sitting at work (OR = 0.04 to OR = 1.86). For clustering of health risk indicators, blue-collar workers had significantly higher clustering of health risks (OR: 1.80; 95% CI 1.71–1.90) compared to white-collar workers (reference). Compared to high-skilled white-collar workers, low-skilled white-collar workers had similar OR (2.00; 1.88–2.13) as high-skilled blue-collar workers (1.98; 1.86–2.12), with low-skilled blue-collar workers having the highest clustered risk (2.32; 2.17–2.48). Conclusion There were large differences in health risk indicators across occupational groups, mainly between high-skilled white-collar occupations and the other occupations, with important variations also between major and sub-major occupational groups. Future health interventions should target the occupational groups identified with the highest risk for effective disease prevention.
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Affiliation(s)
- Daniel Väisänen
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden.
| | - Lena V Kallings
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | | | | | - Erik Hemmingsson
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Elin Ekblom-Bak
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
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Chung W, Kim R. A Reversal of the Association between Education Level and Obesity Risk during Ageing: A Gender-Specific Longitudinal Study in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186755. [PMID: 32948024 PMCID: PMC7559988 DOI: 10.3390/ijerph17186755] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022]
Abstract
This study aimed to examine and quantify obesity risk across different education levels during ageing using the dataset of a nationally representative longitudinal survey. A total of 45,391 observations of 9991 individuals aged ≥45 years were included in this study. Obesity was defined as a body mass index of ≥25, according to a guideline for Asians by the World Health Organization, and education level was grouped into three categories. Socio-demographics, lifestyles, and health conditions were used as covariates. Adjusted odds ratios and predicted probabilities of obesity were computed and adjusted for a complex survey design. With respect to gender, education level and age were significantly associated with obesity risk, and the association was stronger in women than in men. Furthermore, education level was negatively associated with obesity risk in the middle age in each gender. However, the association became positive in the old age, specifically among highly educated women. Therefore, policy efforts to reduce obesity risk and the resulting education gradients should be established based on studies considering their old age. Further longitudinal studies are required to examine whether these findings are valid in other socio-cultural or economic settings.
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Affiliation(s)
- Woojin Chung
- Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea;
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea
| | - Roeul Kim
- Labor Welfare Research Institute, Korea Workers’ Compensation and Welfare Service, Seoul 07254, Korea
- Correspondence: ; Tel.: +82-2-2670-0448
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Molarius A, Lindén‐Boström M, Karlsson J. Desire to lose weight and need of weight loss support in the adult population-Results from a cross-sectional study in Sweden. Obes Sci Pract 2020; 6:373-381. [PMID: 32874672 PMCID: PMC7448151 DOI: 10.1002/osp4.412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Evidence-based methods to lose weight are important in tackling increasing obesity trends in adult populations. More knowledge about persons who want to lose weight and do not/do need weight loss support is necessary to design effective preventive practices. Thus, the aim of the study was to investigate the prevalence of desire to lose weight in the general population and the prevalence of health problems and health-related factors in persons with overweight or obesity who want to lose weight and believe that they do not/do need weight loss support. METHODS The study included 14 126 persons aged 30 to 69 years who responded to a questionnaire sent to a random sample. Persons with overweight or obesity (BMI ≥ 25 kg/m2) were divided into three groups: those who do not want to lose weight (n = 1236), those who want to lose weight but do not believe they need support (n = 5484), and those who want to lose weight and believe they need weight loss support (n = 1462). RESULTS In total, 69% of the women and 59% of the men reported that they wanted to lose weight. The prevalence of hypertension, musculoskeletal pain, poor self-rated health, anxiety/worry, and depression was highest among persons with overweight or obesity who wanted to lose weight and believed they need weight loss support. They were also more physically inactive and reported less social support. CONCLUSIONS To want to lose weight is very common among adults. People with overweight or obesity who want to lose weight and believe they need weight loss support have higher frequency of various health problems, including mental health problems, and less social support.
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Affiliation(s)
- Anu Molarius
- Centre for Clinical ResearchRegion VärmlandKarlstadSweden
- Department of Public Health SciencesKarlstad UniversityKarlstadSweden
| | | | - Jan Karlsson
- University Health Care Research Center, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
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Chung W, Lim S. Factors contributing to educational differences in obesity among women: evidence from South Korea. BMC Public Health 2020; 20:1136. [PMID: 32690084 PMCID: PMC7370452 DOI: 10.1186/s12889-020-09221-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background Obesity is more prevalent among less-educated women than highly-educated women around the world. However, little is known about the factors which cause this difference in obesity, and almost nothing is known about how the individual factors which explain differences in education among women alone contribute to obesity. In this study, we identified the factors which help explain the relationship between education and obesity in women, and quantified their separate contributions to obesity. Methods We analyzed information on 14,577 women aged 25 years or over using datasets from the Korea National Health and Nutrition Examination Survey (2010–2014). We divided the women into two education groups: women who had, at most, finished high school (less-educated women), and women who had college degrees and beyond (highly-educated women). Using an extended Oaxaca-Blinder method, we decomposed the difference in obesity prevalence between the two education groups into the contributions (%) due to two effects: composition effect and association effect. Results Obesity was more than twice as prevalent among the less-educated women (34.3%) than it was among the highly-educated women (16.0%). The composition effect—contribution of differences in the distribution of observed characteristics compared to that of the difference in obesity prevalence between the two education groups—was 38.2%. The association effect—contributions of differences in the estimated coefficients of characteristics compared to that of the difference in obesity prevalence between the two education groups—was 55.8%, of which lifestyle factors were the most important contributor (43.6%). Of the separate contributions of each factor, the association effect of the factor related to women’s stress exhibited the largest contribution (23.0%). Conclusion We suggest that to effectively mitigate the high prevalence of obesity among less-educated women, it may be necessary to help low-educated women who do not feel stressful develop strategies to combat their higher risk of obesity. We also suggest the need to conduct decomposition studies in countries which show significant relationships between education and obesity among women, and to create targeted policies to reduce this population’s overall risk of obesity.
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Affiliation(s)
- Woojin Chung
- Department of Health Policy and Management, Graduate School of Public Health and Institute of Health Services Research, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Seungji Lim
- Health Insurance Research Institute, National Health Insurance Service, 32, Sambo-ro, Wonju-si, Gangwon-do, 26464, Republic of Korea.
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12
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Hossin MZ, Björk J, Koupil I. Early-life social and health determinants of adult socioeconomic position: associations and trends across generations. J Epidemiol Community Health 2020; 74:412-420. [PMID: 31988239 PMCID: PMC7307663 DOI: 10.1136/jech-2019-213209] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/23/2019] [Accepted: 01/11/2020] [Indexed: 11/23/2022]
Abstract
Background Social and biological circumstances at birth are established predictors of adult socioeconomic position (SEP). This study aims to assess the trends in these associations across two generations and examine the effects of parental early-life characteristics on descendants’ adult SEP. Methods We studied men and women born in the Uppsala University Hospital 1915–1929 (G1) and their offspring born 1932–1960 (G2). Data were collected in archives and routine registers. Adult SEP was assessed as an aggregate measure combining education and occupation. The exposures were family SEP, mother’s marital status, mother’s parity, mother’s age, standardised birth weight, gestational length and birth multiplicity. Linear regression was used to examine the associations across generations. Results The difference in adult SEP between low and high family SEP at birth was 15.8 (95% CI: 13.3 to 18.3) percentage points smaller in G2 compared with G1, although a considerable difference was still evident in G2. The associations of adult SEP with small birth weight for gestational age, post-term birth and high parity were stable between the generations: the generational differences in adjusted coefficients were 1.5 (95% CI: −1.1 to 4.1), 0.6 (–1.7 to 2.9) and 1.8 (–0.2 to 3.8) percentage points, respectively. The association between grandparental and grandchildren’s SEPs was largely explained by parental socioeconomic conditions. Father’s preterm birth was independently associated with offspring’s SEP. Conclusion The stability of the associations between early-life biological disadvantages and adult SEP and the persistent, although attenuated, association between early-life and adult SEPs necessitates increased policy attention to both social and health conditions at birth.
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Affiliation(s)
| | - Jonas Björk
- Department of Occupational and Environmental Medicine, Lunds Universitet, Lund, Sweden
| | - Ilona Koupil
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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13
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García-Esquinas E, Rodríguez-Sánchez I, Ortolá R, Lopez-Garcia E, Caballero FF, Rodríguez-Mañas L, Banegas JR, Rodríguez-Artalejo F. Gender Differences in Pain Risk in Old Age: Magnitude and Contributors. Mayo Clin Proc 2019; 94:1707-1717. [PMID: 31486377 DOI: 10.1016/j.mayocp.2019.03.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/19/2019] [Accepted: 03/26/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To identify the factors associated with the excess risk of pain observed among older women compared with men. PATIENTS AND METHODS We used information from a cohort of 851 women and men age 63 years and older who were free of pain during 2012 and were followed up to December 31, 2015. Sociodemographic variables, health behaviors, psychosocial factors, morbidity, and functional limitations were assessed in 2012 during home visits. Incident pain in 2015 was classified according to its frequency, intensity, and number of localizations into lowest, middle, and highest categories. RESULTS During a mean follow-up of 2.8 years, the incidence of middle and highest pain was 12.5% and 22.6% in women and 12.4% and 12.6% in men, respectively. The age-adjusted relative risk ratios and 95% CIs of middle and highest pain in women versus men were 1.20 (0.79-1.83) and 2.03 (1.40-2.94), respectively. In a mediation analysis, a higher frequency in women than men of osteomuscular disease, impaired mobility, and impaired agility accounted, respectively, for 31.1%, 46.6%, and 32.0% of the excess risk of highest pain in women compared with men. Other relevant mediators were psychological distress (25.2%), depression (8.7%), poor sleep quality (10.7%), and lower recreational physical activity (12.6%). CONCLUSION A greater frequency of some chronic diseases, worse functional status, psychological distress, and lower physical activity can mediate the excess risk of pain in older women compared with men. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02804672.
