The association between socioeconomic status and overweight/obesity in a Malay population in Singapore

Trends and social determinants of the obesity epidemic among reproductive-age women in ten Asian countries

The rapid epidemiological transition in Asian countries, resulting from the rising trend of urbanisation and lifestyle changes, is associated with an increasing risk of obesity in women of reproductive age. This is the first study to investigate the trends and population-attributable fraction (PAF) of obesity, and the interaction effects of education and wealth on obesity among reproductive-age women aged 15-49 years in ten Asian countries. This cross-sectional study examined the most recent (2000 to 2022) Demographic and Health Surveys (DHS) data from ten Central and Southeast Asian countries. Multilevel multinomial logistic regression models were used to compute odds ratios (ORs). PAFs adjusted for communality were calculated using adjusted ORs and prevalence estimates for each risk factor. This study included a weighted sample of 743,494 reproductive-age women. All the countries showed an increasing trend for obesity and a decreasing trend for underweight, except for the Maldives. The highest PAFs of obesity were associated with women who were married (PAF = 22.2%; 95% CI 22.1, 22.4), aged 35-49 years (PAF = 16.4%; 95% CI 15.5, 17.1), resided in wealthy households (PAF = 14.5%; 95% CI 14.4, 14.5), watched television regularly (PAF = 12.5%; 95% CI 12.1, 12.8), and lived in urban areas (PAF = 7.8%; 95% CI 7.7, 8.0). The combined PAF showed that these five risk factors were associated with 73.3% (95% CI 71.8, 74.9) of obesity among reproductive-age women. Interaction analysis between women's education and household wealth revealed that having a secondary or higher level of education and residing in a wealthier household was associated with a lower risk of obesity (OR = 0.71, 95% CI 0.66, 0.76). The findings of this study suggest that, in order to address the rising rate of obesity among women in Asian countries, education and lifestyle modifications in urban areas should be a priority. Pakistan and the Maldives need to be a priority given the rapidly increasing trends in obesity and underweight subpopulations in their respective countries.

"They [Doctors] Don't Really Know What We're Actually Experiencing": Undoing Racializing Frames of Heart Health in Singapore by Centering Listening as Method

The mainstream media and local health campaigns in Singapore racialize heart health disparities. Journalists and campaigners report differences in heart health outcomes from a model of race governance known as the Chinese, Malay, Indian, and Others (CMIO) model. This model is then used to frame heart health inequities as an outcome of poor cultural practices and behaviors tied to race. To (un)do the racializing frames of heart health as outcomes of cultural behaviors and practices, I instead center stories of heart health management by Malay participants from lower-income households, identifying the role information asymmetries play in incomplete heart health information retrieval during interactions with providers (social service providers, healthcare workers, doctors, nurses). Cultural and community resources were discussed as critical resources for alleviating urgent heart health episodes or assisting as guides for preventative heart health information. Health campaigners must delve deeper into these findings for more structurally responsive heart health interventions and move away from racializing health disparities based on the CMIO model.

Socioeconomic and behavioral determinants of non-compliance with physician referrals following community screening for diabetes, hypertension and hyperlipidemia: a mixed-methods study

Early detection of undiagnosed diabetes, hypertension or hyperlipidemia through screening could reduce healthcare costs resulting from disease complications. To date, despite ample research on the factors linked to the uptake of community health screening programs, little attention has been directed at delayed or incomplete follow-up after positive outcomes are identified in community screening tests. This study aimed to investigate the socioeconomic and behavioral factors that influence non-compliance with recommendations for primary care physician referrals, following community-based screening for diabetes, hypertension and hyperlipidemia. A parallel mixed-methods study was conducted. For quantitative data, we performed multivariable analysis on community-based chronic disease screening data. The qualitative component involved semi-structured interviews with individuals with both non-compliance and compliance with referral recommendations. Thematic data analysis was undertaken using the Theoretical Domains Framework (TDF). The quantitative analysis showed that older age (OR = 0.92, 95%CI [0.89-0.96]), non-Chinese ethnicity (OR = 0.24; 95% CI [0.08-0.44]) and residing in 5-room public/ private housing (OR = 0.40; 95% CI [0.14-0.74]) were associated with lower odds of non-compliance with referral recommendations. Thematic analysis identified multiple behavioral-level determinants acting as enablers or barriers within 7 TDF domains: awareness of health risks after receiving screening results, self-management orientation and behavioral control, fear of formal diagnosis and concerns about healthcare cost, optimistic belief driven by the lack of symptoms, interpersonal relationship and social obligations, aversion to medication, communication at the result collection and sense of uncertainty regarding self-scheduling of appointment. Findings provide valuable implications for the development of interventions aimed at improving adherence to referral recommendation. Future endeavors should include culturally sensitive outreach, evidence-based information dissemination, family-centered education, positive public health messaging, brief counseling during result collection and an opt-out appointment system to enhance follow-up care.

