Marriage, gender and obesity in later life

Dietary macro and micronutrients associated with MASLD: Analysis of a national US cohort database

INTRODUCTION AND OBJECTIVES

Our objective was to measure and compare the intake of macro and micronutrients in a cohort of individuals with Metabolic Syndrome Associated Steatotic Liver Disease (MASLD) compared with matched controls to identify areas of further research in this area; we identified nutrition-associated associations with MASLD in the United States general population.

MATERIALS AND METHODS

We used the 2017 - 2018 NHANES dataset. Elastography Controlled Attenuation Parameter (CAP score>280) in the absence of other liver disease was defined as MASLD in adults (>18). Advanced fibrosis was defined by transient elastography >10 kPa. Controls were adults without liver disease.

RESULTS

1648 MASLD cases (11.4 % advanced fibrosis) and 2527 controls were identified. MASLD cases were older (P<0.001), more likely males (P = 0.01), less likely to have a college education (P = 0.04) and more likely married (P = 0.002). MASLD cases were more likely to be of Mexican American or Hispanic ethnicity (P = 0.002), have higher BMI, and have higher prevalence of diabetes, hyperlipidemia and hypertension (P<0.001 for all). MASLD cases had higher hs-CRP (P = 0.02) and ferritin (P = 0.02). MASLD cases had lower total (P = 0.004) and added vitamin E in their diet (P = 0.002), lower vitamin K intake (P = 0.005), and higher selenium intake (P = 0.03). Caloric intake (P = 0.04), carbohydrate intake (P = 0.02), cholesterol intake (P = 0.03) and saturated fatty acid intake (P = 0.05) were higher in MASLD. Individuals with MASLD were more likely to be on a diet (P<0.001), sedentary (P = 0.008) and less likely to participate in moderate or vigorous recreational activities (P<0.001).

CONCLUSIONS

The deficiencies of micronutrients and excess of macronutrients point to oxidative stress, pro-inflammatory state, and lipotoxicity as pathways linking the US diet to MASLD. MASLD patients are more often on special diets, which may reflect prior provider counseling on diet changes to improve health.

Examining the risk factors for overweight and obesity among women in Ghana: A multilevel perspective

Overweight/obesity prevalence is on the increase in epidemic proportions across Low- and Middle-Income countries (LMICs). The public health burden associated with obesity/overweight cannot be underestimated due to its association with chronic health outcomes. This study investigated the individual- and community level risk factors for obesity/overweight among reproductive women. The data used consist of 4393 reproductive women and form part of the 2014 Ghana Demographic and Health Survey (GDHS). Information on these women are clustered within 427 communities. A 2-tier random intercept multilevel logistic model was used to assess the effect of individual- and community level factors on the likelihood of a woman to be obese/overweight. The obesity/overweight prevalence among reproductive women was estimated to be 35.5% (95% CI: 34.04, 36.90%), which significantly differed across clusters. Most at risk were women from middle-income households (aOR = 2.85; 95% CI: 2.28, 3.56), upper-income households (aOR = 5.019, 95% CI: 3.85, 6.55), attaining secondary education (aOR = 1.74; 95% CI: 1.41, 2.16), and higher (aOR = 1.63; 95% CI: 1.14, 2.33), old age (20-29 years (aOR = 4.26; 95% CI: 3.142,5.78); 30-39 years (aOR = 8.59; 95% CI: 6.15, 12.00); 40-49 years (aOR = 12.81; 95% CI: 9.10, 18.16)). Significant differences in the probability of being overweight/obese between different communities were observed (MOR = 1.39). The high prevalence of overweight/obesity requires urgent public health interventions to prevent future public health crises. Efforts to strengthen the healthcare system, encourage lifestyle modification, and public health education are needed to solidify the gains of ensuring a healthy population by 2030 (SDG 3).

Child Marriage and Later-Life Risk of Obesity in Women: A Cohort Analysis Using Nationally Representative Repeated Cross-Sectional Data from Tajikistan

Child marriage, defined as union before age 18 years, has detrimental health and socioeconomic consequences. This study examines whether women married as children have a disproportionately higher risk of being obese at adulthood compared to their peers married as adults. Using data from the 2012 and 2017 waves of the Tajikistan Demographic and Health Survey, we matched women aged 25 to 49 years by birth year and month to create four birth cohorts. We fitted multivariable logistic regressions to assess the differential odds of being obese and estimated simultaneous quantile regression models to examine the differences in average body mass index (BMI) between women married as adults and as children within birth cohorts. We found that the adjusted odds of being obese for women married as children were 1.5 (CI: 1.3–1.7) times those of those who were married as adults, after controlling for sociodemographic correlates along with birth cohort and survey wave fixed effects. Results of the quantile regression analyses suggest higher expected BMI levels among women married as children compared to those of women married as adults across different quantiles of BMI. The differences though were more pronounced in the younger cohorts than in the older cohorts.

