Trends in overweight by educational level in 33 low- and middle-income countries: the role of parity, age at first birth and breastfeeding

Comparative assessment of overweight/obesity among rural and urban reproductive-age women in Ethiopia: Evidence from a cross-sectional 2016 national survey

BACKGROUND

Overweight/obesity has become a global health problem for both developed and developing regions. Nowadays, overweight/obesity among childrearing-age women has become rapidly increasing in both urban and rural areas.

AIM

This study aimed to assess the variation of overweight/obesity among urban and rural reproductive-age women in Ethiopia.

METHODS

For this study, the 2016 Ethiopia Demographic and Health Survey data were used. The survey was a community-based cross-sectional study, which used a two-stage stratified cluster sampling technique to select the participants. A total of 13,451 reproductive-age women were included in the analysis. Both descriptive and analytical analysis was performed. A p-value of less than 0.05 was used as the measure of statistical significance.

RESULTS

The prevalence of overweight/obesity among urban reproductive-age women was statistically higher (p = 21.5%; 95% confidence interval (CI): 18.2-25.1) than the rural women (p = 3.5%; 95% CI: 2.9%-4.2%). Women who attend secondary or above education, women in the age groups 25-34 and ≥ 35 years, and high wealth index (rich) had higher odds of overweight/obesity in both urban and rural women. Moreover, women who were married, who had a large family size, and who have a history of alcohol intake had higher odds of overweight/obesity among urban women.

CONCLUSIONS

Overweight/obesity among reproductive-age women is a public health problem in Ethiopia, especially for women who are living in urban settings. Therefore, it is important to establish targeted overweight reduction programs with particular emphasis on urban, older aged, educated, and married women. Additionally, encouraging the limitation of the number of family size and alcohol intake can reduce women's overweight/obesity.

Factors associated with chronic energy malnutrition among reproductive-age women in Ethiopia: An analysis of the 2016 Ethiopia demographic and health survey data

Background

Women with chronic-energy malnutrition persists in many developing countries, including Ethiopia. To avert this problem identifying the predictor variables for a high magnitude of underweight is paramount. Consequently, this study aimed to assess the factors associated with chronic energy malnutrition among reproductive-age women in Ethiopia.

Methods

We used the 2016 Ethiopia demographic health survey data. The survey was a community-based cross-sectional study conducted from January 18 to June 27, 2016. A two-stage stratified cluster sampling technique was employed to select Participants. A total of 13,451 reproductive-age group women (age 15–49 years and who were not pregnant and < 2 months of postpartum) were included in the analysis. Both descriptive and analytical analyses were performed. A P-value of less than 0.05 was used to declare statistical significance.

Results

About 22.6% (95%CI: 21.5%-23.6%) of reproductive-age women were underweight. The magnitude of underweight is highest in the Afar region (39.6%) and lowest in Addis Ababa city administration (13.5%). Women who lived in the rural area (AOR = 1.59; 95%CI: 1.19–2.12), those who did not attend formal education (AOR = 1.23; 95%CI: 1.01–1.50), unemployed women (AOR = 1.28; 95%CI:1.13–1.44), women who belong to the poorest household wealth index (AOR = 1.42; 95%CI:1.04–1.94), women who were not married (AOR = 1.41; 95%CI: 1.18–2.69), women who lived in Tigray and the pastoral regions have higher odds of underweight. On the other hand, women who lived in southern nations nationalities and people’s region, and women whose age group 25–34 years had lower odds of underweight.

Conclusions

Chronic-energy malnutrition among reproductive-age women is high in Ethiopia. Improving the food security of rural, never married, and unemployed women would reduce the magnitude of underweight. Moreover, strengthening girls’ education, creating employment opportunities for women, and enhancing household income can further reduce the problem of chronic energy malnutrition.

Impact of maternal hypertensive disorders on offspring's neurodevelopment: a longitudinal prospective cohort study in China

BACKGROUND

Maternal hypertensive disorders of pregnancy (HDP) are the major causes of maternal mortality. However, the association between HDP and offspring's neurodevelopment remains unclear.

