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Yang Y, Lee H, Shirai K, Liu K, Iso H, Kim HC. Sex-specific associations between socioeconomic status and ideal cardiovascular health among Korean adults: The Korea National Health and Nutrition Examination Survey, 2007-2017. PLoS One 2024; 19:e0307040. [PMID: 39146358 PMCID: PMC11326625 DOI: 10.1371/journal.pone.0307040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/27/2024] [Indexed: 08/17/2024] Open
Abstract
Socioeconomic status (SES) has a considerable impact on cardiovascular health (CVH), which may differ by sex. We aimed to investigate sex-specific socioeconomic disparities in CVH among 31,141 individuals aged 25-64 years who participated in the cross-sectional 2007-2017 Korea National Health and Nutrition Survey (KNHANES) and the Life's Simple 7 metrics were used to define ideal CVH. Latent class analysis was used to estimate overall SES patterns. Logistic regression models were used to estimate sex-specific odds ratios (ORs) and 95% confidence interval (95% CI) for the likelihood of ideal CVH across SES classes, with the highest SES as the reference group. Four SES classes were identified: (1) low class with low education and material property (2.4%), (2) lower-medium class (10.1%) and (3) higher-medium class (43.7%) with increasing material affluence, and (4) high class with highest education and income (43.8%). Lower SES was associated with decreased ideal CVH among women; compared to their high SES counterparts, women with lowest SES were least likely to achieve ideal overall CVH (OR: 0.55, 95%CI: 0.43-0.71). Similar SES gradients in ideal overall CVH for men were also observed but it was less clear (OR (95%CI) for lowest SES: 0.83, 0.51-1.34). Low SES was associated with poorer achievement of ideal CVH with some sex-heterogeneities. Interventions that equalize the distribution of power and resources and targeted sex-specific approaches to empower low socioeconomic subgroups are warranted to prevent the transition from ideal to suboptimal cardiovascular health and to close socioeconomic disparities in CVH among Korean adults.
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Affiliation(s)
- Yiyi Yang
- Department of Public Health, Yonsei University Graduate School, Seoul, South Korea
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine Osaka University, Osaka, Japan
| | - Hokyou Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Kokoro Shirai
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine Osaka University, Osaka, Japan
| | - Keyang Liu
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine Osaka University, Osaka, Japan
| | - Hiroyasu Iso
- Institute for Global Health Policy Research (iGHP), Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, South Korea
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Espírito Santo LR, Faria TO, Silva CSO, Xavier LA, Reis VC, Mota GA, Silveira MF, Mill JG, Baldo MP. Socioeconomic status and education level are associated with dyslipidemia in adults not taking lipid-lowering medication: a population-based study. Int Health 2022; 14:346-353. [PMID: 31693111 PMCID: PMC10575599 DOI: 10.1093/inthealth/ihz089] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/15/2019] [Accepted: 08/20/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Socio-economic disparities account for changes in the lipid profile in developing countries. We aimed to investigate the association between blood lipids and socio-economic and educational strata in adults not taking lipid-lowering medications. METHODS A cross-sectional, population-based study enrolled 1614 individuals not taking lipid-lowering medications. Sociodemographic characteristics, monthly income, education level and the number of consumer goods available at home were obtained and individuals were classified into five socio-economic categories. Blood lipids were obtained in fasting participants. RESULTS In men, the higher the socio-economic or educational stratum, the higher the total cholesterol, low-density lipoprotein cholesterol (LDL-c) and triglyceride (TG) levels and the lower the high-density lipoprotein cholesterol (HDL-c), after controlling for age, body mass index, hypertension, smoking habit and physical activity. In women, the higher socio-economic strata were associated with elevated total cholesterol and HDL-c, while lower total cholesterol, LDL-c and TG levels were found in those with higher education levels. Also, individuals in the upper socio-economic strata had higher levels of total cholesterol and LDL-c, showing more than two times higher odds of having multiple alterations in blood lipids (men: OR 2.99 [95% CI 1.23 to 5.07]; women: OR 2.31 [95% CI 1.09 to 5.83]). CONCLUSIONS Dyslipidemia is highly prevalent in developing countries. Individuals in the highest socio-economic category are the ones at higher risk for dyslipidemia. This phenomenon calls for strategies to stimulate healthy diet habits and a physically active lifestyle to minimize health problems.