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Affiliation(s)
- Esther García-Esquinas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/ IdiPaz, Spain; Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain.
| | - Isabel Rodríguez-Sánchez
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/ IdiPaz, Spain; Department of Geriatric Medicine, Hospital Universitario La Paz/ IdiPaz, Madrid, Spain
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/ IdiPaz, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/ IdiPaz, Spain; Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
| | - Francisco Félix Caballero
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/ IdiPaz, Spain; Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
| | - Leocadio Rodríguez-Mañas
- Department of Geriatric Medicine, Hospital Universitario de Getafe and CIBER of Frailty and Healthy Ageing, Getafe, Spain
| | - José R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/ IdiPaz, Spain; Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/ IdiPaz, Spain; Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
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Tanwi TS, Chakrabarty S, Hasanuzzaman S, Saltmarsh S, Winn S. Socioeconomic correlates of overweight and obesity among ever-married urban women in Bangladesh. BMC Public Health 2019; 19:842. [PMID: 31253123 PMCID: PMC6599309 DOI: 10.1186/s12889-019-7221-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 06/20/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The escalating prevalence of overweight and obesity globally is reflected amongst urban women in many low-to-middle income countries. Evidence also shows that overweight and obesity is an increasing trend in Bangladesh. The present study assessed the prevalence and socioeconomic determinants of overweight and obesity among urban women in Bangladesh. METHODS Data were extracted from Bangladesh Demographic and Health Survey (BDHS) 2014. A two-stage stratified sampling technique has been used for data collection in this cross-sectional survey. A sample of 1701 ever-married non-pregnant urban women aged 15-49 years was selected for statistical analysis. Descriptive analysis, multiple binomial logistic regression analysis were executed in this study. RESULTS The prevalence of overweight and obesity was 34% (95% CI, 0.30-0.38) among urban Bangladeshi women. The probability of being overweight and obese increased with increasing age and wealth index. The likelihood of being overweight and obese among the oldest women surveyed (40-49 years) was 4.3 times (OR = 4.3, 95% CI: 2.1-8.8) higher relative to the youngest women (15-19 years). The wealthiest women had 4.1 times (OR = 4.1, 95% CI: 2.5-6.7) higher likelihood of being overweight and obese compared to the reference group of poorest women. Women having higher education (OR = 1.7, 95% CI: 1.0-2.6) were more likely to be overweight and obese. However, women who were no longer living with their husband or separated from their husband were (OR = 0.4, 95% CI: 0.2-0.8) less likely to be overweight and obese. CONCLUSION This study provides evidence that a large number of urban women were overweight and obese in Bangladesh. Women having higher levels of education, being older and belonging in both poorer and richest wealth quintile were at risk of being overweight and obese. Appropriate health promoting interventions based on these factors should be envisaged to reduce this problem.
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Affiliation(s)
- Tania Sultana Tanwi
- Maternal and Child Health Division, icddr,b, Mohakhali, Dhaka, 1212 Bangladesh
- Department of Economics, Shahjalal University of Science & Technology, Sylhet Kumargaon, Sylhet, 3114 Bangladesh
| | - Sayan Chakrabarty
- Faculty of Business, Education, Law and Arts, University of Southern Queensland, Springfield, QLD 4300 Australia
| | - Syed Hasanuzzaman
- Department of Economics, Shahjalal University of Science & Technology, Sylhet Kumargaon, Sylhet, 3114 Bangladesh
| | - Sue Saltmarsh
- School of Teacher Education and Early Childhood, Faculty of Business, Education, Law and Arts, University of Southern Queensland, Springfield, Australia
| | - Stephen Winn
- School of Education, Edith Cowan University, Joondalup, Australia
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15
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Claassen MA, Klein O, Bratanova B, Claes N, Corneille O. A systematic review of psychosocial explanations for the relationship between socioeconomic status and body mass index. Appetite 2019; 132:208-221. [DOI: 10.1016/j.appet.2018.07.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/11/2018] [Accepted: 07/17/2018] [Indexed: 01/21/2023]
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16
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Rubin KH, Andersen MS, Abrahamsen B, Glintborg D. Socioeconomic status in Danish women with polycystic ovary syndrome: A register-based cohort study. Acta Obstet Gynecol Scand 2018; 98:440-450. [PMID: 30516823 DOI: 10.1111/aogs.13514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/01/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Low socioeconomic status (SES) may be associated with increased risk of polycystic ovary syndrome (PCOS) and vice versa. Possible associations between SES, obesity and ethnicity in PCOS are undetermined. MATERIAL AND METHODS National register-based study including women with PCOS aged 25 years or above (PCOS Denmark and an embedded cohort; PCOS Odense University Hospital [OUH]) and one control population. PCOS Denmark (n = 13 891) included women with PCOS in the Danish National Patient Register. Women in PCOS OUH underwent clinical examination (n = 814). Three age-matched controls were included per patient (n = 41 584). The main outcome measure was SES (personal income, occupational status and education). RESULTS The median (Q1; Q3) age of women in PCOS Denmark and controls was 33 (29; 39) years. Women with personal income in the lower tertile had a higher probability of a PCOS diagnosis than women in the high-income tertile (adjusted odds ratio [aOR] 1.5, 95% confidence interval [CI] 1.4-1.6). Women who were unemployed or on welfare payment (aOR 1.5, 95% CI 1.4-1.6), or who retired early (OR 1.8, 95% CI 1.7-2.0) had a higher probability of a PCOS diagnosis than women affiliated to the labor market. Women originating from the Middle East more often had PCOS (aOR 3.2, 95% CI 2.8-3.7) compared with women originating from Europe. In PCOS OUH, SES was lower in obese than in normal weight women. CONCLUSIONS A diagnosis of PCOS was associated with lower SES. In PCOS, women of foreign origin and women with obesity more often had low SES.
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Affiliation(s)
- Katrine H Rubin
- Odense Patient data Explorative Network-OPEN, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | | | - Bo Abrahamsen
- Odense Patient data Explorative Network-OPEN, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark.,Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
| | - Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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17
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Prevalence of Micronutrient Deficiency in Patients with Morbid Obesity Before Bariatric Surgery. Obes Surg 2018; 28:643-648. [PMID: 28849358 DOI: 10.1007/s11695-017-2902-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postoperative micronutrient deficiency is a known side effect of bariatric surgery. In this study, we examined the prevalence of micronutrient deficiency in patients with morbid obesity (MO) preoperatively. METHODS A total of 1732 patients with MO wishing to undergo bariatric surgery (age: 40 ± 12 years, mean BMI: 44 ± 9 kg/m2, means ± SD, 77.3% female) were analyzed in this cross-sectional examination. Iron state, vitamin B12, folic acid, 25hydroxy(OH)-vitamin D, PTH, vitamin A, and vitamin E levels were determined. Subsequently, patients underwent nutritional counseling and were substituted accordingly. RESULTS A total of 63.2% (n = 1094) of the patients had a deficit in folic acid (< 5.3 ng/ml), 97.5% (n = 1689) in 25OHvitamin D (< 75 nmol/l), and 30.2% (n = 523) had a PTH elevation (> 56.9 pg/ml). A total of 5.1% (n = 88) of the patients presented with a deficit in vitamin B12 (< 188 pg/ml) and 6.2% (n = 107) in vitamin A (< 1.05 μmol/l). A total of 9.6% (n = 166) exhibited iron deficiency (ferritin < 15 μg/l). None of the patients had a deficit in vitamin E. There were no gender differences except for ferritin deficiency (women 11.8% vs. men 1.5%, p < 0.001). Patients in the highest BMI tertile had significantly more often a deficit in vitamin D (p = 0.033) and folic acid (p < 0.001). Patients in the lowest age tertile had significantly more often a deficit in folic acid (p < 0.001). CONCLUSIONS Our data show a high prevalence of micronutrient deficiency in patients with morbid obesity preoperatively and emphasize the importance of exact preoperative evaluation and adequate substitution as well as postoperative surveillance.
