China’s transition: the effect of rapid urbanization on adult occupational physical activity. Soc Sci Med. 2007;64:858-870. [PMID: 17125897 DOI: 10.1016/j.socscimed.2006.10.019]

Seasonal differences in participation and time spent in physical activity in Russia: The Know Your Heart survey

This study aimed to assess the levels and investigate socioeconomic, demographic, and health-related predictors of winter and summer physical activity (PA) in Russia using the data from the Know Your Heart population survey conducted in Novosibirsk and Arkhangelsk (2015-2018; n = 5068; aged 35-69 years). Employing a series of probit, Tobit, and the Cragg models, we separated the predictors of the probability of participating in leisure-time PA from the predictors of time spent in PA. Our study showed that financial constraints limited males' participation in winter PA (probability of participation decreased by 12 percentage points) and females' engagement in winter and summer PA (decrease in the number of hours of practicing PA by approximately 1 h a week). Education, self-reported health, smoking, and cues to action had different impacts on both probability and time spent in PA in winter and summer. We also found significant gender differences in participation and time spent in PA across seasons. Older age, poor health, and smoking were greater obstacles to PA for males compared to females both in winter and summer. However, males were more likely to follow physician's advice to lose weight and take up physical exercise. Information campaigns that promote physical activities, including those that are free of charge, are needed to help limit barriers to PA for people with low socioeconomic status and individuals with little or no exercise experience. Also, making sports more accessible to citizens by providing free and low-cost sports facilities can increase their participation and time spent in PA, improving individual health and productivity.

Navigating Nigeria's Health Landscape: Population Growth and Its Health Implications

This comprehensive analysis examines the multifaceted impacts of population growth on public health in Nigeria. Drawing parallels with Omran's epidemiological transition model (that focuses on the intricate means that patterns of health and illness are changing, as well as the relationships that exist between these patterns and the sociological, demographic, and economic factors that influence them) and referencing experiences from Chile and Ceylon. The study highlights a substantial rise in Nigeria's population causing a double burden of infectious and non-communicable diseases, leading to higher morbidity, and mortality rates, increased healthcare costs, decreased productivity, and health inequalities, posing significant challenges to the country's healthcare system. Furthermore, the correlation between low education levels and health outcomes underscores the importance of addressing systemic deficiencies in Nigeria's educational sector. The article emphasizes the urgent need for strategic interventions to mitigate the adverse effects of population growth on health. Recommendations include revitalizing primary healthcare centers, fostering public-private partnerships to enhance healthcare accessibility, leveraging technological advancements like telemedicine, and promoting initiatives to improve nutrition and environmental sustainability. Moreover, prioritizing education on reproductive health and family planning emerges as a crucial strategy to manage population growth sustainably. In conclusion, the article underscores the imperative for collaborative efforts across sectors to navigate Nigeria's evolving health landscape amidst increasing population growth. By implementing targeted policies and interventions, Nigeria can strive toward achieving universal health coverage, enhancing health outcomes, and ultimately raising the standard of living for its populace.

Association of land urbanization and type 2 diabetes mellitus prevalence and mediation of greenness and physical activity in Chinese adults

The prevalence of type 2 diabetes (T2D) is higher in urban than in rural areas. Limited information is available on the association between T2D and Land urbanization (LU) while LU influences not only greenness and Particulate Matter 2.5 (PM2.5) but also inhabitant behavior. We aimed to explore the association between the LU level and T2D prevalence, as well as whether greenness, PM2.5, or conscious physical activity mediated any of the observed associations. This study encompassed 27,633 adult participants from Shandong Province who completed the sixth National Health Service Survey in 2018. Ambient LU exposure was estimated by spatial characteristics, including the existing impervious surface area (ISA), road density (RD), and annual night light (NL). Exposures were estimated using satellite images and OpenStreetMap, with 1000 m used as the main analysis buffer. Two-level logistic regression models were used to investigate the association between the LU metrics and T2D. Additionally, we explored potential mechanisms of the association through mediation analysis. The prevalence of T2D among participants was 5.14%, with average exposures to ISA_1000m of 1.441 km2, RD_1000m of 3.856 km/km2, and NL_1000m of 9.821 nW/cm2/sr. Higher levels of LU exposure were associated with higher T2D ORs [for each interquartile of ISA_1000m, RD_1000m, and NL_1000m, the adjusted OR (95% CI) for the T2D prevalence were 1.29 (1.19-1.4), 1.25 (1.15-1.36), and 1.25 (1.15-1.36), respectively]. This relationship persisted in several sensitivity analyses including use of different buffer sizes. We observed stronger associations among participants younger than 65 years or in men. Greenness mediated a 20.78%-65.36% of the estimated associations, conscious physical activity mediated a 10.35%-15.85%, while PM2.5 mediated insignificantly. These results suggest a deleterious association between higher levels of LU and T2D among adult residents in a developing country. Greenness and conscious physical activity mediate the association.

Global human obesity and global social index: Relationship and clustering

Introduction

Obesity, a complex, multifactorial disease, is considered a global disease burden widely affecting the quality of life across different populations. Factors involved in obesity involve genetics, behavior and socioeconomic and environmental origins, each contributing to the risk of debilitating morbidity and mortality. However, the trends across the world vary due to various globalization parameters.

Methods

This article tends to identify the global social indicators, compiled into a global index, and develop a correlation between the global social index created by using the human development index, social and political globalization, the global happiness index, and the quality of infrastructure, institutions, and individuals using the internet factors and its effect on global obesity.

Results and Discussion

Our results identified a positive correlation between medium human development levels with obesity compared to low and very high human development levels. Economic stability due to rapid industrialization has increased the buying capacity and changed the global food system, which seems to be the major driver of the rise of global obesity.

Conclusion

The results decipher that global social indicators and overall social index have positively affected global obesity, which will help policymakers and governmental organizations monitor the obesity patterns across their regions by a significant contribution from globally influenced social factors.

Urbanization and physical activity in the global Prospective Urban and Rural Epidemiology study

Urbanization may influence physical activity (PA) levels, although little evidence is available for low- and middle- income countries where urbanization is occurring fastest. We evaluated associations between urbanization and total PA, as well as work-, leisure-, home-, and transport-specific PA, for 138,206 adults living in 698 communities across 22 countries within the Prospective Urban and Rural Epidemiology (PURE) study. The 1-week long-form International PA Questionnaire was administered at baseline (2003-2015). We used satellite-derived population density and impervious surface area estimates to quantify baseline urbanization levels for study communities, as well as change measures for 5- and 10-years prior to PA surveys. We used generalized linear mixed effects models to examine associations between urbanization measures and PA levels, controlling for individual, household and community factors. Higher community baseline levels of population density (- 12.4% per IQR, 95% CI - 16.0, - 8.7) and impervious surface area (- 29.2% per IQR, 95% CI - 37.5, - 19.7), as well as the rate of change in 5-year population density (- 17.2% per IQR, 95% CI - 25.7, - 7.7), were associated with lower total PA levels. Important differences in the associations between urbanization and PA were observed between PA domains, country-income levels, urban/rural status, and sex. These findings provide new information on the complex associations between urbanization and PA.

