Socioeconomic status in relation to obesity and abdominal obesity in Korean adults: a focus on sex differences

Race, Educational Attainment, and Sustained High Body Mass Index over 24 Years of Follow-up in Middle-Aged and Older Adults

BACKGROUND

Educational attainment has been linked to reduced risk of health problems such as obesity, but research suggests that this effect may be weaker for non-Hispanic Black individuals compared to non-Hispanic White individuals, a pattern known as minorities' diminished returns (MDRs).

OBJECTIVES

This study is aimed at examining the differential association between educational attainment and sustained high body mass index (BMI) among non-Hispanic Black and non-Hispanic White middle-aged and older adults in the USA.

METHODS

Using data from the Health and Retirement Study (HRS) spanning 1992-2016, we analyzed a national sample of 35,110 individuals, including 7766 non-Hispanic Black and 27,344 non-Hispanic White individuals. We used logistic regression models to examine the relationship between educational attainment, race, and sustained high BMI, while controlling for age, sex, and marital status at baseline.

RESULTS

Approximately 30.6% of the sample (n = 10,727) had sustained high BMI, while 69.4% (n = 24,383) had sustained low BMI over the period of follow-up. Higher levels of educational attainment were associated with a lower risk of sustained high BMI. We also found, however, that the protective effects of education against sustained high BMI were weaker for non-Hispanic Blacks compared to non-Hispanic Whites.

CONCLUSION

Our findings suggest that the protective effects of educational attainment against sustained high BMI may be more robust for non-Hispanic Whites than for non-Hispanic Blacks. Further research should explore whether these results are found in other racial and ethnic minorities and whether potential life history experiences may contribute to these disparities.

Trends in Prevalence of Hypertriglyceridemia and Related Factors in Korean Adults: A Serial Cross-Sectional Study

Objective

We aimed to investigate the longitudinal trends in prevalence of hypertriglyceridemia in Korean adults and hypertriglyceridemia-associated lifestyle habits, socioeconomic factors and comorbidities.

Methods

Data from the 2007-2020 Korea National Health and Nutrition Examination Survey (KNHANES) were used in this study. Two cutoff values (≥150 mg/dL and ≥200 mg/dL) for fasting serum triglyceride levels were used to estimate the age- and sex-specific prevalence of hypertriglyceridemia. Use of lipid-lowering medications, lifestyle factors such as smoking, alcohol consumption, and regular exercise, socioeconomic variables such as educational attainment and household income, and comorbidities such as obesity, abdominal obesity, hypertension, and diabetes mellitus were also investigated.

Results

The prevalence of hypertriglyceridemia among Koreans based on KNHANES 2007-2020 was 29.6% at ≥150 mg/dL and 16.1% at ≥200 mg/dL. While the rate of using lipid-lowering medications increased steadily from 2007 to 2020, changes in annual prevalence of hypertriglyceridemia were subtle. The prevalence of hypertriglyceridemia in men peaked in middle age (47.7% and 30.0% for ≥150 mg/dL and ≥200 mg/dL, respectively, in their 40s), but its prevalence in women increased throughout their lifetime (32.6% and 14.7% for ≥150 mg/dL and ≥200 mg/dL, respectively, in their 70s). Smoking and high-risk drinking exacerbated peak prevalence in both sexes. Young adults with any comorbidities had prominently increased prevalence of hypertriglyceridemia. The lowest levels of education and income were both associated with the higher prevalence of hypertriglyceridemia in both sexes.

Conclusion

It is important to understand the age- and sex-specific epidemiology of hypertriglyceridemia to establish its appropriate management plans.

The Association between Fruit and Vegetable Intake and Socioeconomic Factors in the Households of Pakistan Using Quantile Regression Model

The purpose of this study was to examine the impact of socioeconomic factors on fruit and vegetable consumption in the households of Pakistan. Secondary data were used from a national-level survey, i.e. "Household Integrated Income and Consumption Survey" (HIICS) 2015-2016 published by the Pakistan Bureau of Statistics. A total of 11,187 households were included in the final analysis. Quantile regression models were applied to investigate the association between socioeconomic factors and the consumption of fruit and vegetable. More than half of the households in the sample did not meet the World Health Organization's (WHO) recommended criteria for fruit and vegetable consumption, which is 400 g/day/capita. According to the quantile regression model, household income is an important factor in increasing fruit and vegetable intake because an increase in income leads to a greater likelihood of spending on healthy and nutritious foods. The increased consumption of fruit and vegetable was caused by the household head's high education, which created multiple resources to increase income. Households in two provinces, i.e. Khyber Pakhtunkhwa and Baluchistan, have a greater impact on fruit and vegetable consumption than other provinces due to natural resource availability. Household size and dependency ratio hurt the consumption of fruit and vegetable because women and children are not able to do work. These results are very useful because a better understanding of the socioeconomic characteristics associated with fruit and vegetable intake could improve the effectiveness of policies aimed at increasing fruit and vegetable consumption and reducing the risk of chronic diseases.

Body composition and level of physical activity of elderly people living in north-eastern Poland associated with socioeconomic factors

Introduction: Studies conducted in various regions of the world have indicated that physical activity level, body composition and socioeconomic variables can be associated. Therefore, the objective of this study was to determine whether socioeconomic factors are associated with level of physical activity and differences in the body composition of elderly people living in north-eastern Poland. Materials and Methods: The study involved 774 older residents (60 years or more). Physical activity levels were measured with the International Physical Activity Questionnaire. The respondents’ body composition was determined with an InBody 270 analyser. Pairs of means were compared with Student’s t-test; more than two means were compared with one-way ANOVA; and proportions were compared with the chi-square test. Statistical significance was defined as p≤0.05. Results: The marital status of men and women was significantly associated with differences in physical activity level and body composition. The place of residence and level of education of women (but not of men), were also significantly associated with differences in body composition. Age and material situation were not significantly associated with differences in body composition and physical activity level. Conclusion: The mean values of parameters of body composition in the surveyed group exceeded the norms. The level of physical activity of the subjects is at a sufficient level, but in the case of women it depends on socio-economic characteristics. Therefore, there is a need to find effective ways to support older adults in maintaining (or increase) their physical activity with a particular focus on women.

Association between Green Tea Consumption and Abdominal Obesity Risk in Middle-Aged Korean Population: Findings from the Korean Genome and Epidemiology Study

The prevalence of general and abdominal obesity is increasing with rapid economic growth and the westernization of dietary habits in Korea, especially in the middle-aged population. Data were obtained from the Korean Genome and Epidemiology Study (KoGES), which recruited 10,030 participants between the ages of 40 and 69 years. Information on green tea consumption was obtained from the food frequency questionnaire and categorized as none, <1 cup, between 1 and <4 cups, and ≥4 cups. Multivariable logistic regression models were used to estimate the ORs and 95% CIs to examine any possible associations between green tea consumption and the risk of abdominal obesity after controlling for potential confounders. High consumption of green tea was associated with a 44% lower odds ratio for abdominal obesity (none vs. ≥4 cups/week: OR, 0.56; 95% CI 0.41-0.78; p for trend = 0.001). When stratified by sex, an inverse association between green tea consumption and abdominal obesity was observed only in women (none vs. ≥4 cups/week: OR, 0.71; 95% CI 0.57−0.88; p for trend = 0.004). No significant association was found among men. Our findings indicate that green tea consumption has beneficial effects in the prevention of abdominal obesity in middle-aged Korean women.

Analyzing the Sociodemographic Factors Impacting the Use of Virtual Reality for Controlling Obesity

Obesity is one of the most pressing issues in society today. Virtual reality has been used in the design of tools that promotes obesity control. However, the design of current VR tools lacks the involvement of prospective users and health practitioners. Such engagement is crucial in gathering semantic information that identifies stakeholders’ needs and ensures that all aspects of health are considered. Therefore, this paper aims to study the sociodemographic factors and individual-level characteristics and preferences that make the design of any obesity-control VR tool effective and satisfactory for a wide range of users. The paper also aims to solicit opinions of health practitioners to identify best health aspects that should be available in the design of any VR tool for obesity control. Organizations, businesses, and people will be able to readily augment such VR technologies on the semantic web, as well as on personal and mobile devices.