Changes in neighborhood environments and the increasing socioeconomic gap in child obesity risks: Evidence from Singapore

Most empirical research studying the link between neighborhood environments and child obesity risks are conducted in contexts such as the U.S., with pronounced patterns of residential segregation, making it difficult to extrapolate how far built environment characteristics contribute to socioeconomic disparities in obesity risks in less segregated contexts. Using a large national dataset of almost 625,000 students' height and weight data collected at ages 7, 11 and 14, between 2004 and 2015, this paper explores whether differences in eight neighborhood characteristics measuring access to different type of food outlets, parks and other active spaces, and public transport infrastructure might be responsible for socioeconomic differences in child obesity risks in Singapore, a city-state with relatively low levels of residential segregation. Through descriptive analyses we find that socioeconomic disparities in child BMIz in Singapore widened from 2004 onwards. However, while longitudinal regression models with individual and time fixed effects suggest that family socioeconomic status modified the relationship between environmental exposures and BMIz, there does not seem to be a clear, unequivocal relationship between built environment changes and the observed widening of the socioeconomic obesity gap.

Singaporean Malay-Muslim Women's Lifestyle Habits and Attitudes towards Health

This article examines how the intersections of Singaporean Malay-Muslim women’s religious and gendered subjectivities influence their lifestyle habits and health attitudes. It explores the gaps between their practices, perspectives and discourses that discuss Islam’s relevance in health educational programmes. Individual semi-structured interviews with 19 local women of diverse social backgrounds show that while Islam is influential in their health conceptions, this is limited to the self-internalisation of theologically-based discourses. Discussions on how positive gender relations based on Islamic values can contribute to women’s health outcomes are lacking in their narratives, existing academic literature and public discourses. A comprehensive approach to leveraging religious concepts in advocating good health for Muslims should also include women’s empowerment and improvement of gender relations.

Ethnicity, Neighborhood and Individual Socioeconomic Status, and Obesity: The Singapore Multiethnic Cohort

OBJECTIVE

It remains unclear whether ethnicity has an impact on obesity independent of socioeconomic status (SES) and environmental factors. Singapore provides a unique opportunity to address this issue because three major Asian ethnic groups are represented, and government policies prevent ethnic segregation. Therefore this study examined associations between ethnicity, SES, and obesity within neighborhoods in Singapore.

METHODS

Cross-sectional data from 29,819 participants of the Singapore Multiethnic Cohort who were aged 21 to 75 years and of Chinese, Malay, and Indian ethnicity were used. Obesity was defined using Asian criteria. Multilevel models used obesity as the dependent variable and age, marital status, ethnicity, education level, income, and neighborhood SES as independent variables.

RESULTS

Education level was more strongly inversely associated with obesity than income level or neighborhood SES. The association between ethnicity and obesity was not substantially explained by measures of individual and neighborhood SES. In females, the fully adjusted odds ratio of obesity was 5.01 for Malay ethnicity and 4.81 for Indian ethnicity as compared with Chinese ethnicity. In males, these odds ratios were 2.61 and 2.07, respectively.

CONCLUSIONS

Ethnicity was strongly associated with obesity independent of SES and neighborhood environment. More research on sociocultural factors contributing to ethnic differences in obesity is warranted.

Prevalence of obesity and its associated risk factors among the elderly in Malaysia: Findings from The National Health and Morbidity Survey (NHMS) 2015

Background

Obesity is a crucial public health problem and is rising globally. This study was conducted to determine the prevalence of obesity and its associated factors among the elderly in Malaysia.