Overweight and obesity in south central Uganda: A population-based study

Obesity is a rapidly growing global health challenge, but there are few population-level studies from non-urban settings in sub-Saharan Africa. We evaluated the prevalence of overweight (body mass index (BMI)>25 kg/m2), obesity (BMI>30 kg/m2), and associated factors using data from May 2018 to November 2020 from the Rakai Community Cohort Study, a population-based cohort of residents aged 15 to 49 living in forty-one fishing, trading, and agrarian communities in South Central Uganda. Modified Poisson regression was used to estimate adjusted prevalence risk ratios (PRR) and 95% confidence intervals (CI) in 18,079 participants. The overall mean BMI was 22.9 kg/m2. Mean BMI was 21.5 kg/m2 and 24.1 kg/m2 for males and females, respectively. The prevalence of overweight and obesity were 22.8% and 6.2%, respectively. Females had a higher probability of overweight/obesity (PRR: 4.11, CI: 2.98-5.68) than males. For female participants, increasing age, higher socioeconomic status, residing in a trading or fishing community (PRR: 1.25, CI 1.16-1.35 and PRR: 1.17, CI 1.10-1.25, respectively), being currently or previously married (PRR: 1.22, CI 1.07-1.40 and PRR: 1.16, CI 1.01-1.34, respectively), working in a bar/restaurant (PRR: 1.29, CI 1.17-1.45), trading/shopkeeping (PRR: 1.38, CI 1.29-1.48), and reporting alcohol use in the last year (PRR: 1.21, CI 1.10-1.33) were risk factors for overweight/obese. For male participants, increasing age, higher socioeconomic status, being currently married (PRR: 1.94, CI 1.50-2.50), residing in a fishing community (PRR: 1.68, CI 1.40-2.02), working in a bar/restaurant (PRR: 2.20, CI 1.10-4.40), trading/shopkeeping (PRR: 1.75, CI 1.45-2.11), or fishing (PRR: 1.32, CI 1.03-1.69) increased the probability of overweight/obesity. Non-Muslim participants, male smokers, and HIV-positive females had a lower probability of overweight/obese. The prevalence of overweight/obesity in non-urban Ugandans is substantial. Targeted interventions to high-risk subgroups in this population are needed.

Association Between Nutritional Knowledge, Dietary Regimen, and Excess Body Weight in Primary School Teachers

Introduction

Peru is one of the developing countries with the highest prevalence of overweight and obesity in Latin America and Caribbean region. Primary school teachers are identified as a high-risk group for overweight and obesity. However, studies conducted in this population group are limited. This study evaluated the association between nutritional knowledge, dietary regimen, and excess body weight in primary school teachers.

Methods

This was a cross-sectional study that included 151 teachers from two state schools in the eastern region of Lima, Peru. The level of nutritional knowledge was assessed using a validated questionnaire. Dietary regimen was also determined. The body mass index (BMI) was determined through self-reported weight and height. Logistic regression analysis was used to assess the association between possible risk factors with excess body weight among teachers.

Results

Inadequate nutritional knowledge level (AOR = 5.21, 95% CI: 1.31–20.93), being male teachers (AOR = 2.25, 95% CI: 1.13–4.45), and being married (AOR = 2.49, 95% CI: 1.17–5.30) were the significant predictors of excess body weight. In contrast, vegetarian teachers were less likely to have excess body weight (AOR = 0.35, 95% CI: 0.47–0.97).

Conclusion

Future intervention programs should include improving nutritional knowledge with greater attention to male and married teachers to decrease the risk of excess body weight.

Developing and Validating Risk Algorithm for Hypertension in South Africa: Results from a Nationally Representative Cohort (2008-2017)

Introduction

There is compelling evidence of significant country-level disparities where African countries, particularly South Africa, have the highest hypertension rates in the world.

Aim

To develop and validate a simple risk scoring algorithm for hypertension in a large cohort (80,270) of South African men and women.

Methods

Multivariable logistic regression models were used to build our hypertension risk scoring algorithm and validated externally and internally using the standard statistical techniques. We also compared our risk scores with the results from the Framingham risk prediction model for hypertension.

Results

Six factors were identified as the significant correlates of hypertension: age, education, obesity, smoking, alcohol intake and exercise. A score of ≥ 25 (out of 57) for men and ≥ 35 (out of 75) for women were selected as the optimum cut-points with 82% (43%) and 83% (49%) sensitivity (specificity) for males and females, respectively in the development datasets. We estimated probabilities of developing hypertension using the Framingham risk prediction model, which were higher among those with higher scores for hypertension.

Conclusions

Identifying, targeting and prioritising individuals at highest risk of hypertension will have significant impact on preventing severe cardiometabolic diseases by scaling up healthy diet and life-style factors. Our six-item risk scoring algorithm may be included as part of hypertension prevention and treatment programs by targeting older individuals with high body fat measurements who are at highest risk of developing hypertension.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40292-022-00534-5.

PROTOCOL: The association between marital transitions and physical and mental health in late life: A systematic review

This is the protocol for a Campbell systematic review. The objectives are as follows: What is the association between marital transitions and physical health among people older than 60? What is the association between marital transitions and mental health among people older than 60? What is the role of gender, age, and education on the association between marital transitions and health among people older than 60? What is the influence of geographical region, housing, neighborhood, and social support on the association between marital transitions and health status among people older than 60?

Health endowments, schooling allocation in the family, and longevity: Evidence from US twins

We analyze data from the Minnesota Twin Registry (MTR), combined with the Socioeconomic Survey of Twins (SST), and new mortality data, and contribute to two bodies of literature. First, we demonstrate a beneficial causal effect of education on health and longevity in contrast to other twin-based studies of the US population, which show little or no effect of education on health. Second, we present evidence that is consistent with parental compensation through education for differences in their children's endowments that predict health, but find no evidence that parents reinforce differences in endowments that predict earnings. We argue that there is a bias towards detecting reinforcement both in this paper and in the literature. Despite this bias, we still find statistical evidence of compensating behavior. We account for observed and unobserved confounding factors, sample selection bias, and measurement error in education.

