Assessing obesity and overweight in a high mountain Pakistani population

Intimate-partner violence and its association with symptoms of depression, perceived health, and quality of life in the Himalayan Mountain Villages of Gilgit Baltistan

Study objectives

We aimed to estimate the prevalence of intimate partner violence (IPV) and associated risk factors in married women in rural villages of Gilgit Baltistan in Pakistan.

Methods

A cross-sectional design to assess the magnitude and factors associated with IPV in a random sample of 789 married women aged 18–49 years. A World Health Organization screening instrument was used to assess the presence of IPV in the previous 12 months. A locally validated instrument was adopted to identify self-reported symptoms of major depression according to the DSM IV. Trained nurses obtained socio-demographic and reproductive history through structured interviews. Bivariate and multivariable logistic regression analyses were used to estimate prevalence and identify significant predictors of IPV.

Results

The mean age of the participants was 38.3 years (SD: ±12.8). The prevalence of IPV in women was 22.8% (95% Confidence Interval: 20.0–25.9), 18.5% in pregnant women (95% CI: 11.7–27.9) and significantly associated with depression in 55.1% of IPV cases. Husband education level (college/higher) (Adjusted Odds Ratio: 0.40; 95%CI: 0.22–0.70) and high household income (AOR: 0.44; 95% CI: 0.29–0.68) were protective against IPV. Increase in age (AOR;1.02; 95% CI: 1.01–1.02) and poor relationship with mother-in-law increased the risk of IPV (AOR = 2.85; 95% CI: 1.90–4.28). IPV was positively associated with symptoms of depression (AOR = 1.97; 95% CI:1.39–2.77), poor perceived quality of life (AOR = 3.54; 95% CI: 1.90–6.58) and poor health (AOR = 2.74; 95% CI: 1.92–3.92).

Conclusion

IPV is substantial public health burden significantly associated with depressive symptoms, poor perceived health and the quality of life.

Cardiovascular Risk Is Increased in Miner's Chronic Intermittent Hypobaric Hypoxia Exposure From 0 to 2,500 m?

Over the past 40 years, mining activities in Chile have relocated miners who normally live at sea level to work at high altitudes. This results in a form of chronic intermittent hypobaric hypoxia (CIHH) characterized by alternating periods of work at high altitude and rest periods at sea level. Previous studies performed in our laboratory showed that aerobic capacity is reduced at 3,800 m, even when oxygen content is maintained. Our study aimed to determine the corporal composition, food intake, maximum oxygen uptake, and concentration of high sensitivity C reactive protein (hsCRP) in an acclimatized miner population that work from 0 to 2,500 m with CIHH exposure over 4 years. All miners recruited for our study were operators of heavy trucks with CIHH for over 4 years (shiftwork 7*7 days), and our experimental population was composed of 54 miners at sea level, 61 at 1,600 m, and 38 at 2,500 m. All evaluations were performed on the 3rd or 4th day of diurnal shiftwork. To determine corporal composition, we measured weight and height (to calculate body mass index, BMI), skinfolds (to calculate body fatty, BF), and waist circumference (WC); maximal aerobic capacity was evaluated using a ramp-incremental cycling to exhaustion protocol and a venous blood sample before the exercise test to measure (hsCRP) via an ELISA test. We found higher values of BMI, BF, and WC, in the miners' population but observed no significant difference between populations. We found a decrease in VO₂ of 11.6% at 1,600 m and 25.9% at 2,500 m compared to miners at sea level. An increase in (hsCRP) at 1,600 and 2,500 m regards sea level. We observed a high prevalence of overweight and obese subjects, which was related to the ad libitum availability of food and low physical activity (sedentarism). We found that work capacity was maintained despite a decreased VO₂ max at moderate altitude. However, overweight and obesity support an increased risk of cardiometabolic disease in miner's which is unrelated to altitude. In contrast, an increased hsCRP level could be associated with increased inflammatory mechanisms at 1,600 and 2,500 m.