Prevalence of central obesity and associated factors in Ethiopia: A systematic review and meta-analysis

INTRODUCTION

Obesity is a global public health concern that is now on the rise, especially in low- and middle-income nations. Despite the fact that there are several studies reporting the prevalence of central obesity among adults in Ethiopia, there is a lack of a systematic review and meta-analysis synthesizing the existing observational studies. Therefore, this systematic review and meta-analysis aimed to determine the prevalence of central obesity and its associated factors in Ethiopia.

METHODS

Online libraries such as PubMed, Google Scholar, Scopus, Science Direct, and Addis Ababa University were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (v. 16). Forest plots, Begg's rank test, and Egger's regression test were all used to check for publication bias. To look for heterogeneity, I² was computed, and an overall estimated analysis was carried out. Subgroup analysis was done by region and study setting. In addition, the pooled odds ratio for related covariates was calculated.

RESULTS

Out of 685 studies assessed, 20 met our criteria and were included in the study. A total of 12,603 people were included in the study. The prevalence of central obesity was estimated to be 37.31% [95% confidence interval (CI): 29.55-45.07]. According to subgroup analysis by study region and setting, the highest prevalence was observed in the Dire Dawa region (61.27%) and community-based studies (41.83%), respectively. Being a woman (AOR = 6.93; 95% CI: 3.02-10.85), having better socioeconomic class (AOR = 5.45; 95% CI: 0.56-10.34), being of age 55 and above (AOR = 5.23; 95% CI: 2.37-8.09), being physically inactive (AOR = 1.80; 95% CI: 1.37-2.24), being overweight (AOR = 4.00; 95% CI: 2.58-5.41), being obese (AOR = 6.82; 95% CI: 2.21-11.43), and having hypertension (AOR = 3.84; 95% CI: 1.29-6.40) were the factors associated with central obesity.

CONCLUSION

The prevalence of central obesity was high in Ethiopia. Being a woman, having a higher socioeconomic class, being older, being physically inactive, being overweight or obese, and having hypertension were all associated. Therefore, it is vital for the government and health organizations to design and implement preventive measures like early detection, close monitoring, and positive reversal of central obesity in all patients and the general population. High-quality investigations on the prevalence of central obesity in the Ethiopian people are required to better understand the status of central obesity in Ethiopia.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42022329234.

Genetic propensity for obesity, socioeconomic position, and trajectories of body mass index in older adults

Identifying how socioeconomic positioning and genetic factors interact in the development of obesity is imperative for population-level obesity prevention strategies. The current study investigated whether social positioning, either independently or through interaction with a polygenic score for Body Mass Index (BMI-PGS), influences BMI trajectories across older adulthood. Data were analysed from 7,183 individuals from the English Longitudinal Study of Aging (ELSA). Interactions between the BMI-PGS and; lower educational attainment, self-perceived social status (SSS), and income, on BMI trajectories over 12 years across older adulthood were investigated through linear mixed effects models. Lower educational attainment, SSS and income were each associated with a higher baseline BMI for women, but not for men. There were interaction effects between BMI-PGS and social positioning such that men aged > 65 with a lower educational attainment (β = 0.62; 95%CI 0.00 – 1.24, p < 0.05), men aged ≤ 65 of a lower income (β = − 0.72, 95%CI − 1.21 - − 0.23, p < 0.01) and women aged ≤ 65 of lower SSS (β = − 1.41; 95%CI − 2.46 – 0.36, p < 0.01) showed stronger associations between the BMI-PGS and baseline BMI. There were few associations between markers of socioeconomic position and rate of change in BMI over the follow-up period. In sum, lower socioeconomic positioning showed adverse associations with women’s BMI in older adulthood. Moreover, the expression of the BMI-PGS, or extent to which it translates to a higher BMI, was subtly influenced by socioeconomic standing in both women and in men.

Impact of Mobile Technologies on Cervical Cancer Screening Practices in Lagos, Nigeria (mHealth-Cervix): A Randomized Controlled Trial

PURPOSE

We assessed the impact of mHealth on Pap test screening uptake and also determined the factors that affect screening uptake among women in Lagos, Nigeria.

MATERIALS AND METHODS

A randomized controlled trial was carried out among women in two tertiary health institutions in Lagos, Nigeria, between July 2020 and March 2021. Participants were randomly assigned to either a text message (mHealth) intervention or usual care arm. The main study outcome was the uptake of Pap smear testing within 6 months of enrollment in the study. We tested the associations between two groups of continuous variables using the unpooled independent-sample t-test (normal distribution) and that of two groups of categorical variables with the chi-square (χ²) test. Using a multinomial logistic regression model, we adjusted for relevant sociodemographic and clinical predictors of uptake of Pap smear screening. Statistical significance was defined as P < .05.

RESULTS

There was a significantly higher rate of uptake of Pap smear screening among women in the mHealth arm compared with those in the usual care arm (51.0% v 35.7%, P = .031). Following adjustment in the final multivariate model, level of income (odds ratio [OR] = 5.13, 95% CI, 1.55 to 16.95), awareness of Pap smear (OR = 16.26; 95% CI, 2.49 to 76.64), General Outpatient clinic attendance, and introduction of mHealth intervention during follow-up (OR = 4.36; 95% CI, 1.44 to 13.22) were the independent predictors of Pap smear uptake.

CONCLUSION

The use of mHealth technologies intervention via short-text message services is a feasible solution for cervical cancer prevention in low- and middle-income countries, and thus, the widespread use of mHealth services by health care providers and policymakers could contribute to the implementation of cervical cancer prevention services in Nigeria and in the settings of other low- and middle-income countries.

Do associations between education and obesity vary depending on the measure of obesity used? A systematic literature review and meta-analysis

Background

Consistent evidence suggests a relationship between lower educational attainment and total obesity defined using body mass index (BMI); however, a comparison of the relationships between educational attainment and total obesity (BMI ≥30 kg/m²) and central obesity (waist circumference (WC) > 102 cm for men and WC > 88 cm for women) has yet to be carried out. This systematic literature review (SLR) and meta-analyses aimed to understand whether i) the associations between education and obesity are different depending on the measures of obesity used (BMI and WC), and ii) to explore whether these relationships differ by gender and region.

Methods

Medline, Embase and Web of Science were searched to identify studies investigating the associations between education and total and central obesity among adults in the general population of countries in the Organisation for Economic Co-operation and Development (OECD). Meta-analyses and meta-regression were performed in a subset of comparable studies (n=36 studies; 724,992 participants).

Results

86 eligible studies (78 cross-sectional and eight longitudinal) were identified. Among women, most studies reported an association between a lower education and total and central obesity. Among men, there was a weaker association between lower education and central than total obesity (OR central vs total obesity in men 0.79 (95% CI 0.60, 1.03)). The association between lower education and obesity was stronger in women compared with men (OR women vs men 1.66 (95% CI 1.32, 2.08)). The relationship between lower education and obesity was less strong in women from Northern than Southern Europe (OR Northern vs Southern Europe in women 0.37 (95% CI 0.27, 0.51)), but not among men.

Conclusions

Associations between education and obesity differ depending on whether total or central obesity is used among men, but not in women. These associations are stronger among women than men, particularly in Southern European countries.

Prevalence of abdominal obesity and its association with cardiovascular risk among the adult population in Burkina Faso: findings from a nationwide cross-sectional study

OBJECTIVE

The objective of this study is to determine the prevalence of abdominal obesity, its predictors and its association with cardiovascular risk among adults in Burkina Faso.

DESIGN

We performed a secondary analysis of data from a national cross-sectional study, using WHO STEPwise approach.

SETTING

The study was conducted in Burkina Faso, in all the 13 regions of the country.

PARTICIPANTS

Our study involved 4308 adults of both sexes, aged between 25 and 64 years.

PRIMARY AND SECONDARY OUTCOMES

Our primary outcome was abdominal obesity, which was defined using a cut-off point of waist circumference (WC) of ≥94 cm for men and ≥80 cm for women. The secondary outcome was very high WC (≥102 cm for men and ≥88 cm for women) (for whom weight management is required).

RESULTS

The mean age of participants was 38.5±11.1 years. The age-standardised prevalence of abdominal obesity was 22.5% (95% CI 21.3% to 23.7%). This prevalence was 35.9% (95% CI 33.9% to 37.9%) among women and 5.2% (95% CI 4.3% to 6.2%) among men. In urban areas, the age-standardised prevalence of abdominal obesity was 42.8% (95% CI 39.9% to 45.7%) and 17.0% (95% CI 15.7% to 18.2%) in rural areas. The age-standardised prevalence of very high WC was 10.2% (95% CI 9.3% to 11.1%). The main predictors of abdominal obesity were being female, increased age, married status, high level of education and living in urban areas. Abdominal obesity was also significantly associated with high blood pressure (adjusted prevalence ratio (aPR): 1.30; 95% CI 1.14 to 1.47) and hypercholesterolaemia (aPR: 1.52; 95% CI 1.18 to 1.94). According to the combination matrix between body mass index and WC, 14.6% of the adult population in Burkina Faso had an increased cardiometabolic risk.

