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Basu S, Maheshwari V, Malik M, Barzangi K, Hassan R. The burden and care cascade in young and middle-aged patients with diabetes hypertension comorbidity with abdominal obesity in India: A nationally representative cross-sectional survey. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003413. [PMID: 39018298 PMCID: PMC11253957 DOI: 10.1371/journal.pgph.0003413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 06/05/2024] [Indexed: 07/19/2024]
Abstract
We ascertained the burden, determinants, and care cascade in the young and middle-aged patients having co-existing hypertension (HTN), Diabetes Mellitus (DM), and abdominal obesity in India from a secondary data analysis of nationally representative data. The study examined cross-sectional data from the National Family Health Survey (NFHS-5) conducted in India from 2019 to 2021 in 788974 individuals aged 15-49 years including 695707 women and 93267 men. The weighted prevalence of DM-HTN comorbidity with high waist circumference in the sample was 0.75% (95% CI: 0.71 to 0.79) including 46.33% (95% CI: 44.06 to 48.62) newly diagnosed cases detected for HTN and high blood sugars. The weighted prevalence of Metabolic syndrome as per NCEP ATPIII criteria was found to be 1.13% (95% CI: 1.08 to 1.17). Only 46.16% existing cases were treated with both anti-diabetes and antihypertensive medication (full treatment), while 34.71% cases were untreated. On adjusted analysis, increasing age, females, higher wealth index, high fat diet, obesity and comorbidities were significantly associated with having DM-HTN comorbidity along with high-waist circumference. More than half of young and middle aged-population in India with DM-HTN-abdominal obesity triad are not initiated on treatment for DM and HTN comorbidities, while a majority of the previously diagnosed cases have uncontrolled blood pressure and poor glycemic control. The poor cascade of care for DM and HTN in these high-risk group of patients may substantially increase their risk for early progression and severity of microvascular and macrovascular complications especially cardiovascular disease.
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Affiliation(s)
- Saurav Basu
- Indian Institute of Public Health ‐ Delhi, Public Health Foundation of India, Haryana, India
| | - Vansh Maheshwari
- Indian Institute of Public Health ‐ Delhi, Public Health Foundation of India, Haryana, India
| | - Mansi Malik
- Indian Institute of Public Health ‐ Delhi, Public Health Foundation of India, Haryana, India
| | - Kara Barzangi
- University of Cambridge, Trinity Ln, Cambridge, United Kingdom
| | - Refaat Hassan
- University of Cambridge, Trinity Ln, Cambridge, United Kingdom
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Shakya S, Shrestha V, Neupane D. Social determinants of health and cardiometabolic risk factors in Nepal: A scoping review. Nutr Metab Cardiovasc Dis 2023; 33:2308-2316. [PMID: 37798230 DOI: 10.1016/j.numecd.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/23/2023] [Accepted: 08/02/2023] [Indexed: 10/07/2023]
Abstract
AIMS Cardiometabolic risk factors are modifiable contributors to cardiometabolic disease and adverse outcomes. Cardiometabolic risk factors are emerging health concerns among adults in low and middle-income countries. The role of social determinants of health on cardiometa gaps. DATA SYNTHESIS A comprehensive search was conducted in multiple databases: PubMed (MEDLINE), Web of Science (Clarivate), and CINAHL (EBSCO). Joanna Briggs Institute's (JBI) Scoping Review methodology and PRISMA extension for scoping reviews-SCRA guided this review. Forty-four cross-sectional studies published between 2010 and 2022 were eligible for this review. Men were more likely to have hypertension, while women were more likely to have obesity and abdominal obesity. Participants from marginalized caste/ethnicity, urban regions, and those with lower education, and greater wealth index had a greater likelihood of hypertension, dyslipidemia, and hyperglycemia; however, differences across these sociodemographic subgroups are narrowing. Smoking, harmful alcohol use, high salt intake, low fruit and vegetable intake, and sedentary lifestyles were associated with one or more cardiometabolic risk factors. Finally, one cardiometabolic risk factor increased the risk of others. CONCLUSIONS Findings reflect that Nepal is at the intersection of rapid urbanization, nutritional transition, and socioeconomic shift. Future studies should take a multilevel approach to investigate the role of social determinants in increasing the cardiometabolic risk burden in Nepal.