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18
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Holowko N, Jones M, Tooth L, Koupil I, Mishra GD. Socioeconomic Position and Reproduction: Findings from the Australian Longitudinal Study on Women's Health. Matern Child Health J 2018; 22:1713-1724. [PMID: 29956129 DOI: 10.1007/s10995-018-2567-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To investigate the association of socioeconomic position (SEP) with reproductive outcomes among Australian women. METHODS Data from the Australian Longitudinal Study on Women's Health's (population-based cohort study) 1973-1978 cohort were used (N = 6899, aged 37-42 years in 2015). The association of SEP (childhood and own, multiple indicators) with age at first birth, birth-to-pregnancy (BTP) intervals and total number of children was analysed using multinomial logistic regression. RESULTS 14% of women had their first birth aged < 24 years. 29% of multiparous women had a BTP interval within the WHO recommendation (18-27 months). Women with a low SEP had increased odds of a first birth < 24 years: low (OR 7.0: 95% C.I. 5.3, 9.3) or intermediate education (OR 3.8: 2.8, 5.1); living in rural (OR 1.8: 1.5, 2.2) or remote (OR 2.1: 1.7, 2.7) areas; who found it sometimes (OR 1.8: 1.5, 2.2) or always difficult (OR 2.0: 1.6, 2.7) to manage on their income; and did not know their parent's education (OR 4.5: 3.2, 6.4). Low SEP was associated with having a much longer than recommended BTP interval. CONCLUSION As the first Australian study describing social differences in reproductive characteristics, these findings provide a base for reducing social inequalities in reproduction. Assisting adequate BTP spacing is important, particularly for women with existing elevated risks due to social disadvantage; including having a first birth < 24 years of age and a longer than recommended BTP interval. This includes reviewing services/access to postnatal support, free family planning/contraception clinics, and improved family policies.
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Affiliation(s)
- N Holowko
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Level 2, Public Health Building (887), Corner of Herston Rd and Wyndham St, Herston, QLD, 4006, Australia.
| | - M Jones
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Level 2, Public Health Building (887), Corner of Herston Rd and Wyndham St, Herston, QLD, 4006, Australia
| | - L Tooth
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Level 2, Public Health Building (887), Corner of Herston Rd and Wyndham St, Herston, QLD, 4006, Australia
| | - I Koupil
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Sveavägen 160, 10691, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - G D Mishra
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Level 2, Public Health Building (887), Corner of Herston Rd and Wyndham St, Herston, QLD, 4006, Australia
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Diet and physical activity as possible mediators of the association between educational attainment and body mass index gain among Australian adults. Int J Public Health 2018; 63:883-893. [PMID: 29687156 DOI: 10.1007/s00038-018-1100-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/19/2018] [Accepted: 04/06/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To quantify the mediating role of leisure time physical activity (LTPA) and five dietary behaviours on educational differences in 13-year body mass index (BMI) gain across adulthood. METHODS Participants from the Melbourne Collaborative Cohort Study (4791 women; 3103 men) who maintained or gained BMI over 1990-1994 to 2003-2007 and met our inclusion criteria were selected. Education, potential mediators and confounders (age, alcohol, and smoking) were measured at baseline. We conducted sex-specific multiple mediation analyses using MacKinnon's product of coefficients method. RESULTS A higher educational attainment was associated with a 0.27 kg m-2 (95% CI 0.14, 0.39) lesser 13-year BMI gain among women only. We observed significant indirect effects of educational attainment on 13-year BMI gain through LTPA and nutrient-rich foods (each associated with a higher educational attainment and lesser 13-year BMI gain) and diet soft drink (associated with a lower educational attainment and greater 13-year BMI gain), which mediated 10, 15 and 20% of this relationship, respectively (45% in total). CONCLUSIONS Nutrient-rich foods, LTPA and diet soft drink may represent effective public health targets to reduce inequities in excess weight across adulthood.
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20
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Kakoly NS, Earnest A, Moran LJ, Teede HJ, Joham AE. Group-based developmental BMI trajectories, polycystic ovary syndrome, and gestational diabetes: a community-based longitudinal study. BMC Med 2017; 15:195. [PMID: 29110650 PMCID: PMC5674239 DOI: 10.1186/s12916-017-0957-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 10/13/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Obesity is common in young women, increasing insulin resistance (IR) and worsening pregnancy complications, including gestational diabetes (GDM). Women with polycystic ovary syndrome (PCOS) are commonly obese, which aggravates the severity of PCOS clinical expression. Relationships between these common insulin-resistant conditions, however, remain unclear. METHODS We conducted a secondary analysis of the Australian Longitudinal Study on Women's Health (ALSWH) database, including data from 8009 women aged 18-36 years across six surveys. We used latent-curve growth modelling to identify distinct body mass index (BMI) trajectories and multinomial logistic regression to explore sociodemographic and health variables characterizing BMI group membership. Logistic regression was used to assess independent risk of GDM. RESULTS A total of 662 women (8.29%, 95% CI 7.68-8.89) reported PCOS. Three distinct BMI trajectories emerged, namely low stable (LSG) (63.8%), defined as an average trajectory remaining at ~25 kg/m2; moderately rising (MRG) (28.8%), a curvilinear trajectory commencing in a healthy BMI and terminating in the overweight range; and high-rising (HRG) (7.4%), a curvilinear trajectory starting and terminating in the obese range. A high BMI in early reproductive life predicted membership in higher trajectories. The HRG BMI trajectory was independently associated with GDM (OR 2.50, 95% CI 1.80-3.48) and was a stronger correlate than PCOS (OR 1.89, 95% CI 1.41-2.54), maternal age, socioeconomic status, or parity. CONCLUSION Our results suggest heterogeneity in BMI change among Australian women of reproductive age, with and without PCOS. Reducing early adult life weight represents an ideal opportunity to intervene at an early stage of reproductive life and decreases the risk of long-term metabolic complications such as GDM.
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Affiliation(s)
- Nadira Sultana Kakoly
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, 3168, Australia
| | - Arul Earnest
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, 3168, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, 3168, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, 3168, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, 3168, Australia.,Monash Partners Academic Health Sciences Centre, Melbourne, Victoria, Australia
| | - Anju E Joham
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, 3168, Australia. .,Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, 3168, Australia. .,School of Public Health and Preventive Medicine, Monash University, Locked bag 29, Monash Medical Centre, Clayton, Victoria, 3168, Australia.
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Fang C, Liang Y. Social disparities in body mass index (BMI) trajectories among Chinese adults in 1991-2011. Int J Equity Health 2017; 16:146. [PMID: 28814339 PMCID: PMC5559788 DOI: 10.1186/s12939-017-0636-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 07/24/2017] [Indexed: 12/21/2022] Open
Abstract
Background Obesity is a serious public health problem in China. The relationship between obesity and socio-economic status (SES) is changing and affected by uncertainty, particularly, in developing countries. The sex-related differences in body mass index (BMI) trajectories are controversial and require substantial empirical data for updating and enriching. Methods This study examined the relationship between SES and BMI in Chinese adults from a dynamic perspective using longitudinal data (1991–2011) from the China Health and Nutrition Survey (CHNS). Then, sex-related differences were determined. A hierarchical linear model was used. Results SES positively affected the male BMI changes, with faster BMI growth rates in the high-SES males over the past 20 years. By contrast, female BMI was only affected by BMI baseline and residential area. Specifically, greater BMI baseline led to greater BMI growth rate and earlier BMI decline. In the past 20 years, the BMI growth rate has been greater in the urban females than in the rural females. Conclusions The relationship between SES and obesity is complex in China, and a substantial sex-related difference exists. We argue that this large sex-related difference is due to the rapid economic and social changes that have affected national health and increased the gender inequality and social role restrictions in females. We provide insights for further research and policy recommendations.
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Affiliation(s)
- Changchun Fang
- School of Social and Behavioral Sciences, Nanjing University, 163 Xianlin Avenue, Qixia District, Nanjing, 210023, Jiangsu Province, People's Republic of China.
| | - Ying Liang
- School of Social and Behavioral Sciences, Nanjing University, 163 Xianlin Avenue, Qixia District, Nanjing, 210023, Jiangsu Province, People's Republic of China.
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Prescott E, Godtfredsen N, Osler M, Schnohr P, Barefoot J. Social gradient in the metabolic syndrome not explained by psychosocial and behavioural factors: evidence from the Copenhagen City Heart Study∗. ACTA ACUST UNITED AC 2016; 14:405-12. [PMID: 17568240 DOI: 10.1097/hjr.0b013e32800ff169] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Psychosocial stressors may mediate the effect of social status on the metabolic syndrome (MS). The paper explores this hypothesis in a random sample of the general population. DESIGN A total of 3462 women and 2576 men aged 20-97 years from the Copenhagen City Heart Study. METHODS An MS index was defined from the seven components: waist-hip ratio, high-density lipoprotein (HDL)-cholesterol, triglycerides, systolic blood pressure (SBP), blood glucose, C-reactive protein (CRP) and fibrinogen. Social status was measured by educational level. Psychosocial factors included fatigue and depression, perceived stress, social network and cohabitation. Behavioural factors were smoking, alcohol and physical activity. RESULTS There was an inverse social gradient in the prevalence of the seven components of the MS. The age-adjusted odds ratio (OR) (95% confidence interval) for occupying the most disadvantaged quintile, comparing highest with lowest educational level, were for men and women, respectively: waist-hip ratio 0.48 (0.34-0.69) and 0.48 (0.33-0.69); HDL-cholesterol 0.61 (0.45-0.84) and 0.46 (0.33-0.64); triglycerides 0.71 (0.51-0.98) and 0.37 (0.25-0.53); SBP 0.64 (0.44-0.92) and 0.76 (0.50-1.15); blood glucose 0.57 (0.41-0.80) and 0.55 (0.38-0.78); CRP 0.53 (0.37-0.74) and 0.44 (0.31-0.63), and fibrinogen 0.50 (0.35-0.70) and 0.56 (0.38-0.82). The pooled OR for having an MS index score of 3 or more was 0.32 (0.24-0.42) for highest versus lowest educational level. A higher fatigue and depression score in both sexes and a lack of social support in men were associated with the MS, as were smoking, low alcohol consumption and a lack of physical activity. However, OR for educational level were not affected by adjustment for the psychosocial or behavioural factors. CONCLUSIONS There is a strong inverse social gradient in the prevalence of the MS, which is not explained by psychosocial or major behavioural factors.