METHOD

Participants were 4031 singleton live births from a prospective cohort study in Wuhan, China, during October 2013 to October 2014. Neurodevelopment of infant was evaluated by using Chinese version of Gesell Developmental Schedules at 0.5 year of age. Maternal HDP and potential confounders were ascertained by healthcare records at baseline.

RESULTS

Generalized linear model analysis indicated that maternal chronic hypertension were significantly associated with development quotient on fine motor (β = -3.32, 95% CI: -6.33 to -0.31), adaptability (β = -2.87, 95% CI: -5.31 to -0.43), language (β = -1.23, 95% CI: -2.12 to -0.34) and social behavior (β = -2.53, 95% CI: -4.69 to -0.37), and gestational hypertension was significantly associated with development quotient on social behavior (β = -1.42, 95% CI: -2.03 to -0.81), even after adjustment of major confounders. Multivariable logistic regression analysis showed that maternal chronic hypertension also increased the risk of diagnosis of "neurodevelopmental delay" on fine motor (OR = 1.85, 95% CI: 1.19-2.89), adaptability (OR = 2.32, 95% CI: 1.42-3.78), language (OR = 2.86, 95% CI: 1.74-4.70), and social behavior (OR = 2.13, 95% CI: 1.73-2.59).

CONCLUSION

This study suggests that exposure to HDP is associated with an increased risk of neurodevelopment impairment in the offspring at the age of 0.5 year.

A cross-sectional study exploring obesity and pregnancy planning among women attending an antenatal clinic in Suva, Fiji

BACKGROUND

Pregnancy planning enables maternal health optimisation which is particularly important for women who have obesity and are at increased risk of adverse perinatal outcomes.

AIMS

The prevalence of pregnancy planning and its relationship to body mass index (BMI) was investigated in a cohort of women attending antenatal clinics in the main referral hospital in Suva, Fiji.

MATERIALS AND METHODS

The questionnaire captured health and socio-demographic data, anthropometry and asked about pregnancy planning.

RESULTS

Two thousand, two hundred and three pregnant women presenting for their first booking at the antenatal clinic were enrolled; 721 (37.4%) out of 1926 women with complete data reported they did not plan their pregnancy. A third of women (n = 633, 32.8%) had overweight and 805 (41.7%) had obesity. In multivariable analyses parity, employment status, marital status, and BMI were significantly associated with pregnancy planning. Compared to women of a healthy weight or underweight, women who have obesity were less likely to plan their pregnancy (adjusted odds ratio 0.742; 95% CI 0.569-0.967).

CONCLUSION

Tackling the cycle of obesity will require attention to preconception care and optimising weight before pregnancy.

Overweight and abdominal obesity in women of childbearing age of Russian, Somali and Kurdish origin and the general Finnish population

Background

Migrant background and higher parity may increase the risk of being overweight. We compared the prevalence of overweight (body mass index ≥25 kg/m2) and abdominal obesity (waist-to-height ratio ≥0.5) between non-pregnant migrant and Finnish women aged 18-45 years.

Methods

The participants were 165 Russian, 164 Somali and 179 Kurdish origin women from the cross-sectional Migrant Health and Wellbeing study. The reference group included 388 women from the general Finnish population. Body anthropometrics were measured. The main statistical methods were logistic regression adjusted for sociodemographic and reproductive variables.

Results

The unadjusted prevalence of overweight and obesity, respectively, were higher among Somali (32.9%, 30.9%, P < 0.001) and Kurdish women (41.1%, 19.5%, P < 0.001) than among Finnish women (19.9%, 9.8%). The adjusted odds ratios (95% CI) for overweight (including obesity) were 0.54 (0.33; 0.89) for Russian, 2.89 (1.66; 5.03) for Somali and 2.56 (1.64; 4.00) for Kurdish women compared with Finnish women. Kurdish women had 2.96-fold (1.75; 5.00) adjusted odds ratio for abdominal obesity compared with Finnish women. Being parous was associated with overweight and abdominal obesity among Kurdish women.