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Affiliation(s)
- Shamatree Shakya
- College of Nursing, University of Illinois at Chicago, United States.
| | | | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Mahadevan M, Bose M, Gawron KM, Blumberg R. Metabolic Syndrome and Chronic Disease Risk in South Asian Immigrants: A Review of Prevalence, Factors, and Interventions. Healthcare (Basel) 2023; 11:healthcare11050720. [PMID: 36900725 PMCID: PMC10000781 DOI: 10.3390/healthcare11050720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 03/05/2023] Open
Abstract
South Asians (SAs) are among the fastest-growing ethnic groups in the U.S. Metabolic syndrome (MetS) is a condition that is characterized by multiple health factors that increase the risk for chronic diseases, such as cardiovascular disease (CVD) and diabetes. MetS prevalence among SA immigrants ranges from 27-47% in multiple cross-sectional studies using different diagnostic criteria, which is generally higher compared to other populations in the receiving country. Both genetic and environmental factors are attributed to this increased prevalence. Limited intervention studies have shown effective management of MetS conditions within the SA population. This review reports MetS prevalence in SAs residing in non-native countries, identifies contributing factors, and discusses ways to develop effective community-based strategies for health promotion targeting MetS among SA immigrants. There is a need for more consistently evaluated longitudinal studies to facilitate the development of directed public health policy and education to address chronic diseases in the SA immigrant community.
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Affiliation(s)
- Meena Mahadevan
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ 07043, USA
- Correspondence: ; Tel.: +1-973-655-7574
| | - Mousumi Bose
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ 07043, USA
| | | | - Renata Blumberg
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ 07043, USA
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Gupta MK, Dutta G, G S, Raghav P, Goel AD, Bhardwaj P, Saurabh S, S S, K H N, T P, Rustagi N, Sharma PP. Application of Indian Diabetic Risk Score (IDRS) and Community Based Assessment Checklist (CBAC) as Metabolic Syndrome prediction tools. PLoS One 2023; 18:e0283263. [PMID: 36972242 PMCID: PMC10042346 DOI: 10.1371/journal.pone.0283263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/05/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Indian Diabetic Risk Score (IDRS) and Community Based Assessment Checklist (CBAC) are easy, inexpensive, and non-invasive tools that can be used to screen people for Metabolic Syndrome (Met S). The study aimed to explore the prediction abilities of IDRS and CBAC tools for Met S. METHODS All the people of age ≥30 years attending the selected rural health centers were screened for Met S. We used the International Diabetes Federation (IDF) criteria to diagnose the Met S. ROC curves were plotted by taking Met S as dependent variables, and IDRS and CBAC scores as independent/prediction variables. Sensitivity (SN), specificity (SP), Positive and Negative Predictive Value (PPV and NPV), Likelihood Ratio for positive and negative tests (LR+ and LR-), Accuracy, and Youden's index were calculated for different IDRS and CBAC scores cut-offs. Data were analyzed using SPSS v.23 and MedCalc v.20.111. RESULTS A total of 942 participants underwent the screening process. Out of them, 59 (6.4%, 95% CI: 4.90-8.12) were found to have Met S. Area Under the Curve (AUC) for IDRS in predicting Met S was 0.73 (95%CI: 0.67-0.79), with 76.3% (64.0%-85.3%) sensitivity and 54.6% (51.2%-57.8%) specificity at the cut-off of ≥60. For the CBAC score, AUC was 0.73 (95%CI: 0.66-0.79), with 84.7% (73.5%-91.7%) sensitivity and 48.8% (45.5%-52.1%) specificity at the cut-off of ≥4 (Youden's Index, 2.1). The AUCs of both parameters (IDRS and CBAC scores) were statistically significant. There was no significant difference (p = 0.833) in the AUCs of IDRS and CBAC [Difference between AUC = 0.00571]. CONCLUSION The current study provides scientific evidence that both IDRS and CBAC have almost 73% prediction ability for Met S. Though CBAC holds relatively greater sensitivity (84.7%) than IDRS (76.3%), the difference in prediction abilities is not statistically significant. The prediction abilities of IDRS and CBAC found in this study are inadequate to qualify as Met S screening tools.
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Affiliation(s)
- Manoj Kumar Gupta
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
- School of Public Health (SPH), All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Gitashree Dutta
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Sridevi G
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Pankaja Raghav
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Akhil Dhanesh Goel
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Pankaj Bhardwaj
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
- School of Public Health (SPH), All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Suman Saurabh
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Srikanth S
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Naveen K H
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Prasanna T
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Neeti Rustagi
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Prem Prakash Sharma
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
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Adhikari C, Dhakal R, Adhikari LM, Parajuli B, Subedi KR, Aryal Y, Thapa AK, Shah K. Need for HTA supported risk factor screening for hypertension and diabetes in Nepal: A systematic scoping review. Front Cardiovasc Med 2022; 9:898225. [PMID: 35979024 PMCID: PMC9376353 DOI: 10.3389/fcvm.2022.898225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Health Technology Assessment (HTA) is a comprehensive and important tool for assessment and decision-making in public health and healthcare practice. It is recommended by the WHO and has been applied in practice in many countries, mostly the developed ones. HTA might be an important tool to achieve universal health coverage (UHC), especially beneficial to low-and-middle-income countries (LMIC). Even though the Package for Essential Non-communicable Diseases (PEN) has already been initiated, there is a clear policy gap in the HTA of any health device, service, or procedure, including the assessment of cardiovascular risk factors (CVRFs) in Nepal. Hence, we carried out the review to document the HTA supported evidence of hypertension and diabetes screening, as CVRFs in Nepal. Materials and methods We searched in PubMed, Cochrane, and Google Scholar, along with some gray literature published in the last 6 years (2016–2021) in a systematic way with a controlled vocabulary using a well-designed and pilot tested search strategy, screened them, and a total of 53 articles and reports that matched the screening criteria were included for the review. We then, extracted the data in a pre-designed MS-Excel format, first in one, and then, from it, in two, with more specific data. Results Of 53 included studies, we reported the prevalence and/or proportion of hypertension and diabetes with various denominators. Furthermore, HTA-related findings such as cost, validity, alternative tool or technology, awareness, and intervention effectiveness have been documented and discussed further, however, not summarized due to their sparingness. Conclusion Overall, the prevalence of DM (4.4–18.8%) and HTN (17.2–70.0%) was reported in most studies, with a few, covering other aspects of HTA of DM/HTN. A national policy for establishing an HTA agency and some immediately implementable actions are highly recommended.