CONCLUSION

Our study showed a high prevalence of abdominal obesity and a high proportion of adults who require weight management strategies to prevent cardiometabolic complications. Strategies to reduce the burden of abdominal obesity and very high WC should be considered by Burkina Faso's policy-makers.

Income Inequality and Obesity among US Adults 1999-2016: Does Sex Matter?

Obesity is a major public health problem that varies by income and sex, yet there is little evidence to determine the association between income inequality and obesity. We examined the association between income and obesity in adults ages 20 years and older and tested whether this relationship differs by sex in the United States. We used the 1999-2016 National Health and Nutrition Examination Survey (NHANES). We defined obesity if the body mass index was ≥30 kg/m2, and calculated the Gini coefficient (GC) to measure income inequality by using the Poverty Income Ratio. We examined the association between income and obesity using a Modified Poisson regression in a sample of 36,665 adults. We adjusted the models according to age, racial/ethnic groups, marital status, education, health behaviors, health insurance, self-reported health, and household structure. The association between income and obesity was consistently more significant among middle-income quintile and higher-income quintile men than among lower-income quintile men. The same association was not found for women; women in the highest income quintile were less likely to suffer from obesity than among lower-income quintile women. Our results suggest that policymakers should consider strategies to reduce structural inequality and encourage access to healthy foods and community-supported agricultural programs as nutritional interventions in low-income population settings.

Perinatal Outcomes in a Population of Diabetic and Obese Pregnant Women-The Results of the Polish National Survey

Obesity and diabetes increase the risk of complications during gestation and at delivery. The aim of this study was to compare the perinatal outcomes in the populations of diabetic and obese Polish women, based on the results of a national survey performed in years 2012 and 2017, as well as to determine the risk factors of the gestational diabetes mellitus (GDM). Questionnaires from 6276 women were collected. Obese women constituted 5.5% and 7.5% of study population in years 2012 and 2017, respectively. Among women whose pregnancies were complicated by diabetes mellitus, GDM constituted the most common type of glucose intolerance during both time periods (2012: 89% vs. 2017: 85.6%). In the group of obese women an insignificant increase in the rate of induced deliveries was noted (2012: 9.9% vs. 2017: 11.7%), whereas the fetal birth-weight decreased significantly (2012: 3565 g vs. 2017: 3405 g, p < 0.05). In the group of diabetic pregnant women the percentage of cesarean sections, labour inductions and fetal birth defects was characterized by an insignificant upward trend. Risk of GDM was significantly increased in women aged over 35 years—(2012: OR 1.9 (95% CI: 1.1–2.9) and 2017: OR = 2.1 (95% CI: 1.5–2.9), p < 0.05—, as well as in overweight women—2012: OR 1.8 (95% CI: 1.2–2.7) and 2017: OR 2.6 (95% CI: 1.9–3.4), p < 0.05—during both analysed time periods. Based on the study results, it is necessary to develop population-based programmes to prevent obesity and to introduce and enforce the rules of appropriate screening for glucose tolerance disorders during pregnancy.

Association between obesity and education level among the elderly in Taipei, Taiwan between 2013 and 2015: a cross-sectional study

The inverse association between obesity and education level has been demonstrated in many developed countries; however, few studies have investigated obesity in geriatric populations. This cross-sectional analysis explored the association between geriatric obesity and education level, along with other demographic characteristics in Taipei, Taiwan between 2013 and 2015. Taipei citizens ≥ 65 years (aborigines ≥ 55 years) were recruited to participate in the elderly health examination programme. Logistic regression was applied to analyse the relationship between obesity (defined as body mass index ≥ 27 kg/m² in Taiwan) and education level among men and women after controlling for age, race, income status, and smoking status. A total of 28,092 men and 31,835 women were included in the final analysis. Compared to those with education years ≥ 16, older men and women with education years ≤ 12 had higher odds of being obese. The odds ratios increase as years of education decrease, and the trend is more pronounced among women. Aborigines had much higher chances of being obese among men and women, while there were no differences by income status. The results clarified the factors related to obesity in the elderly, and will be useful for authorities working to improve health outcomes among this population.

Income-related inequities of adult obesity and central obesity in China: evidence from the China Health and Nutrition Survey 1997-2011

OBJECTIVES

The aim of this study was to analyse the status regarding inequities in adult obesity and central obesity in China. Thus, income-related inequality for both diseases and the underlying factors were examined.

METHODS AND DESIGN

The China Health and Nutrition Survey (CHNS)-conducted from 1997 to 2011-included 128 307 participants; in this study, 79 566 individuals classified as obese and 65 250 regarded as suffering from central obesity according to the CHNS were analysed. A body mass index greater than 27 was considered indicative of obesity; men and women with a waist circumference of more than 102 cm and 80 cm, respectively, were considered as suffering from central obesity. The concentration index was employed to analyse inequality in adult obesity and central obesity. The decomposition of this index based on a probit model was used to calculate the horizontal inequality index.

RESULTS

The prevalence of adult obesity increased from 8.34% in 1997 to 17.74% in 2011, and that of central obesity increased from 6.52% in 1997 to 16.79% in 2011. The horizontal inequality index for adult obesity decreased from 0.1377 in 1997 to 0.0164 in 2011; for central obesity, it decreased from 0.0806 in 1997 to -0.0193 in 2011. The main causes of inequality for both diseases are, among others, economic status, marital status and educational attainment.

CONCLUSIONS

From 1997 to 2011, the prevalence of adult obesity and central obesity increased annually. The pro-rich inequalities in both adult and central obesity decreased from 1997 to 2011. The inequality in central obesity was more prominent in the low-income group in 2011. Future policies may need to address obesity reduction among the poor.

A Reversal of the Association between Education Level and Obesity Risk during Ageing: A Gender-Specific Longitudinal Study in South Korea

This study aimed to examine and quantify obesity risk across different education levels during ageing using the dataset of a nationally representative longitudinal survey. A total of 45,391 observations of 9991 individuals aged ≥45 years were included in this study. Obesity was defined as a body mass index of ≥25, according to a guideline for Asians by the World Health Organization, and education level was grouped into three categories. Socio-demographics, lifestyles, and health conditions were used as covariates. Adjusted odds ratios and predicted probabilities of obesity were computed and adjusted for a complex survey design. With respect to gender, education level and age were significantly associated with obesity risk, and the association was stronger in women than in men. Furthermore, education level was negatively associated with obesity risk in the middle age in each gender. However, the association became positive in the old age, specifically among highly educated women. Therefore, policy efforts to reduce obesity risk and the resulting education gradients should be established based on studies considering their old age. Further longitudinal studies are required to examine whether these findings are valid in other socio-cultural or economic settings.

Factors contributing to educational differences in obesity among women: evidence from South Korea

Background

Obesity is more prevalent among less-educated women than highly-educated women around the world. However, little is known about the factors which cause this difference in obesity, and almost nothing is known about how the individual factors which explain differences in education among women alone contribute to obesity. In this study, we identified the factors which help explain the relationship between education and obesity in women, and quantified their separate contributions to obesity.

Methods

We analyzed information on 14,577 women aged 25 years or over using datasets from the Korea National Health and Nutrition Examination Survey (2010–2014). We divided the women into two education groups: women who had, at most, finished high school (less-educated women), and women who had college degrees and beyond (highly-educated women). Using an extended Oaxaca-Blinder method, we decomposed the difference in obesity prevalence between the two education groups into the contributions (%) due to two effects: composition effect and association effect.

Results

Obesity was more than twice as prevalent among the less-educated women (34.3%) than it was among the highly-educated women (16.0%). The composition effect—contribution of differences in the distribution of observed characteristics compared to that of the difference in obesity prevalence between the two education groups—was 38.2%. The association effect—contributions of differences in the estimated coefficients of characteristics compared to that of the difference in obesity prevalence between the two education groups—was 55.8%, of which lifestyle factors were the most important contributor (43.6%). Of the separate contributions of each factor, the association effect of the factor related to women’s stress exhibited the largest contribution (23.0%).