Methods

Data were obtained from the National Health and Morbidity Survey (NHMS) 2015. This was a cross sectional population-based study using a two stage stratified random sampling design. Elderly population aged 60 years and above was selected. Data were collected using pre-tested self-administered questionnaire in the form of sociodemographic profile, non-communicable diseases (NCD) comorbidities (status on hypertension, diabetes and hypercholesterolemia) and NCD risk factors (current smoker and physical activity). Obesity has been defined using the World Health Organization (WHO) Body Mass Index (BMI) guideline, 1998. A complex sampling design analysis was used for the descriptive statistics. The associated risk factors for obesity were identified using Multiple Logistic Regression analysis.

Results

A total of 3794 respondents were included in this study. The prevalence of obesity among Malaysian elderly was 30.2%. The prevalence of obesity among the elderly was significantly higher in females, respondents from urban areas and Indians. Approximately one third of the elderly with non-communicable diseases such as hypertension (33.1%) and diabetes (38.8%), respectively, were obese. Among elderly who were obese, majority of them (89.8%) had at least one NCD. The prevalence of obesity was 16.8% among current smokers (aOR 0.59). Multiple logistic regression analysis revealed that elderly females (aOR [adjusted odds ratio] 1.52), having secondary education (aOR 1.96) with household income of RM 3000 and above (aOR 1.57) as well as being hypertensive (aOR 1.61) and diabetic (aOR 1.50) were more likely to be obese. In contrast, the Chinese elderly respondents (aOR 0.62) and current smokers (aOR 0.59) were less likely to be obese. There were no significant associations of obesity with hypercholesterolemia or with physical activity.

Conclusions

A substantial proportion of Malaysian elderly were obese, and factors associated with obesity among them were being female, having secondary education with a household income of RM 3000 and above and being hypertensive or diabetic. Enhanced health promotion and education should be targeted at younger people in order to prevent obesity in the later years.

Kejadian Obesitas, Obesitas Sentral, dan Kelebihan Lemak Viseral pada Lansia Wanita

Background: Obesity, central obesity, and visceral fat is an excessive fat that can release various types of diseases such as cardiovascular disease, stroke and can increase the risk of bone damage in the elderly. Objectives: The purpose of this study was to analyze the risk factors of obesity, central obesity, and visceral fat in elderly women. Methods:This was an observational analytic study with cross sectional design. The samples of the study were 81 elderly women registered as member of Posyandu Lansia in the working area of Puskesmas Jagir, Wonokromo, Surabaya. The data collected using 3 times 24-hour food recall, anthropometry (body weight, body height, and waist circumference), visceral fat using Bio Impedance Analysis (BIA), and questionnaire related to subject’s characteristic. The data were analyzed using logistic regression analysis. Results: The results showed that the mean age of the subjects were 67.12±5.97 years old. Most of the subjects have low education (71.6%) and 87.7% of subjects didn’t work. The mean value of daily energy intake was 1074.31±298.67 kcal.  There were 34.6% obese subjects, only 17.3% subjects didn’t experience central obesity, and 28.4% of subjects had excess body visceral fat. The statistical test showed significant correlation between age with obesi (p-value=0.042), age with central obesity (p-value=0.009) but age with visceral fat had no significant correlation (p-value=0.163). Daily food intake, education, and occupation did not show significant correlation with obesity, central obesity, or visceral fat (p-value>0.05).  Conclusions: The risk for obesity and central obesity was decreased with aging in elderly but not with visceral fat.ABSTRAKLatar Belakang: Obesitas, obesitas sentral, dan lemak viseral merupakan penumpukan lemak tubuh yang berlebihan dan berisiko untuk menimbulkan berbagai penyakit degeneratif seperti jantung iskemi dan stroke serta dapat meningkatkan risiko kerusakan tulang pada lansia.  Tujuan: Tujuan dari penelitian ini adalah untuk menganalisis faktor risiko obesitas, obesitas sentral, dan kelebihan lemak viseral pada lansia wanita.Metode: Penelitian ini menggunakan desain studi cross sectional dengan pendekatan kuantitatif.  Sampel dari penelitian ini adalah 81 lansia wanita yang menjadi anggota posyandu lansia di wilayah kerja Puskesmas Jagir, Wonokromo, Surabaya. Pengumpulan data menggunakan food recall 3 x 24 jam, antropometri (berat badan, tinggi badan, dan lingkar perut), lemak viseral menggunakan Bio Impedance Analysis (BIA), serta kuesioner terkait data diri subjek. Data dianalisis dengan menggunakan analisis regresi logistik.Hasil: Hasil penelitian menujukkan rata-rata usia subjek adalah 67,12±5,97. Sebagian besar subjek memiliki riwayat pendidikan rendah (71,6%) dan sebanyak 87,7% subjek tidak bekerja. Rata-rata asupan zat gizi subjek lebih rendah jika dibandingkan dengan Angka Kecukupan Gizi (AKG). Sebanyak 34,6% subjek mengalami obesitas; angka kejadian obesitas sentral yaitu 17,3%; dan 28,4% subjek memiliki lemak viseral tubuh berlebih. Uji statistik menunjukkan hubungan signifikan antara usia dengan obesitas (p-value = 0,042), usia dengan obesitas sentral (p-value = 0,009) tetapi usia dengan lemak viseral tidak memiliki hubungan signifikan (p-value = 0,163). Asupan makanan harian, pendidikan, dan pekerjaan tidak  menunjukkan hubungan signifikan dengan obesitas, obesitas sentral, maupun lemak viseral (p-value > 0,05).Kesimpulan: Pada lansia, risiko mengalami obesitas maupun obesitas sentral semakin menurun seiring dengan bertambahnya usia. Lemak viseral tidak berhubungan dengan usia.