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Affiliation(s)
- Chiranjivi Adhikari
- Department of Public Health, SHAS, Pokhara University, Pokhara, Nepal
- Indian Institute of Public Health Gandhinagar, Gandhinagar, India
- *Correspondence: Chiranjivi Adhikari
| | - Rojana Dhakal
- Department of Nursing, School of Health and Allied Sciences, Pokhara University, Pokhara, Nepal
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Lal Mani Adhikari
- Health Research and Social Development Forum International, Kathmandu, Nepal
| | - Bijaya Parajuli
- Ministry of Health and Population, Gandaki Province, Myagdi Health Office, Myagdi, Nepal
| | - Khem Raj Subedi
- Department of Economics, Far Western University, Tikapur Multiple Campus, Kailali, Nepal
| | | | - Arjun Kumar Thapa
- Department of Economics, School of Humanities and Social Sciences, Pokhara University, Pokhara, Nepal
| | - Komal Shah
- Indian Institute of Public Health Gandhinagar, Gandhinagar, India
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Pengpid S, Peltzer K. National trends in metabolic syndrome among adults in Mongolia from three cross-sectional surveys in 2009, 2013 and 2019. Diabetes Metab Syndr 2022; 16:102375. [PMID: 34952288 DOI: 10.1016/j.dsx.2021.102375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/23/2021] [Accepted: 12/18/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM Metabolic syndrome (MetS) may increase the risk of cardiometabolic diseases. The study aimed to estimate the proportion and associated factors of MetS among individuals (≥15 years) across three cross-sectional surveys in 2009, 2013 and 2019 in Mongolia. METHOD Cross-sectional data were analysed from 6,321 individuals (15-64/69 years, median age = 42 years) that participated in the 2009, 2013 or 2019 Mongolia STEPS surveys, and had complete MetS (harmonized definition) measurements. RESULTS Almost two in five participants (35.6%) had MetS, 33.3% in 2009, 35.3% in 2013, ad 37.0% in 2019 (p-for trend 0.023). In adjusted logistic regression analyses, older age was associated with MetS in 2009 and in 2019, male sex and higher education were associated with MetS in 2013, and urban residence was associated with MetS in 2009. Current tobacco use was associated with MetS in 2009 and 2019, moderate or high physical activity was protective against MetS in 2013 and 2019, while general overweight and obesity increased the odds of MetS in 2009, 2013, and 2019. CONCLUSION The study showed that almost two in five adults were identified as having MetS, which significantly increased from 2009 to 2019, and that several predictors of MetS were found.
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Affiliation(s)
- Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand; Department of Research Administration and Development, University of Limpopo, Polokwane, South Africa
| | - Karl Peltzer
- Department of Research Administration and Development, University of Limpopo, Polokwane, South Africa; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Jayawardena R, Sooriyaarachchi P, Misra A. Abdominal obesity and metabolic syndrome in South Asians: prevention and management. Expert Rev Endocrinol Metab 2021; 16:339-349. [PMID: 34586004 DOI: 10.1080/17446651.2021.1982381] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The prevalence of metabolic syndrome (MetS) and abdominal obesity are escalating in South Asian countries. It is well established that MetS is associated with increased risk for both Type 2 diabetes mellitus and cardiovascular diseases. South Asians have an increased risk of MetS due to a variety of factors including unhealthy lifestyle and their unique body composition. AREAS COVERED In this review, we discuss the prevalence, associated risk factors, and evidence-based preventive and curative strategies for MetS and abdominal obesity in South Asians. A literature search through PubMed®, Web of Science®, and Scopus® was performed for studies published before 31st April 2021. A combination of the following keywords was used with the names of the individual South Asian countries: 'metabolic syndrome,' 'syndrome X,' 'abdominal obesity,' 'central obesity,' 'visceral obesity,' 'prevention,' and 'management.' EXPERT OPINION According to current evidence, MetS and abdominal obesity are highly prevalent among South Asians. Several risk factors, such as lifestyle, socio-demography, cultural, and body composition, are associated with MetS. Limited research shows culturally tailored lifestyle interventions are effective in preventing and managing MetS and abdominal obesity among South Asians.
