Absolute wealth and world region strongly predict overweight among women (ages 18-49) in 360 populations across 36 developing countries

Assessing comparative asset-based measures of material wealth as predictors of physical growth and mortality

Social scientists and policymakers have increasingly relied on asset-based indices of household wealth to assess social disparities and to identify economically vulnerable populations in low- and middle-income countries. In the last decade, researchers have proposed a number of asset-based measures that permit global comparisons of household wealth across populations in different countries and over time. Each of these measures relies on different assumptions and indicators, and little is known about the relative performance of these measures in assessing disparities. In this study, we assess four comparative, asset-based measures of wealth—the Absolute Wealth Estimate (AWE), the International Wealth Index (IWI), the Comparative Wealth Index (CWI), and the “Standard of Living” portion of the Multi-Dimensional Poverty Index (MPI), along with a variable measuring television ownership—and compare how well each predicts health related variables such as women's BMI, children's height-for-age Z scores, and infant mortality at the household and survey level. Analyzing data from over 300 Demographic and Health surveys in 84 countries (n = 2,304,928 households), we found that AWE, IWI, CWI, MPI are all highly correlated (r = 0.7 to 0.9). However, IWI which is based on a common set of universally weighted indicators, typically best accounts for variation in all three health measures. We discuss the implications of these findings for choosing and interpreting these measures of wealth for different purposes.

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Assessing four comparative, asset-based measures of wealth.

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The four comparative asset-based measures of wealth are all highly correlated.

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International Wealth Index best accounts for variation in adult female BMI, child height-for-age, and infant mortality.

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Asset-based measures of wealth relying on universal indicators and weights perform better at explaining variance.

Transitioning to an obese India: Demographic and structural determinants of the rapid rise in overweight incidence

India, which has long suffered from undernutrition, has seen a rapid rise in overweight incidence in the last decade and a half. These changes are characterized by significant within-country differences in overweight incidence that vary by gender and regional development levels. In this paper, we provide an integrative framework, linking the income-gradient hypothesis of obesity with biological, obesogenic, and environmental factors to provide an explanation on the emergence of within-country differences in overweight patterns. We utilize measured body mass index (BMI), along with individual- and household-level data of over 800,000 men and women surveyed in the National Family Health Surveys of 2005-06 and 2015-16 to identify correlates of within-country differences in overweight incidence. A decomposition analysis reveals that among women, in addition to increasing access to obesogenic technologies, biological factors are associated with overweight incidence. Among men, obesogenic factors related to technology use and health behaviors are associated with the rise in overweight incidence, but biological factors are not. At lower levels of regional development, overweight incidence is associated with greater access to obesogenic technology such as motorized transport, which reduces physical activity among men at higher rates than women. At higher levels of economic development, obesogenic behaviors, such as watching more television and reducing smoking, are associated with overweight incidence. Our results corroborate the call by public health experts for group-specific policies to stem the rise of overweight incidence in developing countries.

Wealth index and other behavioral and sociodemographic characteristics associated with body mass index in Ethiopia

Background:

Nowadays, the burden of non-communicable diseases including obesity has been an increasing public health concern. This menace can be monitored using indexing method like body mass index. Studies indicate that socioeconomic indicators such as income, biology, behavior, and demographic factors associated with body mass index. In Ethiopia, few studies associate wealth index with body mass index in people of ages between 15 and 49. This study was aimed to assess the association of body mass index with wealth index, and behavioral and sociodemographic population characteristics.

Methods:

A cross-sectional population-based study was conducted using the 2016 Ethiopian Demographic and Health Survey population of ages 15–49. A total of 10,245 individuals were considered to detect the effect of socioeconomic, biological, behavioral, and demographic factors on body mass index using logistic regression.

Results:

The prevalence of underweight, overweight, and obesity among men are 23.8%, 6.6%, and 2.0%, respectively, which is lower than that of women (underweight 25.3%, overweight 9.1%, and obesity 2.9%). The poorest men had higher odds of being underweight (adjusted odds ratio = 2.395%; 95% confidence interval = 2.020–3.544) as compared to the richest men. Merchants and government employees have lower odds (adjusted odds ratio = 0.744; 95% confidence interval = 0.588–0.899) compared to men whose occupation is farming and labor, indicating that merchants and government employees are more likely to become overweight and obese compared to men who are farmers and laborers.