Global human obesity and political globalization; asymmetric relationship through world human development levels

Purpose - Political globalization is a crucial and distinct component of strengthening global organizations. Obesity is a global epidemic in a few nations, and it is on the verge of becoming a pandemic that would bring plenty of diseases. This research aims to see how the political globalization index affects worldwide human obesity concerning global human development levels. Methods- To assess any cross-sectional dependence among observed 109 nations, the yearly period from 1990 to 2017 is analyzed using second generation panel data methods. KAO panel cointegration test and Fully Modified Least Square model were used to meet our objectives. Finding- Low level of political globalization tends to increase global human obesity because countries cannot sway international decisions and resources towards them. While the high level of political globalization tends to reduce obesity because it can control and amends international decisions. For the regression model, a fully modified Least Square model was utilized. The study observed that the R squared values for all models are healthy, with a minimum of 87 percent variables explaining differences in global obesity at the country level. Originality: There is very important to tackle the globalization issue to reduce global human obesity. With the simplicity of dietary options and the amount of physical labour they undergo in their agricultural duties, an increase in rural population percentage tends to lower the average national obesity value.

The triple benefits of slimming and greening the Chinese food system

The Chinese food system has undergone a transition of unprecedented speed, leading to complex interactions with China's economy, health and environment. Structural changes experienced by the country over the past few decades have boosted economic development but have worsened the mismatch between food supply and demand, deteriorated the environment, driven obesity and overnutrition levels up, and increased the risk for pathogen spread. Here we propose a strategy for slimming and greening the Chinese food system towards sustainability targets. This strategy takes into account the interlinkages between agricultural production and food consumption across the food system, going beyond agriculture-focused perspectives. We call for a food-system approach with integrated analysis of potential triple benefits for the economy, health and the environment, as well as multisector collaboration in support of evidence-based policymaking.

Lifestyle Factors Associated with Metabolic Syndrome in Urban Cambodia

This study aimed to identify lifestyle factors associated with metabolic syndrome (MetS) in urban Cambodia. In this cross-sectional study, we used existing health checkup data from a private hospital in Phnom Penh, Cambodia. The participants comprised 5459 Cambodians aged ≥20 years who underwent health checkups between 2017 and 2019. The harmonized diagnostic definition was used as the MetS criteria. The prevalence of MetS was 56.6% overall, 60.4% in men and 52.6% in women. The lifestyle factor significantly associated with MetS in both sexes were "eating quicker than others", (men: odds ratio [OR]= 2.25, 95% confidence interval [CI] = 1.68-3.03, women: OR = 1.92, 95%CI = 1.41-2.60), "walking faster than others", (men: OR = 0.78, 95% CI = 0.67-0.92, women: OR = 0.75, 95% CI = 0.62-0.89) and "drinking alcohol" (men: OR = 1.33, 95% CI = 1.10-1.61, women: OR = 1.33, 95% CI = 1.09-1.62). Other significant associations with MetS for men was "eating speed is normal", (OR = 1.73, 95%CI = 1.30-2.31), and, for women, "eating food after dinner at least 3 days a week", (OR = 1.25, 95%CI = 1.01-1.55), "skipping breakfast at least 3 days a week", (OR = 0.83, 95%CI = 0.69-0.99) and "getting enough rest from sleep" (OR = 1.19, 95% CI = 1.01-1.42) were significantly associated with MetS. Lifestyle interventions through health education and guidance may be effective in preventing MetS in Cambodia.

Waist Circumference of the Elderly over 65 Years Old in China Increased Gradually from 1993 to 2015: A Cohort Study

Objective

This study aimed to analyze the temporal trends and characteristics associated with waist circumference (WC) among elderly Chinese people.

Methods

We used data from 3,096 adults ≥ 65 years who participated in the China Health and Nutrition Survey (CHNS), an ongoing cohort study, between 1993 and 2015. We used longitudinal quantile regression models to explore the temporal trends and characteristics associated with WC.

Results

WC increased gradually among the elderly Chinese population during the survey. The WC curves shifted to the right with wider distributions and lower peaks in men and women. All WC percentile curves shifted upward with similar growth rates in the 25th, 50th, and 75th percentiles. The WC means increased from 78 cm to 86 cm during the 22 years of our study. WC significantly increased with age and body mass index and decreased with physical activity (PA). These associations were stronger in the higher percentiles than in the lower percentiles.

Conclusions

WC is rising among Chinese adults ≥ 65 years. Factors affecting WC in elderly people may have different effects on different percentiles of the WC distribution, and PA was the most important protective factor in the higher percentiles of the WC distribution. Thus, different interventional strategies are needed.

Diabetes, Hypertension, Atrial Fibrillation and Subsequent Stroke-Shift towards Young Ages in Brunei Darussalam

Southeast Asia harbors a young population of more than 600 million people. Socioeconomic transition within the last decades, driven by globalization and rapid economic growth, has led to significant changes in lifestyle and nutrition in many countries of this region. Hence, an increase in the number of non-communicable diseases is seen in most populations of Southeast Asia. Brunei Darussalam is the smallest country in this region, with a population of around 400,000 inhabitants. Vast hydrocarbon resources have transformed Brunei into a wealthy industrialized country within the last few decades. We compared the age distribution and prevalence of cardiovascular risk factors in ischemic stroke patients between the only stroke unit in Brunei Darussalam and a tertiary stroke center from Frankfurt/Germany. Between 2011 and 2016, a total number of 3877 ischemic stroke patients were treated in both institutions. Even after adjusting for age due to different population demographics, stroke patients in Brunei were younger compared to their German counterparts. The prevalence of hypertension and diabetes mellitus was significantly higher in young age groups in Brunei, whereas no difference was observed for older patients. The rapid socioeconomic transition might be a significant risk factor for the development of non-communicable diseases, including stroke.

The relationship between occupational physical activity and dyslipidaemia in farmers with varying working modes in southwest China: the China multi-ethnic cohort study

Background

Farmers are the integral members of rural communities. In the present study, we determined the association between occupational physical activity (OPA) of farmers and dyslipidaemia.

Methods

We included 7649 farmers from The China Multi-Ethnic Cohort (CMEC) Study. The working modes of all farmers were divided into four types according to their self-reported seasonal changes in farming work and/or other job changes (1: no change; 2: changing job; 3: seasonal changes; and 4: seasonal and job changes). OPA was self-reported, and the OPA levels in the four groups were classified as Q1, Q2–Q3, and Q4 by quantile. Dyslipidaemia was defined as the presence of abnormalities in lipid indicators. Binary logistic regression was used to estimate the association between OPA and dyslipidaemia.

Results

Compared with those in the no change group, the participants in other three groups were younger with lower level of education, annual income, and leisure-time physical activity (LTPA). Active OPA could reduce the risk of dyslipidaemia in the no change [men: odds ratios (OR) = 0.21, 95% confidence intervals (CI): 0.07–0.64; women: OR = 0.43, 95% CI: 0.20–0.93] and seasonal change (men: OR = 0.46, 95% CI: 0.27–0.77; women: OR = 0.59, 95% CI: 0.41–0.86) groups. However, in the seasonal and job change group (men: OR = 3.23, 95% CI: 1.06–9.80; women: OR = 3.24, 95% CI: 1.42–7.41), active OPA increased the risk of dyslipidaemia.

Conclusions

Different OPA levels might lead to differences in association with blood lipid levels. Thus, OPA guidelines must be developed for farmers, especially for those who experience seasonal changes in farming work and job changes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13266-x.

[Analysis on the relationship between urbanization and health behavior in China: An empirical research based on China Health and Retirement Longitudinal Study (CHARLS)]

OBJECTIVE

To explore the relationship between urbanization and residents ' health behaviors in China, and to clarify the impact of urbanization on health behaviors.

METHODS

Based on China Health and Retirement Longitudinal Study (CHARLS), we established a panel data fixed effect model tracked in 2011, 2013 and 2015 to analyze the effect of urbanization level on smoking cessation, drinking, sleep quality and physical exercise behavior. The ratio of population density, gross domestic product (GDP) per capita and output value of secondary and tertiary industries to GDP were used to represent the levels of urbanization.

