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Level of cardiovascular disease knowledge, risk perception and intention towards healthy lifestyle and socioeconomic disparities among adults in vulnerable communities of Belgium and England. BMC Public Health 2022; 22:197. [PMID: 35093056 PMCID: PMC8800212 DOI: 10.1186/s12889-022-12608-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/20/2022] [Indexed: 11/12/2022] Open
Abstract
Background The burden of cardiovascular diseases (CVDs) greatly varies between and within countries. Low- and middle-income countries (LMICs) and vulnerable communities of high-income countries (HIC) share disproportionately higher burden. Evidence is limited on the level of CVD knowledge and risk perception in vulnerable communities. Hence, in this study, we assessed the level of CVD knowledge, risk perception and change intention towards physical activity and healthy diet among vulnerable communities in Antwerp, Belgium and Nottingham, England. Furthermore, we investigated the socioeconomic disparities particularly in the Antwerp setting. Method A cross-sectional study was performed among 1,424 adults (958 in Antwerp and 466 in Nottingham) aged 18 or older among selected vulnerable communities. Districts or counties were selected based on socioeconomic and multiple deprivation index. A stratified random sampling was used in Antwerp, and purposive sampling in Nottingham. We determined the level of CVD knowledge, risk perception and intention towards a healthy lifestyle in Antwerp and Nottingham using a percentage score out of 100. To identify independent socioeconomic determinants in CVD knowledge, risk perception, intention to PA and healthy diet, we performed multilevel multivariable modeling using the Antwerp dataset. Results The mean knowledge percent score was 75.4 in Antwerp and 69.4 in Nottingham, and only 36.5% and 21.1% of participants respectively, had good CVD knowledge (scored 80% or above). In the multivariable analysis using the Antwerp dataset, level of education was significantly associated with (1) CVD knowledge score (Adjusted β = 0.11, 95%CI: 0.03, 0.18), (2) risk perception (0.23, 95%CI: 0.04, 0.41), (3) intention to physical activity (PA) (0.51, 95%CI: 0.35, 0.66), and (4) healthy diet intention (0.54, 95%CI: 0.32, 0.75). Furthermore, those individuals with a higher household income had a better healthy diet intention (0.44, 95%CI: 0.23, 0.65). In contrast, those who were of non-European origin scored lower on intention to have a healthy diet (-1.34, 95%CI:-2.07, -0.62) as compared to their European counterparts. On average, intention to PA was significantly higher among males (-0.43, 95%CI:-0.82, -0.03), whereas females scored better on healthy diet intention (2.02, 95%CI: 1.46, 2.57). Conclusions Knowledge towards CVD risks and prevention is low in vulnerable communities. Males have a higher intention towards PA while females towards a healthy diet and it also greatly varies across level of education. Moreover, those born outside Europe and with low household income have lower healthy diet intention than their respective counterparts. Hence, CVD preventive interventions should be participatory and based on a better understanding of the individuals’ socioeconomic status and cultural beliefs through active individual and community engagement. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12608-z.
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Kadawathagedara M, Ahluwalia N, Dufourg MN, Forhan A, Charles MA, Lioret S, de Lauzon-Guillain B. Diet during pregnancy: Influence of social characteristics and migration in the ELFE cohort. MATERNAL AND CHILD NUTRITION 2021; 17:e13140. [PMID: 33528115 PMCID: PMC8189248 DOI: 10.1111/mcn.13140] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/15/2020] [Accepted: 01/04/2021] [Indexed: 11/26/2022]
Abstract
Better adherence to dietary guidelines during pregnancy is supposed to result in healthier perinatal outcomes. We aim to characterize the diets of pregnant women by hypothesis‐driven and exploratory approaches and describe potential social determinants. Analyses included 12 048 mothers from the French nationwide ELFE birth cohort. Dietary intake over the last three months of the pregnancy was assessed by a food frequency questionnaire. Two hypothesis‐driven scores (the Diet Quality score, based on benchmarks derived from the National Health and Nutrition Program Guidelines, and the PANDiet score, based on nutrient intake) were calculated. Exploratory dietary patterns were also identified by principal component analysis. Multiple linear regressions were used to assess associations of maternal social characteristics with dietary patterns, accounting for the possible effect modification by their migration status. Five dietary patterns were identified: the Western, Balanced, Bread and toppings, Processed products, and Milk and breakfast cereals. Younger maternal age, single motherhood, unemployment and the presence of older children in the household were related to a suboptimal diet during pregnancy. The less acculturated the women were, the healthier and less processed their diets were, independent of their socio‐economic position. Several social determinants of the quality of women's diets were however moderated by their migration status. These findings shed light on the relations between indicators of social vulnerability, such as single motherhood and unemployment, and poorer diet quality. Given the reduced diet quality that accompanies the acculturation process, it is of paramount importance to identify the specific factors or obstacles that affect migrant women in maintaining their diet quality advantage over the majority population.