Conclusion:

It is concluded that wealth index is an important socioeconomic determinant of body mass index among men and women of age 15–49 in Ethiopia. A high prevalence of underweight, and overweight, and obesity is observed, which increases instances of non-communicable diseases. Effects of socioeconomic, biological, behavioral, and demographic indicators on body mass index differed according to sex.

Deprivation or discrimination? Comparing two explanations for the reverse income-obesity gradient in the US and South Korea

In high-income countries, poverty is often associated with higher average body mass index (BMI). To account for this reverse gradient, deprivation theories posit that declining economic resources make it more difficult to maintain a healthy weight. By contrast, discrimination theories argue that anti-fat discrimination in hiring and marriage sorts heavier individuals into lower-income households. This study assesses competing predictions of these theories by examining how household income in representative samples from South Korea (2007-2014, N=20,823) and the US (1999-2014, N=6395) is related to BMI in two key contrasting groups: (1) currently-married and (2) never-married individuals. As expected by anti-fat discrimination in marriage, the reverse gradient is observed among currently-married women but not among never-married women in both countries. Also consistent with past studies no evidence was found for a reverse gradient among men. These findings are consistent with anti-fat discrimination in marriage as a key cause of the reverse gradient and raise serious challenges to deprivation accounts as well as explanations based on anti-fat discrimination in labour markets.

Prevalence of overweight/obesity among the adult population in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Overweight and obesity are emerging public health problems in Ethiopia. However, primary study findings on the prevalence of overweight and obesity in Ethiopia are inconsistent. Therefore, this study aimed to estimate the pooled prevalence of overweight and obesity among adults in Ethiopia.

METHODS

Studies that looked at overweight and obesity among adults were searched from four international databases. The search involved articles published from 1 January 2010 to 10 March 2020. The Cochran's Q χ2 and the I2 test statistics were used to check heterogeneity among the studies. The funnel plot and Egger's regression tests were also used to assess the presence of publication bias. Subgroup analysis was performed by residence, study setting, sample size and year of study. Sensitivity analysis was also done to assess the effect of a single study on the pooled estimates. Data analysis was done using STATA V.14 software program.

RESULTS

A total of 16 studies with 19 527 study participants were included in this systematic review and meta-analysis. The estimated pooled prevalence of overweight among adults in Ethiopia was 20.4%, and after adjustment for publication bias with the trim-and-fill analysis, the estimated prevalence rate was changed to 19%. Besides, the estimated pooled prevalence of obesity was 5.4%. The prevalence of overweight was higher, 22.6% in studies published since 2015, 22.4% in studies conducted only in urban settings and 24.4% in studies with small sample size (≤384 participants). Similarly, the prevalence of obesity was 6.9% in studies published since 2015, 6.2% in studies conducted only in urban settings, 6.4% in institution-based settings and 9.6% in studies with small sample size.

CONCLUSION

The prevalence of overweight and obesity is high in Ethiopia compared with previous studies. This needs large scale awareness creation campaigns and situation-based and context-specific prevention strategies.

Socioeconomic inequalities in the prevalence of underweight, overweight, and obesity among women aged 20-49 in low- and middle-income countries

Objective

To analyze socioeconomic inequalities in the prevalence of underweight and overweight or obesity in women from low and middle-income countries (LMICs).

Methods

Using the last available Demographic Health Survey between 2010 and 2016 from 49 LMICs, we estimated the prevalence of underweight (BMI < 18.5 kg/m²) and overweight or obesity combined (BMI ≥ 25 kg/m²) for women aged 20–49 years. We used linear regression to explore the associations between the two outcomes and gross national income (GNI). We assess within-country socioeconomic inequalities using wealth deciles. The slope index of inequality (SII) and the inequality pattern index (IPI) were calculated for each outcome. Negative values of the latter express bottom inequality (when inequality is driven by the poorest deciles) while positive values express top inequality (driven by the richest deciles).