Psychosocial, Eating Behavior, and Lifestyle Factors Influencing Overweight and Obesity in Adolescents

BACKGROUND

Adolescent overweight and obesity (AOO) is a global public health problem and risk for noncommunicable diseases. Understanding context-specific risks is crucial for interventions.

OBJECTIVE

Determine the prevalence of AOO in the Indonesian National Health Survey (INHS) 2013, assess the 5-year trend from 2013 to 2018, and identify risks.

METHODS

We selected adolescents aged 10 to 19 years (n = 174 290) from the INHS 2013 and used hierarchical logistic regression to identify gender-specific risks for those aged 15 to 19 years (n = 77 534). Change in AOO was assessed by comparison to INHS 2018 reports.

RESULTS

The national AOO prevalence increased over 5 years by 48% in young adolescents (13-15 years) and 85% in older ones (16-18 years). High prevalence areas included the urban location of Jakarta (20.9%) and the remote rural region of Papua (19.4%). Overall, AOO risks were being sedentary, male, lower education, married, younger adolescent, and school enrollment, with urban residence and higher wealth being persistent risks for all analyses. Data for depressive symptoms were available for older adolescents whose additional risks were being sedentary, depressive symptoms, and high-fat diet. Male risks were being sedentary and lower education, and female risks were being married, depressive symptoms, high-fat intake, and lower education. Higher intake of fruits and vegetables and fewer sweets did not protect against AOO if a high-fat diet was consumed.

CONCLUSIONS

Adolescent overweight and obesity in Indonesia is rapidly increasing, especially in older adolescents and males, and with gender-specific risks. Customized multisectoral interventions to identify strategies for lifestyle change are urgently needed.

Marriage contributes to higher obesity risk in China: findings from the China Health and Nutrition Survey

Background

To investigate the association between marriage and the prevalence of overweight and obesity in China.

Methods

We conducted cross-sectional and retrospective cohort analyses using a nationwide sample of 36,310 individuals from the China Health and Nutrition Survey [2004-2015].

Results

The prevalence of overweight and obesity increased from 28.7% to 36.7% and from 8.0% to 14.5% between 2004 and 2015, respectively. The cross-sectional analysis showed that married individuals were at a higher risk of being overweight (OR =2.18; 95% CI, 1.90-2.51) or obese (OR =1.95; 1.57-2.43) than never-married individuals. Divorced/widowed individuals were also at a greater risk of being overweight (OR =1.80; 1.51-2.13) or obese (OR =1.67; 1.28-2.17) than never-married individuals. Retrospective cohort analysis showed that individuals who married during the study were 1.55 (1.13-2.11) times more likely to be overweight than those who remained never-married. Compared to those who remained never-married, individuals who remained married were 1.71 (1.42-2.07) and 1.45 (1.11-1.89) times more likely to be overweight and obese. Individuals who became divorced or widowed were more likely to be overweight (RR =1.59; 1.18-2.15) or obese (RR =1.63; 1.08-2.46) than those who remained never-married. However, the risk of being overweight or obese among those who became divorced or widowed did not differ significantly from the risk among those who remained married.

Conclusions

Marriage contributes to an increased risk of overweight and obesity in China; however, this risk is not significantly reduced by exiting a marriage.

Spatial analysis of the prevalence of obesity and overweight among women in Ghana

OBJECTIVE

Identifying hot spots for the overweight aids in effective public health interventions due to the associated public health burden and morbidities. This study, therefore aimed to explore and determine the spatial disparities in the overweight/obesity prevalence among women in Ghana. The study also aims at modelling the average body mass index (BMI) values using the spatial regression and the performance compared with the standard regression model.

DESIGN

This is a cross-sectional study using data from the 2014 Ghana Demographic and Health Survey (GDHS).

SETTING

The study was set in Ghana.

PARTICIPANTS AND METHODS

Data on 4393 non-pregnant women aged 15-49 years from the 2014 GDHS. Both global (Moran's I) and the local indicators for spatial dependence were examined through the mapped BMI values across the country by clusters. An estimated spatial lag model was used to explain the spatial differences in the average body sizes of women.

RESULTS

The overall prevalence of overweight/obesity among reproductive women in Ghana was 35.4%, and this was highly prevalent among educated women (p<0.001), those from wealthy households (p<0.001) and dwelling in an urban setting (p<0.001). Significant clustering (Moran's I=0.3145, p<0.01) of overweight/obesity was observed with hot spots (clustering) in Greater Accra, Central, Western and Ashanti regions. The spatial lag model was the best fit based on the Likelihood ratio test and the Akaike information criterion and Bayesian information criterion values. The mean age of women and household wealth were significant factors accounting for the increase in the average cluster body size (BMI) of women and the spatial differences.

CONCLUSION

The prevalence of overweight/obesity was high and spatially clustered in the southern, middle and coastal regions. Geographic specific and effective public health interventions and strategies are needed to address the growing morbidity burden associated with the rise in the average body sizes of reproductive women.