Conclusion

We suggest that to effectively mitigate the high prevalence of obesity among less-educated women, it may be necessary to help low-educated women who do not feel stressful develop strategies to combat their higher risk of obesity. We also suggest the need to conduct decomposition studies in countries which show significant relationships between education and obesity among women, and to create targeted policies to reduce this population’s overall risk of obesity.

Socio-economic and reproductive concomitants of abdominal adiposity and hypertension: A study on Bengali-speaking Hindu women of Habra, North 24 Parganas, West Bengal, India

Obesity and hypertension have become a global epidemic among the women, especially as they experience additional stressful events compared to men. The epidemiology of these two metabolic disorders is regulated by various biological, socio-economic, reproductive and lifestyle factors related to women. However, inconsistency in the nature and magnitude of the effects of these traits indicates exploring the areas where little emphasis has been given. In this context, the present study attempted to determine the effect of socio-economic and reproductive traits on hypertension and abdominal adiposity among women living in the North 24 Parganas district of West Bengal, India. Data on socio-demographic and reproductive traits were collected from 319 adult women from both rural and urban sectors of Habra block I. Anthropometric measurements and Blood pressure levels were measured following standard protocols. Results highlighted that the prevalence of obese individuals and hypertensive individuals were 73.4 and 50.5 per cent respectively. Women with low income (OR=0.51) were at lower risk and post-menopausal women (OR=1.71) were at higher risk of developing abdominal adiposity. The risk of developing hypertension increased with higher educational attainment (OR=2.43). Post-menopausal women (OR=0.46) and shifting workers (OR=0.40) were at lower risk of developing hypertension. The risk also decreased with increased age (OR=0.96). Present study revealed that menopause is a significant event to predict abdominal adiposity and hypertension among Bengali-speaking Hindu women.

Eating attitudes, perceptions of body image and patient quality of life before and after bariatric surgery

AIM

This study examined eating attitudes, perceptions of body image and quality of life of patients before and after bariatric surgery.

METHODS

This prospective, descriptive study was conducted with fifty patients between April 23, 2018 and November 05, 2018. The data were collected by a survey form, the Three-Factor Eating Questionnaire, the Body Image Perception Questionnaire and SF-36 Quality of Life Questionnaire. The data collection instruments were applied before the surgery and at 1, 3 and 6 months following the surgery.

RESULTS

The mean age of the patients was 36.34 ± 10.89 years, 78% were females, 44% were university graduates, 80% were married, 78% had a child, 70% were employed, 80% were morbidly obese before the surgery, and 36% were morbidly obese at the first month following the surgery. It was also determined that there was no morbid obesity among the patients, and 84% of the patients were obese at the third month following the surgery. At the sixth postoperative month, 24% of the patients were found to be obese, and 8% had normal weight. It was determined that the patients' eating attitudes and behaviours changed significantly after the surgery in comparison to their pre-surgery values (p = 0.001). The body image perceptions and quality of life of the patients during the postoperative period were found to be significantly higher in comparison to their preoperative values (p = 0.001).

CONCLUSION

This study showed that multidimensional evaluation of patients and implementation of nursing interventions contributed positively to individuals undergoing bariatric surgery based on healthy lifestyle behaviours.

Economic crisis and obesity in the Canary Islands: an exploratory study through the relationship between body mass index and educational level

Background

The Canary Islands is one of the Spanish Regions with the highest obesity prevalence, and one of the Autonomous Communities that was hit hard by the economic crisis that arrived to Spain in 2008. This research studies the education-related inequalities in adult obesity in the Canary Islands and their evolution in recent years, considering the possible impact of the economic recession.

Methods

A repeated cross-sectional analysis is carried out with data obtained from the Canary Islands Health Surveys of 2004, 2009 and 2015. Obesity is measured through the body mass index (BMI). The analysis is performed using linear regression models for the general population and by gender, adjusting by age, educational attainment and island of residence. Likewise, the models also include dummy variables for each year and the corresponding interactions between the years and the education variable.

Results

The results show a decrease in the obesity prevalence in 2015 compared to 2009 (from 19.54 to 18.64%). An increase in the BMI of the population and that of women (+ 0.33 and + 0.59 units, respectively) in 2009, as well as a decline in the BMI of women with medium education (− 0.21 units) are also observed. Besides, there is an inverse correlation between education and BMI, and statistically significant differences among some islands.

Conclusions

Obesity figures in the Canary Islands have decreased and women have been more greatly affected by the changes in BMI during the economic crisis. Due to the fact that educational attainment is a protective factor in general (and for women with medium education levels in times of crisis, in particular), regional authorities should implement actions that promote access to education and healthy lifestyles, paying attention to territorial disparities.

Influences of Built Environment with Hilly Terrain on Physical Activity in Dalian, China: An Analysis of Mediation by Perceptions and Moderation by Social Environment

Neighborhood built environment may influence residents' physical activity, but evidence of non-major Chinese cities is lacking. We investigated the impact of five socio-demographic characteristics, 10 objectively assessed environment characteristics, eight perceived neighborhood attributes, and social environment on physical activity and health outcomes (sense of community, body mass index, as well as self-reported health status). We also examined (1) five conceptually comparable perceived neighborhood attributes as mediators of the relationship between objective environment attributes and physical activity; (2) other perceived indicators and social environment as moderators of those relationships, using the mediation analysis in regression. Objectively assessed residential density, land use mix, street connectivity, and accessibility were curvilinearly and/or linearly related to physical activity. The slope of terrain was inversely associated with body mass index (BMI). None of the perceived attributes were found as mediators probably due to the weak associations between subjective and objective environments. High density facilitated physical activity but hindered the sense of community. Further, the perceived aesthetic and safety were associated with physical activity. Additionally, social environment moderated the positive associations of all perceived environments (except for slope) and sense of community. The present study demonstrated that both physical and social environment attributes significantly correlated with physical activity in Dalian.

Central obesity and hypertension among rural adults of Paschim Medinipur, West Bengal, India

Obesity is generally classified into generalized obesity (BMI ≥30 kg/m2) and abdominal or central obesity (WC ≥90 cm for men and WC ≥80 cm for women) based on World Health Organization recommendation for Asians. Hypertension is one of the most common obesity-related complications, and about 30% of hypertensive individuals can be classified as being obese. The present study aimed to investigate the effect of different age groups (years) on the anthropometric and derived variables. It determined the correlation between anthropometric and derived variables and also estimated the frequency of central obesity and hypertension. Finally, it investigated the relationship between central obesity and blood pressure among rural Bengalee adults of Dirghagram village of Ghatal Block, Paschim Medinipur, West Bengal, India. The present cross-sectional study was undertaken among 310 rural adults (154 males; 156 females) aged over 18 years. Our study was carried out during March, 2017. Height (cm), weight (kg), waist circumference (cm), hip circumference (cm) and blood pressure (systolic and diastolic) were measured using standard procedures. One way ANOVA analysis on most of the anthropometric and derived variables showed a statistically significant increase from younger to older age group in both sexes (p<0.001;p<0.01; p<0.05). In addition to that, more females had central obesity using waist circumference (55.8% vs. 19.5%), waist hip ratio (87.2% vs. 35.7%), waist height ratio (73.7% vs. 44.2%), and conicity index (87.2% vs. 57.8%) criteria, and hypertension (52.5% vs. 27.3%). The prevalence of central obesity was much higher in case of hypertensive individuals. Therefore, the present study showed a high prevalence of central obesity among the rural adults of Dirghagram village. Furthermore, central obesity contributed in increasing hypertension among the villagers.

Measurement of Socioeconomic Position in Research on Cardiovascular Health Disparities in Korea: A Systematic Review

OBJECTIVES

The validity of instruments measuring socioeconomic position (SEP) has been a major area of concern in research on cardiovascular health disparities. The purpose of this systematic review is to identify the current status of the methods used to measure SEP in research on cardiovascular health disparities in Korea and to provide directions for future research.

METHODS

Relevant articles were obtained through electronic database searches with manual searches of reference lists and no restriction on the date of publication. SEP indicators were categorized into compositional, contextual, composite, and life-course measures.

RESULTS

Forty-eight studies published from 2003 to 2018 satisfied the review criteria. Studies utilizing compositional measures mainly relied on a limited number of SEP parameters. In addition, these measures hardly addressed the time-varying and subjective features of SEP. Finding valid contextual measures at the organizational, community, and societal levels that are appropriate to Korea's context remains a challenge, and these are rarely modeled simultaneously. Studies have rarely focused on composite and life-course measures.