Results

In total, 931,145 women were studied. The median prevalence of underweight, overweight or obesity combined, and obesity were 7.3% (range 0.2–20.5%), 31.5% (8.8–85.3%), and 10.2% (1.9–48.8%), respectively. Pearson correlation coefficients with log GNI were −0.33 (p = 0.006) for underweight, 0.72 (p < 0.001) for overweight or obesity, and 0.66 (p < 0.001) for obesity. For underweight, the SII was significantly negative in 38 of the 49 countries indicating a higher burden among poor women. There was no evidence of top or bottom inequality. Overweight or obesity increased significantly with wealth in 44 of the 49 countries. Top inequality was observed in low-prevalence countries, and bottom inequality in high-prevalence countries.

Conclusion

Underweight remains a problem among the poorest women in poor countries, but overweight and obesity are the prevailing problem as national income increases. In low-prevalence countries, overweight or obesity levels are driven by the higher prevalence among the richest women; as national prevalence increases, only the poorest women are relatively preserved from the epidemic.

Identifying the limits to socioeconomic influences on human growth

Contemporary humans occupy the widest range of socioeconomic environments in their evolutionary history, and this has revealed unprecedented environmentally-induced plasticity in physical growth. This plasticity also has limits, and identifying those limits can help researchers: (1) parse when population differences arise from environmental inputs or not and (2) determine when it is possible to infer socioeconomic disparities from disparities in body form. To illustrate potential limits to environmental plasticity, we analyze body mass index (BMI) and height data from 1,768,962 women and 207,341 men (20-49 y) living in households exhibiting 1000-fold variation in household wealth (51 countries, 1985-2017, 164 surveys) across four world regions-sub-Saharan Africa, South Asia, Latin America, and North Africa and the Middle East. We find that relationships of environmental inputs with both mean height and BMI bottom out at roughly 100-700 USD per capita household wealth (2011 international units, PPP), but at different basal BMIs and basal heights for different regions. The relationship with resources tops out for BMI at around 20 K-35 K USD for women, with growth potential due to environmental inputs in the range of 6.2-8.4 kg/m². By contrast, mean BMI for men and mean height for both sexes remains sensitive to environmental inputs even at levels far above the low- and middle-income samples studied here. This suggest that further work integrating comparable data from low- and high-income samples should provide a better picture of the full range of environmental inputs on human height and BMI. We conclude by discussing how neglecting such population-specific limits to human growth can lead to erroneous inferences about population differences.

Analyses of inequalities in RMNCH: rising to the challenge of the SDGs

The Sustainable Development Goal (SDG) 17.18 recommends efforts to increase the availability of data disaggregated by income, gender, age, race, ethnicity, migratory status, disability and geographic location in developing countries. Surveys will continue to be the leading data source for disaggregated data for most dimensions of inequality. We discuss potential advances in the disaggregation of data from national surveys, with a focus on the coverage of reproductive, maternal, newborn and child health indicators (RMNCH). Even though the Millennium Development Goals were focused on national-level progress, monitoring initiatives such as Countdown to 2015 reported on progress in RMNCH coverage according to wealth quintiles, sex of the child, women’s education and age, urban/rural residence and subnational geographic regions. We describe how the granularity of equity analyses may be increased by including additional stratification variables such as wealth deciles, estimated absolute income, ethnicity, migratory status and disability. We also provide examples of analyses of intersectionality between wealth and urban/rural residence (also known as double stratification), sex of the child and age of the woman. Based on these examples, we describe the advantages and limitations of stratified analyses of survey data, including sample size issues and lack of information on the necessary variables in some surveys. We conclude by recommending that, whenever possible, stratified analyses should go beyond the traditional breakdowns by wealth quintiles, sex and residence, to also incorporate the wider dimensions of inequality. Greater granularity of equity analyses will contribute to identify subgroups of women and children who are being left behind and monitor the impact of efforts to reduce inequalities in order to achieve the health SDGs.

Gender empowerment, inequalities and the prevalence of adult female obesity: An empirical analysis using new data, 1990-2013

Aims: Do gender inequality and gender discrimination explain female obesity? Discrimination denies access to choose and constrains agency. Scope: Using the Global Burden of Disease data on overweight and obesity share of the adult female population for almost 160 countries over a 24-year period, we find that female empowerment has no effect on the population share that is overweight, but it reduces the obese share of women. The substantive impact is, however, slight and the results are not robust to testing a sample of only developing countries. Political freedoms for women in general, however, show positive effects on the prevalence of obesity, results that are again substantively meagre. Higher levels of income inequality and a measure of health inequality predict lower levels of female obesity independently of the controls, which raises some doubt about large arguments linking generalized inequality to obesogenic environments. Results: In so far as our measures of female empowerment capture greater access to rights and agency, they are poor predictors of the prevalence of obesity. The results suggest that local-level idiosyncrasies matter a lot more than do macro-level factors. Conclusions: Any conclusion should be treated tentatively given the short temporal domain examined here and uncertainties in the data. While promoting rights and equity for women are still intrinsically valuable and moral, the task of reducing obesity per se may require more targeted public action promoting healthier lifestyles and consumption among vulnerable groups.

