The relative importance of socioeconomic indicators in explaining differences in BMI and waist:hip ratio, and the mediating effect of work control, dietary patterns and physical activity

The influence of metabolic factors and ethnicity on breast cancer risk, treatment and survival: The Oslo ethnic breast cancer study

BACKGROUND

Breast cancer risk remains higher in high-income compared with low-income countries. However, it is unclear to what degree metabolic factors influence breast cancer development in women 30 years after immigration from low- to a high-incidence country.

METHODS

Using Cox regression models, we studied the association between pre-diagnostic metabolic factors and breast cancer development, and whether this association varied by ethnicity among 13,802 women participating in the population-based Oslo Ethnic Breast Cancer Study. Ethnic background was assessed and pre-diagnostic metabolic factors (body mass index, waist:hip ratio, serum lipids and blood pressure) were measured. A total of 557 women developed invasive breast cancer, and these women were followed for an additional 7.7 years.

RESULTS

Among women with an unfavorable metabolic profile, women from south Asia, compared with western European women, had a 2.3 times higher breast cancer risk (HR 2.30, 95% CI 1.18-4.49). Compared with the western European women, the ethnic minority women were more likely to present with triple-negative breast cancer (TNBC) (OR 2.11, 95% CI 0.97-4.61), and less likely to complete all courses of planned taxane treatment (OR 0.26, 95% CI 0.08-0.82). Among TNBC women, above-median triglycerides:HDL-cholesterol (>0.73) levels, compared with below-median triglycerides:HDL-cholesterol (≤0.73) levels, was associated with 2.9 times higher overall mortality (HR 2.88, 95% CI 1.02-8.11).

CONCLUSIONS

Our results support the importance of metabolic factors when balancing breast cancer prevention and disease management among all women, and in particular among non-western women migrating from a breast cancer low-incidence to a high-incidence country.

Lifestyle and work ability in a general working population in Norway: a cross-sectional study

OBJECTIVES

The aim of this study was to investigate the association between multiple lifestyle-related risk factors (unhealthy diet, low leisure-time physical activity, overweight/obesity and smoking) and self-rated work ability in a general working population.

SETTING

Population-based cross-sectional study, in Telemark County, Norway, 2013.

PARTICIPANTS

A random sample of 50 000 subjects was invited to answer a self-administered questionnaire and 16 099 responded. Complete data on lifestyle and work ability were obtained for 10 355 participants aged 18-50 years all engaged in paid work during the preceding 12 months.

OUTCOME MEASURE

Work ability was assessed using the Work Ability Score (WAS)-the first question in the Work Ability Index. To study the association between multiple lifestyle risk factors and work ability, a lifestyle risk index was constructed and relationships examined using multiple logistic regression analysis.

RESULTS

Low work ability was more likely among subjects with an unhealthy diet (ORadj 1.3, 95% CI 1.02 to 1.5), inactive persons (ORadj 1.4, 95% CI 1.2 to 1.6), obese respondents (ORadj 1.5, 95% CI 1.3 to 1.7) and former and current smokers (ORadj 1.2, 95% CI 1.1 to 1.4 and 1.3, 95% CI 1.2 to 1.5, respectively). An additive relationship was observed between the lifestyle risk index and the likelihood of decreased work ability (moderate-risk score: ORadj 1.3; 95% CI 1.1 to 1.6; high-risk score: ORadj 1.9; 95% CI 1.6 to 2.2; very high risk score: ORadj 2.4; 95% CI 1.9 to 3.0). The overall population attributable fraction (PAF) of low work ability based on the overall risk index was 38%, while the PAFs of physical activity, smoking, body mass index and diet were 16%, 11%, 11% and 6%, respectively.

CONCLUSIONS

Lifestyle risk factors were associated with low work ability. An additive relationship was observed. The findings are considered relevant to occupational intervention programmes aimed at prevention and improvement of decreased work ability.