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Affiliation(s)
| | - Thaís O Faria
- Department of Nursing, Prominas University, Montes Claros, MG 39401-089, Brazil
| | - Carla Silvana O Silva
- Department of Nursing, Montes Claros State University, Montes Claros, MG 39401-089, Brazil
| | - Lorena A Xavier
- Department of Medicine, Montes Claros State University, Montes Claros, MG 39401-089, Brazil
| | - Vivianne C Reis
- Department of Physical Education, Montes Claros State University, Montes Claros, MG 39401-089, Brazil
| | - Gabriel A Mota
- Department of Medicine, Montes Claros State University, Montes Claros, MG 39401-089, Brazil
| | - Marise F Silveira
- Department of Statistics, Montes Claros State University, Montes Claros, MG 39401-089, Brazil
| | - José Geraldo Mill
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, ES 27042-755, Brazil
| | - Marcelo P Baldo
- Department of Medicine, Centro Universitário, UniFIPMOC, Montes Claros, MG 39408-007, Brazil
- Department of Pathophysiology, Montes Claros State University, Montes Claros, MG 39401-089, Brazil
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Chairistanidou C, Karatzi K, Karaglani E, Usheva N, Liatis S, Chakarova N, Mateo-Gallego R, Lamiquiz-Moneo I, Radó S, Antal E, Bíró É, Kivelä J, Wikström K, Iotova V, Cardon G, Makrilakis K, Manios Y. Diet quality in association to lipidaemic profile in adults of families at high-risk for type 2 diabetes in Europe: The Feel4Diabetes study. Nutr Metab Cardiovasc Dis 2022; 32:1175-1185. [PMID: 35277326 DOI: 10.1016/j.numecd.2022.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/17/2021] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS The role of diet in blood lipids is scarcely investigated in adults at risk of Type 2 Diabetes Mellitus (T2DM) and even less studied regarding their socioeconomic status (SES). This study aimed to investigate the associations of diet quality with blood lipids in adults from families at high-risk for developing T2DM from six European countries, considering their SES. METHODS AND RESULTS In total 2049 adults (67% women) from relatively low-SES regions and high T2DM risk families were enrolled. Dietary habits, sedentary behaviour and sociodemographic characteristics were assessed using standardised questionnaires. The associations of tertiles of healthy diet score (HDS) with blood lipids were tested by univariate analysis of variance (UNIANOVA). HDL-Cholesterol (HDL-C) was positively (B 1.54 95%CI 0.08 to 2.99) and LDL-Cholesterol (LDL-C) (B -4.15 95%CI -7.82 to -0.48), ratio of total cholesterol to HDL-C (B -0.24 95%CI -0.37 to -0.10), ratio of LDL-C to HDL-C (B -0.18 95%CI -0.28 to -0.08) and Atherogenic Index of Plasma (B -0.03 95%CI -0.06 to 0.00) inversely associated with the highest tertile of diet score compared to the lowest tertile independently of age, sex, Body Mass Index, total screen time and smoking. In sub-analysis of education (<14 and ≥ 14 years of education), these findings were only significant in the high-SES group. CONCLUSION While diet quality was poorer in the low-SES group, an association between diet quality and lipidemic profile was not found, as increased central obesity and smoking prevalence might have confounded this association. These findings indicate the need for tailor-made interventions, guided by the specific risk factors identified per population sub groups.