RESULTS

From 2011 to 2015, China ' s urbanization levels showed an increasing trend, which showed that the ratio of population density, GDP per capita and output value of secondary and tertiary industries in GDP increased year by year. Smoking cessation increased with the increase of GDP per capita and the proportion of the output value of secondary and tertiary industries. Compared with the low-level, the drinking rate in the regions with per capita GDP of more than 45 000 yuan increased by 2.49%, and the drinking rate in the regions with secondary and tertiary industries for 80%-85% decreased by 2.48%. However, there was no significant difference with population density. The sleep quality decreased with the increase of per capita GDP. In regions where per capita GDP was more than 93%, the sleep quality decreased by 3.71% compared with the low-level which was not significantly different from the ratio of population density and the output value of secondary and tertiary industries. For low contrast, the exercise rate in regions with the population density of 400-600 people/km² and over 800 people/km² was reduced by 5.2% and 7.7% respectively. The exercise rate in regions with per capita GDP of 25 000-35 000 yuan and over 45 000 yuan was reduced by 3.26% and 3.73% respectively. The exercise rate in regions with secondary and tertiary industries accounting for more than 93% of GDP was 10.68% lower than that of the low-level regions.

CONCLUSION

Different dimensions of urbanization have different impacts on different health behaviors. The smoking cessation rate increases with the increase of urbanization level, which is related to the proportion of per capita GDP and the output value of secondary and tertiary industries. The exercise rate, related to the three dimensions, decreases with the increase of urbanization. Sleep quality is more closely related to per capita GDP, and the probability of good sleep quality decreases with the increase of urbanization level. However, there is no obvious trend between drinking rate and urbanization level, which needs further study.

[Analysis on the relationship between urbanization and health behavior in China: An empirical research based on China Health and Retirement Longitudinal Study (CHARLS)]

OBJECTIVE

To explore the relationship between urbanization and residents ' health behaviors in China, and to clarify the impact of urbanization on health behaviors.

METHODS

Based on China Health and Retirement Longitudinal Study (CHARLS), we established a panel data fixed effect model tracked in 2011, 2013 and 2015 to analyze the effect of urbanization level on smoking cessation, drinking, sleep quality and physical exercise behavior. The ratio of population density, gross domestic product (GDP) per capita and output value of secondary and tertiary industries to GDP were used to represent the levels of urbanization.

RESULTS

From 2011 to 2015, China ' s urbanization levels showed an increasing trend, which showed that the ratio of population density, GDP per capita and output value of secondary and tertiary industries in GDP increased year by year. Smoking cessation increased with the increase of GDP per capita and the proportion of the output value of secondary and tertiary industries. Compared with the low-level, the drinking rate in the regions with per capita GDP of more than 45 000 yuan increased by 2.49%, and the drinking rate in the regions with secondary and tertiary industries for 80%-85% decreased by 2.48%. However, there was no significant difference with population density. The sleep quality decreased with the increase of per capita GDP. In regions where per capita GDP was more than 93%, the sleep quality decreased by 3.71% compared with the low-level which was not significantly different from the ratio of population density and the output value of secondary and tertiary industries. For low contrast, the exercise rate in regions with the population density of 400-600 people/km2 and over 800 people/km2 was reduced by 5.2% and 7.7% respectively. The exercise rate in regions with per capita GDP of 25 000-35 000 yuan and over 45 000 yuan was reduced by 3.26% and 3.73% respectively. The exercise rate in regions with secondary and tertiary industries accounting for more than 93% of GDP was 10.68% lower than that of the low-level regions.

CONCLUSION

Different dimensions of urbanization have different impacts on different health behaviors. The smoking cessation rate increases with the increase of urbanization level, which is related to the proportion of per capita GDP and the output value of secondary and tertiary industries. The exercise rate, related to the three dimensions, decreases with the increase of urbanization. Sleep quality is more closely related to per capita GDP, and the probability of good sleep quality decreases with the increase of urbanization level. However, there is no obvious trend between drinking rate and urbanization level, which needs further study.

The global, regional, and national disease burden of breast cancer attributable to low physical activity from 1990 to 2019: an analysis of the Global Burden of Disease Study 2019

Background

To assess the spatiotemporal variation in female breast cancer attributable to low physical activity (LPA) at a global scale from 1990 to 2019, which is essential to promote physical activity, as well as prevent and control breast cancer.

Methods

The number of deaths and disability-adjusted life years (DALYs), and the corresponding age-standardized rates (ASMR and ASDR) of LPA-related breast cancer in 204 countries and territories from 1990 to 2019 were retrieved from the Global Burden of Disease Study 2019 to measure the related breast cancer burden by age and region. The estimated annual percentage change (EAPC) was calculated to quantify the secular trend in breast cancer burden rates.

Results

From 1990 to 2019, globally, both breast cancer deaths and DALYs attributable to LPA nearly doubled, although the corresponding ASMR and ASDR decreased slightly, with EAPC of -0.46 (95% confidence interval: -0.52, -0.40) and -0.44 (95% confidence interval: -0.49, -0.39), respectively. The LPA-related breast cancer burden varied considerably across the world, with the highest-burden rates in Oceania, Tropical Latin America and Caribbean, and the fastest growth in North Africa and Middle East. The ASMR and ASDR showed a logarithmic association with the Socio-demographic Index, and a temporally upward trend in most of 204 countries regardless of the Socio-demographic Index or the ASMR in 1990.

Conclusions

Despite a decline in LPA-related breast cancer burden achieved in many countries during the last 3 decades like Bermuda, Myanmar, USA and China, an increase still occurred in most of 204 countries and territories, such as Solomon Islands, Equatorial Guinea, Japan and India. The findings can bring greater awareness to the importance of promoting physical activity for the local government to control the attributable breast cancer burden.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01283-3.

Birth cohort, sex and educational disparities in the trajectories of body mass index in Taiwan: a longitudinal study

Background

Taiwan has gone through rapid industrialization, urbanization and economic growth in the 20th and early 21st centuries. Therefore, the population has experienced significant changes in the physical and social environment during the life course, which may affect the overall adiposity. Our aim was to examine the age trajectories of height, weight and body mass index (BMI) in the Taiwanese population and to explore the influences of sex, birth cohort and education.

Methods

The sample comprised 572,358 residents between 20 and 94 years of age in Taiwan who attended at least one health examination during 1996 to 2017 in a cohort study. Repeated measures of body weight and height were collected using an auto-anthropometer. We conducted a series of linear mixed-effects growth curve models to examine the trajectory of height, weight, and BMI across the life course with stratification by sex.

Results

Age-related trajectories of BMI differed between men and women and stronger cohort effects were observed among men, with younger cohorts having higher BMI. After holding cohort and age variables constant, men with junior high or lower education were shorter, thinner and had higher BMI than men with university or higher education (effect sizes: − 3.138 cm, p < 0.001; − 2.277 kg, p < 0.001; 0.121 kg/m², p < 0.001, respectively). Women with junior high or lower education were shorter, heavier and had higher BMI than women with university or higher education (effect sizes: − 2.368 cm, p < 0.001; 2.417 kg, p < 0.001; 1.691 kg/m², p < 0.001, respectively). The educational disparities in BMI were found to be larger among women.

Conclusions

Our findings suggest that younger generations, especially men, and lower educational level individuals, particularly women, have increasing levels of BMI. The influence of age and cohort effects together with sex and educational disparities on adiposity should be highlighted when designing future interventions and policies regarding overweight and obesity.