Age and gender differential relationship between employment status and body mass index among middle-aged and elderly adults: a cross-sectional study

OBJECTIVE

To determine the influence of age and gender, respectively, on the association between employment status and body mass index (BMI) in Korean adults using a large, nationally representative sample.

DESIGN

Cross-sectional study.

SETTING

South Korea.

PARTICIPANTS

7228 from fourth wave of the Korean Longitudinal Study of Aging (KLoSA), the survey's short form and year: 'KLoSA 2012'.

MAIN OUTCOME MEASURES

BMI.

RESULTS

BMI among the employed was higher than among the unemployed for those under 60. In terms of gender, employed men reported higher BMI than their unemployed counterparts, whereas employed women reported lower BMI than did unemployed women.

CONCLUSIONS

Employment status showed varying impacts on obesity by age and gender. Both unemployment at or after 60, as well as unemployment among women, is associated with increased BMI compared with unemployment among younger individuals or men, respectively.

Body size dynamics in young adults: 8-year follow up of cohorts in Brazil and Thailand

Increase in body size has appeared as an epidemic in Western countries and is now rapidly emerging in low- and middle-income countries, contributing to the rise in non-communicable diseases worldwide. Brazil and Thailand have gone through similar economic and health transitions, and this unique comparative study investigates changes in body size (body mass index) in relation to socioeconomic status in two cohorts of similar age followed from 2004/2005 to 2012/2013. At 20-24 years of age, Pelotas cohort members had a much higher prevalence of overweight and obesity (20.7 and 8.6%) than the Thai cohort (6.0 and 1.7%); these proportions rose to 34.6% and 22.9% vs 15.8% and 5.1%, respectively, in their early 30s. An association between a higher socioeconomic status and increase in overweight and obesity was observed among males; but an inverse pattern was noted for females in both cohorts and remained statistically significant after 8 years of follow up. Our comparative longitudinal analyses highlight the relationship between two middle-income settings facing rapid increases in body size (2-3 fold increase in the rate of overweight and obesity). Long-term follow up and a lifecourse approach for effective prevention of obesity will minimize adverse health burdens in later life.

Prevalence and Socio-Demographic Determinants of Overweight and Obesity in a Nigerian Population

Objective

This survey explored prevalence of overweight and obesity and their associations with socio-demographic variables in a Nigerian population.

Methods

This cross-sectional survey involved 1521 adults in Nnewi. Age, sex, educational and occupational status, and BMI were recorded.