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Affiliation(s)
| | | | | | - Anne Forhan
- Université de Paris, CRESS, INSERM, INRAE, Paris, France
| | - Marie Aline Charles
- Université de Paris, CRESS, INSERM, INRAE, Paris, France.,INED, INSERM, Joint Unit Elfe, Paris, France
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Addo IY, Brener L, Asante AD, de Wit J. Determinants of post-migration changes in dietary and physical activity behaviours and implications for health promotion: Evidence from Australian residents of sub-Saharan African ancestry. Health Promot J Austr 2019; 30 Suppl 1:62-71. [PMID: 30710450 DOI: 10.1002/hpja.233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 12/20/2018] [Indexed: 01/17/2023] Open
Abstract
ISSUE ADDRESSED Several studies have attributed excess weight gain after immigration to changes in dietary and physical activity behaviours. However, recognising the main factors that influence post-migration changes in dietary and physical activity behaviours is less clear, particularly among Australian residents of sub-Saharan African (SSA) ancestry. Drawing on acculturation theory, this study examines main factors driving changes in dietary and physical activity behaviours among Australian residents who were born in SSA and provides insight into the extent to which the factors are related to immigration. METHODS A qualitative design based on a phenomenological approach was employed and a quota sampling technique was used to recruit 24 study participants for in-depth interviews. RESULTS The study found significant self-reported changes in dietary and physical activity behaviours after immigration that increase the risk of excess weight gain. The changes in dietary and physical activity behaviours were mainly driven by issues related to availability, accessibility and affordability of dietary and physical activity products. Time management and factors related to convenience also emerged as key determinants of change in dietary and physical activity behaviours. Apparently, some factors noted by participants shape dietary and physical activity behaviours irrespective of immigration, and these factors include: tastes and cravings for foods; friends and family influence on behaviour; and misconceptions about food and exercise. CONCLUSION Migration from SSA to Australia contributed to changes (mainly less healthy) in dietary and physical activity behaviours. To a large extent, post-migration changes in dietary and physical activity behaviours were driven by socio-economic and environmental factors. SO WHAT?: Health promotion programs that address the risky behaviours associated with excess weight gain among Australian residents of SSA ancestry should pay more attention to socio-economic and environmental factors.
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Affiliation(s)
- Isaac Yeboah Addo
- Faculty of Arts and Social Sciences, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Loren Brener
- Faculty of Arts and Social Sciences, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Augustine Danso Asante
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - John de Wit
- Faculty of Arts and Social Sciences, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia.,Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
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Holdsworth M, Nicolaou M, Langøien LJ, Osei-Kwasi HA, Chastin SFM, Stok FM, Capranica L, Lien N, Terragni L, Monsivais P, Mazzocchi M, Maes L, Roos G, Mejean C, Powell K, Stronks K. Developing a systems-based framework of the factors influencing dietary and physical activity behaviours in ethnic minority populations living in Europe - a DEDIPAC study. Int J Behav Nutr Phys Act 2017; 14:154. [PMID: 29115995 PMCID: PMC5678802 DOI: 10.1186/s12966-017-0608-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 10/24/2017] [Indexed: 12/20/2022] Open
Abstract
Background Some ethnic minority populations have a higher risk of non-communicable diseases than the majority European population. Diet and physical activity behaviours contribute to this risk, shaped by a system of inter-related factors. This study mapped a systems-based framework of the factors influencing dietary and physical activity behaviours in ethnic minority populations living in Europe, to inform research prioritisation and intervention development. Methods A concept mapping approach guided by systems thinking was used: i. Preparation (protocol and terminology); ii. Generating a list of factors influencing dietary and physical activity behaviours in ethnic minority populations living in Europe from evidence (systematic mapping reviews) and ‘eminence’ (89 participants from 24 academic disciplines via brainstorming, an international symposium and expert review) and; iii. Seeking consensus on structuring, rating and clustering factors, based on how they relate to each other; and iv. Interpreting/utilising the framework for research and interventions. Similar steps were undertaken for frameworks developed for the majority European population. Results Seven distinct clusters emerged for dietary behaviour (containing 85 factors) and 8 for physical activity behaviours (containing 183 factors). Four clusters were similar across behaviours: Social and cultural environment; Social and material resources; Psychosocial; and Migration context. Similar clusters of factors emerged in the frameworks for diet and physical activity behaviours of the majority European population, except for ‘migration context’. The importance of factors across all clusters was acknowledged, but their relative importance differed for ethnic minority populations compared with the majority population. Conclusions This systems-based framework integrates evidence from both expert opinion and published literature, to map the factors influencing dietary and physical activity behaviours in ethnic minority groups. Our findings illustrate that innovative research and complex interventions need to be developed that are sensitive to the needs of ethnic minority populations. A systems approach that encompasses the complexity of the inter-related factors that drive behaviours may inform a more holistic public health paradigm to more effectively reach ethnic minorities living in Europe, as well as the majority host population. Electronic supplementary material The online version of this article (10.1186/s12966-017-0608-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michelle Holdsworth
- Public Health Section, School of Health and Related Research-ScHARR, The University of Sheffield, Sheffield, UK.