Conclusions

Overweight and obesity were very common among Somali and Kurdish origin women. Information on diet and physical activity in these groups is needed.

Metabolic health in the Middle East and north Africa

The Middle East and north Africa are home to different populations with widely varying cultures, histories, and socioeconomic settings. Hence, their health status, health management, and access to appropriate health care differ accordingly. In this Review, we examine data on the historical and prospective status of metabolic diseases in this region including obesity, diabetes, hypertension, dyslipidaemia, and non-alcoholic fatty liver disease. Women in the Middle East and north Africa have the highest risk of metabolic diseases of all women globally, whereas men rank second of all men in this respect. Metabolic risk factors are responsible for more than 300 deaths per 100 000 individuals in this region, compared with a global mean of fewer than 250. Physical inactivity, especially in women, and an unhealthy diet (ie, low consumption of whole grains, nuts, and seafoods) stand out. More than one in every three women are obese in most countries of the region. Prevention programmes have not fully been achieved in most of these countries and the projected future is not optimistic. Comprehensive surveillance and monitoring of metabolic diseases, robust multisectoral systems that support primordial and primary preventions, continuous education of health-care providers, as well as collaboration between countries for joint projects in this region are urgently needed to overcome the paucity of data and to improve the metabolic health status of inhabitants in the Middle East and north Africa.

Patterns and risk factors of double burden of malnutrition among adolescent girls and boys in Indonesia

OBJECTIVES

As an emerging middle-income country, Indonesia is grappling with the double burden of malnutrition across all age groups, including adolescents. Slow gains in reducing undernutrition are compounded by rapidly increasing overnutrition. This study aims to determine the patterns and determinants of this double burden, particularly stunting, thinness and overweight, among adolescent girls and boys aged 12-18 years in Indonesia.

METHODS

A cross-sectional survey was conducted among 2,160 girls and boys in the districts of Klaten and Lombok Barat in 2017. Data were collected on adolescents' nutritional status, sociodemographic characteristics, morbidity, dietary intake and physical activity and other relevant factors. Multivariable logistic regression models using generalized estimation equation were employed to determine risk factors for stunting, thinness and overweight.

RESULTS

About a quarter of adolescent girls (25%) and boys (21%) were stunted. Approximately 5% of girls and 11% of boys were thin, whereas 11% girls and boys each were overweight. Living in a higher wealth household (OR = 0.67; 95% CI: 0.49-0.91), compared to a lower wealth household, and living in a district with higher socioeconomic status (OR = 0.63; 95% CI: 0.51-0.79) were associated with lower odds of being stunted. Adolescent education was also protective against stunting (OR = 0.52; 95% CI: 0.33-0.88). Older adolescents aged 15-18 years were more likely to be stunted (OR = 1.88; 95% CI: 1.42-2.46). Being a girl was associated with reduced odds of being thin (OR = 0.42; 95% CI: 0.30-0.58). Higher household wealth (OR = 1.93; 95% CI: 1.27-2.97) predicted being overweight, while maternal primary or some secondary education, compared to no or incomplete primary education, was protective against adolescent overweight (OR = 0.60; 95% CI: 0.40-0.90).

CONCLUSION

Indonesian adolescent girls and boys face both extreme spectrums of malnutrition. Addressing the dual burden of malnutrition requires a multi-pronged approach, and urgent shift is warranted in nutrition policy and programmes targeting adolescents to effectively address the associated underlying determinants.

Ethnic differences in body mass index trajectories from 18 years to postpartum in a population-based cohort of pregnant women in Norway

OBJECTIVES

To explore ethnic differences in changes in body mass index (BMI) from the age of 18 years to 3 months postpartum.

DESIGN

A population-based cohort study.

SETTING

Child Health Clinics in Oslo, Norway.

PARTICIPANTS

Participants were 811 pregnant women (mean age 30 years). Ethnicity was categorised into six groups.