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Affiliation(s)
- Eva Prescott
- The Copenhagen City Heart Study, Bispebjerg University Hospital, Copenhagen, Denmark.
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Choi SW, Park DJ, Kim J, Park TJ, Kim JS, Byun S, Lee YS, Kim JH. Association between Obesity and Neighborhood Socioeconomic Status in Korean Adolescents Based on the 2013 Korea Youth Risk Behavior Web-Based Survey. Korean J Fam Med 2016; 37:64-70. [PMID: 26885325 PMCID: PMC4754289 DOI: 10.4082/kjfm.2016.37.1.64] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 07/31/2015] [Accepted: 09/24/2015] [Indexed: 11/13/2022] Open
Abstract
Background An increase in the obese adolescent population is being recognized as a serious medical and social problem. The present study aimed to examine the association between neighborhood socioeconomic status (SES) and obesity in Korean adolescents based on total available resources and local social inequality models. Methods The present study used data from the 2013 Korea Youth Risk Behavior Web-based Survey in analyzing 72,438 Korean adolescents aged 12–18. The analysis investigated obesity odds ratio (OR) according to neighborhood SES adjusted for age and individual SES indices, which included family affluence scale (FAS), education level of parents, cohabitation with parents, and weekly allowance. Obesity OR was investigated according to neighborhood SES by FAS, and according to FAS by neighborhood SES. Results After adjusting for age and individual SES variables, there was no significant association between neighborhood SES and adolescent obesity for either boys or girls. However, girls in the high FAS group showed a pattern of lower neighborhood SES being associated with a significant increase in risk of obesity; in the high neighborhood SES group, boys showed a pattern of higher FAS being associated with a significant increase in risk of obesity, whereas girls show a pattern of decrease. Conclusion Although limited, the present study demonstrated that some girl groups exhibited a pattern of lower neighborhood SES being associated with an increase in risk of obesity, as well as a gender-based difference in risk of obesity by individual SES. Therefore, measures to prevent adolescent obesity should be established with consideration for differences in risk according to individual and neighborhood SES.
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Affiliation(s)
- Sung Won Choi
- Department of Family Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Da-Jung Park
- Department of Family Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jinseung Kim
- Department of Family Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Tae-Jin Park
- Department of Family Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jun-Su Kim
- Department of Family Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sunghun Byun
- Department of Family Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young-Seok Lee
- Department of Family Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jung-Hoon Kim
- Department of Family Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Soler-Vila H, García-Esquinas E, León-Muñoz LM, López-García E, Banegas JR, Rodríguez-Artalejo F. Contribution of health behaviours and clinical factors to socioeconomic differences in frailty among older adults. J Epidemiol Community Health 2015; 70:354-60. [PMID: 26567320 DOI: 10.1136/jech-2015-206406] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/24/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND To examine the association between socioeconomic status (SES) and risk of frailty, and to assess whether behavioural and clinical factors (BCF) mediate this association. METHODS Cohort of 1857 non-institutionalised individuals aged ≥ 60 years recruited in 2008-2010 and followed through 2012. Education, occupation, and BCF were ascertained at baseline, and incident frailty was assessed at follow-up with the Fried frailty criteria. RESULTS Men showed no differences in frailty risk by education or occupation. Compared with women with university education, the adjusted OR (aOR) adjusted for age and the number of frailty criteria at baseline for incident frailty in women with primary or lower education was 3.02 (95% CI 1.25 to 7.30); once fully adjusted for BCF, the OR was 2.00 (95% CI 0.76 to 5.23). No alcohol intake (vs light-moderate), longer time spent watching TV, less time spent reading, and a higher frequency of obesity, depression and musculoskeletal disease in those with primary or lower education accounted for most of the decline in OR. BCF explained 50.5% of the excess frailty risk associated with lower education. The aOR of frailty incidence for manual versus non-manual occupation was 2.24 (95% CI 1.41 to 3.56) versus a fully aOR of 2.05 (95% CI 1.24 to 3.37). BCF explained 15.3% of the association, with individual mediators being similar to those for education-related differences. CONCLUSIONS A lower education or a manual occupation was associated with higher frailty risk in older women. These associations were partly explained by lower alcohol consumption, higher sedentariness, and higher obesity and chronic disease rates in women with lower SES.
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Affiliation(s)
- Hosanna Soler-Vila
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain Department of Public Health Sciences, Leonard Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Luz Ma León-Muñoz
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Esther López-García
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - José R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Abbott G, Backholer K, Peeters A, Thornton L, Crawford D, Ball K. Explaining educational disparities in adiposity: the role of neighborhood environments. Obesity (Silver Spring) 2014; 22:2413-9. [PMID: 25111375 DOI: 10.1002/oby.20853] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/23/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the extent to which characteristics of the neighborhood built environment explain the association between adiposity and educational qualifications in Australian women. METHODS A community sample of 1,819 women (aged 18-66) from the Melbourne SESAW study provided information regarding their body mass index (BMI) and level of education. Objective measures of participants' residential neighborhood built environments were obtained using a Geographic Information System. RESULTS Compared with women with a high school degree or above, women who did not complete high school had higher average BMI, which was partially explained by lower density of sports facilities and living less proximally to the coastline and to supermarkets. In a multiple mediator model, which explained 16.6% of the educational disparity in BMI, the number of sports facilities and presence of the coastline within 2 km of participants' homes were significant mediators of the observed socioeconomic disparity in BMI. CONCLUSIONS The residential neighborhood environment may help to explain socioeconomic patterning of overweight and obesity in Australian women. These results provide further support for considering the built environment in obesity prevention initiatives, suggesting a potential role in decreasing social inequalities in obesity.
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Affiliation(s)
- Gavin Abbott
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
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Kim J, Sharma SV, Park SK. Association between socioeconomic status and obesity in adults: evidence from the 2001 to 2009 Korea national health and nutrition examination survey. J Prev Med Public Health 2014; 47:94-103. [PMID: 24744826 PMCID: PMC3988287 DOI: 10.3961/jpmph.2014.47.2.94] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 01/16/2014] [Indexed: 01/03/2023] Open
Abstract
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.
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Affiliation(s)
- Jihye Kim
- Department of Epidemiology, University of Texas School of Public Health, Houston, TX, USA
| | - Shreela V Sharma
- Department of Epidemiology, Michael and Susan Dell Center for Healthy Living, University of Texas School of Public Health, Houston, TX, USA
| | - Sung Kyun Park
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Hajizadeh M, Campbell MK, Sarma S. Socioeconomic inequalities in adult obesity risk in Canada: trends and decomposition analyses. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2014; 15:203-221. [PMID: 23543117 DOI: 10.1007/s10198-013-0469-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 02/20/2013] [Indexed: 06/02/2023]
Abstract
This study examines trends in socioeconomic-related inequalities in obesity risk among Canadian adults (aged 18-65 years) from 2000 to 2010 using five nationally representative Canadian Community Health Surveys (CCHSs). We employed the concentration index (C) to quantify the socioeconomic inequalities in obesity risk across different demographic groups and geographic regions in each survey period. A decomposition analysis of inequality is performed to determine factors that lie behind income-related inequality in obesity risk. Although declining over time, the results show that there exists income-related inequality in obesity risk in Canada. The estimated Cs for men indicate that obesity is concentrated among the rich and its trend is increasing over time. The findings, however, suggest that obesity is more prevalent among economically disadvantaged women. While we found that obesity is mainly concentrated among the poor in the Atlantic Provinces, the degree of socioeconomic related inequality in obesity risk is increasing in these provinces. The results for Alberta showed that obesity is concentrated among the better-off individuals. The decomposition analysis suggests that factors such as demographics, income, immigration, education, drinking habits, and physical activity are the key factors explaining income-related inequality in obesity risk in Canada. Our empirical findings suggest that, in order to combat the obesity epidemic, health policies should focus on poorer females and economically well-off males.
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Affiliation(s)
- Mohammad Hajizadeh
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, N6A 5C1, Canada,
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Area-level socioeconomic characteristics, prevalence and trajectories of cardiometabolic risk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:830-48. [PMID: 24406665 PMCID: PMC3924477 DOI: 10.3390/ijerph110100830] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/10/2013] [Accepted: 12/20/2013] [Indexed: 01/04/2023]
Abstract
This study examines the relationships between area-level socioeconomic position (SEP) and the prevalence and trajectories of metabolic syndrome (MetS) and the count of its constituents (i.e., disturbed glucose and insulin metabolism, abdominal obesity, dyslipidemia, and hypertension). A cohort of 4,056 men and women aged 18+ living in Adelaide, Australia was established in 2000–2003. MetS was ascertained at baseline, four and eight years via clinical examinations. Baseline area-level median household income, percentage of residents with a high school education, and unemployment rate were derived from the 2001 population Census. Three-level random-intercepts logistic and Poisson regression models were performed to estimate the standardized odds ratio (SOR), prevalence risk ratio (SRR), ratio of SORs/SRRs, and (95% confidence interval (CI)). Interaction between area- and individual-level SEP variables was also tested. The odds of having MetS and the count of its constituents increased over time. This increase did not vary according to baseline area-level SEP (ratios of SORs/SRRs ≈ 1; p ≥ 0.42). However, at baseline, after adjustment for individual SEP and health behaviours, median household income (inversely) and unemployment rate (positively) were significantly associated with MetS prevalence (SOR (95%CI) = 0.76 (0.63–0.90), and 1.48 (1.26–1.74), respectively), and the count of its constituents (SRR (95%CI) = 0.96 (0.93–0.99), and 1.06 (1.04–1.09), respectively). The inverse association with area-level education was statistically significant only in participants with less than post high school education (SOR (95%CI) = 0.58 (0.45–0.73), and SRR (95%CI) = 0.91 (0.88–0.94)). Area-level SEP does not predict an elevated trajectory to developing MetS or an elevated count of its constituents. However, at baseline, area-level SEP was inversely associated with prevalence of MetS and the count of its constituents, with the association of area-level education being modified by individual-level education. Population-level interventions for communities defined by area-level socioeconomic disadvantage are needed to reduce cardiometabolic risks.