Results

Prevalence of overweight was higher in males (32.3%; 95% CI, 29.5%–35.2%) than in females (29.8%; 95% CI, 26.8%–33.0%); the reverse was the case for prevalence of obesity (19.6%; 95% CI, 17.3%–22.2% in males and 36.0%; 95% CI, 32.8%–39.4% in females). Higher odds ratios (ORs) for overweight and obesity were observed in participants aged 41–60 years (OR 2.03; 95% CI, 1.57–2.61 for overweight and OR 4.29; 95% CI, 3.25–5.67 for obesity) and those >60 years (OR 1.72; 95% CI, 1.21–2.43 for overweight and OR 4.21; 95% CI, 2.86–6.19 for obesity) compared to those aged 18–40 years. Female sex was associated with higher ORs for overweight (OR 1.20; 95% CI, 0.96–1.51) and obesity (OR 2.21; 95% CI, 1.73–2.83). Participants with secondary education had marginally higher ORs for overweight (OR 1.15; 95% CI, 0.88–1.51) and obesity (OR 1.17; 95% CI, 0.86–1.59) than those with tertiary education, and so were those with primary education for obesity (OR 1.19; 95% CI, 0.74–1.89) but higher OR for overweight (OR 1.44; 95% CI, 0.98–2.13). Unskilled participants had about the same OR for overweight and obesity as professionals, and while skilled participants had about the same OR for overweight as professionals, their OR for obesity (OR 1.27; 95% CI, 0.67–2.43) was fairly higher than that for professionals.

Conclusions

Prevalence of overweight is higher in males than in females, but the reverse is the case for prevalence of obesity. Older age and female sex are associated with increased risk of overweight and obesity, while working at a skilled occupation is associated with obesity, and tertiary educational attainment is associated with overweight.

BMI, overweight status and obesity adjusted by various factors in all age groups in the population of a city in Northeastern Brazil

OBJECTIVE

In Brazil, demographic, socioeconomic and epidemiological changes over time have led to a transition in nutritional standards, resulting in a gradual reduction of malnutrition and an increased prevalence of overweight and obese individuals, similar to the situation in developed countries in previous decades. This study assessed the body mass index (BMI) and the prevalence of an overweight status and obesity, adjusted for various factors, in a population in northeastern Brazil including all age groups.

METHODS

This is a cross-sectional population-based epidemiological study using single sampling procedure composed of levels. Given the heterogeneity of the variable "income" and the relationship between income, prevalence of diseases and nutrition, a stratified sampling on blocks in the first level was used. In this, city districts were classified by income into 10 strata, according to information obtained from IBGE. A systematic sampling was applied on randomly selected blocks in order to choose the residences that would be part of the sample (second level), including 1165 participants from all age groups.

RESULTS AND DISCUSSION

The prevalence of an overweight status or obesity was adjusted for demographic, socioeconomic and lifestyle variables. When the Chi-square test was applied, a relationship was observed between the prevalence of an overweight status or obesity and the age group, gender, educational level and income of the participants. Regarding lifestyle parameters, only smoking was associated with the prevalence of an overweight status or obesity, in both adults and in the total sample. The results for the following groups were significant (p < 0.05): the age group from 20 to 59 years, when the individual presented an educational level greater than or equal to high school; and the age group ≥ 60 years, when the individual was female. It is noteworthy that educational level and being female were significant in adjusting for the total population as major factors influencing an increased BMI, followed by the variables physical activity and family income.

CONCLUSIONS

The adjusted results justify the adoption of intervention and prevention policies to combat these clinical conditions for the study population as a whole, particularly directed toward adults with higher education level as well as elderly females.

Perceived Barriers to and Ideas for Weight Control Interventions in Malay Homemakers

Objective. To develop a better understanding of perceived barriers to and ideas for weight loss and maintenance among Malay homemakers in Singapore. Methods. Interventions for weight management were reviewed, and 5 focus groups were conducted among overweight and obese Malay homemakers (n = 24) to explore barriers to and concepts and ideas pertaining to weight loss and maintenance. Results. Barriers identified included the lack of time, finances, and motivation. Ideas that were most appealing included free health screening, workshops on how best to manage children and family, regular fun group activities, monetary incentives for participation in activities for healthy living, and flexible part-time jobs. Conclusion. The focus groups provided useful insights pointing toward possible interventions that could appeal to Malay homemakers in Singapore. The most appealing approaches were those that were time flexible and had the least financial burden or had a financial benefit.