Dietary patterns: a literature review of the methodological characteristics of the main step of the multivariate analyzes

OBJECTIVE

To describe the solutions adopted in the multiple steps of the use of multivariate techniques to obtain a dietary pattern (DP) concerning: the objective of the studies, the selection of the method for measuring food intake, the criteria for grouping the foods, the number of food groups used, the number of DP obtained, and the nomenclature criteria.

METHODS

The articles were selected from MEDLINE and Lilacs scientific databases using the following keywords: "dietary patterns" versus "factor analysis"; "principal components analysis"; "cluster analysis" and "reduced regression rank." The initial search resulted in 1,752 articles. After inclusion and exclusion criteria, 189 publications were selected.

RESULTS

The following aspects were relevant among the studies: the prevalence of the principal component analysis (PCA); the prevalence of the use of 4 to 5 DPs in the studies of association with health outcomes; the use of 30 or more food groups from the food frequency questionnaire (FFQ); the prevalence of studies that associated DPs with health outcomes and socioeconomic factors; and the heterogeneity of criteria used throughout the analytical stages of the multivariate techniques.

CONCLUSION

The heterogeneity between the publications concentrates on the criteria for food grouping, the nomenclature, and the number of dietary patterns calculated, which varied depending on the number of food groups present in these analyses. To understand, apply, and explore in full, the multivariate techniques has become necessary in order to improve the reliability of the results and, consequently, to improve the relationships with health outcomes and socioeconomic factors.

Four major dietary patterns identified for a target-population of adults residing in Newfoundland and Labrador, Canada

Background

Very limited nutritional epidemiological studies conducted to explore the unique dietary exposure in Newfoundland and Labrador (NL). This study aims to identify and characterize major dietary patterns in the target-population from general adult NL residents and assess the associations with selected demographic factors.

Methods

A total of 192 participants, aged 35–70 years, completed and returned a food-frequency questionnaire (FFQ) and participated in a telephone interview to collect demographic information. Dietary patterns were identified by common factor analysis. Univariate and multivariate linear regression analyses were used to assess determinants of the different food consumption patterns. Pearson’s correlation coefficients were calculated for food scores of each pattern, total energy, and energy-adjusted nutrient intakes.

Results

Factor analyses identified four dietary patterns, which were labeled as “Meat”, “Vegetable/fruit”, “Fish”, and “Grain” patterns. In combination, the four dietary patterns explained 63% of the variance in dietary habits of the study population. Multivariate linear regression analysis indicated an increasing trend of factor scores for Meat and Grain pattern with age. Male participants were found to be more likely to choose the Meat and Fish patterns. Current smokers and those married/living together tend to choose the Grain pattern. Pearson’s correlation coefficients showed positive correlations between fat and cholesterol and the Meat pattern, fiber and the Vegetable/fruits pattern, protein and the Fish pattern, and carbohydrates and the Grain pattern.

Conclusion

This study derived four dietary patterns and obtained their significant associations with specific demographic characteristics in this population. It identified one dietary consumption pattern (Fish) not yet seen in other studied populations. These findings will update the current dietary-health information published in this province, and contribute to further research into the association between dietary practices and health.

Explaining educational disparities in adiposity: the role of neighborhood environments

OBJECTIVE

To examine the extent to which characteristics of the neighborhood built environment explain the association between adiposity and educational qualifications in Australian women.

METHODS

A community sample of 1,819 women (aged 18-66) from the Melbourne SESAW study provided information regarding their body mass index (BMI) and level of education. Objective measures of participants' residential neighborhood built environments were obtained using a Geographic Information System.

RESULTS

Compared with women with a high school degree or above, women who did not complete high school had higher average BMI, which was partially explained by lower density of sports facilities and living less proximally to the coastline and to supermarkets. In a multiple mediator model, which explained 16.6% of the educational disparity in BMI, the number of sports facilities and presence of the coastline within 2 km of participants' homes were significant mediators of the observed socioeconomic disparity in BMI.