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Affiliation(s)
- Ranil Jayawardena
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Piumika Sooriyaarachchi
- School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chirag Enclave, New Delhi, India
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Lipid Metabolism Disorders in the Comorbid Course of Nonalcoholic Fatty Liver Disease and Chronic Obstructive Pulmonary Disease. Cells 2021; 10:cells10112978. [PMID: 34831201 PMCID: PMC8616072 DOI: 10.3390/cells10112978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is currently among the most common liver diseases. Unfavorable data on the epidemiology of metabolic syndrome and obesity have increased the attention of clinicians and researchers to the problem of NAFLD. The research results allow us to emphasize the systemicity and multifactoriality of the pathogenesis of liver parenchyma lesion. At the same time, many aspects of its classification, etiology, and pathogenesis remain controversial. Local and systemic metabolic disorders are also a part of the pathogenesis of chronic obstructive pulmonary disease and can influence its course. The present article analyzes the metabolic pathways mediating the links of impaired lipid metabolism in NAFLD and chronic obstructive pulmonary disease (COPD). Free fatty acids, cholesterol, and ceramides are involved in key metabolic and inflammatory pathways underlying the pathogenesis of both diseases. Moreover, inflammation and lipid metabolism demonstrate close links in the comorbid course of NAFLD and COPD.
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Shahril MR, Amirfaiz S, Lua PL, Nurnazahiah A, Zakarai NS, Kow VL, Ahmad A, Sulaiman S. Prevalence of metabolic syndrome among breast cancer survivors in East Coast of Peninsular Malaysia. BMC Public Health 2021; 21:238. [PMID: 33509143 PMCID: PMC7844947 DOI: 10.1186/s12889-021-10288-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 01/20/2021] [Indexed: 11/27/2022] Open
Abstract
Background To date, limited data are available on metabolic syndrome prevalence among breast cancer survivors in Malaysia. Therefore, this study was conducted to determine the prevalence of metabolic syndrome and abnormal metabolic syndrome components among breast cancer survivors in East Coast of Peninsular Malaysia. Methods This cross-sectional study included 95 breast cancer survivors (age 53.7 ± 7.6 years) who have completed main cancer treatments for ≥6 months. Cancer survivors were recruited from two main government hospitals in Kelantan and Terengganu using a purposive sampling method. Results According to the Harmonized criteria, the metabolic syndrome prevalence was 50.5%. Among those with metabolic syndrome, the most prevalent abnormal metabolic components were triglycerides (91.2%), fasting blood glucose (79.6%) and HDL-c level (78.4%). Except for total cholesterol and LDL-c, all other metabolic syndrome components were significantly different (p < 0.05) between those with and without metabolic syndrome. Significant differences between metabolic syndrome and non-metabolic syndrome groups were found for weight, BMI, waist circumference, body fat percentage and cancer stages (p < 0.05). However, no significant relationship was reported between sociodemographic, clinical parameters and metabolic syndrome among breast cancer survivors in this study. Conclusions Metabolic syndrome was highly prevalent among breast cancer survivors. It is recommended for health care professionals to closely monitor and improve the triglycerides, blood glucose and HDL-c level of the breast cancer survivors under their care to control the detrimental effect of metabolic syndrome. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10288-9.
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Affiliation(s)
- Mohd Razif Shahril
- Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia. .,Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus, Kuala Nerus, 21300, Kuala Terengganu, Terengganu, Malaysia.