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Johnston DW, Lordan G. Weight perceptions, weight control and income: an analysis using British data. ECONOMICS AND HUMAN BIOLOGY 2014; 12:132-139. [PMID: 23578515 DOI: 10.1016/j.ehb.2013.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 02/21/2013] [Accepted: 02/21/2013] [Indexed: 06/02/2023]
Abstract
The aim of this paper is to better understand one of the mechanisms underlying the income-obesity relationship so that effective policy interventions can be developed. Our approach involves analysing data on approximately 9000 overweight British adults from between 1997 and 2002. We estimate the effect of income on the probability that an overweight individual correctly recognises their overweight status and the effect of income on the probability that an overweight individual attempts to lose weight. The results suggest that high income individuals are more likely to recognise their unhealthy weight status, and conditional on this correct weight perception, more likely to attempt weight loss. For example, it is estimated that overweight high income males are 15 percentage-points more likely to recognise their overweight status than overweight low income males, and overweight high income males are 10 percentage-points more likely to be trying to lose weight. An implication of these results is that more public education on what constitutes overweight and the dangers associated with being overweight is needed, especially in low income neighbourhoods.
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Affiliation(s)
- David W Johnston
- Centre of Health Economics Monash, University of Monash, Clayton Campus, Wellington Road, Clayton, Victoria 3800, Australia
| | - Grace Lordan
- School of Social Policy LSE, Houghton Street, London WC2A 2AE, United Kingdom.
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Gearon E, Backholer K, Hodge A, Peeters A. The mediating role of dietary factors and leisure time physical activity on socioeconomic inequalities in body mass index among Australian adults. BMC Public Health 2013; 13:1214. [PMID: 24359490 PMCID: PMC3912343 DOI: 10.1186/1471-2458-13-1214] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 12/12/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relationship between socioeconomic position and obesity has been clearly established, however, the extent to which specific behavioural factors mediate this relationship is less clear. This study aimed to ascertain the contribution of specific dietary elements and leisure-time physical activity (LTPA) to variations in obesity with education in the baseline (1990-1994) Melbourne Collaborative Cohort Study (MCCS). METHODS 18, 489 women and 12, 141 men were included in this cross-sectional analysis. A series of linear regression models were used in accordance with the products of coefficients method to examine the mediating role of alcohol, soft drink (regular and diet), snacks (healthy and sweet), savoury items (healthy and unhealthy), meeting fruit and vegetable guidelines and LTPA on the relationship between education and body mass index (BMI). RESULTS Compared to those with lowest educational attainment, those with the highest educational attainment had a 1 kg/m2 lower BMI. Among men and women, 27% and 48%, respectively, of this disparity was attributable to differences in LTPA and diet. Unhealthy savoury item consumption and LTPA contributed most to the mediated effects for men and women. Alcohol and diet soft drink were additionally important mediators for women. CONCLUSIONS Diet and LTPA are potentially modifiable behavioural risk factors for the development of obesity that contribute substantially to inequalities in BMI. Our findings highlight the importance of specific behaviours which may be useful to the implementation of effective, targeted public policy to reduce socioeconomic inequalities in obesity.
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Affiliation(s)
| | | | | | - Anna Peeters
- Obesity and population health unit, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
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Differential association between adherence to nutritional recommendations and body weight status across educational levels: a cross-sectional study. Prev Med 2013; 57:488-93. [PMID: 23845712 DOI: 10.1016/j.ypmed.2013.06.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 06/19/2013] [Accepted: 06/25/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The impact of diet quality and physical activity (PA) on weight might be different according to socioeconomic status. Our aim was to estimate associations between adherence to nutritional guidelines and BMI and the interaction with socioeconomic characteristics. METHODS A total of 11,931 men and 39,737 women from the NutriNet-Santé cohort (France, 2009-2012) were included in this cross-sectional analysis. The association between PNNS-GS (a score estimating adherence to French nutritional guidelines) and BMI was assessed by multivariate linear regression. A modified score (mPNNS-GS) separating diet quality from PA was also used. RESULTS BMI, overweight and obesity displayed an inverse gradient from less to more educated groups, whereas PNNS-GS increased. A higher PNNS-GS was associated with a lower BMI, more importantly in the less educated: BMI decrease ranged from -1.1% in less educated to -0.7% in more educated men and from -0.6% to -0.3% in women. The effect of mPNNS-GS and PA in particular was also stronger among less educated subjects. CONCLUSION Overall, better adherence to nutritional recommendations was inversely associated with BMI, and this association was stronger in the less educated groups. This suggests that nutritional policies should still concentrate on promoting access to a healthier diet and PA, especially among less educated individuals.
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León-Muñoz LM, Gutiérrez-Fisac JL, Guallar-Castillón P, Regidor E, López-García E, Martínez-Gómez D, Graciani A, Banegas JR, Rodríguez-Artalejo F. Contribution of lifestyle factors to educational differences in abdominal obesity among the adult population. Clin Nutr 2013; 33:836-43. [PMID: 24183662 DOI: 10.1016/j.clnu.2013.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 08/23/2013] [Accepted: 10/17/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND & AIMS This is the first study to systematically examine the behavioral factors that may explain the inverse association between education and abdominal obesity in adults. METHODS Cross-sectional study conducted among 3541 men and 3564 women representative of the population aged 25-64 years in Spain. Abdominal obesity was defined as waist circumference >102 cm in men and >88 cm in women. Analyzes were performed with logistic regression, with progressive adjustment for obesity-related behaviors. RESULTS The age-, sex- and town size-adjusted odds ratios for abdominal obesity were 1.69 in men and 1.85 in women among individuals with lowest versus highest education. After adjustment for all the studied behaviors, the odds ratio was reduced to 1.49 in men and to 1.45 in women. The factors with the largest contribution to the higher prevalence of abdominal obesity in individuals with lowest versus highest education were more time spent watching TV and less time spent in exercising, as well as a higher energy intake in women. Tobacco and alcohol consumption, physical activity at home, leisure walking, sedentary behaviors other than TV watching, and sleep duration did not explain the educational gradient in abdominal obesity. CONCLUSION Watching TV, physical exercise and energy intake explain a substantial part of the inverse association between education and abdominal obesity.
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Affiliation(s)
- Luz Ma León-Muñoz
- CIBER of Epidemiology and Public Health (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Madrid 28029, Spain
| | - Juan L Gutiérrez-Fisac
- CIBER of Epidemiology and Public Health (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Madrid 28029, Spain
| | - Pilar Guallar-Castillón
- CIBER of Epidemiology and Public Health (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Madrid 28029, Spain
| | - Enrique Regidor
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Esther López-García
- CIBER of Epidemiology and Public Health (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Madrid 28029, Spain
| | - David Martínez-Gómez
- CIBER of Epidemiology and Public Health (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Madrid 28029, Spain
| | - Auxiliadora Graciani
- CIBER of Epidemiology and Public Health (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Madrid 28029, Spain
| | - José R Banegas
- CIBER of Epidemiology and Public Health (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Madrid 28029, Spain
| | - Fernando Rodríguez-Artalejo
- CIBER of Epidemiology and Public Health (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Madrid 28029, Spain.
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Ngo AD, Paquet C, Howard NJ, Coffee NT, Adams R, Taylor A, Daniel M. Area-level socioeconomic characteristics and incidence of metabolic syndrome: a prospective cohort study. BMC Public Health 2013; 13:681. [PMID: 23886070 PMCID: PMC3733986 DOI: 10.1186/1471-2458-13-681] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 07/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The evidence linking socioeconomic environments and metabolic syndrome (MetS) has primarily been based on cross-sectional studies. This study prospectively examined the relationships between area-level socioeconomic position (SEP) and the incidence of MetS. METHODS A prospective cohort study design was employed involving 1,877 men and women aged 18+ living in metropolitan Adelaide, Australia, all free of MetS at baseline. Area-level SEP measures, derived from Census data, included proportion of residents completing a university education, and median household weekly income. MetS, defined according to International Diabetes Federation, was ascertained after an average of 3.6 years follow up. Associations between each area-level SEP measure and incident MetS were examined by Poisson regression Generalised Estimating Equations models. Interaction between area- and individual-level SEP variables was also tested. RESULTS A total of 156 men (18.7%) and 153 women (13.1%) developed MetS. Each percentage increase in the proportion of residents with a university education corresponded to a 2% lower risk of developing MetS (age and sex-adjusted incidence risk ratio (RR)=0.98; 95% confidence interval (CI) =0.97-0.99). This association persisted after adjustment for individual-level income, education, and health behaviours. There was no significant association between area-level income and incident MetS overall. For the high income participants, however, a one standard deviation increase in median household weekly income was associated with a 29% higher risk of developing MetS (Adjusted RR=1.29; 95%CI=1.04-1.60). CONCLUSIONS While area-level education was independently and inversely associated with the risk of developing MetS, the association between area-level income and the MetS incidence was modified by individual-level income.