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Affiliation(s)
- Christina Chairistanidou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece.
| | - Kalliopi Karatzi
- Laboratory of Dietetics and Quality of Life, Department of Food Science & Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, Athens, Greece.
| | - Eva Karaglani
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece.
| | - Natalya Usheva
- Department of Paediatrics, Medical University Varna, Varna, Bulgaria.
| | - Stavros Liatis
- National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece.
| | - Nevena Chakarova
- Clinical Center of Endocrinology, Medical University of Sofia, Sofia, Bulgaria.
| | | | - Itziar Lamiquiz-Moneo
- Unidad Clínica y de Investigación en Lípidos y Arteriosclerosis, Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria Aragón (IIS Aragón) CIBERCV, Zaragoza, Spain.
| | - Sándorné Radó
- University of Debrecen, Faculty of Health, Debrecen, Hungary.
| | - Emese Antal
- Hungarian Society of Nutrition, 1088 Budapest, Hungary.
| | - Éva Bíró
- Division of Health Promotion, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, 4032 Debrecen, Hungary.
| | - Jemina Kivelä
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland.
| | - Katja Wikström
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland.
| | - Violeta Iotova
- Department of Paediatrics, Medical University Varna, Varna, Bulgaria.
| | - Greet Cardon
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000 Gent, Belgium.
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Agro-Health, Heraklion, Greece.
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Panagiotakos DB, Pitsavos C, Manios Y, Polychronopoulos E, Chrysohoou CA, Stefanadis C. Socio-Economic Status in Relation to Risk Factors Associated with Cardiovascular Disease, in Healthy Individuals from the ATTICA Study. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/204748730501200111] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Social status has been related with the prevalence and incidence of cardiovascular disease. The aim of this study is to investigate the relationships between socio-economic status (SES) and clinical and biochemical factors related to coronary heart disease, in a sample of cardiovascular disease-free men and women. Design Cross-sectional survey. Methods During 2001-2002, 1514 men (20-87 years old) and 1528 women (20-89 years old) from the Attica region (Greece) were randomly enrolled into the study. Trends in established and emerging cardiovascular risk factors were examined across the participants' socio-economic status. A special index was developed (years of school by annual income) and three socio-economic classes were created. Results An inverse relationship was found regarding all lipids and glucose levels across the tertiles of the SES index. An inverse association was observed between body mass index, waist-to-hip ratio and SES in men, but not in women. Furthermore, compared to the lowest tertile, individuals who were classified in the highest SES tertile had lower levels of C-reactive protein, fibrinogen, homocysteine, tumour necrosis factor-α, interleukin-6 levels and white blood cell counts, even after adjusting for various potential confounders. Finally, a considerable proportion of men and women reported lack of health knowledge and education. Conclusions An inverse association between SES and factors related to cardiovascular risk exists, but the causal pathway itself requires more detailed explanation before the social status can have explanatory power.
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Affiliation(s)
- Demosthenes B. Panagiotakos
- First Cardiology Department, School of Medicine, University of Athens, Athens
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Christos Pitsavos
- First Cardiology Department, School of Medicine, University of Athens, Athens
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
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Roohafza HR, Sadeghi M, Kelishadi R. Cardiovascular Risk Factors in Iranian Adults according to Educational Levels: Isfahan Healthy Heart Program. Asia Pac J Public Health 2016; 17:9-14. [PMID: 16044825 DOI: 10.1177/101053950501700103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is abundant evidence that the socioeconomic status (SES) is inversely associated with CVD risk factors. The objective of this study is to describe the distribution of CVD risk factors according to educational level in Iranian adults. A cross-sectional survey was performed on subjects over the age of 19 in three cities. Demographic data, as well as information on educational level and smoking habits was obtained and then height, weight and blood pressure measurement and blood sampling were arranged. Data was analyzed by the Mantel-Haenszel, Kendalls T correlation and multivariate analysis test. Of 9587 subjects, 48% were men and 52% were women, with mean ages of 39.0±15.3 and 38.8±14.5 years, respectively. All CVD risk factors showed an inverse relationship with educational level in all subjects, except for smoking and low HDL-C in women. High TC and LDL-C and low HDL-C were inversely related to educational level (P<0.05); however, this relationship was not significant with Mantel-Haenszel test in men. The association between CVD risk factors and educational level in women was stronger than in men. The differences found between CVD risk factors with educational level are important and should be considered in programs designed to increase level of education in order to lower CVD risk factors. Asia Pac J Public Health 2005: 17(1): 9-14.
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Affiliation(s)
- H R Roohafza
- Mental Health Department, Isfahan University of Medical Sciences, Isfahan, Iran.