Prevalence of anaemia and associated risk factors amongst The Malaysian Cohort participants

This study was aimed at determining the prevalence of anaemia amongst the Malaysian Cohort participants and the associated risk factors. This was a cross-sectional study that involved 102,388 participants from The Malaysian Cohort (TMC) aged between 35 and 70 years old recruited from April 2006 to September 2012. Venous blood was taken for the full blood count. The prevalence of anaemia was 13.8% with majority having the microcytic-hypochromic type (59.7%). Comparison between the ethnic groups showed that Indians have the highest prevalence of anaemia (19.9%), followed by Malays (13.1%), and Chinese (12.0%). The prevalence of anaemia was substantially higher in females (20.1%) compared to males (4.9%). Amongst the female participants, the prevalence of anaemia was highest amongst those who were younger than 49 years old and decreased as the age increased. In contrast, the prevalence of anaemia in males increased with age. Gender, ethnicity, age, marital status, presence of platelet disorders and kidney disease were significant risk factors associated with anaemia and contributed to 14.9% of the risk of developing anaemia in this population. The prevalence of anaemia amongst the Malaysian Cohort participants is 13.8% with the majority having the microcytic and hypochromic type implying iron deficiency as the main cause. It is important that those who have anaemia be further investigated and treated.

Partnering and parenting transitions in Australian men and women: associations with changes in weight, domain-specific physical activity and sedentary behaviours

Background

Partnering and parenting are important life-stage transitions often accompanied by changes in social networks, roles and responsibilities. There have been no longitudinal studies examining associations of partnering and parenting with changes in domain-specific physical activity (PA) and sedentary behaviours, and our understanding of whether these transitions are associated with weight change is limited.

Methods

Two thousand one hundred and twenty-four Australian adults from a national cohort (mean age 31.7 (2.7) years, 47.5% male) completed questionnaires at baseline (2004–06) and follow-up (2009–11), reporting marital and parental status. Weight (kg) was measured at baseline and self-reported at follow-up. PA and sedentary behaviours (sitting and television (TV) viewing) were self-reported in a subset (n = 1221). Linear regression estimated the longitudinal associations of parenting and partnering transitions with PA, sedentary behaviours and weight at follow-up, adjusted for baseline value of the respective outcome variable, age, education, follow-up duration and other life-stage transition.

Results

During the 5-year follow-up, 17.3% men and 12.9% women partnered, and 27.3% men and 19.1% women had their first child. Compared to staying not partnered, partnering was associated with an increase in total PA (177.5mins/week, 95% Confidence Interval (CI) 18.0 to 337.0) among men and a greater weight gain (2.2 kg, 95% CI 0.6 to 3.7) among women. Compared to remaining child-free, having a first child was associated with greater reductions in total PA (− 123.9mins/week, 95% CI − 248.8 to 1.1) and TV viewing time (− 27.0mins/day, 95% CI − 50.6 to − 3.3) among men. Women who had their first child had greater weight gain (1.4 kg, 95% CI 0.1 to 2.7) but spent less time sitting (− 103.8mins/day, 95% CI − 135.5 to − 72.1) than those remaining child-free. For women, having additional children was associated with less sitting time (− 39.4mins/week, 95% CI − 66.0 to − 12.8) than having the same number of children.

Conclusions

Partnering was associated with an increase in men’s total PA and women’s weight. Transitions into parenthood with a first child or additional children were associated with potentially health-impairing changes in weight and PA, but health-promoting changes in sedentary behaviours. Future PA promotion strategies should pay attention to men who had their first child to mitigate declining total PA.

An alarmingly high and increasing prevalence of obesity in Jordan

OBJECTIVES

The aim of this study was to determine the prevalence of obesity in Jordan, to assess related trends, and to determine associated factors and comorbidities.

METHODS

A multipurpose national household survey of Jordanian adults was conducted over a 4-month period in 2017. Data were collected using a structured validated questionnaire. Anthropometric measurements including waist circumference (WC; measured midway between the iliac crest and the lower rib margin), body mass index (BMI), hip circumference, waist-to-hip ratio, and waist-to-height ratio were obtained to categorize participants with regard to overweight and obesity.

RESULTS

This study included 4,056 persons (1,193 men and 2,863 women) aged 18 years to 90 years (mean±standard deviation, 43.8±14.2 years). According to the International Diabetes Federation WC criteria, the age-standardized prevalence of obesity was 60.4% among men and 75.6% among women, while approximately three-quarters of men and women were overweight or obese as defined by BMI. The age-adjusted odds of obesity in 2017 were approximately twice those in 2009 in men (odds ratio [OR], 1.98) and women (OR, 1.96). In the multivariate analysis, age, region of residence, and marital status were significantly associated with obesity in both genders. Obesity was significantly associated with increased odds of diabetes mellitus, hypertension, elevated triglycerides, and low high-density lipoprotein cholesterol after adjusting for age.

CONCLUSIONS

The rate of obesity in Jordan is high and increasing, and obesity is associated with other metabolic abnormalities. Well-defined programs to control and prevent obesity, as well as intersectoral action, are urgently required to reverse current trends.

The economic gradient of obesity in Mexico: Independent predictive roles of absolute and relative wealth by gender

Despite the vast literature on the economic gradient of obesity, no study investigates the independent predictive roles of absolute and relative standards of living using a large nationally representative adult sample. This gap limits our ability to discern 'material' and 'psychosocial' pathways to obesity as well as our understanding of the role played by economic inequality in the growing obesity epidemic. Using a large and nationally representative Mexican dataset, we find that absolute wealth and relative deprivation are independently related to obesity, and that such relationships are patterned by sex. Absolute wealth predicts body mass index as well as abdominal obesity according to an inverted-U shape for both sexes, and more markedly so for females. Relative deprivation predicts higher body mass index for females and higher waist circumference for both sexes, with highly relatively deprived females being 24.29% (95% CI [24.26, 24.31]) more likely to be obese and 34.46% (95% CI [34.40,34.53]) more likely to be abdominal obese, and highly relatively deprived males being 14.91% (95% CI [14.88,14.93] more likely to be abdominal obese. Our results offer a new perspective on the economic gradient of obesity and highlight the potential impact of economic inequality, especially for women. Greater awareness of the independent and sex-specific roles of the absolute and relative facets of economic status is needed to better understand and address the obesity epidemic.