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Affiliation(s)
- Anh D Ngo
- Social Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, and School of Population Health, University of South Australia, Adelaide 5001, Australia
- Social Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, and School of Population Health, University of South Australia, P4-18F, Playford Building, City East Campus, Adelaide 5000, Australia
| | - Catherine Paquet
- Social Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, and School of Population Health, University of South Australia, Adelaide 5001, Australia
- Research Centre of the Douglas Mental Health University Institute, Verdun, Québec H4H 1R2, Canada
| | - Natasha J Howard
- Social Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, and School of Population Health, University of South Australia, Adelaide 5001, Australia
| | - Neil T Coffee
- Social Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, and School of Population Health, University of South Australia, Adelaide 5001, Australia
| | - Robert Adams
- Population Research and Outcome Studies, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Anne Taylor
- The Health Observatory, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Mark Daniel
- Social Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, and School of Population Health, University of South Australia, Adelaide 5001, Australia
- Department of Medicine, The University of Melbourne, St Vincent’s Hospital, Melbourne, Victoria 3065, Australia
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Padyab M, Malmberg G, Norberg M, Blomstedt Y. Life course socioeconomic position and mortality: a population register-based study from Sweden. Scand J Public Health 2013; 41:785-91. [PMID: 23804966 DOI: 10.1177/1403494813493366] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS Adverse social circumstances during one's life course have been related to an increased risk of mortality. This article extends the literature by focusing on adversity at each phase of, and cumulatively at midlife in the Swedish population. METHODS Data on socioeconomic indicators from 1970, 1980 and 1990 were linked to death registrations from 2000 to 2009. Relative indices of inequalities were computed for socioeconomic indicators, in order to measure the cumulative impact of inequality on mortality. RESULTS A significant cumulative effect of being in the worst-off socioeconomic groups was found. For men, almost all indicators had a significant independent impact on risk of death. Among women, significant independent impacts were found for education in 1990 and for socioeconomic index in the 2 census years of 1970 and 1980. CONCLUSIONS Being disadvantaged during a longer period in midlife has a significant negative impact on health. Policies targeted to reduce health inequality should focus on every stage of the midlife course.
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Affiliation(s)
- Mojgan Padyab
- 1Centre for Population Studies, Ageing and Living Conditions Programme, Umeå University, Umeå, Sweden
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Burkert NT, Rásky É, Großschädl F, Muckenhuber J, Freidl W. The influence of socioeconomic factors on health parameters in overweight and obese adults. PLoS One 2013; 8:e65407. [PMID: 23755228 PMCID: PMC3673947 DOI: 10.1371/journal.pone.0065407] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 04/29/2013] [Indexed: 11/24/2022] Open
Abstract
The prevalence of being overweight and of obesity is increasing worldwide, and is associated with a high risk to health. Therefore, the aim of our study was to investigate whether normal weight, overweight and obese subjects of low, middle or high socioeconomic status (SES) differ with regard to their health behavior, health, quality of life, and the use of medical care. Data from the Austrian Health Interview Survey (ATHIS) 2006/07, comprising 3 groups of 1,077 individuals, each of whom were normal weight, overweight, or obese, respectively, and matched according to their age, sex and SES, were analyzed concerning health outcomes. The results show that subjects with a low SES differ significantly from those of high SES in terms of their health behavior, self-perceived health, levels of impairment, chronic conditions, quality of life, and health care. Additionally, obesity in adults is associated with sub-optimal dietary practices and worse health, poorer quality of life and medical care than normal weight and overweight individuals. A significant interaction between the weight class and SES was found concerning physical exercise, impairment due to health problems and chronic diseases. A low SES has a strong negative impact on health, especially in obese individuals. Therefore a continuous target group-oriented, non-discriminatory public health program is required, prioritizing obese subjects with low SES.
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Affiliation(s)
- Nathalie T Burkert
- Institute of Social Medicine and Epidemiology, Medical University Graz, Graz, Styria, Austria.
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Erem C, Arslan C, Hacihasanoglu A, Deger O, Topbas M, Ukinc K, Ersöz HO, Telatar M. Prevalence of Obesity and Associated Risk Factors in a Turkish Population (Trabzon City, Turkey). ACTA ACUST UNITED AC 2012; 12:1117-27. [PMID: 15292476 DOI: 10.1038/oby.2004.140] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To estimate the prevalence of overweight and obesity (general and central) in the Trabzon Region and its associations with demographic factors (age, sex, marital status, reproductive history in women, and level of education), socioeconomic factors (household income and occupation), family history of selected medical conditions (diabetes, hypertension, and obesity), lifestyle factors (smoking habits, physical activity, and alcohol consumption), and hypertension in the adult population. RESEARCH METHODS AND PROCEDURES A sample of households was systematically selected from the central province of Trabzon and its five towns, namely, Sürmene, Vakfikebir, Maçka, Hayrat, and Tonya. A total of 5016 subjects (2728 women and 2288 men) were included in the study. Individuals more than 20 years old were selected from their family health cards. Demographic factors, socioeconomic factors, family history of selected medical conditions, and lifestyle factors were obtained for all participants. Systolic blood pressure and diastolic blood pressure levels were measured for all subjects. Study procedures were carried out in the local health centers in each town over an 8-month period. Obesity was defined as BMI > or = 30 kg/m2 and overweight as BMI = 25.0 to 29.9 kg/m2. RESULTS The prevalence of obesity was 23.5%: 29.4% in women and 16.5% in men. The combined prevalence of both overweight and obesity was 60.3%. The prevalence of abdominal obesity was 29.4%: 38.9% among women and 18.1% among men. The prevalence of obesity increased with age, being highest in the 60- to 69-year-old age group (40.8%) but lower again in the 70+ age group. Obesity was associated positively with marital status, parity, cessation of cigarette smoking, alcohol consumption, and household income and inversely with level of education, cigarette use, and physical activity. Also, obesity was associated positively with hypertension. DISCUSSION In the Trabzon Region, 60.3% of the adult population presents with some excess weight. Obesity is a major public health problem that requires generalized interventions to prevent it among the adult population.
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Affiliation(s)
- Cihangir Erem
- Department of Internal Medicine, Karadeniz Technical University, Trabzon, Turkey.
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Bobrow KL, Quigley MA, Green J, Reeves GK, Beral V. Persistent effects of women's parity and breastfeeding patterns on their body mass index: results from the Million Women Study. Int J Obes (Lond) 2012; 37:712-7. [PMID: 22777544 PMCID: PMC3647235 DOI: 10.1038/ijo.2012.76] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: To explore the long-term effects of women's childbearing patterns on their body mass index. Design: Cross-sectional analysis. Setting: Population-based study of UK women. Participants: 740 628 postmenopausal participants in the Million Women Study who reported their height, weight, reproductive histories and other relevant factors. Main Outcome Measures: Standardized mean BMI (kg m−2) in groups defined by their parity and breastfeeding history. Results: Women were aged 57.5 (s.d. 4) years on average, and had a mean BMI of 26.2 kg m−2 (s.d. 5); 88% were parous, with 2.1 (s.d. 1.2) children on average. The standardised mean BMI increased progressively with the number of births from 25.6 kg m−2 (95% confidence interval (CI): 25.5–25.6) in nulliparous women up to 27.2 kg m−2 (CI: 27.2–27.3) for women with four or more births, a difference of 1.7 kg m−2 (CI: 1.6–1.7). Among the parous women 70% had ever breastfed and their average total duration of breastfeeding was 7.7 (s.d. 8.8) months. At every parity level the standardised mean BMI was significantly lower among women who had breastfed than those who had not, decreasing by 0.22 kg m−2 (CI: 0.21–0.22) for every 6 months of breastfeeding, that is, women's mean BMI was 1% lower for every 6 months that they had breastfed. These associations were highly statistically significant (P<0.0001) and independent of the effects of socioeconomic group, region of residence, smoking and physical activity. Conclusions: Childbearing patterns have a persistent effect on adiposity in this population. The reduction in BMI associated with just 6 months breastfeeding in UK women could importantly reduce their risk of obesity-related disease as they age.
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Affiliation(s)
- K L Bobrow
- Cancer Epidemiology Unit, University of Oxford, Oxford, UK.