The capacity-load model of non-communicable disease risk: understanding the effects of child malnutrition, ethnicity and the social determinants of health

The capacity-load model is a conceptual model developed to improve understanding of the life-course aetiology of non-communicable diseases (NCDs) and their ecological and societal risk factors. The model addresses continuous associations of both (a) nutrition and growth patterns in early life and (b) lifestyle factors at older ages with NCD risk. Metabolic capacity refers to physiological traits strongly contingent on early nutrition and growth during the first 1000 days, which promote the long-term capacity for homeostasis in the context of fuel metabolism and cardiovascular health. Metabolic load refers to components of nutritional status and lifestyle that challenge homeostasis. The higher the load, and the lower the capacity, the greater the NCD risk. The model therefore helps understand dose-response associations of both early development and later phenotype with NCD risk. Infancy represents a critical developmental period, during which slow growth can constrain metabolic capacity, whereas rapid weight gain may elevate metabolic load. Severe acute malnutrition in early childhood (stunting, wasting) may continue to deplete metabolic capacity, and confer elevated susceptibility to NCDs in the long term. The model can be applied to associations of NCD risk with socio-economic position (SEP): lower SEP is generally associated with lower capacity but often also with elevated load. The model can also help explain ethnic differences in NCD risk, as both early growth patterns and later body composition differ systematically between ethnic groups. Recent work has begun to clarify the role of organ development in metabolic capacity, which may further contribute to ethnic differences in NCD risk.

Material wealth in 3D: Mapping multiple paths to prosperity in low- and middle- income countries

Material wealth is a key factor shaping human development and well-being. Every year, hundreds of studies in social science and policy fields assess material wealth in low- and middle-income countries assuming that there is a single dimension by which households can move from poverty to prosperity. However, a one-dimensional model may miss important kinds of prosperity, particularly in countries where traditional subsistence-based livelihoods coexist with modern cash economies. Using multiple correspondence analysis to analyze representative household data from six countries-Nepal, Bangladesh, Ethiopia, Kenya, Tanzania and Guatemala-across three world regions, we identify a number of independent dimension of wealth, each with a clear link to locally relevant pathways to success in cash and agricultural economies. In all cases, the first dimension identified by this approach replicates standard one-dimensional estimates and captures success in cash economies. The novel dimensions we identify reflect success in different agricultural sectors and are independently associated with key benchmarks of food security and human growth, such as adult body mass index and child height. The multidimensional models of wealth we describe here provide new opportunities for examining the causes and consequences of wealth inequality that go beyond success in cash economies, for tracing the emergence of hybrid pathways to prosperity, and for assessing how these different pathways to economic success carry different health risks and social opportunities.

Anthropometric indices for non-pregnant women of childbearing age differ widely among four low-middle income populations

Background

Maternal stature and body mass indices (BMI) of non-pregnant women (NPW) of child bearing age are relevant to maternal and offspring health. The objective was to compare anthropometric indices of NPW in four rural communities in low- to low-middle income countries (LMIC).

Methods

Anthropometry and maternal characteristics/household wealth questionnaires were obtained for NPW enrolled in the Women First Preconception Maternal Nutrition Trial. Body mass index (BMI, kg/m²) was calculated. Z-scores were determined using WHO reference data.