Lifestyle Health Behaviors of Hong Kong Chinese

Sociodemographics affect health through pathways of lifestyle choices. Using data from a survey of 467 Hong Kong Chinese, this study aims to examine the prevalence of their lifestyle behaviors, identify profiles based on their sociodemographic and lifestyle variables, and compare differences among the profile groups. Two-step cluster analysis was used to identify natural profile groups within the data set: only 37% of the participants engaged in regular physical exercises, and less than 50% monitored their dietary intake carefully. The analysis yields 2 clusters, representing a “healthy” and a “less-healthy” lifestyle group. The “less-healthy” group was predominantly male, younger, employed, and had high-to-middle levels of education. The findings reveal the lifestyle behavior patterns and sociodemographic characteristics of a high-risk group, which are essential to provide knowledge for the planning of health promotion activities.

Gender differences and socioeconomic status in relation to overweight among older Korean people

Background

The ever-increasing older population and its association with serious overweight problems have garnered much attention. The correlation between being overweight and socioeconomic status factors could be helpful for understanding the inequalities among the overweight population. We examined the correlation between being overweight and some key variables, such as demographics, socioeconomic status, general health status, and health behavior in a large sample of older individuals, by each gender.

Methods

We used data from the 2008 Korean Longitudinal Study of Aging and it included 8,157 participants who were 45 years or older. To understand the relationship between the overweight participants in accordance to demographic and socioeconomic characteristics, health status, and health behaviors, a weighted chi-square test and logistic regression analysis were conducted by separating variables related to overweight, according to the genders.

Results

The number of people in the normal group was 6,347 (77.8%), while the people who were considered overweight were 1,810 (22.2%). Women (n = 4,583) constituted 52.7% of the subject, 24.9% of whom were classified as overweight. Meanwhile, 20.6% of the 47.3% (n = 3,574) of the sample who were men were classified as overweight. Participants between the ages of 45 and 64 with chronic diseases were more likely to be overweight. Men in the 4th quartile of household income were more likely to be overweight than those who were in the 1st quartile, in contrast, while unemployed women with lower education levels and urban residents were at greater risk for being overweight.

Conclusions

Among the men, health status and health behavior appeared to show a correlation with being overweight; however, among women, socioeconomic status factors were strongly related to being overweight. These findings appear to support the association of gender-specifics with the prevalence of being overweight.

Educational attainment and obesity: a systematic review

Although previous systematic reviews considered the relationship between socioeconomic status and obesity, almost 200 peer-reviewed articles have been published since the last review on that topic, and this paper focuses specifically on education, which has different implications. The authors systematically review the peer-reviewed literature from around the world considering the association between educational attainment and obesity. Databases from public health and medicine, education, psychology, economics, and other social sciences were searched, and articles published in English, French, Portuguese and Spanish were included. This paper includes 289 articles that report on 410 populations in 91 countries. The relationship between educational attainment and obesity was modified by both gender and the country's economic development level: an inverse association was more common in studies of higher-income countries and a positive association was more common in lower-income countries, with stronger social patterning among women. Relatively few studies reported on lower-income countries, controlled for a comprehensive set of potential confounding variables and/or attempted to assess causality through the use of quasi-experimental designs. Future research should address these gaps to understand if the relationship between educational attainment and obesity may be causal, thus supporting education policy as a tool for obesity prevention.

Ethnic differences in the association between blood pressure components and chronic kidney disease in middle aged and older Asian adults

Background

Chronic kidney disease (CKD) is an emerging public health problem worldwide. Previous studies have shown an association between blood pressure (BP) and CKD. However, it is not clear if there are ethnic differences in this association. We examined the association between BP and CKD in a multi-ethnic Asian population in Singapore.