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Nyberg ST, Heikkilä K, Fransson EI, Alfredsson L, De Bacquer D, Bjorner JB, Bonenfant S, Borritz M, Burr H, Casini A, Clays E, Dragano N, Erbel R, Geuskens GA, Goldberg M, Hooftman WE, Houtman IL, Jöckel KH, Kittel F, Knutsson A, Koskenvuo M, Leineweber C, Lunau T, Madsen IEH, Hanson LLM, Marmot MG, Nielsen ML, Nordin M, Oksanen T, Pentti J, Rugulies R, Siegrist J, Suominen S, Vahtera J, Virtanen M, Westerholm P, Westerlund H, Zins M, Ferrie JE, Theorell T, Steptoe A, Hamer M, Singh-Manoux A, Batty GD, Kivimäki M. Job strain in relation to body mass index: pooled analysis of 160 000 adults from 13 cohort studies. J Intern Med 2012; 272:65-73. [PMID: 22077620 PMCID: PMC3437471 DOI: 10.1111/j.1365-2796.2011.02482.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Evidence of an association between job strain and obesity is inconsistent, mostly limited to small-scale studies, and does not distinguish between categories of underweight or obesity subclasses. OBJECTIVES To examine the association between job strain and body mass index (BMI) in a large adult population. METHODS We performed a pooled cross-sectional analysis based on individual-level data from 13 European studies resulting in a total of 161 746 participants (49% men, mean age, 43.7 years). Longitudinal analysis with a median follow-up of 4 years was possible for four cohort studies (n = 42 222). RESULTS A total of 86 429 participants were of normal weight (BMI 18.5-24.9 kg m(-2) ), 2149 were underweight (BMI < 18.5 kg m(-2) ), 56 572 overweight (BMI 25.0-29.9 kg m(-2) ) and 13 523 class I (BMI 30-34.9 kg m(-2) ) and 3073 classes II/III (BMI ≥ 35 kg m(-2) ) obese. In addition, 27 010 (17%) participants reported job strain. In cross-sectional analyses, we found increased odds of job strain amongst underweight [odds ratio 1.12, 95% confidence interval (CI) 1.00-1.25], obese class I (odds ratio 1.07, 95% CI 1.02-1.12) and obese classes II/III participants (odds ratio 1.14, 95% CI 1.01-1.28) as compared with participants of normal weight. In longitudinal analysis, both weight gain and weight loss were related to the onset of job strain during follow-up. CONCLUSIONS In an analysis of European data, we found both weight gain and weight loss to be associated with the onset of job strain, consistent with a 'U'-shaped cross-sectional association between job strain and BMI. These associations were relatively modest; therefore, it is unlikely that intervention to reduce job strain would be effective in combating obesity at a population level.
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Affiliation(s)
- S T Nyberg
- Finnish Institute of Occupational Health, Helsinki,
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Ledoux TA, Mama SK, O'Connor DP, Adamus H, Fraser ML, Lee RE. Home Availability and the Impact of Weekly Stressful Events Are Associated with Fruit and Vegetable Intake among African American and Hispanic/Latina Women. J Obes 2012; 2012:737891. [PMID: 22666558 PMCID: PMC3361275 DOI: 10.1155/2012/737891] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 01/16/2012] [Accepted: 02/28/2012] [Indexed: 11/18/2022] Open
Abstract
Background. Mediating and moderating variables may interfere with the association between neighborhood availability of grocery stores (NAG) and supermarkets (NAS) and fruit and vegetable (FV) intake. Objective. The purpose of this study was to test mediation of home availability of FV (HAFV) and moderation of impact of weekly stressful events (IWSE) on the association between NAG and NAS with FV consumption among African American (AA) and Hispanic/Latina (HL) women. Methods. Three hundred nine AA and HL, 25-60 year old women in the Health Is Power (HIP) randomized controlled trial completed validated measures of HAFV, IWSE, and FV intake at baseline. Trained field assessors coded NAG and NAS. Institutional Review Board approval was obtained. Results. NAG and NAS were not associated with FV intake or HAFV, so HAFV was not a mediator. HAFV (std. Beta = .29, P < 0.001) and IWSE (std. Beta = .17; P < 0.05) were related to FV intake (R(2) = 0.17; P < 0.001), but IWSE was not a moderator. Conclusion. Increasing HAFV and decreasing the IWSE should increase FV consumption. The extent to which the neighborhood environment is related to the home food environment and diet, and the mechanisms for the association between IWSE and diet should be examined in future research.
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Affiliation(s)
- Tracey A. Ledoux
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, 3855 Holman Street Garrison Room 104, Houston, TX 77204-6015, USA
| | - Scherezade K. Mama
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, 3855 Holman Street Garrison Room 104, Houston, TX 77204-6015, USA
| | - Daniel P. O'Connor
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, 3855 Holman Street Garrison Room 104, Houston, TX 77204-6015, USA
| | - Heather Adamus
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, 3855 Holman Street Garrison Room 104, Houston, TX 77204-6015, USA
| | - Margaret L. Fraser
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, 3855 Holman Street Garrison Room 104, Houston, TX 77204-6015, USA
| | - Rebecca E. Lee
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, 3855 Holman Street Garrison Room 104, Houston, TX 77204-6015, USA
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Burkert NT, Freidl W, Muckenhuber J, Stronegger WJ, Rásky E. Self-perceived health, quality of life, and health-related behavior in obesity: is social status a mediator? Wien Klin Wochenschr 2012; 124:271-5. [PMID: 22527823 DOI: 10.1007/s00508-012-0160-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Obesity prevalence is increasing worldwide and is associated with a high health risk. Unfavorable psychological factors, lower self-ratings of health, and worse health-related behavior can be found in individuals with a low socioeconomic status (SES). Therefore, the aim of this study is to investigate whether obese subjects with a high SES differ from those with a low SES depending on these outcomes. METHODS Data of the Austrian Health Interview Survey (ATHIS) 2006/2007-precisely of 760 obese subjects with a low SES and 851 with a high SES-were analyzed stratified by sex and adjusted by age with regard to differences in self-perceived health, quality of life (regarding physical and psychological health, environment, and social relationships), and health-related behavior (smoking, alcohol consumption, eating behavior, physical exercise). RESULTS The results have shown that obese subjects with a low SES differ significantly from those with a high SES in terms of self-perceived health, quality of life, and intensity of physical activities. Furthermore, differences were found in obese women as to smoking behavior, alcohol consumption, and continuance of physical exercise. CONCLUSION It seems that not only obesity but also the socioeconomic status plays a role in health, and the risk assessment of obese individuals in the primary health care setting should include socioeconomic factors. Furthermore, public health programs which focus on obese subjects with a low SES are urgently needed.
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Affiliation(s)
- Nathalie T Burkert
- Institute of Social Medicine and Epidemiology, Medical University Graz, Universitaetsplatz 6/I, 8010, Graz, Austria.
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Burkert N, Rásky E, Freidl W. Social inequalities regarding health and health behaviour in Austrian adults. Wien Klin Wochenschr 2012; 124:256-61. [PMID: 22527826 DOI: 10.1007/s00508-012-0164-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
Studies have shown that people of a low socioeconomic status (SES) show worse health and health behaviour as well as a higher mortality rate than subjects with a high SES. Studies concerning the association between mortality and SES in Austrian adults have been conducted before, but not regarding specific variables which have an influence on mortality. Therefore the aim of our study was to investigate whether Austrian adults with a high versus low SES differ concerning ill health, health-related behaviour, quality of life as well as use of medical care. Data of 12,892 subjects from the Austrian Health Interview Survey (ATHIS) 2006/2007 were analysed concerning these outcomes. Subjects with low SES differ significantly from those with high SES in terms of health behaviour (e.g. eating behaviour, physical activity) and quality of life. They report significantly more diseases (e.g. cardiac infarction) and use health services more often. Low SES has a strong negative impact on health in Austrian adults. Therefore, in Austria a continued strong public health programme is required with absolute priority on low-SES groups.
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Affiliation(s)
- Nathalie Burkert
- Institute of Social Medicine and Epidemiology, Medical University Graz, Universitaetsplatz 6/I, 8010, Graz, Austria.
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Larsson CA, Krøll L, Bennet L, Gullberg B, Råstam L, Lindblad U. Leisure time and occupational physical activity in relation to obesity and insulin resistance: a population-based study from the Skaraborg Project in Sweden. Metabolism 2012; 61:590-8. [PMID: 22146090 DOI: 10.1016/j.metabol.2011.09.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 08/26/2011] [Accepted: 09/14/2011] [Indexed: 11/23/2022]
Abstract
The objective was to study obesity and insulin resistance in relation to leisure time physical activity (LTPA) and occupational physical activity (OPA) in a Swedish population, with particular focus on sex differences. Using a cross-sectional design, waist circumference, body mass index (BMI), glucose/insulin metabolism, blood pressure, heart rate, self-reported education, smoking, alcohol consumption, LTPA, and OPA were assessed in 1745 men and women (30-74 years) randomly chosen from 2 municipalities in southwestern Sweden. In both men and women, LTPA was inversely associated with BMI, waist circumference, and the homeostasis model assessment of insulin resistance (HOMA-IR), respectively. These associations remained statistically significant after adjustments for age, OPA, education, alcohol consumption, smoking, and study area, and also for BMI in the analyses concerning waist circumference and HOMA-IR. A statistically significant interaction term (P = .030), adjusted for multiple confounders, revealed a stronger association between LTPA and HOMA-IR in women compared with men. Occupational physical activity was positively associated with BMI (P < .001), waist circumference (P < .001), and HOMA-IR (P = .001), however, only in women. These associations remained when adjusting for multiple confounders. The sex differences were confirmed by statistically significant interaction terms between sex and OPA in association with BMI, waist circumference, and HOMA-IR, respectively. The observed sex differences regarding the strength of the association between LTPA and insulin resistance, and the positive association between OPA and obesity and insulin resistance found solely in women, warrant further investigation. Although exploration of the metabolic effects of OPA appears to be needed, thorough measurement of potential confounders is also vital to understand contextual effects.
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Affiliation(s)
- Charlotte A Larsson
- Department of Clinical Sciences, University of Lund, Malmö, Community Medicine, Malmö University Hospital, 205 02 Malmö, Sweden.