| | - Syed Amirfaiz
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus, Kuala Nerus, 21300, Kuala Terengganu, Terengganu, Malaysia
| | - Pei Lin Lua
- Faculty of Pharmacy, Universiti Sultan Zainal Abidin, Besut Campus, Besut, 22200, Kuala Terengganu, Terengganu, Malaysia
| | - Ali Nurnazahiah
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus, Kuala Nerus, 21300, Kuala Terengganu, Terengganu, Malaysia
| | - Nor Syamimi Zakarai
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus, Kuala Nerus, 21300, Kuala Terengganu, Terengganu, Malaysia
| | - Ving Lok Kow
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus, Kuala Nerus, 21300, Kuala Terengganu, Terengganu, Malaysia
| | - Aryati Ahmad
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus, Kuala Nerus, 21300, Kuala Terengganu, Terengganu, Malaysia
| | - Suhaina Sulaiman
- Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
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Prevalence and associated factors of metabolic syndrome among a national population-based sample of 18–108-year-olds in Iraq: results of the 2015 STEPS survey. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-020-00912-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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Tladi D, Mokgatlhe L, Nell T, Shaibu S, Mitchell R, Mokgothu C, Gabonthone T, Hubona O. Prevalence of the Metabolic Syndrome Among Batswana Adults in Urban and Semi-Urban Gaborone. Diabetes Metab Syndr Obes 2021; 14:2505-2514. [PMID: 34113142 PMCID: PMC8186999 DOI: 10.2147/dmso.s285898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/07/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The metabolic syndrome (MetS) is on the rise in Sub-Saharan Africa, attributed to increased and uncontrollable urbanization accompanied by its lifestyle changes. Non-communicable diseases, such as hypertension, diabetes, and obesity, which are components of the (MetS) are also on the increase in Botswana. To date, no study has determined the prevalence of the MetS in the apparently healthy Batswana adults. The objective of the study was to determine the prevalence of the MetS among the 25-65-year-old Batswana residing in urban and neighboring semi-urban areas of Gaborone. PARTICIPANTS AND METHODS A cross-sectional study was used to collect data from N=794 participants, n=383 men and n=411 women, residing in Gaborone and two surrounding semi-urban areas. Data collected included demographic, anthropometric measurements, blood pressure (BP), blood glucose, triglycerides, high-density lipoprotein cholesterol (HDL-C) and total cholesterol. RESULTS A high prevalence of 26.8% was reported, with women mostly afflicted (35.0% vs 18.0%). The MetS risk factors found to be common in women were low HDL-C at (50% vs 48.7%) compared to men, while proportions with elevated BP (50.3% vs 39.4%) were prominent in men. The prevalence increased with age, with the oldest age group showing a higher prevalence in both women and men, respectively (55-65 years; 38.5% vs 41.2%). CONCLUSION An unprecedented high MetS prevalence was revealed among perceived to be healthy Batswana adults, with women at a higher risk. This public health concern creates an opportunity to establish evidence of risk factors, develop guidelines and strategies with appropriate public health measures to prevent and control the MetS.
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Affiliation(s)
- Dawn Tladi
- Department of Sport Science, University of Botswana, Gaborone, Botswana
- Correspondence: Dawn Tladi Department of Sport Science, Private Bag 00702, Gaborone, BotswanaTel +267 71896028Fax +267 3185096 Email
| | - Lucky Mokgatlhe
- Department of Statistics, University of Botswana, Gaborone, Botswana
| | - Theo Nell
- Centre for Cardio-metabolic Research in Africa (CARMA), Integrated Metabolic Research Group, Department of Physiological Sciences, Faculty of Natural Sciences, University of Stellenbosch, Stellenbosch, 7600, South Africa
| | - Sheila Shaibu
- School of Nursing and Midwifery, The Aga Khan University, Nairobi, Kenya
| | | | - Comfort Mokgothu
- Department of Sport Science, University of Botswana, Gaborone, Botswana
| | - Tebogo Gabonthone
- Department of Sport Science, University of Botswana, Gaborone, Botswana
| | - Omphile Hubona
- Department of Sport Science, University of Botswana, Gaborone, Botswana
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Nowicki GJ, Ślusarska B, Naylor K, Prystupa A, Rudnicka-Drożak E, Halyuk U, Pokotylo P. The Relationship Between the Metabolic Syndrome and the Place of Residence in the Local Community on the Example of the Janów Lubelski District in Eastern Poland: A Population-Based Study. Diabetes Metab Syndr Obes 2021; 14:2041-2056. [PMID: 33986605 PMCID: PMC8110259 DOI: 10.2147/dmso.s301639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/20/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The aim of this study was to estimate the incidence concerning metabolic syndrome (MetS) in a local community with a low socioeconomic status and a medium and high cardiovascular risk on the example of residents of Janów Lubelski district, eastern Poland. The second goal of the research was to analyze the relationship between residence and the occurrence of MetS. METHODS We conducted a cross-sectional study of 4040 people living in eastern Poland. A group of 3046 people with medium and high cardiovascular risk was selected among the respondents and included in further analyzes. The research adopted the definition criteria proposed by the National Cholesterol Education Program - Third Adult Treatment Panel (NCEP ATP III) to implement diagnostic evaluation of MetS. RESULTS It was observed that metabolic syndrome was significantly more frequent among the inhabitants of rural areas (40.56%; n=810) compared to those living in the city (35.27%; n=370) p=0.005. Among the inhabitants of rural areas, the percentage of people with elevated glucose levels was significantly higher, fasting blood glucose (FGB) p<0.001, elevated blood pressure (HBP) p<0.001, elevated serum triglycerides (TGs) p=0.01, and abnormal waist circumference (WC) p=0.003 compared to urban inhabitants. After adjusting for potential confounding variables (age, education, smoking, marital status, and level of physical activity), in both women and men, the odds of developing metabolic syndrome were approximately 30% higher in rural areas compared to urban residents (women: odds ratio (OR)=1.25, 95% confidence intervals (CI)=1.01-1.56; men: OR=1.30, 95% CI=1.01-1.67). CONCLUSION AND RECOMMENDATIONS A higher incidence of metabolic syndrome was observed among respondents living in rural areas than those living in cities. Similarly, across the gender strata, metabolic syndrome is more commonly diagnosed among men and women living in rural areas. Healthcare workers, especially in rural areas, should engage in education, prevention, and the promotion of a healthy lifestyle.