"Men like to Eat More Rice and Beans and Things like That": The Influence of Childhood Experience and Life Course Events on Dietary Acculturation

Life course perspective provides a framework for examining the immigrant experience within the context of globalization and transnationalism. Life course perspective states that individuals develop food choice trajectories based on childhood experiences with food. This study examined the influence of childhood experiences and life events on eating behaviors of Dominican born women in Santo Domingo, Dominican Republic, and New York City. Findings revealed that women developed traditional or non-traditional food choice trajectories. These food choice trajectories remained stable through transition points, such as immigration, marriage, and divorce. Women discussed changes in the amount of food that was eaten, which may explain weight gain after immigration. These findings highlight the limitations of acculturation theory in understanding the eating behaviors of immigrants and provide an alternative explanation for weight gain after immigration.

Factors associated with anemia among female adult vegetarians in Malaysia

BACKGROUND/OBJECTIVES

A large number of studies on anemia have focused mostly on pregnant women or children. The vegetarian population, which is another potential risk group for anemia, remains largely unexplored. Therefore, this cross-sectional study examined the associations of the sociodemographic, lifestyle, nutritional, and psychological factors with the anemia status among female adult vegetarians.

SUBJECTS/METHODS

A total of 177 female vegetarians were recruited from a Buddhist and Hindu organization in Selangor, Malaysia. The participants completed a self-administered questionnaire, which analyzed their sociodemographic characteristics, physical activity level, sleep quality, depression, anxiety, and stress. The body weight, height, waist circumference, and body fat percentage of the participants were also measured. A 3-day dietary recall was conducted to assess their dietary intake. Blood samples (3 ml) were withdrawn by a nurse from each participant to determine the hemoglobin (Hb) level.

RESULTS

The findings revealed 28.2% of the participants to be anemic. The age group (AOR = 2.46, 95% CI = 1.19-5.05), marital status (AOR = 2.69, 95% CI = 1.27-5.71), and percentage of energy from protein (AOR = 5.52, 95% CI = 1.41-21.65) were the significant predictors of anemia.

CONCLUSIONS

Anemia is a public health problem among female vegetarians in this study. Health promotion programs that target female adult vegetarians should be conducted to manage and prevent anemia, particularly among those who are married, aged 50 and below, and with an inadequate protein intake.

Income and Marital Status Interact on Obesity Among Black and White Men

Racial disparities in obesity among men are accompanied by positive associations between income and obesity among Black men only. Race also moderates the positive association between marital status and obesity. This study sought to determine how race, income, and marital status interact on obesity among men. Using data from the 2007 to 2014 National Health and Nutrition Examination Survey, obesity was measured as body mass index ≥30 kg/m2 among 6,145 Black and White men. Income was measured by percentage of the federal poverty line and marital status was categorized as currently, formerly, or never married. Using logistic regression and interaction terms, the associations between income and obesity were assessed by race and marital status categories adjusted for covariates. Black compared to White (OR = 1.19, 95% CI [1.03, 1.38]), currently married compared to never married (OR = 1.45, 95% CI [1.24, 1.69]), and high-income men compared to low income men (OR = 1.26, 95% CI [1.06, 1.50]) had higher odds of obesity. A three-way interaction was significant and analyses identified that income was positively associated with obesity among currently married Black men and never married White men with the highest and lowest probabilities of obesity, respectively. High-income, currently married Black men had higher obesity rates and may be at increased risk for obesity-related morbidities.

The prevalence of abdominal obesity and the association with socioeconomic status in Regions of the Russian Federation, the results of the epidemiological study - ESSE-RF

Abdominal obesity (AO) is a predictor of cardiovascular disease and diabetes mellitus type 2. The assessment of the disease prevalence and the study of socioeconomic status of people with this phenotype of obesity are necessary to develop effective mechanisms to combat this risk factor in the population. The aim of the study is to determine the prevalence of AO in the population and to assess the association with socioeconomic factors according to the data of the ESSE-RF study (Epidemiology of Cardiovascular diseases in the Regions of the Russian Federation). Materials and methods. The object of the study is a random population sample of men and women aged 25-64 years from 13 regions of the Russian Federation (n=21 817). Abdominal obesity in men was defined as waist circumference (WC) >94 cm, and in women - WC >80 cm. Body mass index (BMI) >30.0 kg/m2 was adopted as the criterion of common obesity. Results and discussion. The prevalence of AO in Russia was 55% (61.8% in women and 44% in men), while the percent of people with obesity, defined by BMI was significantly lower (33.4%). The number of examined patients with AO increased with age among both men and women (p

Prospective cohort study of overweight and obesity among rural Indian adults: sociodemographic predictors of prevalence, incidence and remission

OBJECTIVES

To assess sociodemographic predictors of prevalence, incidence and remission of overweight including obesity among adults (aged ≥18 years) in rural Eastern India.

DESIGN

Prospective cohort study.