The nutrition transition to a stage of high obesity and noncommunicable disease prevalence dominated by ultra-processed foods is not inevitable

The Nutrition Transition model is presented with the nature and pace of change in key stages varying by location and subpopulations. At present, all high-income and many low- and middle-income countries are in a stage of the transition where nutrition-related noncommunicable diseases including obesity, type 2 diabetes, and hypertension are dominating adult morbidity and mortality and are very high or growing rapidly in prevalence. Some countries still have key subpopulations facing hunger and undernutrition defined by stunting or extreme thinness among adults. We call these double burden of malnutrition countries. All low- and middle-income countries face rapid growth in consumption of ultra-processed food and beverages, but it is not inevitable that these countries will reach the same high levels of consumption seen in high-income countries, with all the negative impacts of this diet on health. With great political and civil society commitment to adoption of policies shown in other countries to have improved dietary choices and social norms around foods, we can arrest and even reverse the rapid shift to diets dominated by a stage of high ultra-processed food intake and increasing prevalence of nutrition-related noncommunicable diseases.

A national and sub-national metaregression of the trend of insufficient physical activity among Iranian adults between 2001 and 2016

Insufficient physical activity (IPA) caused approximately 5% of mortalities in 2017 in Iran, almost double its global average. Despite the relatively considerable burden, a knowledge gap exists regarding the trend of IPA in recent years. We described the trend of IPA prevalence utilizing the data from six rounds of STEPwise approach to risk factor Surveillance (STEPS) in Iran. We estimated the physical activity status of Iranian adults from 2006 to 2016 after adjusting for years of schooling, urbanization percentage, and wealth index. We used the spatiotemporal model to interpolate and extrapolate the IPA prevalence for the years in-between the series and from 2001 to 2006, respectively. We used the data of 177,910 participants from six STEPS surveys and found that the national prevalence of IPA had steadily increased over the course of 16 years and had almost doubled in this time period (23.1% in 2001 to 55.4% in 2016). The increase was persistent across all age and gender strata and in every province. Moreover, IPA was more prevalent among women than their male peers regardless of their age category or province of residence. The prevalence of IPA in Khuzestan (highest prevalence) was almost double compared to that in Lorestan (lowest prevalence) in 2016. The IPA prevalence increased considerably and almost doubled in 16 years among Iranian adults, particularly women. Policies need to target IPA as a high priority contributing to the burden of Non-communicable diseases.

Productive engagement of older adults in China: A multilevel analysis

AIM

This study investigates how the personal characteristics and behavior, and health status of older adults in China influenced their productive engagement in paid and unpaid jobs.

METHODS

Data for this analysis came from 2002, 2005, 2008 and 2011 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We used a random intercept multilevel multinomial logit model to analyze data from 3208 older adults aged 65 from the 2002 wave, which decreased to 1385 in 2011. The main study variable is older adults' engagement in paid jobs and unpaid work (including housework, care-taking, poultry farming, and planting vegetables that have an economic value).

RESULTS

There was a strong association between older adults' productive engagement and their functional limitations to daily living activities, health and healthy behavior. Older adults with inadequate finance were more likely to be working to support themselves. Those who exercised less and living in the provinces with higher GDP were less likely to work post-retirement. Chronic diseases, advances in age, no education and rural residence did not deter older adults from doing unpaid work.

CONCLUSION

Older adults in China were actively engaged in paid and unpaid activities. Efforts to support the active engagement of older adults require all stakeholders to promote healthy living, facilitate social engagements and provide an age-friendly work environment. Geriatr Gerontol Int 2021; 21: 1138-1146.

What the World Needs Now: Lifestyle Medicine for All Women

Over the last several centuries, economic progress has allowed millions of women to move from rural subsistence agriculture to urban, more economically prosperous lifestyles. This trend is set to continue, even accelerate in the next century. Due to changes in diet, activity, and lifestyle, non-communicable diseases, such as cancer and heart disease, will continue to rise for women globally. At this time, we are uniquely positioned to anticipate this impact and empower women in both the developed and the developing world to learn from what has worked. Choosing the best approaches to nutrition, exercise, sleep, connectedness, substances, and stress can optimize women's health span across the globe.

Occupational Physical Activity and New-Onset Hypertension: A Nationwide Cohort Study in China

[Figure: see text].

The Effect of Urbanization on Population Health: Evidence From China

This paper explores the relationship between urbanization rate and death incidence by applying panel threshold regression model to the inland provinces of China. The empirical results highlight that there is a nonlinear single threshold effect between urbanization and population health indicators. In China's inland provinces, the negative impact of urbanization on death rate is reduced when per capita GDP exceeds the threshold, that is, the positive impact of urbanization on population health is significantly weakened. Similarly, this result can also be applied to the north provinces, while there is a no threshold effect in south. These asymmetric effects are strongly related to geographical location, historical background, economic development conditions, and health policies. Therefore, in the urbanization process, while promoting the steady development of population urbanization, the government should also increase health investment to improve the system and mechanism, formulate policies to raise health awareness, protect residents' health and reduce the waste of health resources.

Inequality in the treatment of diabetes and hypertension across residency status in China

Objectives: This paper studies the institutional inequality that exists in the prevalence of diabetes and hypertension, as well as their diagnosis and medication management, between urban and rural residency status (hukou) holders in China.Methods: Exploiting the Chinese Health and Nutrition Survey, we primarily demonstrate that while a lower proportion of rural residency holders suffer from diabetes and hypertension, a larger proportion have never been diagnosed with these conditions and do not take medicine to control them. We explore the determinants of these disparities by the non-linear decomposition method.Results: Decomposition results illustrate that a large part of disparities in the prevalence of diabetes and hypertension can be explained by the differences in demographic structure and occupational socio-economic status. Regarding the ruralurban disparity in the under diagnosis and under-medication rates, the differences in demographic structure, household affluence, occupational socio-economic status and consumption patterns make the greatest contributions.Conclusions: This evidence suggests that improving the institutional economic inequality and enhancing the occupational mobility of rural residency holders are of paramount importance to mitigate any inequality in health and healthcare utilisation.

Nutrition Transition with Accelerating Urbanization? Empirical Evidence from Rural China

Although rapid urbanization is often considered as one of the most important drivers for changing dietary patterns, little attention has been paid to rural areas despite the profound transformation they have undergone. Using longitudinal data from the China Health and Nutrition Survey (CHNS) for the period from 2004 to 2011, this study seeks to better understand the relationship between the urbanization of rural areas and dietary transition, with the focus on nutrition intake and dietary quality. Our results suggest that with increasing urbanization, rural residents tend to have on average lower calorie intakes but higher dietary quality. Specifically, increasing urbanization consistently reduces carbohydrate consumption and reduces fat consumption after a turning point; protein consumption first decreases and then increases after the turning point with increasing urbanization. Urbanization shows a significant and positive effect on the Healthy Eating Index (HEI). In addition to sociodemographic changes, we find that changing consumer preferences and knowledge serve as important determinants in explaining the dietary transition in rural China from 2004 to 2011. In our study, urbanization appears to positively affect rural residents’ healthy food preferences and dietary knowledge. This study is a first attempt for better understanding the nutrition transition resulting from accelerating urbanization in rural China; several limitations and areas for future research have been highlighted.

Association between urbanisation and the risk of hyperuricaemia among Chinese adults: a cross-sectional study from the China Health and Nutrition Survey (CHNS)

OBJECTIVE

To explore the association between urbanicity and hyperuricaemia (HUA) and whether urbanicity is an independent risk factor for HUA in Chinese adults.

DESIGN

Data analysis from a cross-sectional survey.

SETTING AND PARTICIPANTS

8579 subjects aged 18 years or older were enrolled in the study from the 2009 wave of the China Health and Nutrition Survey to analyse the association between urbanicity and HUA. We divided them into three categories according to urbanisation index (low, medium and highly urbanised groups).