| | - Mary Nicolaou
- Academic Medical Centre, University of Amsterdam, Department of Public Health, Amsterdam Public Health research Institute, Amsterdam, The Netherlands
| | - Lars Jørun Langøien
- Department of Physical Education, Norwegian School of Sport Sciences, Oslo, Norway
| | - Hibbah Araba Osei-Kwasi
- Public Health Section, School of Health and Related Research-ScHARR, The University of Sheffield, Sheffield, UK
| | - Sebastien F M Chastin
- Institute for Applied Health Research, School of Health and Life Science, Glasgow Caledonian University, Glasgow, UK
| | - F Marijn Stok
- Department of Psychological Assessment and Health Psychology, University of Konstanz, Constance, Germany
| | - Laura Capranica
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, Italy
| | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
| | - Laura Terragni
- Department of Nursing and Health Promotion Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Pablo Monsivais
- UKCRC Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.,Present address: Department of Nutrition and Exercise Physiology, Elson S Floyd College of Medicine, Washington State University, Spokane, WA 99210-1495, USA
| | - Mario Mazzocchi
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Lea Maes
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Gun Roos
- Consumption Research Norway SIFO, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Caroline Mejean
- UMR MOISA, Campus INRA-SupAgro de la Gaillarde, Montpellier, France
| | - Katie Powell
- Public Health Section, School of Health and Related Research-ScHARR, The University of Sheffield, Sheffield, UK
| | - Karien Stronks
- Academic Medical Centre, University of Amsterdam, Department of Public Health, Amsterdam Public Health research Institute, Amsterdam, The Netherlands
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Osei-Kwasi HA, Nicolaou M, Powell K, Terragni L, Maes L, Stronks K, Lien N, Holdsworth M. Systematic mapping review of the factors influencing dietary behaviour in ethnic minority groups living in Europe: a DEDIPAC study. Int J Behav Nutr Phys Act 2016; 13:85. [PMID: 27465354 PMCID: PMC4964011 DOI: 10.1186/s12966-016-0412-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/20/2016] [Indexed: 12/25/2023] Open
Abstract
Background Europe has a growing population of ethnic minority groups whose dietary behaviours are potentially of public health concern. To promote healthier diets, the factors driving dietary behaviours need to be understood. This review mapped the broad range of factors influencing dietary behaviour among ethnic minority groups living in Europe, in order to identify research gaps in the literature to guide future research. Methods A systematic mapping review was conducted (protocol registered with PROSPERO 2014: CRD42014013549). Nine databases were searched for quantitative and qualitative primary research published between 1999 and 2014. Ethnic minority groups were defined as immigrants/populations of immigrant background from low and middle income countries, population groups from former Eastern Bloc countries and minority indigenous populations. In synthesizing the findings, all factors were sorted and structured into emerging clusters according to how they were seen to relate to each other. Results Thirty-seven of 2965 studies met the inclusion criteria (n = 18 quantitative; n = 19 qualitative). Most studies were conducted in Northern Europe and were limited to specific European countries, and focused on a selected number of ethnic minority groups, predominantly among populations of South Asian origin. The 63 factors influencing dietary behaviour that emerged were sorted into seven clusters: social and cultural environment (16 factors), food beliefs and perceptions (11 factors), psychosocial (9 factors), social and material resources (5 factors), accessibility of food (10 factors), migration context (7 factors), and the body (5 factors). Conclusion This review identified a broad range of factors and clusters influencing dietary behaviour among ethnic minority groups. Gaps in the literature identified a need for researchers to explore the underlying mechanisms that shape dietary behaviours, which can be gleaned from more holistic, systems-based studies exploring relationships between factors and clusters. The dominance of studies exploring ‘differences’ between ethnic minority groups and the majority population in terms of the socio-cultural environment and food beliefs suggests a need for research exploring ‘similarities’. The evidence from this review will feed into developing a framework for the study of factors influencing dietary behaviours in ethnic minority groups in Europe. Electronic supplementary material The online version of this article (doi:10.1186/s12966-016-0412-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hibbah Araba Osei-Kwasi
- Public Health Section, School of Health and Related Research-ScHARR, The University of Sheffield, Sheffield, UK
| | - Mary Nicolaou
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Katie Powell
- Public Health Section, School of Health and Related Research-ScHARR, The University of Sheffield, Sheffield, UK
| | - Laura Terragni
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Lea Maes
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Karien Stronks
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
| | - Michelle Holdsworth
- Public Health Section, School of Health and Related Research-ScHARR, The University of Sheffield, Sheffield, UK.
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Dake FAA, Thompson AL, Ng SW, Agyei-Mensah S, Codjoe SNA. The Local Food Environment and Body Mass Index among the Urban Poor in Accra, Ghana. J Urban Health 2016; 93:438-55. [PMID: 27091736 PMCID: PMC4899328 DOI: 10.1007/s11524-016-0044-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Obesity in the sub-Saharan Africa region has been portrayed as a problem of affluence, partly because obesity has been found to be more common in urban areas and among the rich. Recent findings, however, reveal rising prevalence among the poor particularly the urban poor. A growing body of literature mostly in Western countries shows that obesity among the poor is partly the result of an obesogenic-built environment. Such studies are lacking in the African context. This study examines the characteristics of the local food environment in an urban poor setting in Accra, Ghana and further investigates the associated risk of obesity for residents. Data on the local food environment was collected using geographic positioning system (GPS) technology. The body mass indices (BMI) of females (15-49 years) and males (15-59 years) were calculated from measured weight and height. Data on the socio-demographic characteristics and lifestyle behaviors of respondents was also collected through a household survey. Spatial analysis tools were used to examine the characteristics of the local food environment while the influence of the food environment on BMI was examined using a two-level multilevel model. The measures of the food environment constituted the level 2 factors while individual socio-demographic characteristics and lifestyle behaviors constituted the level 1 factors. The local food environment in the study communities is suggestive of an obesogenic food environment characterized by an abundance of out-of-home cooked foods, convenience stores, and limited fruits and vegetables options. The results of the multilevel analysis reveal a 0.2 kg/m(2) increase in BMI for every additional convenience store and a 0.1 kg/m(2) reduction in BMI for every out-of-home cooked food place available in the study area after controlling for individual socio-demographic characteristics, lifestyle behaviors, and community characteristics. The findings of this study indicate that the local food environment in urban poor Accra is associated with increased risk of obesity through providing access to convenience stores. In order to reduce the risk of obesity in these urban poor communities, there is the need to regulate the availability of and access to convenience stores while also encouraging healthier offerings in convenience stores.