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Shohaimi S, Boekholdt MS, Luben R, Wareham NJ, Khaw KT. Distribution of lipid parameters according to different socio-economic indicators- the EPIC-Norfolk prospective population study. BMC Public Health 2014; 14:782. [PMID: 25179437 PMCID: PMC4155077 DOI: 10.1186/1471-2458-14-782] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 07/29/2014] [Indexed: 11/24/2022] Open
Abstract
Background Data on the relationship between plasma levels of cholesterol and triglycerides and social class have been inconsistent. Most previous studies have used one classification of social class. Methods This was a cross-sectional population based study with data on occupational social class, educational level obtained using a detailed health and lifestyle questionnaire. A total of 10,147 men and 12,304 women aged 45–80 years living in Norfolk, United Kingdom, were recruited using general practice age-sex registers as part of the European Prospective Investigation into Cancer (EPIC-Norfolk). Plasma levels of cholesterol and triglycerides were measured in baseline samples. Social class was classified according to three classifications: occupation, educational level, and area deprivation score according to Townsend deprivation index. Differences in lipid levels by socio-economic status indices were quantified by analysis of variance (ANOVA) and multiple linear regression after adjusting for body mass index and alcohol consumption. Results Total cholesterol levels were associated with occupational level among men, and with educational level among women. Triglyceride levels were associated with educational level and occupational level among women, but the latter association was lost after adjustment for age and body mass index. HDL-cholesterol levels were associated with both educational level and educational level among men and women. The relationships with educational level were substantially attenuated by adjustment for age, body mass index and alcohol use, whereas the association with educational class was retained upon adjustment. LDL-cholesterol levels were not associated with social class indices among men, but a positive association was observed with educational class among women. This association was not affected by adjustment for age, body mass index and alcohol use. Conclusions The findings of this study suggest that there are sex differences in the association between socio-economic status and serum lipid levels. The variations in lipid profile with socio-economic status may be largely attributed to potentially modifiable factors such as obesity, physical activity and dietary intake.
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Affiliation(s)
- Shamarina Shohaimi
- Department of Biology, Faculty of Science, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia.
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Samuel P, Antonisamy B, Raghupathy P, Richard J, Fall CHD. Socio-economic status and cardiovascular risk factors in rural and urban areas of Vellore, Tamilnadu, South India. Int J Epidemiol 2012; 41:1315-27. [PMID: 22366083 PMCID: PMC3541500 DOI: 10.1093/ije/dys001] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We examined associations between socio-economic status (SES) indicators and cardiovascular disease (CVD) risk factors among urban and rural South Indians. METHODS Data from a population-based birth cohort of 2218 men and women aged 26-32 years from Vellore, Tamilnadu were used. SES indicators included a household possessions score, attained education and paternal education. CVD risk factors included obesity, hypertension, impaired glucose tolerance or diabetes, plasma total cholesterol to high density lipoprotein (HDL) ratio and triglyceride levels and consumption of tobacco and alcohol. Multiple logistic regression analysis was used to assess associations between SES indicators and risk factors. RESULTS Most risk factors were positively associated with possessions score in urban and rural men and women, except for tobacco use, which was negatively associated. Trends were similar with the participants' own education and paternal education, though weaker and less consistent. In a concurrent analysis of all the three SES indicators, adjusted for gender and urban/rural residence, independent associations were observed only for the possessions score. Compared with those in the lowest fifth of the score, participants in the highest fifth had a higher risk of abdominal obesity [odds ratio (OR) =6.4, 95% CI 3.4-11.6], high total cholesterol to HDL ratio (OR=2.4, 95% CI 1.6-3.5) and glucose intolerance (OR=2.8, 95% CI 1.9-4.1). Their tobacco use (OR=0.4, 95% CI 0.2-0.6) was lower. Except for hypertension and glucose intolerance, risk factors were higher in urban than rural participants independently of SES. CONCLUSION In this young cohort of rural and urban south Indians, higher SES was associated with a more adverse CVD risk factor profile but lower tobacco use.