MAIN OUTCOME MEASURES

HUA was defined as serum uric acid ≥7 mg/dL in men and ≥6 mg/dL in women.

RESULTS

The prevalence of HUA in low, medium and highly urbanised groups was 12.2%, 14.6% and 19.8%, respectively. The independent factors influencing serum uric acid included age, gender, hypertension, diabetes, chronic kidney disease, drinking, obesity and community-level urbanisation index (β=0.016, p<0.001). The risk of HUA in the highly urbanised group was significantly higher than that of the low urbanised group (OR 1.771, 95% CI 1.545 to 2.029, p<0.001), even after adjusting for other covariates (OR 1.661, 95% CI 1.246 to 2.212, p=0.001). In a subgroup analysis, we found that age, gender, comorbidity (such as hypertension, diabetes, obesity and chronic kidney disease) and physical activity affected the association between urbanisation and the risk of HUA.

CONCLUSIONS

Our findings suggest that living in highly urbanised areas is linked with higher risk of HUA independent of cardiometabolic and health-related behavioural risk factors, which have been shown to increase along with urbanisation.

Accessibility of Rural Life Space on the Jianghan Plain, China: The Role of Livelihood

This article aims to contribute to the relationship between accessibility of rural life space and rural livelihood capital and transitions in rural central China. Employing data produced from a household survey, we developed a composite index for accessibility of rural life space incorporating spatial and temporal attributes of a household’s daily activities and then explored the mediation effect of rural livelihood capital and transitions on accessibility. Results revealed a pattern of diversification in terms of life space accessibility undertaken for daily activities across households. Both livelihood capital and transitions had significant mediation effects on the relationship between socio-economic characteristics of rural households and accessibility of rural life space. The effects of livelihood capital on livelihood transitions also influenced the path on rural households’ accessibility of rural life space. One of the implications of this article is to link rural transformation to the context of urbanization and rural access issues from a perspective of daily activity, and then to figure out the best method for rural development policy and service planning.

Anger Expression and the Risk of Cardiovascular Disease Among Urban and Rural Japanese Residents: The Circulatory Risk in Communities Study

OBJECTIVE

It has been suggested that urbanization, which has been expanding rapidly for the past several decades, increases the risk of cardiovascular disease (CVD) associated with psychological factors such as anger, but the evidence is limited. We examined the hypothesis that urbanicity modifies the association of anger expression with the risk of CVD.

METHODS

A prospective study was conducted in 5936 residents of urban and rural communities aged 40 to 79 years who had completed an annual health checkup including a questionnaire on anger expression between 1995 and 1998. Associations of anger expression with the risk of CVDs were examined using Cox proportional hazards models, after adjusting for classical cardiovascular risk factors.

RESULTS

During a median follow-up of 16.6 years, we identified 312 incident CVDs. The means (SDs) of anger expression were 24.7 (5.8) among urban residents and 24.6 (5.7) among rural participants (p = .87). Among urban residents, anger expression was positively associated with the risk of total CVD: the multivariable hazard ratio (95% confidence interval) was 1.27 (1.05-1.54). In contrast, no association was found among rural residents: the corresponding ratio (interval) was 0.96 (0.85-1.09), with a significant interaction between urban and rural residency with anger expression for incident CVD (p = .047). Similar associations were observed with the risk of CVD subtypes, including ischemic stroke and ischemic CVD.

CONCLUSIONS

We found a positive association between anger expression and the risk of CVD among urban residents but not rural residents, suggesting that urbanicity enhances the anger-CVD association.

Level of physical activity among middle-aged and older Chinese people: evidence from the China health and retirement longitudinal study

Background

With data from different regions accumulated, physical inactivity (PI) was found to be pandemic worldwide. Using China Health and Retirement Longitudinal Study (CHARLS), a nationwide longitudinal survey data, we aimed to delineate the prevalence, incidence and risk factors of physical inactivity (PI) among Chinese people aged 45 years and older.

Methods

The CHARLS covered nearly all provinces, autonomous regions, municipalities of mainland China. With data from CHARLS, three cross-sectional analyses and a cohort analysis were conducted. In cross-sectional studies, we used surveys at 2011, 2013 and 2015 to examine the prevalence and its trend of PI. Multivariate generalized linear model was conducted in survey at 2011 to examine the risk factors for prevalent PI. Multiple imputation of missing values was used and results before and after imputation were compared. In cohort analysis, we identified people free of PI at 2011 and followed them up until 2015 to estimate the incidence of PI. Generalized estimating equation was used to examine the risk factors associated with incidence PI. In all analyses, PI was defined as insufficient physical activity according to the International Physical Activity Questionnaire (IPAQ) criterion.

Results

6650, 5946 and 9389 participants were eligible for cross-sectional analyses, and 4525 participants were included for cohort analysis. The weighted prevalence of PI was 22.25% (95% CI: 20.63–23.95%) in 2011, 20.64% (95% CI: 19.22–22.14%) in 2013 and 19.31% (95% CI: 18.28–20.38%) in 2015. In multivariate analysis, PI was associated with older age, higher education, overweight, obesity and difficulties in daily living, and was negatively associated with working and higher level of expenditure. No material change was detected in results after multiple imputation. In cohort analysis, older age, abundant public facilities, difficulties in daily living were identified as risk factors of incidence PI, while urban areas, college and above education, and working were protective factors.

Conclusions

PI is pandemic in 45 years and older people in China. People with older age, difficulties in daily living and people who are not working are at higher risk. More efforts should be paid in estimating and promoting leisure-time physical activities.

Urban rural differences in prevalence and risk factors of self-reported hypertension among Kenyan women: a population-based study

This study investigated rural-urban variation in the prevalence of self-reported hypertension and its risk factors among reproductive-age women in Kenya. The 2014 nationally representative Kenya Demographic and Health Survey (KDHS) data were used in this analysis. The survey adopted a multistage, geographically clustered, and probability-based sampling approach. Multivariable logistic regression was performed to assess the association between risk factors and self-reported hypertension. Overall, 9.38% of the women were hypertensive with higher prevalence among urban 11.61%, compared to rural women, 7.86%. Older age, obesity, having diabetes, and increased the odds of hypertension in both rural and urban areas. We also observed that the odds of hypertension differed by ethnic group. High wealth status was a significant correlate only among urban women with women from rich and richest wealth groups had 2-2.3 times higher odds of hypertension compared to the poor and poorest wealth groups. Women with diabetes had 22 times higher odds of hypertension in both in rural and urban areas compared to women without diabetes. In conclusion, our study found that an estimated 1 out of 10 Kenyan women have hypertension. We believe that this study contributes to better understanding of regional variation of hypertension prevalence and risk factors for reproductive women in Kenya. Future studies should seek to develop evidence-based hypertension prevention and management interventions that are targeted and tailored for urban and rural women in Kenya.