Correlation between central obesity and blood pressure in an adult Nigerian population

Background: Obesity has been recognised as a major risk factor in the pathogenesis of cardiovascular disease. The aim of this study is to determine the prevalence of central obesity [using waist–hip ratio (WHR) as an indicator] and the correlation between central obesity and blood pressure (BP) in adults seen in a Nigerian tertiary health facility.Materials and methods: The study was a cross-sectional design carried out between February and November 2015 at the General Outpatient Clinic of the Federal Medical Centre, Owerri, Nigeria. A total of 482 consenting adults aged 16–40 years formed the study population. Consecutive sampling was used in the recruitment of subjects, whereas data were collected by the use of an interviewer-administered questionnaire.Results: The mean age of the study population was 25.37 ± 5.49, whereas the mean WHR for men and women was 0.83 ± 0.04 and 0.82 ± 0.05, respectively. The prevalence of central obesity in the study population was 39.4% (n = 190). Female respondents had a higher prevalence (59.2%) than male respondents (8.5%), and the relationship between central obesity and sex was statistically significant (p = 0.001). Correlation analysis showed a positive correlation between WHR and BP (diastolic BP: r = 0.122, p = 0.008; systolic BP: r = 0.015, p = 0.742) in both sexes. Obese respondents were observed to be more likely to develop hypertension than the non-obese respondents.Conclusion: This study showed a correlation between central obesity and BP in adults aged 16–40 years.

Glucose homeostasis during short-term and prolonged exposure to high altitudes

Most of the literature related to high altitude medicine is devoted to the short-term effects of high-altitude exposure on human physiology. However, long-term effects of living at high altitudes may be more important in relation to human disease because more than 400 million people worldwide reside above 1500 m. Interestingly, individuals living at higher altitudes have a lower fasting glycemia and better glucose tolerance compared with those who live near sea level. There is also emerging evidence of the lower prevalence of both obesity and diabetes at higher altitudes. The mechanisms underlying improved glucose control at higher altitudes remain unclear. In this review, we present the most current evidence about glucose homeostasis in residents living above 1500 m and discuss possible mechanisms that could explain the lower fasting glycemia and lower prevalence of obesity and diabetes in this population. Understanding the mechanisms that regulate and maintain the lower fasting glycemia in individuals who live at higher altitudes could lead to new therapeutics for impaired glucose homeostasis.

Prevalence of obesity and overweight and their related factors among the adults of Mazandaran Province, Iran, in 2010

Background:

Obesity is an unpleasant outcome of changes in the behavior and lifestyle, and it leads to premature inability and loss of job in most cases. This study aimed at determining the prevalence of obesity and overweight conditions and some related factors among the adults in Mazandaran Province, Iran.

Methods:

This cross-sectional study was conducted in 2010. The data collection tool was a standard questionnaire provided by the World Health organization (WHO).The sample of this study was selected from all people in the age range of 15 to 64 who lived in the urban and rural areas of Mazandaran Province. The researchers studied 1000 people (500 males and 500 females). The data were analyzed using mean, standard deviation, chi-squared, linear regression, and Logistic regression in SPSS version 16 software.

Results:

The average and the standard deviation of Body Mass Index (BMI) of the participants was 27.36±6.04 (25.76±4.5 for males and 28.95±6.9 for females), and the average prevalence of overweight was 34% (males: 35.8%, females: 32.2%); the average incidence of obesity was 28.4% (males: 17.8%, females: 39%).It was found that age groups of 35–44 (OR: 3.1, CI: 95%: 1.7–5.8), 45–54 (OR: 3.1, CI: 95%: 1.7–5.8), and 55–64 (OR: 4.02, CI: 95%: 2.1–7.5) and being a housewife (OR: 2.3, 95% CI: 1.03–5.1) were predictive of BMI values equal to or greater than 30.

Conclusion:

The results of this study showed that the prevalence of overweight and obesity was significant among people of Mazandaran Province. Therefore, it is recommended that educational-research centers and health authorities look for appropriate strategies to reduce the prevalence of this problem.

Chronic intermittent high altitude exposure, occupation, and body mass index in workers of mining industry

The obesity and overweight rates in population exposed to chronic intermittent exposure to high altitudes are not well studied. The aim of the retrospective study was to evaluate whether there are differences in body mass index in different occupation groups working in intermittent shifts at mining industry at high altitude: 3800-4500 meters above sea level. Our study demonstrated that obesity and overweight are common in workers of high altitude mining industry exposed to chronic intermittent hypoxia. The obesity rate was lowest among miners as compared to blue- and white-collar employees (9.5% vs. 15.6% and 14.7%, p=0.013). Obesity and overweight were associated with older age, higher rates of increased blood pressure (8.79% and 5.72% vs. 1.92%), cholesterol (45.8% and 45.6% vs. 32.8%) and glucose (4.3% and 1.26% vs. 0.57%) levels as compared to normal body mass index category (p<0.0001 for all). There were differences in patterns of cholesterol and glucose levels in men and women employees according to occupation type. In conclusion, obesity and overweight rates are prevalent and associated with increase in blood pressure, cholesterol, and glucose levels in workers of mining industry exposed to intermittent high-altitude hypoxia. Therefore, assessment and monitoring of body mass index seems to be essential in those who live and work at high altitudes to supply the correct nutrition, modify risk factors, and prevent related disorders.