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Affiliation(s)
- Fidelia A A Dake
- Regional Institute for Population Studies, University of Ghana, P.O. Box LG 96, Legon, Accra, Ghana.
| | - Amanda L Thompson
- Department of Anthropology and Carolina Population Center, University of North Carolina at Chapel Hill, CB # 8120, 137 East Franklin St., Chapel Hill, NC, 27516, USA
| | - Shu Wen Ng
- Department of Nutrition and Carolina Population Center, University of North Carolina at Chapel Hill (UNC), CB # 8120, 137 East Franklin St., Chapel Hill, NC, 27516, USA
| | - Samuel Agyei-Mensah
- Department of Geography and Resource Development, University of Ghana, P.O. Box LG 59, Legon, Accra, Ghana
| | - Samuel N A Codjoe
- Regional Institute for Population Studies, University of Ghana, P.O. Box LG 96, Legon, Accra, Ghana
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Molarius A, Lindén-Boström M, Granström F, Karlsson J. Obesity continues to increase in the majority of the population in mid-Sweden—a 12-year follow-up. Eur J Public Health 2016; 26:622-7. [DOI: 10.1093/eurpub/ckw042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Abstract
Objective To evaluate the association between length of residence in an urban area and obesity
among Peruvian rural-to-urban migrants. Design Cross-sectional database analysis of the migrant group from the PERU MIGRANT Study
(2007). Exposure was length of urban residence, analysed as both a continuous (10-year
units) and a categorical variable. Four skinfold site measurements (biceps, triceps,
subscapular and suprailiac) were used to calculate body fat percentage and obesity (body
fat percentage >25% males, >33% females). We used Poisson generalized
linear models to estimate adjusted prevalence ratios and 95 % confidence intervals.
Multicollinearity between age and length of urban residence was assessed using
conditional numbers and correlation tests. Setting A peri-urban shantytown in the south of Lima, Peru. Subjects Rural-to-urban migrants (n 526) living in Lima. Results Multivariable analyses showed that for each 10-year unit increase in residence in an
urban area, rural-to-urban migrants had, on average, a 12 % (95 % CI 6, 18 %) higher
prevalence of obesity. This association was also present when length of urban residence
was analysed in categories. Sensitivity analyses, conducted with non-migrant groups,
showed no evidence of an association between 10-year age units and obesity in rural
(P=0·159) or urban populations (P=0·078). High
correlation and a large conditional number between age and length of urban residence
were found, suggesting a strong collinearity between both variables. Conclusions Longer lengths of urban residence are related to increased obesity in rural-to-urban
migrant populations; therefore, interventions to prevent obesity in urban areas may
benefit from targeting migrant groups.
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Abstract
This final chapter reviews the main conclusions reached by the Special Issue articles in the areas of EUNAM (EU and North African Migrants: Health and Health Systems) activities, covering well-being, health status, disease panorama and use of health services of immigrants to the EU. The reviewed chapters show that immigrants are a vulnerable population experiencing, in some aspects, discrimination and hardship similar to the socially weakest national population groups. Immigration has changed the disease spectrum, particularly in infectious diseases and recessive conditions such as sickle cell disease and familial Mediterranean fever. Importantly, health questions of immigrants cannot be separated from those of any human health issues. An imminent new immigrant question for the EU will be the massive internal migration. Although the overall disease spectrum may not be vastly different between EU countries, the internal migrants will be exposed to lifestyle-dependent ill health and diseases probably in a similar way as did migrants from outside Europe. Migrant health research requires dedicated funding, which needs to come from central EU sources because multiple nationalities are involved. This funding should be able to project the course of health from the country of origin to the country of destination and back again, which was one of guidelines in the funding that initiated EUNAM.
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Affiliation(s)
- Kari Hemminki
- 1 Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), D-69120 Heidelberg, Germany2 Center for Primary Health Care Research, Lund University, 205 02 Malmö, Sweden
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Sandström E, Bolmsjö I, Janzon E. Attitudes to and Experiences of Physical Activity among Migrant Women from Former Yugoslavia: -- a qualitative interview study about physical activity and its beneficial effect on heart health, in Malmö, Sweden. AIMS Public Health 2015; 2:194-209. [PMID: 29546104 PMCID: PMC5690276 DOI: 10.3934/publichealth.2015.2.194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 05/07/2015] [Indexed: 11/18/2022] Open
Abstract
Background Many risk factors for heart disease can be reduced by lifestyle modifications such as physical activity, but the attitude to and the knowledge about the beneficial effect of physical activity vary among the population. Migrant women are reported to have a higher BMI and to be less physically active than the Swedish-born women. In order to motivate them to participate in physical activity it is necessary to understand that they are not a homogenous group, and thus their knowledge about, needs for, and attitude to physical activity have to be examined. Aim: The aim of the study was to explore structural and individual factors working either as barriers against or as motivation for a change towards higher levels of physical activity and a healthy lifestyle. Furthermore, the aim was to investigate if the migration had changed the women's level of physical activity and what would be required to increase it. Method Seven women from Bosnia living in Malmö, Sweden, were interviewed by means of a semi-structured interview guide. The data was analyzed using Burnard's content analysis method. Results The findings were presented in two categories, namely, "barriers against physical activity" and "motivational factors for physical activity". With regard to the category "barriers against physical activity", the move to Sweden had led to losses and shifts in lifestyles for the women. The greatest lifestyle changes were reported among women who had moved from rural areas in Bosnia to urban areas in Sweden. They found it troublesome to reach the same activity level in Sweden and expressed a greater need to do so. Earlier negative experiences or no experiences at all, of performing physical activity, as well as the winter climate, were seen as obstacles to being active. All the women prioritized family, work, school, and club activities above physical activity. With respect to the category "motivational factors for physical activity", it was found that physical activity could help improve their mental balance, and the women also considered the possibility of losing weight. Conclusion The study showed that although these migrant women had difficulties finding appropriate and realistic physical activities, and prioritized family activities, they desired to be more physically active, even if the climate was seen as a hindrance. They also reported that physical activity could be a means to achieve better mental health as well as weight loss. Politicians ought to allocate funding, and public health worker to focus more on and enable this high risk group of immigrant women to become more physical active. They should also be informed about their increased risk of myocardial infarction. This, to stimulate increased physical activity among them and in ought to be in co-working with their own immigrant organization.