Nutrition transition and related health challenges over decades in China

Since the Opening of China, the country's economy has continuously and rapidly improved. Various economic, educational, and health policies have been implemented to shape the development of society, which may have greatly affected the Chinese diet and related malnutrition issues. The objective of the present review was to comprehensively review long-term trends in dietary intakes, nutrition status, and subsequent health challenges among Chinese adults. The data sources were mainly the 1982, 1992, 2002, and 2010-2012 China National Nutrition Surveys (CNNS) and reports and the 1989-2015 China Health and Nutrition Survey (CHNS). Over decades, there have been significant changes in the dietary structure of Chinese adults, characterized as decreased intake of cereals and vegetables and increased intake of animal foods with pork dominating. Intakes of eggs, fish, and dairy has reminded at a low level, with only a small increase over time. Consumption of cooking oil and salt was substantively far above the recommendations. A great proportion of fat-to-energy intake and "hidden hunger" was still prominent. Despite nutrition deficiency, there have been some modest improvements in related diseases, but overweight and obesity has become a prominent issue, with the prevalence in adults increasing from 16.4% and 3.6% in 1982 to 30.1% and 11.9% in 2012, respectively. In conclusion, this review sheds light on some salient problems with nutrition and malnutrition status in China, especially the dual challenges of undernutrition and overnutrition. Dynamic monitoring of nutritional characteristics in China should be strengthened, and effective strategies to improve nutrition need to be targeted at the national, societal, family, and individual levels.

Physical activity and sedentary behaviour in the Middle East and North Africa: An overview of systematic reviews and meta-analysis

To support the global strategy to reduce risk factors for obesity, we synthesized the evidence on physical activity (PA) and sedentary behaviour in the Middle East and North Africa (MENA) region. Our systematic overview included seven systematic reviews reporting 229 primary studies. The meta-analysis included 125 prevalence measures from 20 MENA countries. After 2000, 50.8% of adults (ranging from 13.2% in Sudan to 94.9% in Jordan) and 25.6% of youth (ranging from 8.3% in Egypt to 51.0% in Lebanon) were sufficiently active. Limited data on PA behaviours is available for MENA countries, with the exception of Gulf Cooperation Council countries. The meta-regression identified gender and geographical coverage among youth, and the PA measurement as predictors of PA prevalence for both adults and youth. Our analysis suggests a significant PA prevalence increase among adults over the last two decades. The inconsistency in sedentary behaviour measurement is related to the absence of standardized guidelines for its quantification and interpretation. The global epidemic of insufficient PA is prevalent in MENA. Lower PA participation among youth and specifically females should be addressed by focused lifestyle interventions. The recognition of sedentary behaviour as a public health issue in the region remains unclear. Additional data on PA behaviours is needed from low- and middle-income countries in the region.

Longitudinal Association between Urbanicity and Total Dietary Fat Intake in Adults in Urbanizing China from 1991 to 2015: Findings from the CHNS

Few studies have examined the longitudinal association between urbanicity and dietary fat intake in Chinese adults. A population-based longitudinal observational study was carried out in Chinese adults aged 18–65 from the China Health and Nutrition Survey. Three consecutive 24 h dietary recalls were used to assess dietary fat intake. Multilevel models were used to explore the relationship between urbanicity and dietary fat intake. People in the highest urbanicity quartile had the increments of 7.48 g/d (95% CI:5.42–9.58) and 8.92 g/d (95% CI: 7.03–10.80) in dietary fat intake, 2.86 (95% CI: 2.29–3.44) and 2.69 (95% CI: 2.13–3.25) in proportion of energy from total fat, and odds ratios (ORs) for the risk of excess dietary fat intake of 1.84 (95% CI: 1.65–2.05) and 2.01 (95% CI: 1.78–2.26) for men and women, respectively, compared to the lowest quartile after controlling for potential confounders. These results indicate that urbanicity was an important factor influencing dietary fat intake among Chinese adults. Aggressive nutritional education action coupled with governmental guidelines and programs tailored for the Chinese population are required to promote less dietary fat intake, especially in those adults living in less urbanized areas and whose dietary fat intake is ≥ 30% of their total energy intake per day.

Adherence to dietary recommendations and colorectal cancer risk: results from two prospective cohort studies

BACKGROUND

Understanding the association between diet and colorectal cancer (CRC) risk is essential to curbing the epidemic of this cancer. This study prospectively evaluated adherence to the Chinese Food Pagoda (CHFP), and two American Dietary Guidelines: the Alternative Healthy Eating Index (AHEI-2010) and the Dietary Approaches to Stop Hypertension (DASH) in association with CRC risk among Chinese adults living in urban Shanghai, China.

METHODS

Participants included 60 161 men and 72 445 women aged 40-74, from two ongoing population-based prospective cohort studies. Associations between dietary guideline compliance scores and CRC risk were evaluated by Cox proportional hazard regression analyses, with age as time metric, and potential confounders were adjusted.

RESULTS

We identified 1670 CRC incidence cases (691 males and 979 females) during an average 8.1 years of follow-up for men and 13.4 years for women. CHFP score was inversely associated with risk of CRC, with hazard ratios (HRs) (95% confidence intervals) of 0.88 (0.77, 1.00), 0.86 (0.75, 0.98) and 0.84 (0.73, 0.96) for the 2nd, 3rd and 4th quartiles versus 1st quartile, respectively (Ptrend= 0.01). The inverse association appeared stronger for rectal cancer, individuals at younger age (< 50 years), with a lower BMI (<25 kg/m2) or without any metabolic conditions at baseline, although no multiplicative interactions were noted. No consistent association pattern was observed for the modified DASH score and the modified AHEI-2010.

CONCLUSIONS

Compliance with the Dietary Guidelines for Chinese was associated with reduced risk of CRC among Chinese adults. To maximize health impacts, dietary recommendations need to be tailored for specific populations.

Explaining Income-Related Inequalities in Dietary Knowledge: Evidence from the China Health and Nutrition Survey

Lack of adequate dietary knowledge may result in poor health conditions. This study aims to measure income-related inequality in dietary knowledge, and to explain the sources of the inequality. Data were from the China Health and Nutrition Survey (CHNS) conducted in 2015. A summary of the dietary knowledge score and dietary guideline awareness was used to measure the dietary knowledge of respondents. The concentration index was employed as a measure of socioeconomic inequality and was decomposed into its determining factors. The study found that the proportion of respondents who correctly answered questions on dietary knowledge was significantly low for some questions. Compared to rural residents, urban residents had a higher proportion of correctly answered dietary knowledge questions. In addition, there are pro-rich inequalities in dietary knowledge. This observed inequality is determined not only by individual factors but also high-level area factors. Our study recommends that future dietary education programs could take different strategies for individuals with different educational levels and focus more on disadvantaged people. It would be beneficial to consider local dietary habits in developing education materials.

Deciphering the stroke-built environment nexus in transitional cities: Conceptual framework, empirical evidence, and implications for proactive planning intervention

Adverse lifestyle-associated health outcomes, and stroke in particular, have been aggravated in transitional countries under high-speed urbanisation. Against this backdrop, deciphering the nexus between built environments (BEs) and lifestyle-associated health outcomes is of importance for crafting proactive interventions. The existing literature on this topic, however, fails to sufficiently capture the multiplicity of health-related BEs and, in turn, the complexity of such a nexus, largely challenging the applicability of established frameworks and the reliability of relevant findings. Looking at the case of stroke in Wuhan, China, this research aims to flesh out the understanding of the nexus between multidimensional BEs and lifestyle-associated health outcomes in transitional cities, with regards to conceptual framework and empirical evidence. To this end, we clarified stroke-related BE elements and integrated them into one conceptual framework. We then visualised stroke risk and examined its BE determinants using the Bayesian conditional autoregressive model. The visualisation results showed that stroke risks exhibited significant clustering in the high-density urban core. The statistical analysis found that, after the data were controlled for sociodemographic characteristics, net population density and building density were positively associated with stroke risk. In contrast, an abundance of public parks and institutional land use and access to medical care facilities have presented negative correlations with stroke risk, regardless of urban density. Our research reveals that compact urban developments might not be a silver bullet for health promotion in transitional cities, calling for an urgent need to scrutinise their applicability. To offset the adverse effects of increasingly dense urban environments, more efforts should also be made to provide better access to the identified salubrious resources. Furthermore, we argue that the establishment of comprehensive conceptual frameworks that connect BEs and lifestyle-associated health outcomes deserves to be highlighted in further research, planning intervention schemes, and health impact assessment projects.