Results

A total of 7268 NPW participated in Equateur, DRC (n = 1741); Chimaltenango, Guatemala (n = 1695); North Karnataka, India (n = 1823); and Thatta, Sindh, Pakistan (n = 2009). Mean age was 23 y and mean parity 1.5. Median (P25-P75) height (cm) ranged from 145.5 (142.2–148.9) in Guatemala to 156.0 (152.0–160.0) in DRC. Median weight (kg) ranged from 44.7 (39.9–50.3) in India to 52.7 (46.9–59.8) in Guatemala. Median BMI ranged from 19.4 (17.6–21.9) in India to 24.9 (22.3–28.0) in Guatemala. Percent stunted (<−2SD height for age z-score) ranged from 13.9% in DRC to 80.5% in Guatemala; % underweight (BMI <18.5) ranged from 1.2% in Guatemala to 37.1% in India; % overweight/obese (OW, BMI ≥25.0) ranged from 5.7% in DRC to 49.3% in Guatemala. For all sites, indicators for higher SES and higher age were associated with BMI. Lower SES women were underweight more frequently and higher SES women were OW more frequently at all sites. Younger women tended to be underweight, while older women tended to be OW.

Conclusions

Anthropometric data for NPW varied widely among low-income rural populations in four countries located on three different continents. Global comparisons of anthropometric measurements across sites using standard reference data serve to highlight major differences among populations of low-income rural NPW and assist in evaluating the rationale for and the design of optimal intervention trials.

Trial registration

ClinicalTrials.gov #NCT01883193 (18 June 2013, retrospectively registered)

How much do universal anthropometric standards bias the global monitoring of obesity and undernutrition?

Each year, hundreds of articles in population health and nutrition, many in high-profile journals, use standard cutoffs based on weight and height as assessments of obesity and undernutrition. These global efforts to monitor overweight and underweight often rest on the assumption that ethnic differences in underlying body form are sufficiently small to permit universal anthropometric cutoffs for comparing excess and insufficient body fat across populations. However, a century of work in human biological variation suggests that human populations can vary dramatically in underlying body form in a way that may require population-sensitive cutoffs for monitoring. Here, we describe recently developed methods that can provide population-sensitive assessments of both excess and insufficient energy reserves in a wide range of countries. We use this approach to illustrate how worldwide variation in human body form is far more widespread than previously thought, and that it can occur at several geographic scales, including the level of world regions, countries and populations within countries. The findings also suggest that using standard cutoffs that ignore this variation can underestimate current obesity levels in adults by more than 400-500 million while also incorrectly prioritizing high-risk areas for undernutrition in children in key regions around the world.

The fatter are happier in Indonesia

PURPOSE

Although obesity and happiness are known to be negatively related in the developed world, little attention has been paid to this relationship in the developing world. We thus investigated the relationship in Indonesia and attempted to explain the underlying rationale.

METHODS

We considered about 12,000 respondents aged 15+ for each gender obtained from the Indonesian Family Life Survey 2007 by relating a measure of happiness to weight-related measures in ordered probit models.

RESULTS

The relationship between obesity and happiness was positive in Indonesia, and this relationship was robust. Our evidence suggests that the contrasting results for the two worlds result from affordability of obesity. That is, while even low socioeconomic status (SES) individuals in the developed world can afford to be obese, only high SES individuals in the developing world can do.

CONCLUSIONS

Our findings imply that obesity prevention in the developing world requires different measures than those used in the developed world.

The Double Burden of Undernutrition and Overnutrition in Developing Countries: an Update

Many developing countries have achieved a remarkable improvement in nutrition status in the past decades. However, the prevalence of undernutrition remains a serious problem. At the same time, the prevalence of obesity is increasing substantially, and in some countries, it has approached that of developed countries. This article provides an update on this double burden of malnutrition (DBMN) in developing nations. One hundred countries (lower, middle-lower, and upper-middle income countries) were selected and analysed, and to support the analysis, a systematic review of current published studies was performed. The results show that DBMN already exists in almost all developing countries and that the DBMN ratio (i.e., overweight/underweight) has increased as income per capita has increased. DBMN may manifest within the community, household, or individual. In addition to common factors, poor nutrition in early childhood is suggested as another important driving factor behind the rising obesity rate in most developing countries. A life-course approach has been proposed to prevent undernutrition and overnutrition and should be integrated into the development of health systems to control double burden in developing countries.

Estimating the absolute wealth of households

Objective

To estimate the absolute wealth of households using data from demographic and health surveys.

Methods

We developed a new metric, the absolute wealth estimate, based on the rank of each surveyed household according to its material assets and the assumed shape of the distribution of wealth among surveyed households. Using data from 156 demographic and health surveys in 66 countries, we calculated absolute wealth estimates for households. We validated the method by comparing the proportion of households defined as poor using our estimates with published World Bank poverty headcounts. We also compared the accuracy of absolute versus relative wealth estimates for the prediction of anthropometric measures.