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Affiliation(s)
- Prasanna Samuel
- Department of Biostatistics, Christian Medical College, Vellore, Tamilnadu, India
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Boykin S, Diez-Roux AV, Carnethon M, Shrager S, Ni H, Whitt-Glover M. Racial/ethnic heterogeneity in the socioeconomic patterning of CVD risk factors: in the United States: the multi-ethnic study of atherosclerosis. J Health Care Poor Underserved 2011; 22:111-27. [PMID: 21317510 PMCID: PMC3312013 DOI: 10.1353/hpu.2011.0001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Many studies document racial variation, gender differences, and socioeconomic status (SES) patterning in cardiovascular disease (CVD) risk factors but few studies have investigated heterogeneity in SES differences by race/ethnicity or gender. Using data from the Multi-Ethnic Study of Atherosclerosis (N=6,814) and stratified regression models, we investigated race/ethnic differences in the SES patterning of diabetes, hypertension, smoking, and body mass index (BMI). Inverse socioeconomic gradients in hypertension, diabetes, smoking, and BMI were observed in White and Black women but associations were weaker or absent in Hispanic and Chinese women (except in the case of diabetes for Hispanic women). Even greater heterogeneity in social patterning of risk factors was observed in men. In White men all four risk factors were inversely associated with socioeconomic position, although often associations were only present or were stronger for education than for income. The inverse socioeconomic patterning was much less consistent in men of other races/ethnic groups, and higher SES was associated with higher BMI in non-White men. These findings have implications for understanding the causes of social patterning, for the analysis of SES adjusted race/ethnic differences, and for the targeting of interventions.
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Affiliation(s)
- Shawn Boykin
- Center for Integrative Approaches to Health Disparities, Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, MI 48109-2029, USA.
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Huang S, Xu Y, Yue L, Wei S, Liu L, Gan X, Zhou S, Nie S. Evaluating the risk of hypertension using an artificial neural network method in rural residents over the age of 35 years in a Chinese area. Hypertens Res 2010; 33:722-6. [PMID: 20505678 DOI: 10.1038/hr.2010.73] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Hypertension (HTN) has been proven to be associated with an increased risk of cardiovascular diseases. The purpose of the study was to examine risk factors for HTN and to develop a prediction model to estimate HTN risk for rural residents over the age of 35 years. This study was based on a cross-sectional survey of 3054 rural community residents (N=3054). Participants were divided into two groups: a training set (N1=2438) and a validation set (N2=616). The differences between the training set and validation set were not statistically significant. The predictors of HTN risk were identified from the training set using logistic regression analysis. Some risk factors were significantly associated with HTN, such as a high educational level (EL) (odds ratio (OR)=0.744), a predominantly sedentary job (OR=1.090), a positive family history of HTN (OR=1.614), being overweight (OR=1.525), dysarteriotony (OR=1.101), alcohol intake (OR=0.760), a salty diet (OR=1.146), more vegetable and fruit intake (OR=0.882), meat consumption (OR=0.787) and regular physical exercise (OR=0.866). We established the predictive models using logistic regression model (LRM) and artificial neural network (ANN). The accuracy of the models was compared by receiver operating characteristic (ROC) when the models were applied to the validation set. The ANN model (area under the curve (AUC)=0.900+/-0.014) proved better than the LRM (AUC=0.732+/-0.026) in terms of evaluating the HTN risk because it had a larger area under the ROC curve.
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Affiliation(s)
- Shuqiong Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
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The effects of socio-economic status on BMI, waist:hip ratio and waist circumference in a group of Iranian women. Public Health Nutr 2008; 11:757-61. [PMID: 18194587 DOI: 10.1017/s1368980007001577] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess the effects of socio-economic status (SES) on BMI, waist:hip ratio (WHR) and waist circumference (WC) in a group of Iranian women. METHODS A cross-sectional study was conducted on 888 women in Sistan and Baluchestan Province. SES was measured using level of education. In addition, parity, marital status and physical activity were assessed. Standardized measurements were taken, BMI and WHR were calculated. RESULTS Low education level was a strong determinant of overweight and obesity among Iranian women. After controlling for age, women with higher education level had significantly lower BMI, WC and parity. Multiple linear regression analysis found a significant negative association of BMI and WC with education level and a significant positive association of BMI and WC with parity. Significant factors associated with obesity by a logistic regression model were education level (OR for university graduates v. illiterate or low literacy levels: 1.00 v. 3.70; P = 0.01), living with spouse (OR for married v. single subjects: 1.00 v. 0.15; P = 0.05), parity (OR for more than five v. less than two pregnancies: 1.00 v. 0.34; P = 0.03) and WC (OR for < 0.88 cm v. > or = 0.88 cm: 1.00 v. 11.20; P = 0.001). CONCLUSION The present study revealed that educational level, multiple pregnancies, marital status and lack of exercise are some possible explanations for the obesity among Sistan and Baluchestan women.