The Rise of Noncommunicable Diseases in Kenya: An Examination of the Time Trends and Contribution of the Changes in Diet and Physical Inactivity

This study examined correlations of historical changes in diet and physical inactivity with the rise of noncommunicable diseases (NCDs) in Kenya. Historical data on diet, wage jobs by industry, urbanization, gross domestic product (GDP), and morbidity due to NCDs were extracted from Kenya Statistical Abstracts, Food and Agriculture Organization (FAOSTAT), and the World Bank online database. These data were plotted and correlations between these factors and the incidence of different NCDs over time were evaluated. There was a rapid rise in the incidence of circulatory disease starting in 2001, and of hypertension and diabetes starting in 2008. The rise of these NCDs, especially hypertension and diabetes, was accompanied over the same period by a rise in per capita GDP and physical inactivity (as measured by increased urbanization and declining proportion of agricultural and forestry wage jobs); a rise in per capita supply of rice, wheat and its products, and cooking oils; and a decline in the per capita supply of maize and sugar. In conclusion, the positive correlations between indicators of dietary consumption and physical inactivity and rates of hypertension, circulatory disease, and diabetes suggest that the rapid rise of NCDs in Kenya may be, in part, due to changes in these modifiable factors.

Overweight in Indonesia: an observational study of trends and risk factors among adults and children

OBJECTIVE

To conduct a secondary data analysis detailing overweight prevalence and associations between key hypothesised determinants and overweight.

DESIGN

This observational study used publicly available data from the Indonesian Family Life Survey (IFLS) (1993-2014). The IFLS is a home-based survey of adults and children that collected data on household characteristics (size, physical infrastructure, assets, food expenditures), as well as on individual-level educational attainment, occupation type, smoking status and marital status. These analyses used data on the self-reported consumption of ultra-processed foods and physical activity. Anthropometrics were measured.

SETTING

Indonesia.

PRIMARY OUTCOME MEASURES

We described the distribution of overweight by gender among adults (body mass index (BMI) ≥25 kg/m2) and by age among children, over time. Overweight was defined as weight-for-height z-score >2 among children aged 0-5 years and as BMI-for-age z-score >1 among children aged 6-18 years. We also described individuals who were overweight by selected characteristics over time. Finally, we employed multivariable logistic regression models to investigate risk factors in relation to overweight in 2014.

RESULTS

One-third of adults were overweight in 2014. Between 1993 and 2014, the prevalence of overweight among adults doubled from 17.1% to 33.0%. The prevalence of overweight among children under 5 years increased from 4.2% to 9.4% between 1993 and 2007, but then remained relatively stagnant between 2007 and 2014. Among children aged 6-12 years and 13-18 years, the prevalence of overweight increased from 5.1% to 15.6% and from 7.1% to 14.1% between 1993 and 2014, respectively. Although overweight prevalence remains higher in urban areas, the increase in overweight prevalence was larger among rural (vs urban) residents, and by 2014, the proportions of overweight adults were evenly distributed in each wealth quintile. Data suggest that the consumption of ultra-processed foods was common and levels of physical activity have decreased over the last decade. In multivariable models, urban area residence, higher wealth, higher education and consumption of ultra-processed foods were associated with higher odds of overweight among most adults and children.

CONCLUSION

Urgent programme and policy action is needed to reduce and prevent overweight among all ages.

Prevalence of obesity in rural and urban areas in Brazil: National Health Survey, 2013

OBJECTIVE

To investigate the role of the domiciliary situation in the prevalence of general and abdominal obesity through the National Health Survey of 2013.

METHODOLOGY

General obesity (body mass index ≥ 30 kg/m2) and abdominal obesity (waist circumference ≥ 102 cm in men and ≥ 88 cm in women) in rural and urban areas were described according to sex and macroregion. Crude and adjusted Poisson regression models were used to test the association between obesity and household situation, with the significance level of 5%.

RESULTS

The study included 59,226 individuals. Out of these, 20.7% presented general obesity and 38% abdominal obesity (higher in women: 24.3 and 52%, respectively). The highest prevalences of general obesity were observed in southern urban areas, for both sexes (20.8% in men and 26.5% in women). In rural areas, the highest prevalences were observed for the central-west region (17.2%) in men and in the south region (27.4%) in women. In males, after adjusting for demographic variables, living in rural areas was associated with lower prevalences of general obesity in the North (prevalence ratios - PR = 0.60; confidence interval of 95% - 95%CI 0.40 - 0.89) and Northeast (PR = 0.47, 95%CI 0,38 - 0.59), and for abdominal obesity in all regions. For women in the Midwest, the rural household situation was associated with lower prevalences of obesity. (PR = 1.11, 95%CI 1.01 - 1.23).

CONCLUSIONS

The results evidenced the role of the domiciliary situation among outcomes at the national level, with lower prevalence of general and abdominal obesity in men living in rural areas. However, higher prevalences were found among women, especially for abdominal obesity.

Decomposing adult obesity trends in China (1991-2011)

Using data from the China Health and Nutrition Survey, this study analyses two decades (1991-2011) of change in adult obesity in China with a focus on whether rising obesity rates result from all population cohorts becoming more obese across time (intra-cohort change) or recent cohorts being more obese than their earlier counterparts (inter-cohort change or cohort replacement). To do so, we decompose changes in the body mass index (BMI), waist circumference (WC), general obesity and abdominal obesity of adults aged 20+ using both Firebaugh's linear decomposition and Das Gupta's non-linear technique. Our analysis not only reveals significant increases in both general and abdominal obesity (8.1 and 32 percentage points, respectively) in the two decades studied but shows that the rising means in all four measures are mostly attributable to intra-cohort change. In fact, contrary to findings for the U.S., inter-cohort change for the Chinese sample is actually negative, implying that cohort replacement attenuates intra-cohort change over time. Given that intra-cohort change is the central force for the increase in BMI, WC and obesity with individual increases in obesity widely distributed across all cohorts and age groups over time, policy interventions should focus more broadly on all age groups and birth cohorts.

Labor market engagement and the body mass index of working adults: Evidence from India

Galvanized by rapid income growth, labor market transitions in the nature of jobs, and lifestyle factors, there has been an increase in rates of obesity in many developing countries. This paper examines the relationship between BMI and sector and physical intensity of work among urban adults in India. We document that BMI is positively and significantly associated with labor market inactivity. Women in white-collar work have about 1.01 kg/m² higher BMI than women in blue-collar work. For working men, the comparable estimate is approximately 1.18 kg/m². We find that the increase in overall BMI originates from those who are already at high levels of BMI. Further, relative to the non-working sample, employment in a blue-collar occupation is associated with a BMI penalty for men and women. We find suggestive evidence that the increase in BMI for women is driven by a decline in energy expenditure, while both a decrease in energy expenditure and an increase in energy intake are important in explaining BMI dynamics for men. These results are robust to a variety of specification and methodological checks, and suggest that the increasing trend in BMI may be attributed to the transition towards a more sedentary occupational structure. Overall our research underlines the important role played by occupational engagement in determining the general health of populations in developing countries.