SETTING

Birbhum Health and Demographic Surveillance System, West Bengal, India.

PARTICIPANTS

Self-weighted sample of 24 115 adults (men: 10915, women: 13200) enrolled in 2008 were followed up for body mass index (BMI) reassessment in 2017.

PRIMARY AND SECONDARY OUTCOME MEASURES

Measured BMI was categorised as: underweight (<18.5 kg/m²), normal weight (18.5-22.9 kg/m²) and overweight including obesity (≥23 kg/m²; hereinafter overweight). Incident overweight was defined as transition from normal weight in 2008 to overweight in 2017, whereas if overweight individuals in 2008 measured normal BMI in 2017, it was classified as remission from overweight.

RESULTS

In 2008, 10.1% of men and 14.6% of women were overweight, whereas 17.3% of men and 24.7% of women were overweight in 2017. At the same time, in 2017, 35.6% of men and 33.3% of women were underweight. Incident overweight was 19.0% among men and 27.2% among women, whereas remission among men was higher (15.4%) than women (11.5%). Women were more likely to be overweight in 2008 and to experience incident overweight than men. For men and women, education level and wealth were positively associated with prevalence and incidence of overweight. Remission from overweight was less likely in Sainthia, a business hub in the district, as compared with Mohammad Bazar, a more rural area.

CONCLUSION

A nutrition transition to higher risk of overweight is evident in this rural setting in India, especially among women and individuals with high socioeconomic status. At the same time, a high prevalence of underweight persists, resulting in a significant double burden. Culturally sensitive interventions that address both ends of the malnutrition spectrum should be prioritised.

Women's spousal choices and a man's handshake: Evidence from a Norwegian study of cohort differences

Both high grip strength and being married independently relate to better functional capacity and health at older ages, but the combined effect of marital status and strength have not been investigated. Especially at older ages, declining strength can have adverse health and social consequences, where having a spouse could potentially help with everyday support and alleviate some of the negative effects of sarcopenia. We investigate how grip strength relates to being married among two cohorts of 59–71 year olds (born 1923-35 and 1936-48) in the Norwegian city of Tromsø, controlling for a broad set of health variables and sociodemographic characteristics. The baseline included N = 5009 participants of whom 649 died during follow-up. We find that for men, particularly among younger cohorts, the physically stronger are more likely to be married, but no relation is found for women. This is consistent with a hypothesis that women increasingly have selected male marital partners based on preferred individual traits, whereas men do not emphasize strength when selecting women. We find that both marital status and grip strength independently affect mortality, but there is no significant joint effect. However, the distribution of strength and marital status implies that more men than women and increasing shares of later born cohorts have a “double-burden” of low strength and a lack of support from a spouse.

Urban green space and obesity in older adults: Evidence from Ireland

We examine the association between living in an urban area with more or less green space and the probability of being obese. This work involves the creation of a new dataset which combines geo-coded data at the individual level from the Irish Longitudinal Study on Ageing with green space data from the European Urban Atlas 2012. We find evidence suggestive of a u-shaped relationship between green space in urban areas and obesity; those living in areas with the lowest and highest shares of green space within a 1.6 km buffer zone have a higher probability of being classified as obese (BMI [Formula: see text]). The unexpected result that persons in areas with both the lowest and highest shares of green space have a higher probability of being obese than those in areas with intermediate shares, suggests that other characteristics of urban areas may be mediating this relationship.

Criminal Justice Contact, Stressors, and Obesity-Related Health Problems Among Black Adults in the USA

Criminal justice contact-defined as lifetime arrest, parole, or incarceration, seems to exacerbate chronic conditions, and those who are most likely to have had contact with the criminal justice system, such as Black adults, often already have pre-existing disproportionately high rates of stress and chronic conditions due to the social determinants of health that affect underrepresented minorities. Findings from this study suggest that there is a mechanism that links the stressors among Black adults manifested by such factors as family, financial, neighborhood, and personal problems with criminal justice contact to obesity-related health status. Using the National Survey of American Life (NSAL), modified Poisson regression analyses were used to determine the association between criminal justice contact, stressors, and obesity-related health problems among a national sample of Black adults (n = 5008). In the full model, the odds of experiencing obesity-related health problems for Black adults who had criminal justice contact was reduced (PR, 1.23 to 1.14) and not statistically significant. Black adults who reported experiencing family stressors (PR, 1.21; 95% CI, 1.08, 1.36), financial stressors (PR, 1.30; 95% CI, 1.16, 1.47), and personal stressors (PR, 1.16; 95% CI, 1.02, 1.31) were statistically significant and higher than those who reported not experiencing any of these stressors; neighborhood stressors was not statistically significant. The evidence suggests a relationship between the stressors associated with criminal justice contact and obesity-related health status. These findings emphasize the need to further explore the family, financial, and personal stressors for Black adults with criminal justice contact in order to further our understanding of their obesity-related health problems.ᅟ.

Gender disparities in the association between socio-demographics and non-communicable disease risk factors among adults with disabilities in Shanghai, China

Background

Non-communicable disease (NCD) risk factors can co-exist with disability and cause a greater burden on the health status of adults with disabilities. A lack of egalitarian social policies in China may result in gender disparities in the NCD risk factors of adults with disabilities. However, little is known about the gender disparities in the association between socio-demographics and NCD risk factors among adults with disabilities in China; consequently, we examined this association among adults with disabilities in Shanghai, China.