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Affiliation(s)
- Elin Sandström
- The national Swedish organization for consumers, Stockholm, Sweden
| | - Ingrid Bolmsjö
- Health and Society, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Ellis Janzon
- Health and Society, Faculty of Health and Society, Malmö University, Malmö, Sweden
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Bjermo H, Lind S, Rasmussen F. The educational gradient of obesity increases among Swedish pregnant women: a register-based study. BMC Public Health 2015; 15:315. [PMID: 25886465 PMCID: PMC4391086 DOI: 10.1186/s12889-015-1624-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 03/09/2015] [Indexed: 01/07/2023] Open
Abstract
Background Overweight or obesity is detrimental during pregnancy. We studied time trends in the educational gradient of overweight and obesity among pregnant women. Differences in overweight and obesity by area of residence and country of birth were also examined. Methods The study was based on the Swedish Medical Birth Register between 1992 and 2010 and included 1,569,173 singleton pregnancies. Weight and height were registered during the first visit at the antenatal-care clinic. Data on education, country of birth, and area of residence were derived from registers with national coverage. Results In 2008–2010, 32% of Swedish nulliparous pregnant women were overweight or obese. The relative risk of obesity among lower educated women compared to women with higher education increased from 1.91 (95% confidence interval: 1.85-1.97) in 1992–1995 to 2.09 (95% confidence interval: 2.05-2.14) in 2008–2010. There was an inverse linear relationship between risks of overweight or obesity, and population density and type of residence municipality. An excessive gestational weight gain according to the American Institute of Medicine was observed among 57-63% of the overweight or obese women, but there were small differences by education. Pregnant women born in Africa, Middle East or Latin America had higher risks of being overweight or obese compared to women born in Sweden. Conclusions The prevalence of obesity as well as the social inequalities in obesity during pregnancy increased in Sweden between 1992 and 2010. Further understanding of social inequalities and geographical differentials in health behaviours of pregnant women is needed when planning public health interventions.
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Affiliation(s)
- Helena Bjermo
- Unit of Child and Adolescent Health, Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, SE-171 29, Solna, Sweden. .,Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
| | - Simon Lind
- Unit of Child and Adolescent Health, Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, SE-171 29, Solna, Sweden.
| | - Finn Rasmussen
- Unit of Child and Adolescent Health, Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, SE-171 29, Solna, Sweden. .,Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
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Memarian E, Sundquist K, Calling S, Sundquist J, Li X. Country of origin and bariatric surgery in Sweden during 2001-2010. Surg Obes Relat Dis 2015; 11:1332-41. [PMID: 25979207 DOI: 10.1016/j.soard.2015.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/24/2015] [Accepted: 03/24/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prevalence of obesity, as well as use of bariatric surgery, has increased worldwide. The aim of the present study was to investigate the potential differences in the use of bariatric surgery among Swedes and immigrants in Sweden and whether the hypothesized differences remain after adjustment for socioeconomic factors. METHODS A closed cohort of all individuals aged 20-64 years was followed during 2001-2010. Further analyses were performed in 2 periods separately (2001-2005 and 2006-2010). Age-standardized cumulative incidence rates (CR) of bariatric surgery were compared between Swedes and immigrants considering individual variables. Cox proportional hazards models were used in univariate and multivariate models for males and females. RESULTS A total of 12,791 Swedes and 2060 immigrants underwent bariatric surgery. The lowest rates of bariatric surgery were found in immigrant men. The largest difference in CR between Swedes and immigrants was observed among low-income individuals (3.4 and 2.3 per 1000 individuals, respectively). Adjusted hazard ratios (HRs) were lower for all immigrants compared with Swedes in the second period. The highest HRs were observed among immigrants from Chile and Lebanon and the lowest among immigrants from Bosnia. Except for Nordic countries, immigrants from all other European countries had a lower HR compared with Swedes. CONCLUSIONS Men in general and some immigrant groups had a lower HR of bariatric surgery. Moreover, the difference between Swedes and immigrants was more pronounced in individuals with low socioeconomic status (income). It is unclear if underlying barriers to receive bariatric surgery are due to patients' preferences/lack of knowledge or healthcare structures. Future studies are needed to examine potential causes behind these differences.
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Affiliation(s)
- Ensieh Memarian
- Center for Primary Healthcare Research, Lund University/Region Skåne, Malmö, Sweden.
| | - Kristina Sundquist
- Center for Primary Healthcare Research, Lund University/Region Skåne, Malmö, Sweden; Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Susanna Calling
- Center for Primary Healthcare Research, Lund University/Region Skåne, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Healthcare Research, Lund University/Region Skåne, Malmö, Sweden; Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Xinjun Li
- Center for Primary Healthcare Research, Lund University/Region Skåne, Malmö, Sweden
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Wang X, Sundquist J, Zöller B, Memon AA, Palmér K, Sundquist K, Bennet L. Determination of 14 circulating microRNAs in Swedes and Iraqis with and without diabetes mellitus type 2. PLoS One 2014; 9:e86792. [PMID: 24497980 PMCID: PMC3907562 DOI: 10.1371/journal.pone.0086792] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 12/14/2013] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Recent reports suggest that immigrants from Middle Eastern countries are a high-risk group for type 2 diabetes (T2D) compared with Swedes, and that the pathogenesis of T2D may be ethnicity-specific. Deregulation of microRNA (miRNA) expression has been demonstrated to be associated with T2D but ethnic differences in miRNA have not been investigated. The aim of this study was to explore the ethnic specific expression (Swedish and Iraqi) of a panel of 14 previously identified miRNAs in patients without T2D (including those with prediabetes) and T2D. METHODS A total of 152 individuals were included in the study (84 Iraqis and 68 Swedes). Nineteen Iraqis and 14 Swedes were diagnosed with T2D. Expression of the 14 selected miRNAs (miR-15a, miR-20, miR-21, miR-24, miR-29b, miR-126, miR-144, miR-150, miR-197, miR-223, miR-191, miR-320a, miR-486-5p, and miR-28-3p) in plasma samples was measured by real-time PCR. RESULTS In the whole study population, the expression of miR-24 and miR-29b was significantly different between T2D patients and controls after adjustment for age, sex, waist circumference, family history of T2D, and a sedentary lifestyle. Interestingly, when stratifying the study population according to country of birth, we found that higher expression of miR-144 was significantly associated with T2D in Swedes (OR = 2.43, p = 0.035), but not in Iraqis (OR = 0.54, p = 0.169). The interaction test was significant (p = 0.017). CONCLUSION This study suggests that the association between plasma miR-144 expression and T2D differs between Swedes and Iraqis.