Urban developments and health: Evidence from the distributional analysis of biomarkers in China

This study explores the association between urban developments and health in China, a country that has experienced unprecedented economic growth and consequential rapid urbanisation over the last few decades. Exploiting the Chinese Health and Nutrition Survey, this study analyses the effect of these urban developments on the entire distribution of 11 objectively measured health outcomes related to non-communicable diseases. Quantification of the effects on health distribution is achieved by estimating health distribution in a counter-factual situation in which every individual is exposed to the minimum level of urban development. In decomposing the estimated effect into the part attributable to the observed path through which urban developments change observed health-related behaviours (behavioural effect), and the remaining part which cannot be attributable to this observed path (non-behavioural effect), this study sheds light on the mechanisms underlying how urban developments are associated with health outcomes. The results indicate that urban developments are negatively associated in this regard, especially with health outcomes related to body lipids such as triglycerides and cholesterols, blood pressure and kidney-related biomarkers. Furthermore, the results provide strong evidence of heterogeneity in the degrees of association across the distribution.

Food choice and food consumption frequency of Cape Verde inhabitants

The knowledge of the food pattern of a population is crucial for establishing nutritional and epidemiological profiles, as well as for controlling the market of foodstuffs and to help in the management of stock of staple foods. This study aims to evaluate food consumption and its association with the underlying motives for consumers' food choices, through the application of a Food Frequency Questionnaire (FFQ) followed by a Food Choice Questionnaire (FCQ). Face to face interviews were conducted with 503 participants, recruited at their homes, workplaces, health centers and other central locations in Cape Verde, only including subjects aged ≥18 years, without a self-reported history of chronic diseases. Food frequency analysis, as well as exploratory factorial analysis (EFA) were used to determine dietary patterns and nonparametric statistical tests for comparisons and associations of variables. The EFA yielded 4 patterns termed as: "Traditional", "Western", "Balanced" and "Energetic". Using an FCQ structure of 9 factors, three different groups were obtained from hierarchical clustering. (Cabral, de Almeida, & Cunha, 2017). The results show that Cape Verdean inhabitants follow global diet trends (towards the so-called "westernization"), however, in a more moderate rate if compared to other developing country populations. Consuming "junk food" is infrequent in Cape Verde, which appears to be due to limited availability and accessibility of this type of food. The rural coastal population remains more attached to traditional foods, consuming local products and traditional dishes, whereas in the urban population, one may notice the "westernization" of consumption. The application of an FFQ in combination with the FCQ provided in-depth information on eating attitudes and behaviors.

The association between population density and blood lipid levels in Dutch blood donors

BACKGROUND

In low and middle-income countries (LMIC), the total and LDL cholesterol and triglyceride levels of residents of urban areas are reported to be higher than those of rural areas. This may be due to differences in lifestyle behaviors between residents of urban areas and rural areas in LMIC. In this study, our aims were to (1) examine whether or not LDL cholesterol, total/HDL ratios and triglyceride levels of individuals in densely populated areas are higher than those of individuals living in less-densely populated areas in a high-income country (HIC) and (2) investigate the potential mediating roles of physical activity and sedentary behavior.

METHODS

We used cross-sectional data from 2547 Dutch blood donors that participated in Donor InSight-III. Linear regression was used to analyze the association between population density and LDL cholesterol, total/HDL cholesterol ratio and HDL cholesterol. The mediating roles of moderate-to-vigorous physical activity (MVPA) and sedentary behavior were investigated in a subsample (n = 740) for which objectively measured MVPA/sedentary behavior data was available. Multiple mediation with linear regression analyses were performed and the product-of-coefficients method was used to calculate direct and indirect effects.

RESULTS

Mean LDL cholesterol and median total cholesterol/HDL cholesterol ratio and triglyceride levels were 2.89, 3.43 and 1.29 mmol/L, respectively. Population density was not associated with LDL cholesterol [β 0.00 (- 0.01; 0.01)], log transformed total/HDL cholesterol ratio [β 1.00 (1.00; 1.00)] and triglyceride levels [β 1.00 (0.99; 1.00)]. No statistically significant direct or indirect effects were found.

CONCLUSION

Contrary to previous findings in LMIC, no evidence was found that population density is associated with blood lipid levels in blood donors in the Netherlands or that MVPA and sedentary behavior mediate this association. This may be the result of socioeconomic differences and, in part, may be due to the good health of the study population and the relatively high population density in the Netherlands. Also, compared to LMIC, differences in physical activity levels in more versus less populated areas may be less pronounced in HIC.

Changes in the configuration and patterns of physical activity among Mongolian adults, 2005-2013

Objective: This study examined the change in physical activity status and patterns and their associations with urban and rural residence and employment status in Mongolia.

Methods: We analyzed data from 7,738 adults aged from 20 to 64 years (n = 2,877 and 4,861 for 2005 and 2013, respectively) from the Mongolian STEPS Survey on the Prevalence of Non-Communicable Disease Risk Factors (NCD-STEPS survey). Physical activity in three domains, including work (occupational and household work); transport (walk or cycling); and leisure (sport or fitness) was measured by Global Physical Activity Questionnaire (GPAQ). Physical activity levels were classified into three groups: low, moderate, and high according to the GPAQ analysis framework. The associations between physical activity time, residential area, and employment status were examined using a multivariate negative binomial regression model.

Results: The percentage of respondents with low-level physical activity increased from 10.9% in 2005 to 27.2% in 2013. The median minutes of physical activity time per week were 1,020 in 2005 and 600 in 2013. Physical activity time at work, transport and overall decreased in 2013. Work-related physical activity was the most dominant component of physical activity time (55.6% in 2005 and 54.6% in 2013), the transport domain was the second-highest contributor of physical activity time in 2005 (24.0%) and was replaced by the leisure domain (26.8%) in 2013. Rural residents practiced more physical activity at work, transport, and leisure than urban residents did in 2005 (prevalence ratio [PR]: 1.33, 95% confidence interval [CI]: 1.20–1.47; PR: 1.21, 95%CI: 1.14–1.29; and PR: 1.21, 95%CI: 1.13–1.30, respectively), but there was no significant difference by residential area in 2013. Mongolian adults with higher educational attainment, employee status, and non-employment status were less likely to engage in physical activity compared to those among adults with lower educational attainment and self-employed status.

Multilevel socioeconomic differentials in allostatic load among Chinese adults

Capitalizing on the biomarker data from the 2009 wave of the China Health and Nutrition Survey (CHNS), this study examines the extent to which multilevel socioeconomic status (SES) gets "under the skin" to affect individuals' health, measured by allostatic load (AL). Multilevel analyses suggest that in the context of China's socioeconomic and health transitions, high income, prestigious but sedentary occupations, and high level of urbanization were independently associated with higher AL scores, or increased health risks of physiological dysfunction in cardiovascular, metabolic, inflammation, and urinary systems. Higher educational attainment was related to a decrease in AL, but the significant difference was only observed among the college-educated compared to lower levels of education.

Night light intensity and women's body weight: Evidence from Nigeria

The prevalence of overweight and obesity are increasing in many African countries and hence becoming regional public health challenges. We employ satellite-based night light intensity data as a proxy for urbanization to investigate the relationship between urbanization and women's body weight. We use two rounds of the Demographic and Health Survey data from Nigeria. We employ both nonparametric and parametric estimation approaches that exploit both the cross-sectional and longitudinal variations in night light intensities. Our empirical analysis reveals nonlinear relationships between night light intensity and women's body weight measures. Doubling the sample's average level of night light intensity is associated with up to a ten percentage point increase in the probability of overweight. However, despite the generally positive relationship between night light intensity and women's body weight, the strength of the relationship varies across the assorted stages of night light intensity. Early stages of night light intensity are not significantly associated with women's body weight, while higher stages of nightlight intensities are associated with higher rates of overweight and obesity. Given that night lights are strong predictors of urbanization and related economic activities, our results hint at nonlinear relationships between various stages of urbanization and women's body weight.