PRIMARY OUTCOME MEASURES

The outcome variable was BMI (kg/m²) measured at the age of 18 and 25 years, at prepregnancy and at 3 months postpartum. Body weight at 18 years, 25 years and prepregnancy were self-reported in early pregnancy, while body height and weight at 3 months postpartum were measured. The main statistical method was generalised estimating equations, adjusted for age. The analyses were stratified by parity due to ethnicity×time×parity interaction (p<0.001).

RESULTS

Primiparous South Asian women had a 1.45 (95% CI 0.39 to 2.52) kg/m² higher and Middle Eastern women had 1.43 (0.16 to 2.70) kg/m² higher mean BMI increase from 18 years to postpartum than Western European women. Among multiparous women, the mean BMI increased 1.99 (1.02 to 2.95) kg/m² more in South Asian women, 1.48 (0.31 to 2.64) kg/m² more in Middle Eastern women and 2.49 (0.55 to 4.42) kg/m² more in African women than in Western European women from 18 years to prepregnancy. From 18 years to postpartum, the mean increase was 4.40 (2.38 to 6.42) kg/m² higher in African women and 1.94 to 2.78 kg/m² higher in the other groups than in Western European women.

CONCLUSIONS

Multiparous women of ethnic minority origin seem substantially more prone to long-term weight gain than multiparous Western European women in Norway.

Sociodemographic, obstetric and psychological determinants of obesity among women in early to mid-pregnancy in South India

Background: Worldwide, the occurrence of obesity has markedly increased over the past decades with serious public health consequences. Obese pregnant women are more likely to develop hypertension, pre-eclampsia and gestational diabetes, resulting in obstetric complications which in turn may contribute to an increase in adverse child outcomes and maternal mortality. The present study was done to determine the prevalence of obesity and its association with socio-demographic variables, obstetric history and mental health. Methods: This study was nested within an ongoing cohort study, CASCADE, in a public hospital in Bangalore. The study participants comprised of 280 pregnant women who were 18 years of age and above, with a gestational age of less than 24 weeks, enrolled between a period of August 1st, 2017 until April 30th, 2018. Weight and height were measured using calibrated devices to calculate the body mass index. Results: The prevalence of obesity was observed to be 33.9% among the pregnant mothers. Obesity was found to be significantly associated with age, history of abortion, gravidity on multivariate logistic regression. No association was found with depression and anxiety. Conclusions: Obesity is an important health concern among urban pregnant women in the region of South India. The prevalence is much higher than that reported in other studies. Increasing age, multigravidity and past history of abortion were significantly associated with maternal obesity.

Obesity matters but is not perceived: A cross-sectional study on cardiovascular disease risk factors among a population-based probability sample in rural Zambia

Background

Sub-Saharan Africa, including Zambia, has experienced an increase in overweight and obesity due to rapid lifestyle changes associated with recent economic growth. We explored the prevalence and correlates of overweight and obesity in rural Zambia. We also investigated the role of self-perception of body weight in weight control given the local socio-cultural context.

Methods

In this cross-sectional study, we recruited 690 residents of the Mumbwa district aged 25–64 years through a multistage, clustered, household random sampling. We administered a questionnaire and collected anthropometric and bio-behavioral data from May to July 2016. Factors associated with body mass index (BMI) ≥25 kg/m² and underestimation of body weight were assessed using multiple logistic regression.

Results

Of the weighted sample of 689 participants (335 men and 354 women), 185 (26.8%) had BMI ≥25 kg/m². In multivariate analyses, female gender, age 45–64 years, tertiary education, higher fruit and vegetable intake, high blood pressure, abnormal blood lipid profile, and Hemoglobin A1c ≥5.7% were significantly associated with BMI ≥25 kg/m². Among participants with BMI ≥25 kg/m², 14.2% and 58.2% perceived themselves as being underweight and normal weight, respectively. Age 45–64 years was the only factor significantly associated with body weight underestimation. Preference for obesity was reported by 17.5% and 3.6% of respondents with BMI <25 kg/m² and BMI≥25 kg/m², respectively; “looks attractive” and “fear of being perceived as HIV-positive” were the main reasons.