The risk of colonic adenomas and colonic cancer in obesity

Increasing body fatness has been associated with an increased burden from colorectal cancer. An increased susceptibility spanning the entire continuum from precancerous adenomatous polyps to the development of colorectal cancer, poor outcome with treatment, and reduced survival when compared to those with normal body weight has been described. It is unknown which age period and which degree and duration of excess weight are associated with increased colorectal cancer risk. It is uncertain whether weight loss can reverse this risk. If it can, how long will the new lower or normal weight be maintained to effect enduring risk reduction? Furthermore, it is controversial whether the increased burden of colorectal cancer warrants earlier and/or more frequent screening for obese persons. This article reviews the relationship between obesity and colorectal neoplasia, explores the postulated mechanism of carcinogenesis, discusses interventions to reduce the burden of disease, and suggests future directions of research.

Hypoxia, energy balance and obesity: from pathophysiological mechanisms to new treatment strategies

High altitude exposure is often accompanied by weight loss. Postulated mechanisms are a reduction of nutritional energy intake, a reduction of intestinal energy uptake from impaired intestinal function and increased energy expenditure. Beyond the field of altitude, there are good reasons for renewed interest in the relationship between hypoxia and energy balance. The increasing prevalence of obesity and associated comorbidities represent a major health concern. Obesity is frequently associated with sleep disorders leading to intermittent systemic hypoxia with deleterious cardiovascular and metabolic consequences. Hypoxic regions may be present within hypertrophic white adipose tissue leading to chronic systemic inflammation. Among the increasing number of people commuting to altitude for work or leisure, obesity is a risk factor for acute mountain sickness. Paradoxically, exposure to intermittent hypoxia might be considered as a means to lose body mass and to improve metabolic risk factors. Daytime exposure to intermittent hypoxia has been used to treat hypertension in former Soviet Union countries and is now being experimented elsewhere. Such intermittent hypoxic exposure at rest or during exercise may lead to improvement in body composition and health status with improved exercise tolerance, metabolism and systemic arterial pressure. Future research should confirm whether hypoxic training could be a new treatment strategy for weight loss and comorbidities in obese subjects and elucidate the underlying mechanisms and signalling pathways.

Non-communicable diseases and injuries in Pakistan: strategic priorities

Non-communicable diseases, including cardiovascular diseases, cancers, respiratory diseases, diabetes, and mental disorders, and injuries have become the major causes of morbidity and mortality in Pakistan. Tobacco use and hypertension are the leading attributable risk factors for deaths due to cardiovascular diseases, cancers, and respiratory diseases. Pakistan has the sixth highest number of people in the world with diabetes; every fourth adult is overweight or obese; cigarettes are cheap; antismoking and road safety laws are poorly enforced; and a mixed public-private health-care system provides suboptimum care. Furthermore, almost three decades of exposure to sociopolitical instability, economic uncertainty, violence, regional conflict, and dislocation have contributed to a high prevalence of mental health disorders. Projection models based on the Global Burden of Disease 2010 data suggest that there will be about 3·87 million premature deaths by 2025 from cardiovascular diseases, cancers, and chronic respiratory diseases in people aged 30-69 years in Pakistan, with serious economic consequences. Modelling of risk factor reductions also indicate that Pakistan could achieve at least a 20% reduction in the number of these deaths by 2025 by targeting of the major risk factors. We call for policy and legislative changes, and health-system interventions to target readily preventable non-communicable diseases in Pakistan.

Obesity and cardiovascular disease risk factors among the indigenous and immigrant Pakistani population: a systematic review

AIM

The aim of this study was to systematically describe the gender and ethnic differences regarding the prevalence of general/central obesity and cardiovascular disease (CVD) risk factors such as diabetes mellitus type 2, hypertension, and hypercholesterolemia among the indigenous and immigrant Pakistani communities.

METHODS

The search engine used was PubMed, supplemented with regional data from the Medical Institutes of Pakistan. The focus was on the adult Pakistani population (18 years and older).