Findings

The median absolute wealth estimates of 1 403 186 households were 2056 international dollars per capita (interquartile range: 723–6103). The proportion of poor households based on absolute wealth estimates were strongly correlated with World Bank estimates of populations living on less than 2.00 United States dollars per capita per day (R² = 0.84). Absolute wealth estimates were better predictors of anthropometric measures than relative wealth indexes.

Conclusion

Absolute wealth estimates provide new opportunities for comparative research to assess the effects of economic resources on health and human capital, as well as the long-term health consequences of economic change and inequality.

Genetic population structure accounts for contemporary ecogeographic patterns in tropic and subtropic-dwelling humans

Contemporary human populations conform to ecogeographic predictions that animals will become more compact in cooler climates and less compact in warmer ones. However, it remains unclear to what extent this pattern reflects plastic responses to current environments or genetic differences among populations. Analyzing anthropometric surveys of 232,684 children and adults from across 80 ethnolinguistic groups in sub-Saharan Africa, Asia and the Americas, we confirm that body surface-to-volume correlates with contemporary temperature at magnitudes found in more latitudinally diverse samples (Adj. R² = 0.14-0.28). However, far more variation in body surface-to-volume is attributable to genetic population structure (Adj. R² = 0.50-0.74). Moreover, genetic population structure accounts for nearly all of the observed relationship between contemporary temperature and body surface-to-volume among children and adults. Indeed, after controlling for population structure, contemporary temperature accounts for no more than 4% of the variance in body form in these groups. This effect of genetic affinity on body form is also independent of other ecological variables, such as dominant mode of subsistence and household wealth per capita. These findings suggest that the observed fit of human body surface-to-volume with current climate in this sample reflects relatively large effects of existing genetic population structure of contemporary humans compared to plastic response to current environments.

The income body weight gradients in the developing economy of China

Existing theories predict the income gradient of individual body weight to change sign from positive to negative in process of economic development. However, there are only few empirical studies which test this hypothesis. This paper adds to the literature on that topic by investigating the case of China. Using individual and community data from 1991 to 2009 waves of the China Health and Nutrition Survey regression analyses suggest that after controlling for important confounding factors (1) higher income is positively related to future growth of individuals' BMI in less developed areas (i.e. BMI growth is 0.7-1.5 percentage points higher when comparing the richest with the poorest individuals), but negatively related to BMI growth in more developed areas (i.e. BMI growth is 0.8-1.6 percentage points lower for the richest individuals), and (2) that concentrations of overweight are "trickling down" to lower income ranks as regions become more developed. Moreover, the reversal of the income gradient appears to happen at earlier stages of development for females.

Temporal trends in BMI in Argentina by socio-economic position and province-level economic development, 2005-2009

OBJECTIVE

We investigated temporal trends in BMI, and assessed hypothesized predictors of trends including socio-economic position (SEP) and province-level economic development, in Argentina.

DESIGN

Using multivariable linear regression, we evaluated cross-sectional patterning and temporal trends in BMI and examined heterogeneity in these associations by SEP and province-level economic development with nationally representative samples from Argentina in 2005 and 2009. We calculated mean annual changes in BMI for men and women to assess secular trends.

RESULTS

Women, but not men, exhibited a strong cross-sectional inverse association between SEP and BMI, with the lowest-SEP women having an average BMI 2.55 kg/m(2) greater than the highest-SEP women. Analysis of trends revealed a mean annual increase in BMI of 0.19 kg/m(2) and 0.15 kg/m(2) for women and men, respectively, with slightly greater increases occurring in provinces with greater economic growth. No significant heterogeneity in trends existed by individual SEP.

CONCLUSIONS

BMI is increasing rapidly over time in Argentina irrespective of various sociodemographic characteristics. Higher BMI remains more common in women of lower SEP compared with those of higher SEP.

A short note on economic development and socioeconomic inequality in female body weight

The origin of the obesity epidemic in developing countries is still poorly understood. It has been prominently argued that economic development provides a natural interpretation of the growth in obesity. This paper tests the main aggregated predictions of the theoretical framework to analyze obesity. Average body weight and health inequality should be associated with economic development. Both hypotheses are confirmed: we find higher average female body weight in economically more advanced countries. In relatively nondeveloped countries, obesity is a phenomenon of the socioeconomic elite. With economic development, obesity shifts toward individuals with lower socioeconomic status.