CONCLUSIONS

Future studies should develop and utilize valid compositional and contextual measures and appraise social patterns that vary across time, place, and culture using such measures. Studies should also consider multilevel influences, adding a focus on the interactions between different levels of intertwined SEP factors to advance the design of research. More attention should be given to composite and life-course measures.

Measuring Socioeconomic Inequalities in Obesity among Korean Adults, 1998⁻2015

Obesity is a prominent global public health challenge as its prevalence has grown. Even though the increase in prevalence of obesity in Korea has been relatively low, it is expected to continually increase in the next several years, leading to social and economic burdens. This study aimed to assess socioeconomic inequalities in obesity among Korean adults. Using nationally representative survey datasets, the concentration index (CI) and decomposition of the CI were used to capture and quantify obesity-related inequalities from 1998 to 2015. The results suggested that pro-poor inequalities in obesity existed in Korea, indicating that obesity was more concentrated among individuals with lower income. In a gender-stratified model, obesity was more concentrated among women with lower income and men with higher income, showing that the trend and magnitude of inequalities in obesity each vary by gender. The decomposition approach revealed that, over the past 17 years, the main contributors to the existing inequalities were higher education and higher income levels. These findings suggest that comprehensive and multifaceted interventions at the local and national levels should be considered to address the identified income- and education-related barriers with respect to obesity among Korean adults.

The Effect of Cross-Level Interaction between Community Factors and Social Capital among Individuals on Physical Activity: Considering Gender Difference

This study examines the effect of cross-level interaction between community physical environment and social capital among individuals on physical activity by considering gender difference. In this regard, we ask two research questions: (1) What is the effect of cross-level interaction between community factors and social capital among individuals on physical activity? (2) Is there gender difference in the effect of the cross-level interaction? To examine the research questions, this study used the 2015 Korea Community Health Survey and used multi-level analyses. The empirical analyses show that while there are both positive and negative cross-level interaction effects between physical activity-supportive community environment and social capital among individuals on physical activity, the positive cross-level interaction effect is more pronounced for women than for men. These findings suggest that local efforts to improve public health should take into account the cross-level interaction effect between community physical environment and social capital among individuals as well as gender difference.

Clinical Significance of Gender and Body Mass Index in Asian Patients with Colorectal Cancer

Objective: Colorectal cancer is a disease closely associated with anthropometric values. This study aimed to evaluate the clinical relevance of gender and body mass index (BMI) with colorectal cancer using a Korean nationwide cohort. Methods: Data of colorectal cancer cohorts between 2012 and 2013 were acquired from the Health Insurance Review and Assessment Service. All patients underwent surgery due to colorectal cancers. Stage IV patients were excluded due to possible clinical heterogeneity. BMI was classified with the World Health Organization criteria. Results: A total of 31,756 patients were analyzed. The underweight group had 33% higher risk of stage III disease (p<0.001). The overweight and obese groups had 20% and 19% lower risk of stage III (p<0.001 and p=0.002, respectively). The underweight and obese groups had higher risk of longest hospitalization period quartile (≥19 days), with odds ratio of 2.26 (p<0.001) and 1.33 (p<0.001), respectively. The overweight group had a 22% lower risk of the longest hospitalization period quartile (p=0.002). Females had 12% lower risk of distal cancer than males (p<0.001). There was no significant relationship between cancer stage and gender. The proportions of patients who were <50 years and ≥70 years old were higher in the females, and the proportions of patients in their 50s and 60s were higher in the males. Conclusions: Cancer stages and hospitalization period varied depending on BMI. Disease location and the age distribution were affected by gender.

The Association between Socioeconomic Status and Adherence to Health Check-up in Korean Adults, Based on the 2010-2012 Korean National Health and Nutrition Examination Survey

Background

We investigated the association between socioeconomic status and adherence to health check-ups in a Korean population aged 40 years or older.

Methods

This cross-sectional study included 12,311 participants who participated in the 2010–2012 Korean National Health and Nutrition Examination Survey. Self-reported questionnaires were used to assess each participant's socioeconomic status (household income, occupation, and education) and adherence to health check-ups.

Results

Men with a higher income (highest vs. lowest: odds ratio [OR], 1.799; 95% confidence interval [CI], 1.296–2.497) and men with a higher education level (≥12 vs. <6 years: OR, 1.488; 95% CI, 1.078–2.054) and office workers compared with manual workers (men: OR, 1.431; 95% CI, 1.077–1.902; women: OR, 1.783; 95% CI, 1.256–2.532) appeared to undergo more health check-ups. In particular, men and women with a higher income and education appeared more likely to undergo opportunistic health check-ups (men: highest vs. lowest income: OR, 2.380; 95% CI, 1.218–4.653; ≥12 vs. <6 years education: OR, 2.121; 95% CI, 1.142–3.936; women: highest vs. lowest income: OR, 4.042; 95% CI, 2.239–7.297; ≥12 vs. <6 years education: OR, 2.475; 95% CI, 1.283–4.775).

Conclusion

A higher socioeconomic status was associated with a higher rate of participation in health check-ups. More efforts are needed to identify the factors associated with disparity in adherence to health check-ups.

Gender Difference and Spatial Heterogeneity in Local Obesity

This study asks if there is gender-specific spatial heterogeneity in local obesity. By using the 2015 Korea Community Health Survey and employing spatial analyses, this study found that there is considerable gender-specific spatial heterogeneity in local obesity rates. More specifically, we found that: (1) local obesity rates are more spatially dependent for women than for men; (2) environmental factors, in general, have stronger effects on local obesity rates for women than for men; (3) environmental factors have more spatially varying effects on local obesity rates for women than for men. Based on these findings, we suggest that policies for obesity prevention should not be based on the assumption of spatial homogeneity and gender indifference, but rather should be refined based on gender-specific spatial heterogeneity in local obesity.

Prevalence of Overweight and Income Gaps in 245 Districts of Korea: Comparison Using the National Health Screening Database and the Community Health Survey, 2009-2014

BACKGROUND

We compared age-standardized overweight prevalence and their income gaps at the level of district in Korea using the National Health Screening Database (NHSD) and the Community Health Survey (CHS).

METHODS

We analyzed 39,093,653 subjects in the NHSD and 926,580 individuals in the CHS between 2009 and 2014. For the comparison of body mass index (BMI) distributions, data from 26,100 subjects in the Korea National Health and Nutrition Examination Survey (KNHANES) were also analyzed. We calculated the age-standardized overweight prevalence and its interquintile income gap at the district level. We examined the magnitudes of the between-period correlation for age-standardized overweight prevalence. The differences in overweight prevalence and its income gap between the NHSD and the CHS were also investigated.

RESULTS

The age-adjusted mean BMI from the CHS was lower than those from the NHSD and the KNHANES. The magnitudes of the between-period correlation for overweight prevalence were greater in the NHSD compared to the CHS. We found that the district-level overweight prevalence in the NHSD were higher in all districts of Korea than in the CHS. The correlation coefficients for income gaps in overweight prevalence between the two databases were relatively low. In addition, when using the NHSD, the district-level income inequalities in overweight were clearer especially among women than the inequalities using the CHS.

CONCLUSION

The relatively large sample size for each district and measured anthropometric data in the NHSD are more likely to contribute to valid and reliable measurement of overweight inequality at the district level in Korea.

Temporal trends in educational inequalities in non-communicable diseases in Korea, 2007-2015

Background

Socioeconomic inequalities in non-communicable diseases are known to exist; however there is a paucity of research describing the secular trends in these inequalities. To this end, the current study aims to explore the recent time trends in social patterning of selected non-communicable diseases among Korean adults between 2007 and 2015.

Methods

Using data from the Korea National Health and Nutrition Examination Survey (KNHANES), temporal trends in socioeconomic inequalities in diabetes, arthritis, asthma and depressive symptoms were assessed across three time points. Respondents were adults aged 20 years or over (N = 47,091, 20,180 men and 26,911 women). Socioeconomic circumstance was assessed based on highest level of educational attainment. We estimated prevalence ratios with 95% confidence intervals using Poisson regression with robust variance estimation (adjusted for age, smoking status, alcohol consumption, obesity, and physical activity) separately for men and women. The magnitude of the inequalities was computed using the relative index of inequality (RII).