Methods

We analysed data from three large population-based studies conducted between 2004–2011, (n=3,167 Chinese, 3,082 Malays and 3,228 Indians) aged 40–80 years. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73m² from serum creatinine. Hypertension was defined as a self-reported current use of antihypertensive medication or systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg. We also analysed the association of CKD with individual BP components.

Results

The prevalence of both hypertension and CKD was higher among Malays (68.6, 21%) compared to Chinese (57.9, 5.9%) and Indians (56.0, 7.4%), but treatment for hypertension was lower among Malays (53.4%) compared to Chinese (89.8%) and Indians (83.1%). Hypertension was associated with CKD in all three ethnic groups (OR [95% CI] = 2.71 [1.59-4.63], 2.08 [1.62-2.68], 2.43 [1.66-3.57] in Chinese, Malays and Indians). Among the BP components, both systolic and diastolic BP were associated with CKD in Malays whereas, systolic BP was not significantly associated with CKD, and diastolic BP showed an inverse association which was explained by anti-hypertensive medication use in Chinese and Indians.

Conclusions

Hypertension was associated with CKD in Chinese, Malays and Indians. However, the BP components were associated with CKD only in Malays.

The Relationship Between Economic Status and Mortality of South Koreans, as It Relates to Average Life Expectancy

This study investigates the relationship between economic status and mortality of Korean men and women who were under and over the average national life expectancy using Cox’s proportional hazard model to adjust for health status, past medical history, and age. The study subjects come from local applicants of Korean National Health Insurance who had a health examination in 2005. They were enrolled into a follow-up investigation from 2005 to 2011. In individuals younger than the average life expectancy, the mortality of the lowest economic status was 2.48 times higher in men and 2.02 times higher in women than that in the highest economic status. Economic status–mortality association in males older than the average life expectancy was attenuated but not eliminated. However, there is no significant relationship between economic status and mortality for females above the average life expectancy.

Is there an association between socioeconomic status and body mass index among adolescents in Mauritius?

There are no documented studies on socioeconomic status (SES) and body mass index (BMI) among Mauritian adolescents. This study aimed to determine the relationships between SES and BMI among adolescents with focus on diet quality and physical activity (PA) as mediating factors. Mauritian school adolescents (n = 200; 96 males, 104 females) were recruited using multistage sampling. Participants completed a self-reported questionnaire. Height and weight were measured and used to calculate BMI (categorised into underweight, healthy-weight, overweight, obese). Chi-square test, Pearson correlation, and Independent samples t-test were used for statistical analysis. A negative association was found between SES and BMI (χ(2) = 8.15%, P < 0.05). Diet quality, time spent in PA at school (P = 0.000), but not total PA (P = 0.562), were significantly associated with high SES. Poor diet quality and less time spent in PA at school could explain BMI discrepancies between SES groups.

Variation in and Correlates of Body Mass Status of Older Singaporean Men and Women

This study describes the body mass status of older (≥60 years) Singaporeans, using the international and Asian body mass index (BMI) classifications, assesses sociodemographic correlates of BMI, underweight, obesity, and “high-risk” BMI (≥27.5 kg/m2), and ascertains the relationship between body mass and important health outcomes. Prevalence of underweight, obesity, and high-risk BMI among 4371 older Singaporeans was 6.8%, 7.4%, and 18.6%, respectively. Women (vs men) and Malays and Indians (vs Chinese) were more likely to have obesity or high-risk BMI. Increasing education decreased the odds of obesity and high-risk BMI only among women. Prevalence and odds of various health conditions was similar in corresponding categories of the two BMI classifications. Whereas the prevalence of obesity is lower among elderly in Singapore than in many other countries, the prevalence of high-risk BMI is considerable. It is important to address high-risk BMI among them, with elderly of minority ethnic groups, especially females, being a priority.

Community-Specific BMI Cutoff Points for South Indian Females

Objective. To analyze multiparameters related to total body composition, with specific emphasis on obesity in South Indian females, in order to derive community-specific BMI cutoff points. Patients and Methods. A total number of 87 females (of age 37.33 ± 13.12 years) from South Indian Chennai urban population participated in this clinical study. Body composition analysis and anthropometric measurements were acquired after conducting careful clinical examination. Results. BMI demonstrated high significance when normal group (21.02 ± 1.47 kg/m(2)) was compared with obese group (29.31 ± 3.95 kg/m(2)), P < 0.0001. BFM displayed high significance when normal group (14.92 ± 4.28 kg) was compared with obese group (29.94 ± 8.1 kg), P < 0.0001. Conclusion. Community-specific BMI cutoffs are necessary to assess obesity in different ethnic groups, and relying on WHO-based universal BMI cutoff points would be a wrong strategy.