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Affiliation(s)
- Grzegorz Józef Nowicki
- Department of Family Medicine and Community Nursing, Medical University of Lublin, Lublin, Poland
- Correspondence: Grzegorz Józef Nowicki Department of Family Medicine and Community Nursing, Medical University of Lublin, Staszica 6 Street, PL-20-081, Lublin, PolandTel +48 81448 6810Fax +48 81448 6811 Email
| | - Barbara Ślusarska
- Department of Family Medicine and Community Nursing, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Naylor
- Department of Didactics and Medical Simulation, Medical University of Lublin, Lublin, Poland
| | - Andrzej Prystupa
- Department of Internal Medicine, Medical University of Lublin, Lublin, Poland
| | | | - Ulyana Halyuk
- Department of Normal Anatomy, Lviv National Medical University, Lviv, Ukraine
| | - Petro Pokotylo
- Department of Normal Anatomy, Lviv National Medical University, Lviv, Ukraine
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Meher T, Sahoo H. The epidemiological profile of metabolic syndrome in Indian population: A comparative study between men and women. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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14
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Poudyal IP, Khanal P, Mishra SR, Malla M, Poudel P, Jha RK, Phuyal A, Barakoti A, Adhikari B. Cardiometabolic risk factors among patients with tuberculosis attending tuberculosis treatment centers in Nepal. BMC Public Health 2020; 20:1364. [PMID: 32891134 PMCID: PMC7487625 DOI: 10.1186/s12889-020-09472-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The co-morbidity of cardiometabolic diseases in patients with Tuberculosis adds a significant burden in current health systems in developing countries including Nepal. The main objective of this study was to explore cardiometabolic risk factors among patients with Tuberculosis. METHODS This was a cross-sectional study conducted among patients with tuberculosis in 12 tuberculosis treatment centers from eight districts of Nepal between May and July 2017. Interviews with participants were conducted using a structured questionnaire and were supplemented by anthropometric measurements and on-site blood glucose tests. Data were analyzed using descriptive and inferential statistics. RESULTS Among 221 study participants, 138 (62.4%) had new smear-positive pulmonary tuberculosis, 24 (10.9%) had new smear-negative pulmonary tuberculosis and 34 (15.4%) had new extra- pulmonary tuberculosis. Overall, 43.1% of the patients with tuberculosis had at least one cardiometabolic risk factor. The prevalence of at least one cardiometabolic risk factor was more in male than female (47.8% versus 33.8%). Prevalence of tobacco (18.9% versus 4.8%), and alcohol (12.6% versus 6.5%) use was proportionately higher in male compared to female. The prevalence of hypertension (17% vs. 21%) and obesity (11.9% vs. 12.9%) was lower in male compared to females. Female (AOR = 0.47; CI: 0.23-0.94), those from Gandaki Province (AOR = 0.32; CI: 0.13-0.79) and literate (AOR = 0.49; CI: 0.25-0.96) had reduced risk of cardiometabolic disease risk factors. CONCLUSIONS This study highlights the role of gender and socio-demographic characteristics associated with the risk of cardiometabolic diseases in patients with Tuberculosis. The findings from this study can guide medical practitioners and policy makers to consider clinical suspicion, diagnosis and treatment. National treatment guideline can benefit by integrating the management of non-communicable diseases in Tuberculosis treatment centers.
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Affiliation(s)
| | - Pratik Khanal
- Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Shiva Raj Mishra
- Nepal Development Society, Bharatpur, Chitwan Nepal
- Queensland University, Brisbane, Queensland Australia
| | - Milan Malla
- Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Prakash Poudel
- Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Raj Kumar Jha
- Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Anil Phuyal
- Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Abiral Barakoti
- Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Bipin Adhikari
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Pengpid S, Peltzer K. Prevalence and correlates of the metabolic syndrome in a cross-sectional community-based sample of 18-100 year-olds in Morocco: Results of the first national STEPS survey in 2017. Diabetes Metab Syndr 2020; 14:1487-1493. [PMID: 32795740 DOI: 10.1016/j.dsx.2020.07.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIM Metabolic syndrome (MetS) may be associated with diabetes and cardiovascular diseases. This investigation assessed prevalence and correlates of MetS among adults (18-100 years) in Morocco. METHOD Cross-sectional data with complete MetS measurements were analysed from 4555 18-100 year old individuals (median age = 40 years) that took part in the "2017 Morocco STEPS survey." MetS was classified using the harmonized definition. RESULTS Two in five participants (40.0%) had MetS, 31.9% among men and 48.0% among women. The average frequency of the five MetS components was 1.9 (1.3 = SD) among men and 2.5 (1.1 = SD) among women. In adjusted logistic and linear regression models, general overweight/obesity, older age, female sex, abnormal waist to hip ratio and low physical activity were associated with the prevalence of MetS and the greater average frequency of MetS components. In addition, in unadjusted analysis, higher education, never married, current smoking and current alcohol use were negatively and urban residence and sedentary behaviour were positively associated with MetS. CONCLUSION The study showed that two in five adults were identified as having MetS and that several predictors of MetS were found.