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Affiliation(s)
- Xiao Wang
- Center for Primary Health Care Research, Lund University/Region Skåne, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Sweden
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, United States of America
| | - Bengt Zöller
- Center for Primary Health Care Research, Lund University/Region Skåne, Sweden
| | - Ashfaque A. Memon
- Center for Primary Health Care Research, Lund University/Region Skåne, Sweden
| | - Karolina Palmér
- Center for Primary Health Care Research, Lund University/Region Skåne, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Sweden
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, United States of America
| | - Louise Bennet
- Center for Primary Health Care Research, Lund University/Region Skåne, Sweden
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Regber S, Mårild S, Johansson Hanse J. Barriers to and facilitators of nurse-parent interaction intended to promote healthy weight gain and prevent childhood obesity at Swedish child health centers. BMC Nurs 2013; 12:27. [PMID: 24308289 PMCID: PMC4175109 DOI: 10.1186/1472-6955-12-27] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 11/29/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Overweight and obesity in preschool children have increased worldwide in the past two to three decades. Child Health Centers provide a key setting for monitoring growth in preschool children and preventing childhood obesity. METHODS We conducted semi-structured interviews with 15 nurses working at Child Health Centers in southwest Sweden in 2011 and 2012. All interviews were tape recorded and transcribed verbatim and imported to QSR N'Vivo 9 software. Data were analyzed deductively according to predefined themes using content analysis. RESULTS Findings resulted in 332 codes, 16 subthemes and six main themes. The subthemes identified and described barriers and facilitators for the prevention of childhood obesity at Child Health Centers. Main themes included assessment of child's weight status, the initiative, a sensitive topic, parental responses, actions and lifestyle patterns. Although a body mass index (BMI) chart facilitated greater recognition of a child's deviant weight status than the traditional weight-for-height chart, nurses used it inconsistently. Obesity was a sensitive topic. For the most part, nurses initiated discussions of a child's overweight or obesity. CONCLUSION CHCs in Sweden provide a favorable opportunity to prevent childhood obesity because of a systematic organization, which by default conducts growth measurements at all health visits. The BMI chart yields greater recognition of overweight and obesity in children and facilitates prevention of obesity. In addition, visualization and explanation of the BMI chart helps nurses as they communicate with parents about a child's weight status. On the other hand, inconsistent use and lack of quality assurance regarding the recommended BMI chart was a barrier to prevention, possibly delaying identification of overweight or obesity. Other barriers included emotional difficulties in raising the issue of obesity because it was perceived as a sensitive topic. Some parents deliberately wanted overweight children, which was another specific barrier. Concerned parents who took the initiative or responded positively to the information about obesity facilitated prevention activities.
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Affiliation(s)
- Susann Regber
- Nordic School of Public Health NHV, Box 12 133, Gothenburg SE- 402 42, Sweden
- Department of Public Health and Community Medicine, Public Health Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Staffan Mårild
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Johansson Hanse
- Nordic School of Public Health NHV, Box 12 133, Gothenburg SE- 402 42, Sweden
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
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15
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Wändell PE. Population groups in dietary transition. Food Nutr Res 2013; 57:21668. [PMID: 24106456 PMCID: PMC3790911 DOI: 10.3402/fnr.v57i0.21668] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 04/25/2013] [Accepted: 04/26/2013] [Indexed: 12/12/2022] Open
Abstract
Background Little is known about the effects of dietary acculturation in minority groups in the Nordic countries, including immigrants from non-Western societies. Methods A search was performed in Medlin33e/PubMed and SweMed+ for articles published in 1990–2011. Results A total of 840 articles were identified, with a final 32 articles used to tabulate results which were included in the primary analysis. High rates of vitamin D deficiency (23 articles) were found in immigrants of non-Western origin; deficiency rates were very high among both pregnant and non-pregnant women, and also among children, with young children of immigrant parents showing 50 times higher risk for rickets when compared to children of indigenous parents. The risk of iron deficiency (two articles) was high among immigrant women, while the results were inconclusive regarding children. High rates of dental caries (seven articles) were found among pre-school and younger school children of immigrant origin, while the risk of caries was not as evident among older children. In a secondary analysis, including 48 articles (results not tabulated), overweight and obesity (14 articles) were seen in many immigrant groups, resulting in a high prevalence of diabetes (2 review articles from a total of 14 original articles) and incidence of coronary heart disease (CHD; seven articles). For hypertension (three articles), dyslipidemia (four articles), and dietary patterns among immigrants (10 articles), the results were contradictory. Conclusions Risk of vitamin D deficiency is alarmingly high in the Nordic countries among immigrants of non-Western origin, especially among women. Dental caries is high among immigrant children aged 0–7 years due to a higher intake of sugary products. Overweight and obesity, associated with a higher risk of diabetes and CHD, are prevalent in many immigrant groups and need further attention.