Methods

We used the health examination data of 44,896 adults with disabilities in Shanghai in 2014. Descriptive analyses and logistic regression models were conducted to estimate gender disparities in the association between socio-demographics, disability characteristics, and four selected NCD risk factors among adults with disabilities—including high blood pressure, high blood glucose, high blood lipids, and being overweight. We estimated marginal effects (MEs) on NCD risk factors between gender and other confounders.

Results

Women with disabilities were about 11.6 percentage points more likely to suffer from high blood lipids and less likely to develop the other three risk factors than men were. The association of age group, residence permit, education level, marital status, and disability type with health outcomes varied by gender among adults with disabilities. The difference in age effects between men and women was more pronounced in older age groups. Urban residence was associated with less risk of high blood pressure risk among women (ΔME =  − 0.035, p < 0.01), but no significant difference in other NCD risk factors. Education remained a major protective factor against high blood pressure, high blood glucose and being overweight among women with disabilities (MEs < 0, p < 0.05); however, this did not hold for men. The difference in marriage effects between men and women was observed in high blood lipids (ΔME =  − 0.048 for the married group and −0.054 for the divorced or widowed group) and overweight individuals (ΔME =  − 0.091 for the married group and −0.114 for the divorced or widowed group). Women with intellectual disabilities or mental disabilities reported worse health conditions than men did.

Discussion

Preventive strategies and interventions on NCD risk factors for adults with disabilities should take into account gender disparities in these socio-demographic effects. Rural women or poorly educated women with disabilities can be a vulnerable population that requires more health education and promotion strategies. Health education for caregivers of women with intellectual or mental disabilities may also play a vital role in preventing their NCD risk factors.

Concordance of health states in couples: Analysis of self-reported, nurse administered and blood-based biomarker data in the UK Understanding Society panel

We use self-reported health measures, nurse-administered measurements and blood-based biomarkers to examine the concordance between health states of partners in marital/cohabiting relationships in the UK. A model of cumulative health exposures is used to interpret the empirical pattern of between-partner health correlation in relation to elapsed relationship duration, allowing us to distinguish non-causal correlation due to assortative mating from potentially causal effects of shared lifestyle and environmental factors. We find important differences between the results for different health indicators, with strongest homogamy correlations observed for adiposity, followed by blood pressure, heart rate, inflammatory markers and cholesterol, and also self-assessed general health and functional difficulties. We find no evidence of a "dose-response relationship" for marriage duration, and show that this suggests - perhaps counterintuitively - that shared lifestyle factors and homogamous partner selection make roughly equal contributions to the concordance we observe in most of the health measures we examine.

The impact of marriage and parenthood on male body mass index: Static and dynamic effects

RATIONALE

Numerous cross-sectional studies investigated the link between marital status and BMI in the context of competing social science theories (marriage market, marriage selection, marriage protection and social obligation), frequently offering conflicting theoretical predictions and conflicting empirical findings.

OBJECTIVE

This study analysed the effects of marriage, divorce, pregnancy, and parenthood on male BMI in a longitudinal setting, avoiding the estimation bias of cross-sectional studies and allowing for an analysis of BMI fluctuation over time and the dynamic effects of these events.

METHOD

Using the Panel Study of Income Dynamics 1999-2013 dataset (N = 8729), this study was the first to employ a dynamic panel-data estimation to examine the static and dynamic effects of marriage, divorce, and fatherhood on male BMI.

RESULTS

The study showed that married men have higher BMI, but marital status changes largely drove this static effect, namely, an increase in BMI in the period following marriage, and a decrease in BMI preceding and following divorce.

CONCLUSIONS

Thus, this study found marked evidence in support of the marriage market and social obligation theories' predictions about male BMI, and supports neither marriage protection theory nor marriage selection theory. Wives' pregnancies had no significant effect on BMI; instead, men tend to have higher BMI in the periods following childbirth. Finally, analyses showed marked contemporaneous correlations between husband and wife BMI over the course of marriage.

Spatial Statistics for Dyadic Data: Analyzing the Relationship Landscape

Spatial statistics has a rich tradition in earth, economic, and epidemiological sciences and has potential to affect the study of couples as well. When applied to couple data, spatial statistics can model within- and between-couple differences with results that are readily accessible for researchers and clinicians. This article offers a primer in using spatial statistics as a methodological tool for analyzing dyadic data. The article will introduce spatial approaches, review data structure required for spatial analysis, available software, and examples of data output.

Urban-rural and geographic differences in overweight and obesity in four sub-Saharan African adult populations: a multi-country cross-sectional study

BACKGROUND

Overweight and obesity are on the rise in developing countries including sub-Saharan Africa. We undertook a four-country survey to show the collective burden of these health conditions as they occur currently in sub-Saharan Africa and to determine the differences between urban and rural populations and other socio-economic factors.

METHODS

Participants were nurses in two hospitals in Nigeria (200), school teachers in South Africa (489) and Tanzania (229), and village residents in one peri-urban (297) and one rural location in Uganda (200) who completed a standardised questionnaire. Their height and weight were measured and body mass index calculated. Factor analysis procedure (Principal component) was used to generate a wealth index. Univariate and multivariate analyses with binary logistic regression models were conducted to examine the associations between potential correlates and the prevalence of overweight and obesity with 95 % confidence intervals.