Conclusion

In rural Zambia, overweight and obesity are prevalent and significantly associated with alterations in blood pressure, blood lipid profile, and glucose metabolism. However, most subjects with BMI ≥25 kg/m² underestimated their body weight; some preferred obesity, in part due to cultural factors and HIV-related stigma. A health promotion program that addresses such perceptions and body weight underestimation should be urgently introduced in Zambia.

Impact of Maternal BMI on Rubella Nonimmunity at Antenatal Screening

OBJECTIVE

The aim of this study was to examine the relationship between BMI and the incidence of rubella nonimmunity among pregnant women with regard to the World Health Organization categories.

METHODS

This was a retrospective cohort study of 117,063 eligible gravidas, managed between 1998 and 2015 in a university hospital of Hong Kong, China. BMI at antenatal booking was banded using the following World Health Organization definitions: < 18.5 kg/m² , 18.5 to 24.9 kg/m² , 25.0 to 29.9 kg/m² , and ≥30.0 kg/m² . Maternal rubella nonimmunity status by BMI was assessed. Incidence rates were also assessed after adjusting for maternal advanced age, short stature < 151 cm, mothers' birthplace, and postobstetric history covariates.

RESULTS

Rubella nonimmunity incidence increased as the BMI increased (P < 0.001). Gravidas with high BMI were more likely to be nonimmune if born in Hong Kong (odds ratio [OR], 1.234; 95% CI: 1.159-1.315; P < 0.001) compared with those born outside of Hong Kong (OR, 1.066; 95% CI: 0.997-1.141; P = 0.063). After adjusting for covariates, women with BMI ≥ 25 kg/m² had 1.127 (P < 0.001; 95% CI: 1.074-1.182) greater odds of being nonimmune.

CONCLUSIONS

High maternal BMI (≥ 25.0 kg/m² ) is associated with reduced rubella immunity, an effect confined to gravidas with almost complete vaccine coverage in childhood.

Socioeconomic differences in childhood BMI trajectories in Belarus

Objective

To examine associations of parental socioeconomic position with early-life offspring body mass index (BMI) trajectories in a middle-income country.

Subjects

Overall, 12,385 Belarusian children born 1996–97 and enrolled in a randomised breastfeeding promotion trial at birth, with 3–14 measurements of BMI from birth to 7 years.

Methods

Cohort analysis in which exposures were parental education (common secondary or less; advanced secondary or partial university; completed university) and occupation (manual; non-manual) at birth, and the outcome was BMI z-score trajectories estimated using multilevel linear spline models, controlling for trial arm, location, parental BMI, maternal smoking status and number of older siblings.

Results

Infants born to university-educated mothers were heavier at birth than those born to secondary school-educated mothers [by 0.13 BMI z-score units (95% confidence interval, CI: 0.07, 0.19) for girls and 0.11 (95% CI: 0.05, 0.17) for boys; equivalent for an infant of average birth length to 43 and 38 g, respectively]. Between the ages of 3–7 years children of the most educated mothers had larger BMI increases than children of the least educated mothers. At age 7 years, after controlling for trial arm and location,  children of university-educated mothers had higher BMIs than those born to secondary school-educated mothers by 0.11 z-score (95% CI: 0.03, 0.19) among girls and 0.18 (95% CI: 0.1, 0.27) among boys, equivalent to differences in BMI for a child of average height of 0.19 and 0.26 kg/m², respectively. After further controlling for parental BMI, these differences attenuated to 0.08 z-score (95% CI: 0, 0.16) and 0.16 z-score (95% CI: 0.07, 0.24), respectively, but changed very little after additional adjustment for number of older siblings and mother’s smoking status. Associations were similar when based on paternal educational attainment and highest household occupation.