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Affiliation(s)
- Per E Wändell
- Centre for Family Medicine, Karolinska Institutet, Huddinge, Sweden
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16
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Edvardsson K, Lindkvist M, Eurenius E, Mogren I, Small R, Ivarsson A. A population-based study of overweight and obesity in expectant parents: socio-demographic patterns and within-couple associations. BMC Public Health 2013; 13:923. [PMID: 24090153 PMCID: PMC3854510 DOI: 10.1186/1471-2458-13-923] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 09/27/2013] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Overweight and obesity in pregnancy increase the risk of several adverse pregnancy outcomes. However, both mothers' and fathers' health play an important role for long-term health outcomes in offspring. While aspects of health and lifestyle of pregnant women have been reported, the health of expectant fathers and correlations of health variables within couples have received less attention. This study aimed to explore the prevalence and socio-demographic patterns of overweight and obesity in Swedish expectant parents, and to assess within-couple associations. METHODS This population-based, cross-sectional study investigated self-reported data from 4352 pregnant women and 3949 expectant fathers, comprising 3356 identified couples. Data were collected in antenatal care clinics between January 2008 and December 2011. Descriptive, correlation and logistic regression analyses were performed. RESULTS The self-reported prevalence of overweight (BMI 25.0-29.99) and obesity (BMI ≥ 30.0) was 29% among women (pre-pregnancy) and 53% among expectant fathers. In a majority of couples (62%), at least one partner was overweight or obese. The odds of being overweight or obese increased relative to partner's overweight or obesity, and women's odds of being obese were more than six times higher if their partners were also obese in comparison with women whose partners were of normal weight (OR 6.2, CI 4.2-9.3). A socio-demographic gradient was found in both genders in relation to education, occupation and area of residence, with higher odds of being obese further down the social ladder. The cumulative influence of these factors showed a substantial increase in the odds of obesity for the least compared to the most privileged (OR 6.5, CI 3.6-11.8). CONCLUSIONS The prevalence of overweight and obesity in expectant parents was high, with a clear social gradient, and a minority of couples reported both partners with a healthy weight at the onset of pregnancy. Partner influence on health and health behaviours, and the role both mothers and fathers play in health outcomes of their offspring, underpin the need for a more holistic and gender inclusive approach to the delivery of pregnancy care and postnatal and child health services, with active measures employed to involve fathers.
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Affiliation(s)
- Kristina Edvardsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE 901 87 Umeå, Sweden.
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17
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Regber S, Novak M, Eiben G, Lissner L, Hense S, Sandström TZ, Ahrens W, Mårild S. Assessment of selection bias in a health survey of children and families - the IDEFICS Sweden-study. BMC Public Health 2013; 13:418. [PMID: 23634972 PMCID: PMC3662638 DOI: 10.1186/1471-2458-13-418] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 04/08/2013] [Indexed: 11/10/2022] Open
Abstract
Background A health survey was performed in 2007–2008 in the IDEFICS/Sweden study (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) in children aged 2–9 years. We hypothesized that families with disadvantageous socioeconomic and -demographic backgrounds and children with overweight and obesity were underrepresented. Methods In a cross-sectional study, we compared Swedish IDEFICS participants (N=1,825) with referent children (N=1,825) using data from Statistics Sweden population registers. IDEFICS participants were matched for age and gender with a referent child living in the same municipality. Longitudinal weight and height data from birth to 8 years was collected for both populations (n=3,650) from the children’s local health services. Outcome measures included the family’s socioeconomic and demographic characteristics, maternal body mass index (BMI) and smoking habits before pregnancy, the children’s BMI standard deviation score (SDS) at the age of inclusion in the IDEFICS study (BMISDS-index), and the children’s BMI-categories during the age-span. Comparisons between groups were done and a multiple logistic regression analysis for the study of determinants of participation in the IDEFICS study was performed. Results Compared with IDEFICS participants, referent families were more likely to have lower education and income, foreign backgrounds, be single parents, and have mothers who smoked before pregnancy. Maternal BMI before pregnancy and child’s BMISDS-index did not differ between groups. Comparing the longitudinal data-set, the prevalence of obesity was significantly different at age 8 years n= 45 (4.5%) versus n= 31 (2.9%) in the referent and IDEFICS populations, respectively. In the multivariable adjusted model, the strongest significant association with IDEFICS study participation was parental Swedish background (odds ratio (OR) = 1.91, 95% confidence interval (CI) (1.48–2.47) followed by parents having high education OR 1.80, 95% CI (1.02-3.16) and being married or co-habiting OR 1.75 95% CI (1.38-2.23). Conclusion Families with single parenthood, foreign background, low education and income were underrepresented in the IDEFICS Sweden study. BMI at inclusion had no selection effect, but developing obesity was significantly greater among referents.
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Affiliation(s)
- Susann Regber
- Nordic School of Public Health NHV, Box 12 133, SE- 402 42, Gothenburg, Sweden.
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18
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Djelantik AAAMJ, Kunst AE, van der Wal MF, Smit HA, Vrijkotte TGM. Contribution of overweight and obesity to the occurrence of adverse pregnancy outcomes in a multi-ethnic cohort: population attributive fractions for Amsterdam. BJOG 2011; 119:283-90. [PMID: 22168897 DOI: 10.1111/j.1471-0528.2011.03205.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To estimate the contribution of pre-pregnancy excessive weight to the occurrence of adverse pregnancy outcomes and to detect the differences in these contributions between different ethnic groups. DESIGN Prospective multi-ethnic community-based cohort study. SETTING The prevalence of excessive weight is increasing and in general higher in immigrant groups in many industrialised countries. Maternal excessive weight, like smoking during pregnancy, is an important risk factor for adverse pregnancy outcomes. POPULATION A total of 8266 pregnant women, living in the Netherlands, were included in the ABCD study between January 2003 and March 2004. METHODS After applying the exclusion criteria, the analysis included 7871 pregnancies. Binomial log-linear regression analyses were performed to estimate relative risks (RRs) expressing the association between overweight/obesity and small-for-gestational-age (SGA), large-for-gestational-age (LGA), preterm birth (PTB; <37 weeks of gestation) and extreme PTB (<32 weeks of gestation), controlling for parity, maternal age, education level and smoking. Next, the RRs were used to estimate population attributive fractions (PAF) for Amsterdam and separately for several ethnic groups. MAIN OUTCOME MEASURES The RRs and PAFs. RESULTS The PAFs for overweight/obesity were: SGA -4.9%, LGA 15.3%, PTB 6.6% and extreme PTB 22.0%. In absolute terms, this corresponds to -47 SGA infants, 126 LGA infants, 35 PTB and 20 extreme PTB per year in Amsterdam. Except for SGA, these PAFs were higher than those for smoking (6.2%, -3.9%, 5.5% and 10.6%, respectively). The contribution of overweight/obesity to LGA and PTB was higher in non-Western immigrant groups. CONCLUSIONS Overweight/obesity has become an important contributor to the occurrence of adverse pregnancy outcomes in Amsterdam. For most outcomes, these contributions are larger than those for smoking. Development of special obesity prevention programmes for young women is required, especially focused on immigrant groups.