Results

In men, diabetes was not associated with educational attainment, while there was evidence of a negative association in women across surveys. Similar inverse associations were found with arthritis and depressive symptoms, but these associations were less clear for asthma. RII showed a non-significant increasing trend in educational disparities in depressive symptoms. Meanwhile, relative inequalities in diabetes, arthritis and asthma have narrowed. These trends were, in general, more pronounced in women.

Conclusions

The findings of this study indicate higher burden of selected NCDs among the lower educational groups, particularly among women. In addition, our results indicated some improvements in inequalities in diabetes, arthritis and asthma in recent years. These findings have important implications for understanding the causes of social patterning of NCDs and for the targeting of effective interventions.

Gender-specific interactions between education and income in relation to obesity: a cross-sectional analysis of the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V)

OBJECTIVES

To identify gender-specific associations between education and income in relation to obesity in developed countries by considering both the interaction-effect terms of the independent variables and their main-effect terms.

DESIGN

A cross-sectional study. Education and income levels were chosen as socioeconomic status indicators. Sociodemographics, lifestyles and medical conditions were used as covariates in multivariable logistic regression models. Adjusted ORs and predicted probabilities of being obese were computed and adjusted for a complex survey design.

SETTING

Data were obtained from the Fifth Korea National Health and Nutrition Examination Survey (2010-2012).

PARTICIPANTS

The sample included 7337 male and 9908 female participants aged ≥19 years.

OUTCOME MEASURE

Obesity was defined as body mass index of ≥25, according to a guideline for Asians.

RESULTS

In models with no interaction-effect terms of independent variables, education was significantly associated with obesity in both men and women, but income was significant only in women. However, in models with the interaction-effect terms, education was significant only in women, but income was significant only in men. The interaction effect between income and education was significant in men but not in women. Participants having the highest predicted probability of being obese over educational and income levels differed between the two types of models, and between men and women. A prediction using the models with the interaction-effect terms demonstrated that for all men, the highest level of formal education was associated with an increase in their probability of being obese by as much as 26%.

CONCLUSIONS

The well-known, negative association between socioeconomic status and obesity in developed countries may not be valid when interaction effects are included. Ignoring these effects and their gender differences may result in the targeting of wrong populations for reducing obesity prevalence and its resultant socioeconomic gradients.

Relationship between obesity and depression in Korean adults: Korea National Health and Nutrition Examination Survey 2014

Previous studies on the relationship between obesity and depression have produced conflicting results. And only a limited number of studies have been conducted in Asians, and few large-scale nationwide studies have been conducted in Korean populations.We investigated the relationship between obesity and depression in Korean adults using data from a population-based sample from the 2014 Korea National Health and Nutritional Examination Survey (KNHANES) by cross-sectional study.In total, 4026 subjects (1692 men, 2334 women) aged 19 to 69 years participated in the 2014 KNHANES. Current depression was defined as a score ≥10 on the 9-item Patient Health Questionnaire. Height and weight were measured and the body mass index (BMI) was calculated. The participants were asked to complete questionnaires about socio-demographic factors and disease comorbidities, and health-related behaviors. The chi-squared test and multivariate logistic regression analyses were performed to examine the relationship between obesity and depression.Depression was diagnosed in 5.7% of the study participants (3.9% of men, 7.0% of women). According to body weight status, there was a significant difference in the prevalence of depression (underweight: 16.2%, normal weight: 5.5%, overweight: 4.3%, obese [BMI ≥30]: 6.9%). Compared with the normal weight group, the underweight group had a higher adjusted odds ratio (OR) for depression (OR = 3.27, 95% confidence interval [CI]: 1.22, 8.75 in men; OR = 2.00, 95% CI: 1.12, 3.57 in women). Overweight (OR = 0.60, 95% CI: 0.32, 1.13) and obese (OR = 0.62, 95% CI: 0.17, 2.27) men had lower ORs for depression, but this trend was not significant. Compared with normal weight women, obese women had higher adjusted ORs for depression (OR = 1.75, 95% CI: 0.79, 3.88), while overweight women had lower ORs for depression (OR = 0.90, 95% CI: 0.56, 1.45), but these trends were not significant.This study shows differences in the risk of depression depending upon body weight status. Being underweight was correlated with a high risk of developing depression in both men and women, but obesity cannot be ruled out as a risk factor for this condition.

The impact of sociodemography, diet, and body size on serum retinol in women 16-35 years of age: SANHANES-1

To determine the current vitamin A status of a nationally representative sample of women aged 16-35 years, compare it with previous national data, and determine the impact of sociodemography, diet, and body size on vitamin A status, we performed secondary analysis of data on South African women who participated in the first South African National Health and Nutrition Examination Survey (SANHANES-1). Vitamin A status was assessed by serum retinol, and the findings are reported as means and prevalences with corresponding 95% confidence intervals. Overall, the age-standardized vitamin A deficiency prevalence was 11.7%, a decrease from previous national data, but serum retinol levels remained lower than in other developing countries. Overall, unweighted, multilevel, multivariate logistic regression showed that vitamin A deficiency was influenced by race only (odds ratio (OR) = 1.89, P = 0.031), while weighted multiple logistic regression for 16- to 18-year-olds showed that vitamin A deficiency was influenced by locality (OR = 9.83, P = 0.005) and household income (intermediate (OR = 0.2, P = 0.022) and upper (OR = 0.25, P = 0.049)). Despite the decreased prevalence, vitamin A deficiency remains a moderate public health problem in the country. Opportunities for targeted interventions have been identified.

Social disparities in body mass index (BMI) trajectories among Chinese adults in 1991-2011

Background

Obesity is a serious public health problem in China. The relationship between obesity and socio-economic status (SES) is changing and affected by uncertainty, particularly, in developing countries. The sex-related differences in body mass index (BMI) trajectories are controversial and require substantial empirical data for updating and enriching.

Methods

This study examined the relationship between SES and BMI in Chinese adults from a dynamic perspective using longitudinal data (1991–2011) from the China Health and Nutrition Survey (CHNS). Then, sex-related differences were determined. A hierarchical linear model was used.

Results

SES positively affected the male BMI changes, with faster BMI growth rates in the high-SES males over the past 20 years. By contrast, female BMI was only affected by BMI baseline and residential area. Specifically, greater BMI baseline led to greater BMI growth rate and earlier BMI decline. In the past 20 years, the BMI growth rate has been greater in the urban females than in the rural females.

Conclusions

The relationship between SES and obesity is complex in China, and a substantial sex-related difference exists. We argue that this large sex-related difference is due to the rapid economic and social changes that have affected national health and increased the gender inequality and social role restrictions in females. We provide insights for further research and policy recommendations.

Trends in socioeconomic inequalities in five major risk factors for cardiovascular disease in the Korean population: a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey, 2001-2014

OBJECTIVES

To examine trends in socioeconomic inequalities in major cardiovascular disease (CVD) risk factors among the Korean population.

DESIGN

Cross-sectional study.

SETTING

A nationally representative population survey database.

PARTICIPANTS

A total of 42 725 Koreans, aged 25-64 years, who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) II (2001) to VI (2013-2014).

MAIN OUTCOME MEASURES

Trends in socioeconomic inequalities in five major CVD risk factors (smoking, obesity, diabetes, hypertension and hypercholesterolaemia).

RESULTS

Gender differences were noted in the time trends in socioeconomic inequalities in smoking, obesity, diabetes and hypertension. Among men, low socioeconomic status (SES) was associated with higher prevalence of smoking, but not with obesity, diabetes or hypertension. The magnitudes of socioeconomic inequalities in smoking, obesity and diabetes remained unchanged, and the magnitude of the inequality in hypertension decreased over time. However, among women, low SES was associated with higher prevalence of smoking, obesity, diabetes and hypertension. Time trends towards increasing socioeconomic inequalities, measured by income, in smoking, obesity and diabetes were found in women. Unlike the other CVD risk factors, hypercholesterolaemia was not associated with socioeconomic inequality.

CONCLUSIONS

SES had a stronger impact on major CVD risk factors among Korean women than men. Moreover, socioeconomic inequalities in smoking, obesity and diabetes worsened among Korean women over time. Public policies to prevent smoking, obesity and diabetes in women with lower SES are needed to address inequalities.

Modifying effects of education on the association between lifestyle behaviors and the risk of obesity: evidence from South Korea

BACKGROUND

No previous study has explored the interactions between education and lifestyle in relation to obesity. This study hypothesized that education may be obesogenic through its interplay with lifestyle behaviors.