Conclusions

In Belarus, consistent with some middle-income countries, higher socioeconomic position was associated with greater BMI trajectories from age 3 onwards.

The burden of obesity in women of reproductive age and in pregnancy in a middle-income setting: A population based study from Jamaica

INTRODUCTION

Obesity is rising globally and is associated with increased risk of adverse pregnancy outcomes. This study aims to investigate overweight and obesity and its consequences among Jamaican women of reproductive age, particularly development of diabetes, hypertension and the risk of maternal death.

MATERIALS AND METHODS

A national lifestyle survey (2007/8) of 1371 women of reproductive age provided data on the prevalence of high BMI, associated risk factors and co-morbidities. A national maternal mortality surveillance database (1998-2012) of 798 maternal deaths was used to investigate maternal deaths in obese women. Chi-squared and Fisher exact tests were used.

RESULTS

High BMI (> = 25kg/m2) occurred in 63% of women aged between 15 and 49 years. It was associated with increasing age, high gravidity and parity, and full time employment (p<0.001). Of those with high BMI, 5.5% were diabetic, 19.3% hypertensive and 2.8% were both diabetic and hypertensive. Obesity was recorded in 10.5% of maternal deaths, with higher proportions of deaths due to hypertension in pregnancy (27.5%), circulatory/ cardiovascular disorders (13.0%), and diabetes (4.3%) compared to 21.9%, 6.9% and 2.6% respectively in non-obese women.

CONCLUSIONS

This is one of a few studies from a middle-income setting to explore maternal burden of obesity during pregnancy, which contributes to improving the knowledge base, identifying the gaps in information and increasing awareness of the growing problem of maternal overweight and obesity. While survey diagnostic conditions require cautious interpretation of findings, it is clear that obesity and related medical conditions present a substantial public health problem for emerging LMICs like Jamaica. There is an urgent need for global consensus on routine measures of the burden and risk factors associated with obesity and development of culturally appropriate interventions.

Adolescent Childbirth Is Associated With Greater Framingham Risk Scores for Cardiovascular Disease Among Participants of the IMIAS (International Mobility in Aging Study)

BACKGROUND

Previous studies observe associations between lifetime parity and cardiovascular disease, but relatively fewer investigate age at first childbirth (AFB). Herein, we examine the association of AFB with a summary cardiovascular risk measure (Framingham Risk Score [FRS]).

METHODS AND RESULTS

As part of the IMIAS (International Mobility in Aging Study), data were collected in 2012 among 1047 women, aged 65 to 74 years, from Canada, Albania, Colombia, and Brazil. FRSs were calculated to describe cardiovascular risk profiles, and linear regression analyses were performed, adjusting for early life and socioeconomic variables. Women with an AFB of <20 years were compared with women with an AFB of 20 to 24, 25 to 29, and ≥30 years, as well as nulliparous women. We also compared FRS between combinations of AFB and parity categories: nulliparous women, parity 1 to 3 combined with AFB <20 years, parity ≥4 with AFB <20 years, parity 1 to 3 with AFB ≥20 years, and parity ≥4 with AFB ≥20 years. Women with an AFB of <20 years had a higher mean FRS compared with all other AFB groups. Compared with the lowest AFB risk group (25-29 years), women with an AFB of <20 years had a 5.8-point higher mean FRS (95% confidence interval, 3.4-8.3 points). Nulliparous women presented the lowest mean FRS in all analyses. The analysis comparing combinations of AFB and parity categories showed no meaningful differences in FRS between women who had 1 to 3 childbirths and those who had ≥4 childbirths within the stratum of AFB <20 years, and in the stratum of AFB ≥20 years.

CONCLUSIONS

Our analyses suggest that nulliparity and AFB, rather than increasing parity, drive the association with cardiovascular disease risk.