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Growth environment and sex differences in lipids, body shape and diabetes risk. PLoS One 2007; 2:e1070. [PMID: 17957253 PMCID: PMC2031823 DOI: 10.1371/journal.pone.0001070] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Accepted: 10/05/2007] [Indexed: 01/15/2023] Open
Abstract
Background Sex differences in lipids and body shape, but not diabetes, increase at puberty. Hong Kong Chinese are mainly first or second generation migrants from China, who have shared an economically developed environment for years, but grew up in very different environments in Hong Kong or contemporaneously undeveloped Guangdong, China. We assessed if environment during growth had sex-specific associations with lipids and body shape, but not diabetes. Methodology and Principal Findings We used multivariable regression in a population-based cross-sectional study, undertaken from 1994 to 1996, of 2537 Hong Kong Chinese residents aged 25 to 74 years with clinical measurements of ischaemic heart disease (IHD) risk, including HDL-cholesterol, ApoB, diabetes and obesity. Waist-hip ratio was higher (mean difference 0.01, 95% CI 0.001 to 0.02) in men, who had grown up in an economically developed rather than undeveloped environment, as was apolipoprotein B (0.05 g/L, 95% CI 0.001 to 0.10), adjusted for age, socio-economic status and lifestyle. In contrast, the same comparison was associated in women with lower waist-hip ratio (−0.01, 95% CI −0.001 to −0.02) and higher HDL-cholesterol (0.05 mmol/L, 95% CI 0.0004 to 0.10). The associations in men and women were significantly different (p-values<0.001). There were no such differences for diabetes. Conclusions Growth in a developed environment with improved nutrition may promote higher sex-steroids at puberty producing an atherogenic lipid profile and male fat pattern in men but the opposite in women, with tracking of increased male IHD risk into adult life.
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Schooling CM, Jiang C, Lam TH, Thomas GN, Heys M, Lao X, Zhang W, Adab P, Cheng KK, Leung GM. Height, its components, and cardiovascular risk among older Chinese: a cross-sectional analysis of the Guangzhou Biobank Cohort Study. Am J Public Health 2007; 97:1834-41. [PMID: 17761579 PMCID: PMC1994197 DOI: 10.2105/ajph.2006.088096] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Better childhood conditions, inferred from height and specifically leg length, are usually protective against ischemic heart disease and its risk factors in Western countries. In other geoethnic populations, height is less clearly protective, casting doubt on there being a biological etiology. To clarify the role of childhood conditions, we examined the associations of height and its components with cardiovascular risk among older Chinese people. METHODS We used multivariable regression to examine the associations of height and its components with blood pressure, lipid profile, and diabetes in 10413 older Chinese adults (mean age=64.6 years). RESULTS After we adjusted for age, gender, socioeconomic status, and lifestyle habits, greater sitting height was associated with diabetes and dyslipidemia. Longer legs were associated with lower pulse pressure and lower low-density lipoprotein cholesterol. CONCLUSIONS We provide indirect anthropometric evidence for the role of pre-pubertal and pubertal exposures on cardiovascular risk. Pubertal exposures are stronger than are prepubertal exposures but may be influenced by osteoporotic decline in old age. Further research should establish whether the observed relations are ethnically specific or relate to the stage or trajectory of socioeconomic development.