CONCLUSIONS

The residential neighborhood environment may help to explain socioeconomic patterning of overweight and obesity in Australian women. These results provide further support for considering the built environment in obesity prevention initiatives, suggesting a potential role in decreasing social inequalities in obesity.

Dietary patterns associated with anthropometric indicators of abdominal fat in adults

This study aimed to identify dietary patterns and assess their association with abdominal fat. A cross-sectional study was conducted in the Central West Region of Brazil with a probabilistic sample of 208 adults of both sexes. Data on food intake was obtained using a food frequency questionnaire and factor analysis (principal components) was conducted to identify dietary patterns. Waist circumference (WC) and waist-to-hip ratio (WHR) were used to assess abdominal fat. The association between dietary patterns and body fat distribution was examined using multiple linear regression analysis adjusted for confounders. Three dietary patterns were identified: Western, regional traditional, and prudent. A positive association was found between the Western pattern and WC (p = 0.04) and WHR (p = 0.001) and between the regional traditional pattern and WHR (p = 0.05) among women. A slight association was also found between the latter pattern and WC (p = 0.07) also among women. An association was found between the Western and regional traditional dietary patterns and a larger concentration of abdominal fat among women.

Central obesity is associated with lower intake of whole-grain bread and less frequent breakfast and lunch: results from the HUNT study, an adult all-population survey

All-population and area-based investigations of diet in central obesity are scarce. We used cross-sectional data from 50 339 individuals who responded to the HUNT3 survey of 2006-2008, which recruited from all county-residing adults 20 years and older, to investigate whether those with central obesity eat and drink differently than others. Answers to dietary questions were recoded and analyzed with multiple linear regression, using waist/hip ratio (WHR), age, and sex as explanatory variables. Frequencies of consumption or amounts of food, beverages, and meals were compared among WHR quartiles. Central obesity was present in the quartile with the highest WHR, WHR4 (WHR ≥ 0.917 for women and 0.981 for men) but not in the quartile with the lowest WHR, WHR1 (WHR < 0.817 for women and 0.895 for men). Dietary variables differed markedly by age and sex. After adjustment for these factors and for multiple testing, we found significant differences between WHR4 and WHR1 for 19 of 30 dietary variables. Central obesity was associated with a lower intake of any bread, and of whole-grain bread in particular. Intake of fruits and berries, vegetables, and pasta and rice was less, and intake of sausages and hamburgers and boiled potatoes was more frequent. Intake of alcohol, tea, and fruit juice was lower in those with central obesity, whereas intake of sugar-free soft drinks and coffee was higher. The frequency of breakfast and lunch was lower and of nightly meals was higher in those with central obesity. In conclusion, in this large area-based population, central obesity was associated with differences in dietary habits, some of which (such as decreased consumption of whole-grain bread and increased intake of sugar-free drinks) are of possible clinical significance.

The abilities of new anthropometric indices in identifying cardiometabolic abnormalities, and influence of residence area and lifestyle on these anthropometric indices in a Chinese community-dwelling population

Objective

The study aimed to investigate the prevalence of overweight, obesity, and cardiometabolic abnormalities, the influence of residence area, occupation, and lifestyle on new anthropometric indices, and the relationship between anthropometric indices and cardiometabolic abnormalities in a Chinese community-dwelling population.

Methods

The study included 4,868 residents through a large health check-up program in Beijing.

Results

Overall obesity existed in 22.2% of men and 28.1% of women. 67.1% of men and 65.2% of women were overweight. 65.99% of men and 65.97% of women had central obesity. Residents of rural areas, manual workers, and smokers had significantly higher anthropometric indices. The power of each anthropometric index varied for identifying different cardiometabolic abnormalities, and the ability of the waist-to-height ratio to identify participants with greater than one or two cardiometabolic abnormalities was optimal. The appropriate cut-off values of all anthropometric indices for cardiometabolic abnormalities were obtained.