Preconceptional and maternal obesity: epidemiology and health consequences

Obesity in women of reproductive age is increasing in prevelance worldwide. Obesity reduces fertility and increases time taken to conceive, and obesity-related comorbidities (such as type 2 diabetes and chronic hypertension) heighten the risk of adverse outcomes for mother and child if the woman becomes pregnant. Pregnant women who are obese are more likely to have early pregnancy loss, and have increased risk of congenital fetal malformations, delivery of large for gestational age infants, shoulder dystocia, spontaneous and medically indicated premature birth, and stillbirth. Late pregnancy complications include gestational diabetes and pre-eclampsia, both of which are associated with long-term morbidities post partum. Women with obesity can also experience difficulties during labour and delivery, and are more at risk of post-partum haemorrhage. Long-term health risks are associated with weight retention after delivery, and inherent complications for the next pregnancy. The wellbeing of the next generation is also compromised. All these health issues could be avoided by prevention of obesity among women of reproductive age, which should be viewed as a global public health priority. For women who are already obese, renewed efforts should be made towards improved management during pregnancy, especially of blood glucose, and increased attention to post-partum weight management. Effective interventions, tailored to ethnicity and culture, are needed at each of these stages to improve the health of women and their children in the context of the global obesity epidemic.

Trends in inequalities in premature cancer mortality by educational level in Colombia, 1998-2007

BACKGROUND

There is a paucity of studies on socioeconomic inequalities in cancer mortality in developing countries. We examined trends in inequalities in cancer mortality by educational attainment in Colombia during a period of epidemiological transition and rapid expansion of health insurance coverage.

METHODS

Population mortality data (1998-2007) were linked to census data to obtain age-standardised cancer mortality rates by educational attainment at ages 25-64 years for stomach, cervical, prostate, lung, colorectal, breast and other cancers. We used Poisson regression to model mortality by educational attainment and estimated the contribution of specific cancers to the slope index of inequality in cancer mortality.

RESULTS

We observed large educational inequalities in cancer mortality, particularly for cancer of the cervix (rate ratio (RR) primary vs tertiary groups=5.75, contributing 51% of cancer inequalities), stomach (RR=2.56 for males, contributing 49% of total cancer inequalities and RR=1.98 for females, contributing 14% to total cancer inequalities) and lung (RR=1.64 for males contributing 17% of total cancer inequalities and 1.32 for females contributing 5% to total cancer inequalities). Total cancer mortality rates declined faster among those with higher education, with the exception of mortality from cervical cancer, which declined more rapidly in the lower educational groups.

CONCLUSIONS

There are large socioeconomic inequalities in preventable cancer mortality in Colombia, which underscore the need for intensifying prevention efforts. Reduction of cervical cancer can be achieved through reducing human papilloma virus infection, early detection and improved access to treatment of preneoplastic lesions. Reinforcing antitobacco measures may be particularly important to curb inequalities in cancer mortality.

Gastric cancer survival and affiliation to health insurance in a middle-income setting

OBJECTIVE

To investigate whether health insurance affiliation and socioeconomic deprivation is associated with overall cause survival from gastric cancer in a middle-income country.

METHODS

All patients resident in the Bucaramanga metropolitan area (Colombia) diagnosed with gastric cancer between 2003 and 2009 (n=1039), identified in the population-based cancer registry, were followed for vital status until 31/12/2013. Kaplan-Meier models provided crude survival estimates by health insurance regime (HIR) and social stratum (SS). Multivariate Cox-proportional hazard models adjusting HIR and SS for sex, age and tumor grade, were performed.

RESULTS

Overall 1 and 5 year survival proportions were 32.4% and 11.0%, respectively, varying from 49.3% and 15.8% for patients affiliated to the most generous HIR to 12.9% and 5.3% for unaffiliated patients, and from 41.4% and 20.7% for patients in the highest SS, versus 27.1% and 7.4% for the lowest SS. The multivariate analyses showed type of HIR as well as SS to remain independently associated with survival, with an 11% improvement in survival for each increase in SS subgroup (HR 0.89 (95% CI 0.83; 0.96), and with worse survival in the subsidized (least generous) HIR and unaffiliated patients compared to the contributory HIR (HR subsidized 1.20 (95% CI 1.00; 1.43) and HR not affiliated 2.03 (95% CI 1.48; 2.78)). Of the non-affiliated patients, 60% had died at the time of diagnosis, versus 4-14% of affiliated patients (p<0.0005).