METHODS

Data for a nationally representative sample (6937 men and 9333 women) from the Korea National Health and Nutrition Examination Survey (2010-2012) were analyzed. Multivariate logistic regressions were performed for three education levels and six lifestyle behaviors, each of which comprised two groups.

RESULTS

Interactions between education and lifestyle behaviors in relation to obesity were observed for all lifestyle behaviors in women (p for interaction <0.001) and for three lifestyle behaviors in men. Education appeared obesogenic for three groups of lifestyle behaviors in men (p for trend <0.05), but was protective against obesity for 11 groups in women. Each one-unit increase in education level in men increased the odds of obesity by 1.29-fold among under-reported energy intake groups (95 % confidence interval: 1.16, 1.44).

CONCLUSIONS

Education may be a risk factor for obesity through its interplay with lifestyle behaviors. Further research is required to examine these findings in different socio-cultural settings.

Body mass index, waist-hip ratio and risk of chronic medical condition in the elderly population: results from the Well-being of the Singapore Elderly (WiSE) Study

BACKGROUND

The aim of the current study was to establish the prevalence and relationship of Body Mass Index (BMI) and Waist-Hip Ratio (WHR) with chronic health conditions and their associated socio-demographic correlates in the elderly population of Singapore.

METHODS

The data was extracted from the Well-being of the Singapore Elderly (WiSE) study, a comprehensive single phase, cross-sectional, population-based, epidemiological study conducted in 2013 among Singaporean residents (n = 2565) aged 60 years and above with a mean age of 72.7 years (range 60 to 105, SD = 9.53). The respondents were assessed with anthropometric measurements including height, weight, BMI, waist circumference, hip circumference and WHR. Participants provided information on their socio-demographic details and chronic health conditions.

RESULTS

Prevalence of those who were obese, overweight, normal and underweight based on BMI was 8.7 %, 33.4 %, 52.5 % and 5.5 % respectively. Malays were more likely to be overweight compared to Chinese and Indians, while Malays and Indians were more likely to be obese compared to Chinese. Participants who were never married were less likely to be overweight compared to married. Participants aged 85 years and above were more likely to be underweight compared to those aged 60-75 years. Prevalence of high WHR (above 0.90 for men and 0.80 for women) was 79.8 % and this was more pervasive amongst Indians. Participants who were homemakers were more likely to have high WHR while those with tertiary education tended to have low WHR. Being overweight was associated with hypertension and heart problems, while obesity was associated with hypertension and diabetes, and a high WHR was associated with hypertension and diabetes. There were no significant differences in the other chronic conditions in this elderly population.

CONCLUSIONS

This study demonstrates the importance of anthropometric measurements in the elderly and its association with certain chronic physical conditions, indicating their utility in the clinical management of these conditions in the elderly.

Social Patterning in Adiposity in Adolescence: Prospective Observations from the Chinese Birth Cohort ''Children of 1997''

INTRODUCTION

Low early life socio-economic position is more strongly associated with adiposity among women than men. We examined whether the sex difference of social patterning in general and central adiposity exists before adulthood.

METHODS

In Hong Kong's "Children of 1997" birth cohort, we used multivariable regression to examine the association of parental education, a marker of early life socio-economic position, with body mass index (BMI) (n = 7252, 88% follow-up) and waist-height ratio (n = 5636, 68% follow-up), at 14 years.

RESULTS

Parental education of Grade 9 or below, compared to Grade 12 or above, was associated with higher waist-height ratio z-score particularly in girls (0.30, 95% confidence interval (CI) 0.19, 0.41) compared to boys (0.12, 95% CI 0.02, 0.22) (p for sex interaction = 0.02). Lower parental education was associated with greater BMI z-score in adolescents of locally born mothers, but not adolescents of migrant mothers, with no difference by sex.

CONCLUSIONS

Different social patterning in different markers of adiposity may imply different sociological and biological mediating pathways. A stronger association between low early life socio-economic position and waist-height ratio in adolescent girls may indicate sex-specific influences of SEP related early life exposures on central adiposity.

The Relationship of Socioeconomic and Behavioral Risk Factors With Trends of Overweight in Korea

Objectives:

Previous studies have shown that overweight (including obesity) has increased significantly in Korea in recent decades. However, it remains unclear whether this change has been uniform among all Koreans and to what extent socioeconomic and behavioral factors have contributed to this increase.

Methods:

Changes in overweight were estimated using data from the 1998, 2001, 2005, 2007-2009, and 2010-2012 Korea National Health and Nutrition Examination Survey (n=55 761).

Results:

Overweight increased significantly among men but not among women between 1998 and 2012. Changes in socioeconomic and behavioral factors over the time period were not associated with overall trends for both men and women. However, we found significant differences in the prevalence of overweight relative to key risk factors. For men, overweight increased at a significantly greater rate among the non-exercising (predicted probability [PP] from 0.23 to 0.32] and high-calorie (PP from 0.18 to 0.37) groups compared to their active and lower-calorie counterparts, respectively. For women, overweight increased only among the non-exercising (PP from 0.27 to 0.28) and low-income (PP from 0.31 to 0.36) groups during this period.

Conclusions:

These findings suggest that programs aimed at reducing overweight should target Korean men and women in specific socioeconomic and behavioral risk groups differentially.

Is There an Association between Sleeping Patterns and Other Environmental Factors with Obesity and Blood Pressure in an Urban African Population?

Beyond changing dietary patterns, there is a paucity of data to fully explain the high prevalence of obesity and hypertension in urban African populations. The aim of this study was to determine whether other environmental factors (including sleep duration, smoking and physical activity) are related to body anthropometry and blood pressure (BP). Data were collected on 1311 subjects, attending two primary health care clinics in Soweto, South Africa. Questionnaires were used to obtain data on education, employment, exercise, smoking and sleep duration. Anthropometric and BP measurements were taken. Subjects comprised 862 women (mean age 41 ± 16 years and mean BMI 29.9 ± 9.2 kg/m²) and 449 men (38 ± 14 years and 24.8 ± 8.3 kg/m²). In females, ANOVA showed that former smokers had a higher BMI (p<0.001) than current smokers, while exposure to second hand smoking was associated with a lower BMI (p<0.001) in both genders. Regression analyses demonstrated that longer sleep duration was associated with a lower BMI (p<0.05) in older females only, and not in males, whilst in males napping during the day for > 30 minutes was related to a lower BMI (β = -0.04, p<0.01) and waist circumference (β = -0.03, p<0.001). Within males, napping for >30 minutes/day was related to lower systolic (β = -0.02, p<0.05) and lower diastolic BP (β = -0.02, p = 0.05). Longer night time sleep duration was associated with higher diastolic (β = 0.005, p<0.01) and systolic BP (β = 0.003, p<0.05) in females. No health benefits were noted for physical activity. These data suggest that environmental factors rarely collected in African populations are related, in gender-specific ways, to body anthropometry and blood pressure. Further research is required to fully elucidate these associations and how they might be translated into public health programs to combat high levels of obesity and hypertension.

Gender differences in the association between socioeconomic status and hypertension incidence: the Korean Genome and Epidemiology Study (KoGES)

Background

Hypertension is a leading cause of cardiovascular events. We examined whether there was a gender difference in the association between SES, measured by education and income, and hypertension incidence.

Methods

Data for 2596 men and 2686 women aged 40–69 years without hypertension at baseline from the Korean Genome and Epidemiology Study (KoGES) were analyzed. Participants had two follow-up examinations during 4 years, and were classified into three categories by self-reported educational attainment: ≥ 10 years, 7–9 years, and 0–6 years, and monthly household income (×10,000 Korean Won): ≥ 200, 100–199, and <100. The association between SES and incidence hypertension was examined by Cox’s proportional hazard regression analyses.

Results

Adjusting for conventional risk factors, compared with the high education group (reference), the hazard ratios (95 % confidence interval) for incident hypertension across the education categories were 1.54 (1.16–2.06) and 1.80 (1.36–2.38) in women and 1.15 (0.92–1.43), and 1.08 (0.84–1.38) in men. Women with the low household income were more likely to have hypertension than those with the high household income and incident hypertension had an inverse association with household income level in women: multivariate adjusted hazard ratios were 1.00 (reference), 1.10 (0.83–1.45), and 1.63 (0.75–2.16). Men with medium income were less likely to have hypertension compared with those with high income (0.76, 0.61–0.90).