RESULTS

We found only 7 studies among the immigrant Pakistani community and 24 studies among the indigenous Pakistani community. The studies had limitations such as low participation rates and use of self-reported data. There is a higher prevalence of central obesity among women (42.2%) than among men (14.7%) (National Health Survey of Pakistan). Certain ethnicities such as Muhajir and Baluchis showed a higher prevalence of cardiovascular risk factors when compared to other ethnicities in the indigenous Pakistani population. The results also indicate that the prevalence of obesity is 10-20% higher among the immigrant Pakistanis than in the indigenous Pakistanis.

CONCLUSION

The relatively high prevalence of obesity and associated CVD risk factors (especially in women) among both indigenous and immigrant Pakistani populations require the attention of the healthcare professionals and policy makers, both inside and outside Pakistan.

Relationship between anthropometric variables and nutrient intake in apparently healthy male elderly individuals: a study from Pakistan

BACKGROUND

The elderly population is increasing worldwide, which warrants their nutritional status assessment more important. The present study was undertaken to establish the nutritional status of the least-studied elderly population in Pakistan.

METHODS

This was a cross-sectional study with a sample of 526 generally healthy free-living elderly men (mean age: 68.9 yr; range: 50-98 yr) from Peshawar, Pakistan. Anthropometric measurements (weight, height, WC) were measured and BMI and WHR were calculated from these measurements following WHO standard procedures. Dietary intake was assessed by 24-hr dietary recall. Nutrients were calculated from the information on food intake. Nutrients in terms of % of RNI were calculated using WHO data on recommended intakes.

RESULTS

Based on BMI, the numbers of obese, overweight and underweight elderly were 13.1, 3.1 and 10.8%, respectively. Age was negatively and significantly correlated with BMI (p = 0.0028). Energy (p = 0.0564) and protein intake (p = 0.0776) tended to decrease with age. There was a significant increase in % BF with age (p = <0.0001). The normal weight elderly had significantly (p < 0.05) higher intake of all nutrients studied, except energy which was significantly (p < 0.05) higher in obese and overweight elderly. Overall, however, the majority of subjects had lower than adequate nutrient intake (67.3 - 100% of recommendation).

CONCLUSIONS

Malnutrition is common in apparently healthy elderly Pakistani men. Very few elderly have adequate nutrient intake. Obese and overweight had higher % BF as compared to normal weight elderly. Older age is associated with changes not only in anthropometrics and body composition but also in intake of key nutrients like energy and protein.

Obesity in Tibetans aged 30-70 living at different altitudes under the north and south faces of Mt. Everest

Risk factors for chronic diseases in Tibetans may be modified due to hypobaric hypoxia. The objectives of this study were to determine the prevalence of obesity at varying altitudes of 1,200, 2,900 and 3,700 meters above sea-level in Tibet and Nepal; to estimate the effect of altitude on body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR). Three cross-sectional studies with simple random sampling were performed on 617 men and women. BMI, WC and WHtR decreased with increasing altitude. It is likely that the physical conditions such as low temperatures and low oxygen levels have a direct catabolic effect.

Snuff use associated with abdominal obesity in former smokers

Aim: To describe the consumption of snuff in a rural male population and to explore associations between snuff use and obesity. Participants and Methods: Tobacco use was explored in 834 men aged 30—75 years old who participated in a cross-sectional population survey in the municipality of Vara (participation rate was 81%). Self-reported questionnaires assessed the habits of smoking and snuff use. Anthropometric measures were obtained during a health examination. Results: Of these men 21% (n = 179) were snuff users, 13% (n = 109) current smokers, and 65% (n = 546) were non-users. Of all snuff users 65% (n = 116) were former smokers, and 35% (n = 63) were exclusive snuff users (current users who never smoked). Among non-users 65% (n = 357) were never users and 35% (n = 189) had quit smoking without nicotine substitution. These men were characterized by abdominal obesity; OR 1.84 (1.08—3.12) (p = 0.002) (WHR 41.0) and OR 1.71 (1.08—2.72) (p = 0.022) (waist circumference 4102 cm). One can/week use of snuff among ex-smokers was associated with a 1.21 cm wider (0.05—2.36) (p = 0.041) waist circumference and 0.01 (0.00—0.02) units higher (p = 0.021) WHR. There were statistically significant associations between former smoking without current nicotine substitute and both general and abdominal obesity. No similar association with abdominal obesity was seen among exclusive snuff users. Conclusions: Abdominal obesity in current snuff users is limited to former smokers. The remaining effect of previous smoking has to be considered in future studies on obesity and related disorders in snuff users. Counselling among people who substitute snuff for smoking should include measures to prevent weight gain.