CONCLUSIONS

Despite the 'universal' health insurance system, large socioeconomic differences in gastric cancer survival exist in Colombia. Both social stratum and access to effective diagnostic and curative care strongly influence survival.

Associations Between Orphan and Vulnerable Child Caregiving, Household Wealth Disparities, and Women's Overweight Status in Three Southern African Countries Participating in Demographic Health Surveys

This study examines whether orphan and vulnerable children (OVC) primary caregivers are facing absolute household wealth (AWI) disparities, the association between AWI and women's overweight status, and the modifying role of OVC primary caregiving status on this relationship. Demographic Health Surveys data (2006-2007) from 20 to 49 year old women in Namibia (n = 6,305), Swaziland (n = 2,786), and Zambia (n = 4,389) were analyzed using weighted marginal means and logistic regressions. OVC primary caregivers in Namibia and Swaziland had a lower mean AWI than other women in the same country. In Zambia, OVC primary caregivers had a lower mean AWI score than non-primary caregivers living with an OVC but a higher mean AWI score than non-OVC primary caregivers. In Swaziland and Zambia, even small increases in household wealth were associated with higher odds for being overweight regardless of women's caregiving status. Only in Namibia, OVC primary caregiving modified the effect of the previous association. Among Namibian OVC primary caregivers, women who had at least medium household wealth (4 or more AWI items) were more likely to be overweight than their poorest counterparts (0 or 1 AWI items). OVC primary caregivers are facing household wealth disparities as compared to other women from their communities. Future studies/interventions should consider using population-based approaches to reach women from every household wealth level to curb overweight in Swaziland and Zambia and to focus on specific household wealth characteristics that are associated with OVC primary caregivers' overweight status in Namibia.

Relationships between eating quickly and weight gain in Japanese university students: a longitudinal study

OBJECTIVE

Many cross-sectional studies have reported a relationship between overweight/obesity and eating quickly, but there have been few longitudinal studies to address this relationship in younger populations. The purpose of this prospective longitudinal study was to investigate whether eating quickly was related to being overweight in Japanese university students.

METHODS

Of 1,396 students who underwent a general examination and completed questionnaires at the start of university and before graduation, 1,314 students (676 male and 638 female) of normal body composition [body mass index (BMI) < 25 kg m(-2) ] at baseline were included in the analysis. The questionnaires included speed of eating and other lifestyle factors. After a 3-year follow-up, the students whose BMIs were ≥ 25 kg m(-2) were defined as overweight.

RESULTS

In this study, 38 participants (2.9%) became overweight. In the logistic regression analysis, the risk of being overweight was increased in males [adjusted odds ratio (OR): 2.77; 95% confidence interval (CI): 1.33-5.79; P < 0.01] and in those who ate quickly at baseline (OR: 4.40; 95% CI: 2.22-8.75; P < 0.001).

CONCLUSIONS

Eating quickly may predict risk of being overweight in Japanese university students.

Social Inequalities in Obesity Persist in the Nordic Region Despite Its Relative Affluence and Equity

Social inequalities in overweight and obesity (OWOB) have persisted in the affluent and reputedly egalitarian Nordic countries. In this review we examine associations between socioeconomic position (SEP) and OWOB, and secular trends in such associations. Determinants and possible causes of the relations are discussed together with opportunities to cope with OWOB as a public health problem. The findings show a persisting inverse social gradient. An interaction between SEP and gender is noted for adults in Denmark, Finland and Iceland and for children in Sweden. There are overall tendencies for increased inequality, however no consistent trend for an increased social gradient in OWOB. Reasons that increased inequality does not unequivocally mirror in a steepened social gradient in obesity may include methodological questions as well as societal efforts to counteract obesity. Multi-level efforts are needed to prevent OWOB.