RESULTS

The prevalence of overweight and obese (combined) was 46 %, 48 %, 68 %, 75 % and 85 % in rural Uganda, peri-urban Uganda, Nigeria, Tanzania and South Africa (SA), respectively. Rural Uganda, Peri- urban Uganda, Nigeria, Tanzania and SA had obesity prevalence of 10 %, 14 %, 31 %, 40 % and 54 %, respectively (p < 0.001). Overall, prevalence of overweight was 374 (31 %) and obesity, 414 (34 %). Female sex was a predictor of overweight and obesity (combined) in peri-urban Uganda [AOR = 8.01; 95 % CI: 4.02, 15.96) and obesity in rural Uganda [AOR = 11.22; 95%CI: 2.27, 55.40), peri-urban Uganda [AOR = 27.80; 95 % CI: 7.13, 108.41) and SA [AOR = 2.17; 95 % CI: 1.19, 4.00). Increasing age was a predictor of BMI > =25 kg/m2 in Nigeria [Age > =45 - AOR = 9.11; 95 % CI: 1.72, 48.16] and SA [AOR = 6.22; 95 % CI: 2.75, 14.07], while marital status was predictor of BMI > =25 kg/m2 only in peri-urban Uganda. [Married - AOR = 4.49; 95 % CI: 1.74, 11.57]. Those in Nigeria [AOR = 2.56; 95 % CI: 1.45, 4.53], SA [AOR = 4.97; 95 % CI: 3.18, 7.78], and Tanzania [AOR = 2.68; 95 % CI: 1.60, 4.49] were more likely to have BMI > =25 kg/m2 compared with the rural and peri-urban sites.

CONCLUSION

The high prevalence of overweight and obesity in these sub-Saharan African countries and the differentials in prevalence and risk factors further highlights the need for urgent focused intervention to stem this trend, especially among women, professionals and urban dwellers.

Physical activity to overcome the adversity of widowhood: Benefits beyond physical health

Widowhood has been increasingly encountered because of increasing longevity of women, often characterized by social stigmatization and poor physical and mental health. However, applied research to overcome its adversity has been quite limited. The goal of this study is to explore the role of physical activity in improving the health of widows.A cohort of 446,582 adults in Taiwan who successively participated in a comprehensive medical screening program starting in 1994, including 232,788 women, was followed up for mortality until 2008. Each individual provided detailed health history, and extensive lab tests results.The number of widows increased with time trend. Every other woman above age 65 was a widow (44%). Widows were less active, more obese, and smoked and drank more, had sleep problems, were more depressed with taking sedatives or psychoactive drugs, leading to more suicides. In the global development of health policies by World Health Organization (WHO), physical activity is one of the main factors to reverse poor health. The poor health of inactive widow was mitigated when becoming fully active in this study. Exercise not only reduced the observed 18% increase in all-cause mortality, but also gained 4 years and as much as 14% mortality advantage over the married but inactive. More importantly, becoming physically active energized their mental status, improved sleep quality and quantity, reduced depressions and the need for psychoactive drugs, and increased socialization circles.Widows, a rapidly growing and socially stigmatized group, suffered from social and financial inequality and tended to develop poorer health. Sustained physical activity could be one of the ways for them to overcome and reverse some of the physical and mental adversities of widowhood, and improve their quality and quantity of life.

Body Weight, Marital Status, and Changes in Marital Status

In this article, I use 20 years of data taken from the 1979 National Longitudinal Study of Youth to examine the relationship between body weight and both marital status and changes in marital status. I use a latent growth curve model that allows both fixed and random effects. The results show that living without a partner, either being divorced or never married, is associated with lower body weight. Cohabitors and married respondents tend to weigh more. Marital transitions also matter but only for divorce. Gender does not appear to moderate these results.

Determinants of Obesity and Associated Population Attributability, South Africa: Empirical Evidence from a National Panel Survey, 2008-2012

Background

Obesity is a major risk factor for emerging non-communicable diseases (NCDS) in middle income countries including South Africa (SA). Understanding the multiple and complex determinants of obesity and their true population attributable impact is critical for informing and developing effective prevention efforts using scientific based evidence. This study identified contextualised high impact factors associated with obesity in South Africa.

Methods

Analysis of three national cross sectional (repeated panel) surveys, using a multilevel logistic regression and population attributable fraction estimation allowed for identification of contextualised high impact factors associated with obesity (BMI>30 kg/m²) among adults (15years+).

Results

Obesity prevalence increased significantly from 23.5% in 2008 to 27.2% in 2012, with a significantly (p-value<0.001) higher prevalence among females (37.9% in 2012) compared to males (13.3% in 2012). Living in formal urban areas, white ethnicity, being married, not exercising and/or in higher socio-economic category were significantly associated with male obesity. Females living in formal or informal urban areas, higher crime areas, African/White ethnicity, married, not exercising, in a higher socio-economic category and/or living in households with proportionate higher spending on food (and unhealthy food options) were significantly more likely to be obese. The identified determinants appeared to account for 75% and 43% of male and female obesity respectively. White males had the highest relative gain in obesity from 2008 to 2012.

Conclusions

The rising prevalence of obesity in South Africa is significant and over the past 5 years the rising prevalence of Type-2 diabetes has mirrored this pattern, especially among females. Targeting young adolescent girls should be a priority. Addressing determinants of obesity will involve a multifaceted strategy and requires at individual and population levels. With rising costs in the private and public sector to combat obesity related NCDS, this analysis can inform culturally sensitive mass communications and wellness campaigns. Knowledge of social determinants is critical to develop “best buys”.