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Affiliation(s)
- C Mary Schooling
- Department of Community Medicine, School of Public Health, University of Hong Kong, Hong Kong, People's Republic of China
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Tugwell P, Robinson V, Kristjansson E. The role of clinical epidemiology in health equity: Let's take action! J Clin Epidemiol 2005; 58:751-2. [PMID: 16018908 DOI: 10.1016/j.jclinepi.2005.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P Tugwell
- Institute of Population Health, University of Ottawa, 1 Stewart St, 2nd floor, Ottawa, Ontario K1N 6N5.
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Kocaoglu B, Moschonis G, Dimitriou M, Kolotourou M, Keskin Y, Sur H, Hayran O, Manios Y. Parental educational level and cardiovascular disease risk factors in schoolchildren in large urban areas of Turkey: directions for public health policy. BMC Public Health 2005; 5:13. [PMID: 15693995 PMCID: PMC549186 DOI: 10.1186/1471-2458-5-13] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2004] [Accepted: 02/04/2005] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It is widely accepted that the development of atherosclerosis starts at an early age. However, there are very few studies evaluating the prevalence of the common clinical and behavioral cardiovascular disease (CVD) risk factors among children, especially in developing countries. The aim of the present cross-sectional survey was to evaluate the distribution of blood lipid profile and various behavioral (i.e. dietary habits, physical activity status) factors related to CVD risk and its relationships to paternal (PEL) and maternal educational level (MEL) among primary schoolchildren in Turkey. METHODS In three major metropolises in Turkey (Istanbul, Ankara and Izmir), a random sample of 1044 children aged 12 and 13 years old was examined. ANOVA was applied to evaluate the tested hypothesis, after correcting for multiple comparisons (Tukey correction). RESULTS After controlling for energy and fat intake, physical activity status and Body Mass Index (BMI), it was found that mostly PEL had a significant positive effect for most of the subgroups examined (Lower vs. Higher and Medium vs. Higher) on TC and HDL-cholesterol and a negative effect on TC/HDL ratio for both genders. Furthermore, both boys and girls with higher PEL and MEL were found to have higher energy intake derived from fat and protein than their counterparts with Medium and Lower PEL and MEL, while the opposite was observed for the percentage of energy derived from carbohydrates. CONCLUSIONS Our study provides indications for a possible association between an adverse lipid profile, certain dietary patterns and Higher PEL and MEL among schoolchildren in Turkey. These findings underline the possible role of social status, indicated by the degree of education of both parents, in developing certain health behaviors and health indices among Turkish children and provide some guidance for Public Health Policy.
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Affiliation(s)
- Bike Kocaoglu
- Department of Tourism Administration, School of Applied Disciplines, Bogazici University, Istanbul, Turkey
| | - George Moschonis
- Department of Nutrition & Dietetics, Harokopio University of Athens, 70, E. Venizelou Ave,17671 Kallithea, Athens, Greece
| | - Maria Dimitriou
- Department of Nutrition & Dietetics, Harokopio University of Athens, 70, E. Venizelou Ave,17671 Kallithea, Athens, Greece
| | - Maria Kolotourou
- Department of Nutrition & Dietetics, Harokopio University of Athens, 70, E. Venizelou Ave,17671 Kallithea, Athens, Greece
| | - Yasar Keskin
- Department of Health Education, University of Marmara School of Health Education, Kartal Devlet Hastanesi Yani, Cevizli, Kartal, Istanbul, Turkey
| | - Haydar Sur
- Department of Health Education, University of Marmara School of Health Education, Kartal Devlet Hastanesi Yani, Cevizli, Kartal, Istanbul, Turkey
| | - Osman Hayran
- Department of Health Education, University of Marmara School of Health Education, Kartal Devlet Hastanesi Yani, Cevizli, Kartal, Istanbul, Turkey
| | - Yannis Manios
- Department of Nutrition & Dietetics, Harokopio University of Athens, 70, E. Venizelou Ave,17671 Kallithea, Athens, Greece