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Affiliation(s)
- Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand; Department of Research Administration and Development, University of Limpopo, Polokwane, South Africa
| | - Karl Peltzer
- Department for Management of Science and Technology Development, Ton Duc Thang University, Ho Chi Minh City, Viet Nam; Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City, Viet Nam.
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Shrestha N, Mishra SR, Ghimire S, Gyawali B, Mehata S. Burden of Diabetes and Prediabetes in Nepal: A Systematic Review and Meta-Analysis. Diabetes Ther 2020; 11:1935-1946. [PMID: 32712902 PMCID: PMC7434818 DOI: 10.1007/s13300-020-00884-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Unhealthy behaviors, such as energy-dense food choices and a sedentary lifestyle, both of which are established risk factors for diabetes, are common and increasing among Nepalese adults. Previous studies have reported a wide variation in the prevalence of prediabetes and diabetes in Nepal, and thus a more reliable pooled estimate is needed. Furthermore, Nepal underwent federalization in 2015, and the province-specific prevalence, which is necessary for the de novo provincial government to formulate local health policies, is lacking. This study aims to provide a comprehensive summary of the current literature on various aspects of diabetes in Nepal, i.e., the prevalence of prediabetes and diabetes as well as of the awareness, treatment, and control of diabetes in Nepal. METHODS This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched three electronic databases-PubMed, Scopus, and Web of Science-using a comprehensive search strategy to identify eligible studies published up to April 2, 2020. Data on prevalence estimates of prediabetes and diabetes were extracted and pooled in a meta-analysis using a random effect model. Subgroup analyses and meta-regression were conducted to assess heterogeneity across the studies. The quality of included studies was assessed using the New Castle-Ottawa scale. RESULTS We included 14 eligible studies that comprised a total of 44,129 participants and 3517 diabetes cases. Half of the included studies had good quality. Overall, the prevalence of prediabetes and diabetes was 9.2% (95% CI 6.6-12.6%) and 8.5% (95% CI 6.9-10.4%), respectively. Among the participants with diabetes, only 52.7% (95% CI 41.7-63.4%) were aware of their diabetes status, and 45.3% (95% CI 31.6-59.8%) were taking antidiabetic medications. Nearly one-third of those under antidiabetic treatment (36.7%; 95% CI 21.3-53.3%) had their blood glucose under control. The prevalence of prediabetes and diabetes gradually increased with increasing age and was more prevalent among males and urban residents. There was a wide variation in diabetes prevalence across the provinces in Nepal, the lowest 2% in Province 6 to the highest 10% in Province 3 and Province 4. CONCLUSIONS The prevalence of prediabetes and diabetes was high in Nepal, while its awareness, treatment, and control were low. Our findings call for urgent nationwide public health action in Nepal.
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Affiliation(s)
- Nipun Shrestha
- Institute for Health and Sport (IHeS), Victoria University, Melbourne, Australia
| | | | - Saruna Ghimire
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Bishal Gyawali
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Suresh Mehata
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
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Dejavitte RAS, Enes CC, Nucci LB. Prevalence of metabolic syndrome and its associated factors in overweight and obese adolescents. J Pediatr Endocrinol Metab 2020; 33:233-239. [PMID: 31804963 DOI: 10.1515/jpem-2019-0369] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/13/2019] [Indexed: 02/06/2023]
Abstract
Background Metabolic syndrome (MetS) is not only a problem of adulthood but is already present in children and adolescents. The aim of this study was to estimate the prevalence of MetS in adolescents and to identify the associated factors. Methods This was a cross-sectional study with 354 overweight and obese school-aged adolescents (10-19 years). Sociodemographic, anthropometric, clinical, biochemical and lifestyle variables were collected. MetS was identified according to the criteria proposed by the International Diabetes Federation (IDF). Multivariate logistic regression models were used to examine the associations between risk variables and MetS. Results The prevalence of MetS was 9.6%. Among adolescents with MetS, all of them had low high-density lipoprotein cholesterol (HDL-c), while 76.5% had hyperglycemia and 38.2% had hypertriglyceridemia. Only 12.1% did not present any component of MetS, while 40% had at least two components. Multivariate analysis showed that being a girl was a protective factor (odds ratio [OR] = 0.29, confidence interval [CI] = 0.13-0.65) for the presence of MetS, while obesity (OR = 3.63, CI = 1.62-8.17) and being insufficiently active (OR = 4.60, CI = 1.01-20.96) were the risk factors for MetS. Conclusions Obese and insufficiently active male adolescents are more likely to have MetS. Early identification of MetS components, especially among obese adolescents, is an important tool for the prevention of cardiovascular complications in adult life.