Disentangling basal and accumulated body mass for cross-population comparisons

Measures of human body mass confound 1) well-established population differences in body form and 2) exposure to obesogenic environments, posing challenges for using body mass index (BMI) in cross-population studies of body form, energy reserves, and obesity-linked disease risk. We propose a method for decomposing population BMI by estimating basal BMI (bBMI) among young adults living in extremely poor, rural households where excess body mass accumulation is uncommon. We test this method with nationally representative, cross-sectional Demographic and Health Surveys (DHS) collected from 69,916 rural women (20-24 years) in 47 low-income countries. Predicting BMI by household wealth, we estimate country-level bBMI as the average BMI of young women (20-24 years) living in rural households with total assets <400 USD per capita. Above 400 USD per capita, BMI increases with both wealth and age. Below this point, BMI hits a baseline floor showing little effect of either age or wealth. Between-country variation in bBMI (range of 4.3 kg m(-2) ) is reliable across decades and age groups (R(2)  = 0.83-0.88). Country-level estimates of bBMI show no relation to diabetes prevalence or country-level GDP (R(2)  < 0.05), supporting its independence from excess body mass. Residual BMI (average BMI minus bBMI) shows better fit with both country-level GDP (R(2)  = 0.55 vs. 0.40) and diabetes prevalence (R(2)  = 0.23 vs. 0.17) than does conventional BMI. This method produces reliable estimates of bBMI across a wide range of nationally representative samples, providing a new approach to investigating population variation in body mass.

Trends in overweight by educational level in 33 low- and middle-income countries: the role of parity, age at first birth and breastfeeding

This study examined trends in overweight among women of reproductive age by educational level in 33 low- and middle-income countries, and estimated the contribution of parity, age at first birth and breastfeeding to these trends. We used repeated cross-sectional Demographic Health Surveys of 255,828 women aged 25-49 years interviewed between 1992 and 2009. We applied logistic regression to model overweight (>25 kg m(-2) ) as a function of education, reproductive variables and time period by country and region. The prevalence of overweight ranged from 3.4% in South and Southeast Asia to 73.7% in North Africa West/Central Asia during the study period. The association between education and overweight differed across regions. In North Africa West/Central Asia and Latin American, lower education was associated with higher overweight prevalence, while the inverse was true in South/Southeast Asia and Sub-Saharan Africa. In all regions, there was a consistent pattern of increasing overweight trends across all educational groups. Older age at first birth, longer breastfeeding and lower parity were associated with less overweight, for differences by educational level in overweight prevalence and trends.

Age trends in prevalence of cardiovascular risk factors in Roma minority population of Croatia

The Roma (Gypsy) are the largest European minority population characterized by poverty, social exclusion as well as by numerous life-style and cultural specificities, which all could have an adverse impact on their cardiovascular health. This study assesses the prevalence of cardiovascular diseases (CVD) risk factors in community-based sample of 430 adult Roma, living in rural area of Croatia, by providing the actual and age-adjusted estimates using the European standard population. The most prominent classical CVD risk phenotypes (blood pressure, obesity, smoking, glucose and lipid profile) were selected, and the standard risk cut-offs were applied. The study has shown that compared to general population of Croatia, the Roma population bears a high CVD risk factors load related to smoking and high glucose level. The CVD risk factors prevalence in Roma also showed important sex and age patterns, the most imposing of which are the findings of higher prevalence of CVD risks in women (especially obesity and triglyceride levels) and the trend of higher body mass index (BMI) level in younger age group (18-34 years) which both stand in contrast to the trends characterizing the general population of Croatia. These findings are complemented by the trend of decreased risk in the oldest age group (65+ years) for all investigated CVD risk factors (with exception of triglycerides level) compared to the 50-64 age group. We conclude that the age and sex CVD risks pattern point to the health transition of this rural Roma population. As we expect the proportion of CVD in the Roma minority of Croatia to increase in the future along with further modernization of their lifestyle, the CVD prevention measures in this population are urgent and should be primarily targeted at women and at the younger segment of this population.