Conclusion

Overweight is common for both sexes in the People’s Republic of China, as are general and central obesity. Residents of rural areas, manual workers, and smokers have significantly higher anthropometric indices. Waist-to-height ratio has the ability to reflect the compound risk of different cardiometabolic abnormalities and the greatest potential to be widely applied in clinical practice.

Reported consumption of takeaway food and its contribution to socioeconomic inequalities in body mass index

The aim of this study was to examine whether takeaway food consumption mediated (explained) the association between socioeconomic position and body mass index (BMI). A postal-survey was conducted among 1500 randomly selected adults aged between 25 and 64years in Brisbane, Australia during 2009 (response rate 63.7%, N=903). BMI was calculated using self-reported weight and height. Participants reported usual takeaway food consumption, and these takeaway items were categorised into "healthy" and "less healthy" choices. Socioeconomic position was ascertained by education, household income, and occupation. The mean BMI was 27.1kg/m(2) for men and 25.7kg/m(2) for women. Among men, none of the socioeconomic measures were associated with BMI. In contrast, women with diploma/vocational education (β=2.12) and high school only (β=2.60), and those who were white-collar (β=1.55) and blue-collar employees (β=2.83) had significantly greater BMI compared with their more advantaged counterparts. However, household income was not associated with BMI. Among women, the consumption of "less healthy" takeaway food mediated BMI differences between the least and most educated, and between those employed in blue collar occupations and their higher status counterparts. Decreasing the consumption of "less healthy" takeaway options may reduce socioeconomic inequalities in overweight and obesity among women but not men.

Differential association between adherence to nutritional recommendations and body weight status across educational levels: a cross-sectional study

OBJECTIVE

The impact of diet quality and physical activity (PA) on weight might be different according to socioeconomic status. Our aim was to estimate associations between adherence to nutritional guidelines and BMI and the interaction with socioeconomic characteristics.

METHODS

A total of 11,931 men and 39,737 women from the NutriNet-Santé cohort (France, 2009-2012) were included in this cross-sectional analysis. The association between PNNS-GS (a score estimating adherence to French nutritional guidelines) and BMI was assessed by multivariate linear regression. A modified score (mPNNS-GS) separating diet quality from PA was also used.

RESULTS

BMI, overweight and obesity displayed an inverse gradient from less to more educated groups, whereas PNNS-GS increased. A higher PNNS-GS was associated with a lower BMI, more importantly in the less educated: BMI decrease ranged from -1.1% in less educated to -0.7% in more educated men and from -0.6% to -0.3% in women. The effect of mPNNS-GS and PA in particular was also stronger among less educated subjects.

CONCLUSION

Overall, better adherence to nutritional recommendations was inversely associated with BMI, and this association was stronger in the less educated groups. This suggests that nutritional policies should still concentrate on promoting access to a healthier diet and PA, especially among less educated individuals.

Central obesity and coronary heart disease risk factors in referral outpatients to zahedan cardiology clinic, iran

BACKGROUND

Coronary Heart Disease (CHD) is one of the most common and life-threatening diseases in both developed and developing countries and a close correlation has been found between different types of obesity and CHD.

OBJECTIVES

The current study investigated the relationship between central obesity and coronary heart disease risk factors in CHD referral outpatients to Khatam Clinic, Zahedan, Iran.

PATIENTS AND METHODS

In this clinical, cross-sectional study, data for 120 CHD patients aged 30-60 years were included. Based on waist-to-hip ratio (WHR), subjects were classified into two groups: not centrally obese (NCO; WHR ≤ 0.95 for men, ≤ 0.8 for women) and centrally obese (CO; WHR > 0.95 and > 0.8 for men and women, respectively). Triglyceride (TG), total cholesterol (TC), blood urea nitrogen, creatinine, and fasting blood sugar (FBS) were enzymatically determined. Sitting systolic and diastolic blood pressures were measured for each patient.