Multi-disease Health Screening in an Urban Low-income Setting: A Community-based Study

Introduction: We were interested to determine the participation rates for health screening in a multi-ethnic urban low-income community. We assessed the health screening rates at baseline, collected data on reasons for non-participation and assessed the impact that a 5-month intervention had on health screening in this community. Materials and Methods: The study population involved all residents aged ≥40 years, living in heavily subsidised public rental flats in Taman Jurong Constituency, Singapore. From January 2009 to May 2009, we collected baseline information and offered eligible residents free blood pressure, fasting blood glucose and lipid measurements, fecal occult blood testing and Pap smears. Screenings were conducted either at or near the residents’ homes. Results: The participation rate was 60.9% (213/350). At baseline, 18.9% (24/127), 26.4% (42/159) and 18.7% (31/166) had gone for regular hypertension, diabetes and hyperlipidaemia screening, respectively; 3.8% (6/157) and 2.9% (2/70) had had regular colorectal and cervical cancer screening, respectively. Post-intervention, rates for hypertension screening increased to 97.6% but increases for other modalities were marginal. High cost, lack of time, not at risk, too old, or unnecessary for healthy people were commonly cited reasons for skipping regular health screening. Being unemployed was associated with missing regular hypertension screening (adjusted OR = 2.48, CI = 1.12-5.53, P = 0.026); those who did not need financial aid were less likely to miss regular hyperlipidaemia screening (adjusted OR = 0.27, CI = 0.10-0.72, P = 0.008). Conclusion: The participation rates for health screening were poor in this low-income community. More can be done to encourage regular health screening participation amongst this segment of the populace, both by reducing costs as well as addressing misperceptions. Key words: Cervical cancer, Colorectal cancer, Diabetes, Hyperlipidaemia, Hypertension

The Third National Health and Morbidity Survey

Obesity is an emerging public health threat in the elderly population in developing countries. Hence, the Third National Health and Morbidity Survey has assessed 4746 individuals aged 60 years and older recruited through a household survey to determine the prevalence of adiposity using body mass index and waist circumference. The national’s prevalence of overweight and obesity in men was 29.2% (95% confidence interval [CI] = 27.2-31.3) and 7.4% (95% CI = 6.4-8.6), respectively. However, the prevalence decreased with age. The figures in women were 30.3% (95% CI = 28.5-32.1) and 13.8% (95% CI = 12.5-15.2), respectively. The prevalence of abdominal obesity was 21.4% (95%CI = 20.2-22.6), with 7.7% (95% CI = 6.7-9.0) in men and 33.4% (95% CI = 31.4-35.3) in women. Predictors of adiposity include the following: Malay and Indian ethnicity, higher education level, higher household income, from urban area, and being married. In conclusion, adiposity affects about one third of the Malaysian elderly population, especially those of the younger age group, women, and those with higher socioeconomic status.

Sociodemographic and health-lifestyle determinants of obesity risks in Malaysia

The purpose of this study was to examine the sociodemographic and health-lifestyle factors that affect the likelihood of obesity among Malaysians. Data were obtained from the Malaysian Non-Communicable Disease Surveillance-1. The cross-sectional population-based survey consisted of 2447 observations, with an obesity prevalence rate of 17.2%. Based on logit regression analysis, the results suggest that obesity risks in Malaysia are affected by gender, education level, family history, health conditions, smoking status, and ethnic backgrounds. Specifically, Malaysians more likely to be obese are females (5.3%), lower educated (0.9%), those with history of family illnesses (4.8%), and nonsmokers (6.4%). However, Chinese (9.3%) and other (5.5%) ethnic groups are less likely to be obese when compared with Malays. Based on these results, several policy implications are discussed vis-à-vis obesity risks in Malaysia.