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Manios Y, Dimitriou M, Moschonis G, Kocaoglu B, Sur H, Keskin Y, Hayran O. Cardiovascular disease risk factors among children of different socioeconomic status in Istanbul, Turkey: directions for public health and nutrition policy. Lipids Health Dis 2004; 3:11. [PMID: 15180897 PMCID: PMC441404 DOI: 10.1186/1476-511x-3-11] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2004] [Accepted: 06/04/2004] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES The aim of the current study was to examine the influence of socioeconomic status (SES) on physiological (lipid profile, obesity indices) and behavioral (dietary habits, physical activity) cardiovascular disease (CVD) risk factors among primary schoolchildren in Istanbul. DESIGN Cross sectional study. SETTING One private school and two public schools from different SES districts in Istanbul. PARTICIPANTS 510 randomly selected children aged 12 and 13 years old (257 boys, 253 girls). RESULTS The prevalence of overweight (15.2%) and the energy intake (p < 0.001 and p < 0.05 for boys and girls respectively) were found to be higher for the middle/high SES group for both genders. Regarding biochemical indices, middle/high SES children had higher values of High Density Lipoprotein-cholesterol (HDL-C) (p < 0.001 and p < 0.05 for boys and girls respectively) and lower values of TC/HDL-C ratio and LDL-C/HDL-C ratio (p < 0.05 and p < 0.001 for boys and girls respectively). This could be attributed to the higher physical activity levels observed for middle/ high SES children (p < 0.001). CONCLUSION The findings of the current study revealed a coexistence of both overweight and higher energy intake in middle/high SES children, as well as a coexistence of underweight and lower physical activity levels in low SES children. These observations should guide the public health policy in developing appropriate intervention strategies to efficiently tackle these health and social issues early in life.
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Affiliation(s)
- Yannis Manios
- Department of Nutrition & Dietetics, Harokopio University of Athens, 70, E. Venizelou Ave,17671 Kallithea, Athens, Greece
| | - Maria Dimitriou
- Department of Nutrition & Dietetics, Harokopio University of Athens, 70, E. Venizelou Ave,17671 Kallithea, Athens, Greece
| | - George Moschonis
- Department of Nutrition & Dietetics, Harokopio University of Athens, 70, E. Venizelou Ave,17671 Kallithea, Athens, Greece
| | - Bike Kocaoglu
- Department of Tourism Administration, School of Applied Disciplines, Bogazici University, Istanbul, Turkey
| | - Haydar Sur
- Department of Health Education, University of Marmara School of Health Education, Kartal Devlet Hastanesi Yani, Cevizli, Kartal, Istanbul, Turkey
| | - Yasar Keskin
- Department of Health Education, University of Marmara School of Health Education, Kartal Devlet Hastanesi Yani, Cevizli, Kartal, Istanbul, Turkey
| | - Osman Hayran
- Department of Health Education, University of Marmara School of Health Education, Kartal Devlet Hastanesi Yani, Cevizli, Kartal, Istanbul, Turkey
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López-Azpiazu I, Sánchez-Villegas A, Johansson L, Petkeviciene J, Prättälä R, Martínez-González MA. Disparities in food habits in Europe: systematic review of educational and occupational differences in the intake of fat. J Hum Nutr Diet 2004; 16:349-64. [PMID: 14516382 DOI: 10.1046/j.1365-277x.2003.00466.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND A higher socio-economic level is associated with healthier dietary habits. Nevertheless, socio-economic differences in the intake of fat have not consistently been reported in Europe. The objective of our study was to systematically assess differences in total fat (TF) intake and saturated fat (SF) intake across social groups. METHODS Representative samples from nine European countries were used to perform a meta-analysis of surveys between 1985-1999, including both published and nonpublished results. RESULTS Because important heterogeneity was found and the estimates for TF from Spain and Estonia were different from all others, we calculated the differences in intake excluding these two countries. We found a lower TF intake in the highest (versus the lowest) occupational level both for men (difference: -1.1% of total energy intake; 95% CI: -1.3 to -0.8%) and women (difference: -0.9%; 95% CI: -1.2 to -0.6%) when Estonia and Spain were excluded. CONCLUSION European surveys indicate that people in the lowest category of occupation consume more fat and SF than people in the highest category.
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Affiliation(s)
- I López-Azpiazu
- Department of Epidemiology and Public Health, University of Navarra, Pamplona, Spain
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