Conclusions

Educational level and economic status had stronger impacts on hypertension in Korean women than men. Thus, a stratified approach for women of low socioeconomic status, especially those with low educational attainment, is needed for the prevention of hypertension.

The population attributable fraction of low education for mortality in South Korea with improvement in educational attainment and no improvement in mortality inequalities

Background

The educational attainment of Koreans has greatly increased, which was expected to reduce the magnitude of the population attributable fraction (PAF) of mortality associated with low education levels. However, increase in the relative risk (RR) of mortality among those with lower educational levels actually increased the PAF. The purpose of this study was to examine the change in the PAF of lower educational levels for mortality in Korea, where educational attainment has improved and is associated with the exacerbation of inequalities in mortality levels.

Methods

National census data were used to derive educational levels. The mortality-associated RR of lower educational levels was calculated by reference to national census and death certificate data from 1995, 2000, 2005, and 2010. PAFs were calculated for all-cause mortality, malignant neoplasms, cerebrovascular disease, heart disease, and suicide by gender and age group (30–44 and 45–59 years).

Results

The PAF of low educational level in terms of total mortality has decreased since 1995 in both genders. This trend was more prominent among those aged 30–44 years. However, the PAFs of suicide in younger females (30–44 years) and of cerebrovascular disease in older males (45–59 years) have increased. The RRs of all-cause mortality and those of the four leading causes of death in those with the lowest educational levels have increased, especially in females aged 30–44 years.

Conclusions

The consistent and sharp increase in the attainment of education has contributed to the reduction in the PAFs of lower education for mortality, despite the fact that mortality inequalities have not improved. Efforts to reduce health inequalities must promote healthy public policy and address public health policies.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1665-x) contains supplementary material, which is available to authorized users.

Diet, physical activity and socio-economic disparities of obesity in Lebanese adults: findings from a national study

BACKGROUND

The prevalence of obesity within countries varies by gender, age, lifestyle and socioeconomic factors. Identification of behavioural factors that are associated with obesity within the country's context is critical for the development of effective public health programs which aim to prevent and manage obesity. The objective of this study was to assess age and gender differentials in the prevalence of obesity in Lebanon and examine correlates of obesity with a focus on socioeconomic disparities.

METHODS

Following the WHO STEPwise guidelines, a national survey was conducted in Lebanon in 2008-2009. Households were selected randomly from all Governorates based on stratified cluster sampling method. One adult aged 20 years and over was randomly selected from each household for the interview. Anthropometric measurements and 24 hour recall dietary intake were obtained. The final sample included 1244 men and 1453 women. Descriptive statistics were computed for BMI, waist circumference, and percent body fat. Multivariate logistic regression analysis was carried out to assess the relationship between energy intake and obesity adjusted for relevant co-variables.

RESULTS

The prevalence of obesity among Lebanese adults was 26.1%. Gender differences in obesity estimates were observed across age groups and the three obesity classes, with men showing higher prevalence rates at the younger age groups (20-49 years), and women showing higher prevalence rates in older age groups (50 years and above). Obesity showed significant associations with socio-economic status in women; it decreased with higher educational attainment (OR = 0.54, 95% CI: 0.32, 0.91), greater household assets (OR = 0.26; 95% CI: 0.10, 0.72) and lower crowding index (OR = 0.62; 95% CI: 0.39, 0.98), net of the effect of other co-variates. There was a significant positive association between obesity and energy intake in both genders, and a negative association between obesity and physical activity, significantly among women.

CONCLUSION

Lifestyle and socioeconomic determinants of obesity are identified in this Lebanese population. Policy makers and service providers need to tailor public health strategies to tackle obesity accordingly.

Association of obesity with socioeconomic status among adults of ages 18 to 80 years in rural Northwest China

Background

Understanding social disparities in obesity are presently an essential element in establishing public health priorities. However, the association between socioeconomic status (SES) and obesity has not been assessed in rural Northwest China. This study aims to explore the effect of SES on overweight/obesity and abdominal obesity by gender and age in rural Northwest China.

Methods

A total of 3030 participants between the ages of 18 to 80 years from rural Hanzhong, Shaanxi province, Northwest China were enrolled in our study using a two-level stratified random cluster sampling technique. Adjusted odds ratio (AOR) were used to assess the relationship between socioeconomic status and obesity after controlling for confounding factors using logistic regression.

Results

Our results indicated that the prevalence of abdominal obesity (38.8%) was the highest in rural Northwest China when compared with overweight (27.8%) and obesity (5.7%). When adjusting for possible risk factors, there were significant gender disparities in SES-obesity association. In men, the likelihoods of overweight/obesity and abdominal obesity were higher in the high SES groups when compared to the low SES groups. However, women with a high level of education were less likely to have overweight/obesity (AOR:0.78, 95% CI: 0.62, 0.98) than their counterparts with a low level of education. After the inclusion of multiple lifestyle factors, we still observed a strong positive association between age and obesity in the population.

Conclusions

Both gender and age differences in SES-obesity association were clearly observed in our study. Therefore, interventional measures should be employed in rural Northwest China to reduce the obesity epidemic that specifically takes into account gender and age differences.

Age- and sex-specific relationships between household income, education, and diabetes mellitus in Korean adults: the Korea National Health and Nutrition Examination Survey, 2008-2010

Background

To investigate the effects of age and sex on the relationship between socioeconomic status (SES) and the prevalence and control status of diabetes mellitus (DM) in Korean adults.

Methods

Data came from 16,175 adults (6,951 men and 9,227 women) over the age of 30 who participated in the 2008-2010 Korea National Health and Nutrition Examination Survey. SES was measured by household income or education level. The adjusted odds ratios (ORs) and corresponding 95% confidence intervals (95% CI) for the prevalence or control status of diabetes were calculated using multiple logistic regression analyses across household income quartiles and education levels.

Results

The household income-DM and education level-DM relationships were significant in younger age groups for both men and women. The adjusted ORs and 95% CI for diabetes were 1.51 (0.97, 2.34) and 2.28 (1.29, 4.02) for the lowest vs. highest quartiles of household income and education level, respectively, in women younger than 65 years of age (both P for linear trend < 0.05 with Bonferroni adjustment). The adjusted OR and 95% CI for diabetes was 2.28 (1.53, 3.39) for the lowest vs. highest quartile of household income in men younger than 65 (P for linear trend < 0.05 with Bonferroni adjustment). However, in men and women older than 65, no associations were found between SES and the prevalence of DM. No significant association between SES and the status of glycemic control was detected.

Conclusions

We found age- and sex-specific differences in the relationship of household income and education with the prevalence of DM in Korea. DM preventive care is needed for groups with a low SES, particularly in young or middle-aged populations.

Metabolic syndrome and sex-specific socio-economic disparities in childhood and adulthood: the Korea National Health and Nutrition Examination Surveys

AIMS

To examine whether adulthood and/or childhood sex-specific socio-economic disparities are associated with metabolic syndrome and its components in a developed non-Western setting.

METHODS

Based on the Fourth Korea National Health and Nutrition Examination Surveys, 14 888 people aged ≥ 20 years were analysed to evaluate the effect of adult and childhood socio-economic status on metabolic syndrome. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III guidelines. Logistic regression analyses were conducted to calculate the odds ratios for metabolic syndrome and each component of metabolic syndrome in later life.

RESULTS

The age-standardized prevalence of metabolic syndrome was 26.6% for men and 21.3% for women. Compared with the highest level of education, men with the lowest education level were significantly less likely to have metabolic syndrome (odds ratio 0.76, 95% CI 0.60-0.96), whereas the opposite association was found in women (odds ratio 3.29, 95% CI 2.45-4.42). Men who were manual labourers and economically inactive had a lower prevalence of metabolic syndrome compared with those with non-manual jobs (odds ratio 0.82, 95% CI 0.69-0.98 and odds ratio 0.79, 95% CI 0.64-0.99, respectively), but the reverse association was observed in women (odds ratio 1.34, 95% CI 1.04-1.73 and odds ratio 1.40, 95% CI 1.09-1.81, respectively). A significant interaction between combined adulthood and childhood socio-economic status on the presence of metabolic syndrome was observed (P < 0.05).

CONCLUSIONS

Our findings suggest that sex-specific socio-economic disparities in childhood and adulthood have differential effects on the prevalence of metabolic syndrome and its individual components in Korea.