RESULTS

Significantly more women than men and significantly more subjects with less education than subjects with more education were CO. Rates of CO were higher in subjects 45-60 years old than in those 30-45 years old (n.s.). CO subjects also had higher mean systolic and diastolic blood pressure, TG, and creatinine levels (n.s.). Significantly higher mean values were observed for FBS in CO subjects than in NCO subjects (P = 0.02). Mean values for smoking were significantly higher in the NCO group compared with the CO group (P = 0.004).

CONCLUSIONS

According to the results of this study, in CHD patients, central obesity was associated with certain risk factors, especially FBS. Central obesity was more evident in women, less educated subjects, and older subjects. Further research is required to clarify these associations.

The InnvaDiab-DE-PLAN study: a randomised controlled trial with a culturally adapted education programme improved the risk profile for type 2 diabetes in Pakistani immigrant women

The objective of the present study was to explore whether a culturally adapted lifestyle education programme would improve the risk factor profile for type 2 diabetes (T2D) and the metabolic syndrome (MetS) among Pakistani immigrant women in Oslo, Norway. The randomised controlled trial (the InnvaDiab study), lasting 7 ± 1 months, comprised six educational sessions about blood glucose, physical activity and diet. Participants (age 25-62 years) were randomised into either a control (n 97) or an intervention (n 101) group. Primary outcome variables were fasting and 2 h blood glucose, and secondary outcome variables were fasting levels of insulin, C-peptide, lipids, glycated Hb, BMI, waist circumference and blood pressure, measured 1-3 weeks before and after the intervention. During the intervention period, the mean fasting blood glucose decreased by 0·16 (95 % CI -0·27, -0·05) mmol/l in the intervention group, and remained unchanged in the control group (difference between the groups, P=0·022). Glucose concentration 2 h after the oral glucose tolerance test decreased by 0·53 (95 % CI -0·84, -0·21) mmol/l in the intervention group, but not significantly more than in the control group. A larger reduction in fasting insulin was observed in the intervention group than in the control group (between-group difference, P= 0·036). Among the individuals who attended four or more of the educational sessions (n 59), we found a more pronounced decrease in serum TAG (-0·1 (95 % CI -0·24, 0·07) mmol/l) and BMI (-0·48 (95 % CI -0·78, -0·18) kg/m²) compared with the control group. During the intervention period, there was a significant increase in participants having the MetS in the control group (from 41 to 57 %), which was not seen in the intervention group (from 44 to 42 %). Participation in a culturally adapted education programme may improve risk factors for T2D and prevent the development of the MetS in Pakistani immigrant women.

Socio-demographic and lifestyle determinants of 'Western-like' and 'Health conscious' dietary patterns in toddlers

Determinants of a child's diet shortly after weaning and lactation have been relatively understudied. The aim of the present study was hence to identify common dietary patterns in toddlers and to explore parental and child indicators of these dietary patterns. The study was a population-based, prospective birth-cohort study in Rotterdam, the Netherlands. Food consumption data of 2420 children aged 14 months were used. A 'Health conscious' dietary pattern characterised by pasta, fruits, vegetables, oils, legumes and fish, and a 'Western-like' dietary pattern characterised by snacks, animal fats, confectionery and sugar-containing beverages were extracted using principal component analysis. Low paternal education, low household income, parental smoking, multiparity, maternal BMI, maternal carbohydrate intake and television-watching of child were determinants of a 'Western-like' diet, whereas parental age, dietary fibre intake during pregnancy, introduction of solids after 6 months and female sex were inversely associated with a 'Western-like' diet of the child. Maternal co-morbidity, alcohol consumption during pregnancy and female sex were inversely associated with a 'Health conscious' dietary pattern of the child, while single parenthood, folic acid use and dietary fibre intake during pregnancy were positively associated. All aforementioned associations were statistically significant. In conclusion, both 'Western-like' and 'Health conscious' diets can already be identified in toddlers. Particularly, adherence to a 'Western-like' diet is associated with unfavourable lifestyle factors of the parents and child, and low socio-economic background. These findings can form a basis for future epidemiological studies regarding dietary patterns and health outcomes in young children.