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Affiliation(s)
- Rosemeire A S Dejavitte
- Master in Health Sciences from the Pontifical Catholic University of Campinas (PUC-Campinas), Campinas, Sao Paulo, Brazil
| | - Carla C Enes
- Pontifical Catholic University of Campinas (PUC-Campinas), Center for Life Sciences, Postgraduate Program in Health Sciences, Campinas, Brazil
| | - Luciana B Nucci
- Pontifical Catholic University of Campinas (PUC-Campinas), Center for Life Sciences, Postgraduate Program in Health Sciences, Campinas, Brazil
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The burden and correlates of multiple cardiometabolic risk factors in a semi-urban population of Nepal: a community-based cross-sectional study. Sci Rep 2019; 9:15382. [PMID: 31653888 PMCID: PMC6814741 DOI: 10.1038/s41598-019-51454-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/01/2019] [Indexed: 01/21/2023] Open
Abstract
This study assessed the burden and correlates of three cardiometabolic risk factors, (hypertension, diabetes, and overweight/obesity), and their possible clustering patterns in a semi-urban population of Nepal. Data were obtained from a community-based management of non-communicable disease in Nepal (COBIN) Wave II study, which included 2,310 adults aged 25-64 years in a semi-urban area of Pokhara Metropolitan City of Nepal, using the World Health Organization-STEPS questionnaire. Unadjusted and adjusted binary logistic regression models were used to study the correlates of the individual risk factors and their clustering. The prevalence of hypertension, diabetes, and overweight/obesity was 34.5%, 11.7%, and 52.9%, respectively. In total, 68.2% of the participants had at least one risk factor and many participants had two risks in combination: 6.8% for 'hypertension and diabetes', 7.4% for 'diabetes and overweight/obesity' and 21.4% for 'hypertension and overweight/obesity'. In total, 4.7% had all three risk factors. Janajati ethnicity (1.4-2.1 times), male gender (1.5 times) and family history of diabetes (1.4-3.4 times) were associated with presence of individual risk factors. Similarly, Janajati ethnicity (aOR: 4.31, 95% CI: 2.53-7.32), current smoking (aOR: 4.81, 95% CI: 2.27-10.21), and family history of diabetes (aOR: 4.60, 95% CI: 2.67-7.91) were associated with presence of all three risk factors. Our study found a high prevalence of all single and combined cardiometabolic risk factors in Nepal. It underlines the need to manage risk factors in aggregate and plan prevention activities targeting multiple risk factors.
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Pedisic Z, Shrestha N, Loprinzi PD, Mehata S, Mishra SR. Prevalence, patterns, and correlates of physical activity in Nepal: findings from a nationally representative study using the Global Physical Activity Questionnaire (GPAQ). BMC Public Health 2019; 19:864. [PMID: 31269984 PMCID: PMC6610855 DOI: 10.1186/s12889-019-7215-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/20/2019] [Indexed: 12/24/2022] Open
Abstract
Background The promotion of a physically active lifestyle might help address the increasing burden of non-communicable diseases in Nepal. However, there is a lack of nationally representative estimates of physical activity (PA) prevalence in Nepal. The aim of this nationwide cross-sectional study was to determine domain-specific PA levels and the association of socio-demographic and lifestyle characteristics with total PA among Nepalese adults aged 15–69 years. Methods The data were collected using self-administered questionnaires in a nationally representative sample of 4143 adults (66.5% females), comprised of both rural and urban populations in Nepal. PA levels were assessed using the Global Physical Activity Questionnaire (GPAQ). Results Based on self-reported estimates, around 97% (95% confidence interval [CI]: 96–98%) of men and 98% (95% CI: 98–99%) of women were found to meet the recommended levels of PA. Both men and women reported high occupational PA, whilst most participants of both sexes did not report engaging in any leisure-time PA. A multiple regression analysis showed that less self-reported total PA was associated with older age, higher level of education, urban place of residence, never been married, being underweight, and smoking in both sexes and with overweight and obesity in males (p < 0.05 for all). Conclusion According to self-reported estimates, majority of Nepalese men and women are meeting the recommended levels of PA. The total self-reported PA in Nepalese adults is high, because many of them have labour intensive jobs. Although older age, higher level of education, urban place of residence, never been married, being underweight, and smoking in both sexes, as well as overweight and obesity in males were inversely associated with self-reported PA, the overall level of PA in all these groups was very high. Given the high overall self-reported PA found in the current study, promoting more PA in Nepal may not be as important as in some other countries; not even in the population groups for which we found a negative association with PA. Nevertheless, future studies should examine whether a more balanced distribution of occupational and leisure-time PA would promote better health among Nepalese adults. Electronic supplementary material The online version of this article (10.1186/s12889-019-7215-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | - Nipun Shrestha
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Paul D Loprinzi
- Physical Activity Epidemiology Laboratory, Exercise Psychology Laboratory, Department of Health, Exercise Science and Recreation Management, The University of Mississippi, Oxford, USA
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