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The relationship between job stress and body mass index using longitudinal data from Canada. Int J Public Health 2012; 57:807-15. [DOI: 10.1007/s00038-012-0348-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 01/26/2012] [Accepted: 02/08/2012] [Indexed: 10/28/2022] Open
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Associations between safety from crime, cycling, and obesity in a Dutch elderly population: results from the Longitudinal Aging Study Amsterdam. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2012; 2012:127857. [PMID: 22523503 PMCID: PMC3317166 DOI: 10.1155/2012/127857] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 12/16/2011] [Accepted: 12/17/2011] [Indexed: 11/18/2022]
Abstract
The objective of this cross-sectional study was to investigate differences in associations between crime rates, cycling, and weight status between people living in low and high socioeconomic status (SES) neighbourhoods. In total, 470 participants in the Longitudinal Aging Study Amsterdam were included (age: 63-70 y). Body height and weight were measured using a stadiometer and calibrated weight scale, respectively. Cycling behaviour was assessed in a face-to-face interview, and neighbourhood crime rates were assessed using data from police reports. Men residing in high SES neighbourhoods cycled more than males residing in low SES neighbourhoods. Cycling was negatively related to crime rates among both men and women living in low SES neighbourhoods. Among men living in low SES neighbourhoods, more cycling was associated with lower BMI. Interventions aiming to prevent obesity in older people may consider aiming at increasing bicycle use in lower SES neighbourhoods, but neighbourhood safety issues should be considered.
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Changes in Body Mass Index across Age Groups in Iranian Women: Results from the National Health Survey. J Nutr Metab 2012; 2012:848403. [PMID: 22523675 PMCID: PMC3306980 DOI: 10.1155/2012/848403] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 10/12/2011] [Accepted: 10/16/2011] [Indexed: 01/10/2023] Open
Abstract
Background. To investigate the associations between some factors with weight gain across age groups in Iranian women. Methods. Proportional odds model was used to estimate the probability of BMI categorized as a function of education, economic index, workforce, smoking, marital status, and place of residence adjusted for age, using data from the “National Health Survey in Iran” database. It included 14176 women aged 20–69 years. Results. For all covariates, age was directly associated with overweight and obesity before 60 years of age. Among women aged 20–40 years, the rates of change in probabilities of overweight and obesity were highest. Among women, being inactive, with high economic index, married, being nonsmoker, in an urban residence, with lower educational attainment, all increased the probabilities of overweight and obesity. Conclusions. Women aged 20–40 years gained weight faster than other groups. They may need additional information and more support on how to reduce their risk for weight gain through positive health behaviors.
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Lahti-Koski M, Harald K, Saarni SE, Peltonen M, Männistö S. Changes in body mass index and measures of abdominal obesity in Finnish adults between 1992 and 2007, the National FINRISK Study. Clin Obes 2012; 2:57-63. [PMID: 25586048 DOI: 10.1111/j.1758-8111.2012.00035.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED What is already known about this subject • Recent obesity trends across the world in adults are mixed, varying from showing signs of levelling off to a continuously increasing prevalence. • Secular trends in body mass index (BMI) and waist circumference may vary by sex and age. • Relying exclusively on BMI data may lead to underestimate the obesity epidemic. What this study adds • Adverse trends in obesity indicators have continued in Finland in the 2000s. • In older men, BMI remained quite stable and in older women BMI has decreased since 1997. • Steep upward trends in abdominal obesity (waist circumference and waist-to-height ratio, WHtR) have taken place in both men and women and in all age groups, especially during the past 10 years. • The impact of BMI adjustment on trends in abdominal obesity varied by age such that increases in BMI-adjusted waist circumference and WHtR were more prominent in older age groups. SUMMARY Signs that obesity trends will level off at the turn of the 21st century have been reported. In these studies, however, the definition of obesity has been based only on body mass index (BMI). We investigated obesity trends among Finnish adults over recent years by using BMI, waist circumference and waist-to-height ratio as indicators for obesity. Data were derived from the national FINRISK surveys, which are cross-sectional population surveys conducted at 5-year intervals between 1992 and 2007. Altogether, 20 551 randomly selected men and women aged 25-64 years participated in health examinations, where weight, height, and waist and hip circumferences were measured by trained nurses. Mean BMI increased in younger men and women (aged 25-44 years) between 1992 and 2007, whereas in older men, BMI remained quite stable and in older women BMI has decreased since 1997. Nevertheless, mean waist circumference and waist-to-height ratio increased in both men and women over the 15-year period. The upward trends took place in all age groups, especially during the past 10 years. Adverse trends in obesity indicators have continued in Finland in the 2000s. In particular, concerns are related to steep upward trends in abdominal obesity.
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Affiliation(s)
- M Lahti-Koski
- Finnish Heart Association, Helsinki, FinlandNational Institute for Health and Welfare (THL), Helsinki, FinlandDepartment of Psychiatry, Health Center, City of Helsinki, Helsinki, Finland
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Siu J, Giskes K, Shaw J, Turrell G. Perceived weight status may contribute to education inequalities in five-year weight change among mid-aged women. Aust N Z J Public Health 2011; 35:284-91. [PMID: 21627730 DOI: 10.1111/j.1753-6405.2010.00705.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To examine education differences in five-year weight change among mid-aged adults, and to ascertain if this may be due to socioeconomic differences in perceived weight status or weight control behaviours (WCBs). METHODS Data were used from the Australian Diabetes, Obesity and Lifestyle Study. Mid-aged men and women with measured weights at both baseline (1999-2000) and follow-up (2004-2005) were included. Percent weight change over the five-year interval was calculated and perceived weight status, WCBs and highest attained education were collected at baseline. RESULTS Low-educated men and women were more likely to be obese at baseline compared to their high-educated counterparts. Women with a certificate-level education had a greater five-year weight gain than those with a bachelor degree or higher. Perceived weight status or WCBs did not differ by education among men and women, however participants that perceived themselves as very overweight had less weight gain than those perceiving themselves as underweight or normal weight. WCBs were not associated with five-year weight change. CONCLUSIONS AND IMPLICATIONS The higher prevalence of overweight/obesity among low-educated women may be a consequence of greater weight gain in mid-adulthood. Education inequalities in overweight/obesity among men and women made be due (in part) to overweight or obese individuals in low-educated groups not perceiving themselves as having a weight problem.
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Affiliation(s)
- Jessica Siu
- School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia.
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Davila EP, Florez H, Trepka MJ, Fleming LE, Niyonsenga T, Lee DJ, Parkash J. Long work hours is associated with suboptimal glycemic control among US workers with diabetes. Am J Ind Med 2011; 54:375-83. [PMID: 21246586 PMCID: PMC10038227 DOI: 10.1002/ajim.20923] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2010] [Indexed: 12/26/2022]
Abstract
BACKGROUND Increasing numbers of US workers are diabetic. We assessed the relationship between glycemic control and work hours and type of occupation among employed US adults with type 2 diabetes. METHODS Data were obtained from the 1999-2004 National Health and Nutrition Examination Survey (NHANES). A representative sample of employed US adults ≥20 years with self-reported type 2 diabetes (n = 369) was used. Two dichotomous glycemic control indicators, based on various HbA1c level cut-points, were used as dependent variables in weighted logistic regression analyses with adjustment for confounders. RESULTS Adults working over 40 hr/week were more likely to have suboptimal glycemic control (HbA1c ≥ 7%) compared to those working 20 hr or less (odds ratio = 5.09; 95% confidence interval: [1.38-18.76]). CONCLUSIONS Work-related factors, such as number of hours worked, may affect the ability of adults with type 2 diabetes to reach and maintain glycemic control goals. These factors should be considered in the development of workplace policies and accommodations for the increasing number of workers with type 2 diabetes.
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Affiliation(s)
- Evelyn P Davila
- Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Florida 33136, USA.
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The relative importance of socioeconomic indicators in explaining differences in BMI and waist:hip ratio, and the mediating effect of work control, dietary patterns and physical activity. Br J Nutr 2010; 104:1230-40. [PMID: 20487579 DOI: 10.1017/s0007114510001868] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Socioeconomic differences in overweight are well documented, but most studies have only used one or two indicators of socioeconomic position (SEP). The aim of the present study was to explore the relative importance of indicators of SEP (occupation, education and income) in explaining variation in BMI and waist:hip ratio (WHR), and the mediating effect of work control and lifestyle factors (dietary patterns, smoking and physical activity). The Oslo Health Study, a cross-sectional study, was carried out in 2000-1, Oslo, Norway. Our sample included 9235 adult working Oslo citizens, who attended a health examination and filled in two complementary FFQ with < 20% missing responses to food items. Four dietary patterns were identified through factor analysis, and were named 'modern', 'Western', 'traditional' and 'sweet'. In multivariate models, BMI and WHR were inversely associated with education (P < 0.001/P < 0.001) and occupation (P = 0.002/P < 0.001), whereas there were no significant associations with income or the work control. The 'modern' (P < 0.001) and the 'sweet' (P < 0.001) dietary patterns and physical activity level (P < 0.001) were inversely associated, while the 'Western' dietary pattern (P < 0.001) was positively associated with both BMI and WHR. These lifestyle factors could not fully explain the socioeconomic differences in BMI or WHR. However, together with socioeconomic factors, they explained more of the variation in WHR among men (21%) than among women (7%).
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Factors related to obesity among Iranian men: results from the National Health Survey. Public Health Nutr 2010; 13:1389-94. [PMID: 20441659 DOI: 10.1017/s1368980010000108] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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