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Affiliation(s)
- A A A M J Djelantik
- Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands
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Koochek A, Mirmiran P, Sundquist K, Hosseini F, Azizi T, Moeini AS, Johansson SE, Karlström B, Azizi F, Sundquist J. Dietary differences between elderly Iranians living in Sweden and Iran a cross-sectional comparative study. BMC Public Health 2011; 11:411. [PMID: 21627780 PMCID: PMC3121638 DOI: 10.1186/1471-2458-11-411] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 05/31/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During the last decades, global migration has increased and many immigrant groups have a higher prevalence than the native born population of several cardiovascular disease risk factors, including poor dietary habits. However, it is uncertain if dietary habits in immigrant populations reflect dietary habits in their country of origin or if the current diet is a consequence of the migration and possible change of dietary habits. The aim of this study was to examine possible dietary differences between elderly Iranians living in Stockholm, Sweden with elderly Iranians living in Tehran, Iran, taking into account sex, age, marital status, and education. METHODS Dietary intakes were assessed by semi--quantitative food frequency questionnaire in a cross-sectional study of 121 Iranians living in Stockholm and 52 Iranians living in Tehran, aged 60-80. Differences in dietary habits between the two groups was analysed by bootstrapped regression analyses with 1000 replications. RESULTS Iranians living in Sweden had significantly higher intake of protein, total fat, fiber than Iranians living in Iran, but lower consumption of carbohydrates. The observed differences in intake of macronutrients were reflected in consumed amount of all food items, which were higher among Iranians living in Iran with the exception of bread and grain consumption which was lower. CONCLUSIONS There are general differences in dietary habits between Iranians living in Iran and Iranians living in Sweden. Parts of observed differences in dietary habits may reflect a favourable adoption process to the Swedish dietary habits after migration. Meanwhile other differences are point of concern in light of the high prevalence of overweight, among Iranians living in Sweden and can have unfavourable impact in particular in the context of cardiovascular health.
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Affiliation(s)
- Afsaneh Koochek
- Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.
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Bennet L, Johansson SE, Agardh CD, Groop L, Sundquist J, Råstam L, Sundquist K. High prevalence of type 2 diabetes in Iraqi and Swedish residents in a deprived Swedish neighbourhood--a population based study. BMC Public Health 2011; 11:303. [PMID: 21569404 PMCID: PMC3120683 DOI: 10.1186/1471-2458-11-303] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 05/12/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immigrants from the Middle-East are at high risk of developing type 2 diabetes (T2D). The aim of the present survey was to measure, in a single deprived neighbourhood, the prevalence rates of impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and T2D in residents originating from Iraq and to compare them to those in residents born in Sweden. An additional aim was to identify metabolic, lifestyle and socioeconomic risk factors associated with IFG/IGT and T2D in these residents. METHODS The study was conducted February 1'st to March 31'st 2010. Men and women aged 45 to 65 years of Swedish or Iraqi origin, living in the neighbourhood of Rosengård, Malmö, Sweden, were randomly selected from the census register. Each participant signed a written informed consent form, underwent a physical examination and an oral glucose tolerance test (OGTT), provided blood samples and filled in a questionnaire. A total of 175 subjects participated (Swedish origin n = 79, Iraqi origin n = 96), reflecting an overall response rate of almost 60%. RESULTS In total, 21.9% and 19.0% of the Iraqi and Swedish participants, respectively, suffered from T2D, while 24.0% of the Iraqi participants and 25.3% of the Swedish participants had IFG/IGT. There were no significant differences in prevalence rates relating to country of origin.Obesity (BMI ≥30 kg/m2) and sedentary leisure time physical activity were highly prevalent in both groups, while a family history of diabetes was more prevalent in participants from Iraq (49.2%) than in those from Sweden (22.8%) (p = 0.001).Being obese or having a sedentary leisure time were, independently associated with T2D (OR 5.43 (95% CI 2.10-14.02) and 2.89 (95% CI 1.03-8.10) respectively), while economic difficulties were independently associated with IFG/IGT (OR 2.55 (95% CI 1.06-6.15)) after adjustment for the confounding effects of other common risk factors for T2D. CONCLUSIONS This study reveals a high prevalence of T2D, independently of country of origin (Iraq or Sweden), in a socially vulnerable area and additionally presents a risk factor profile that is markedly different from that of Sweden in general.
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Affiliation(s)
- Louise Bennet
- Department of Clinical Sciences, Lund University, Malmö, Sweden.
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Hemminki K, Mousavi SM, Sundquist J, Brandt A. Does the breast cancer age at diagnosis differ by ethnicity? A study on immigrants to Sweden. Oncologist 2011; 16:146-54. [PMID: 21266400 DOI: 10.1634/theoncologist.2010-0104] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Age-specific incidence rates for breast cancer in low-risk and high-risk ethnic populations differ by age at which the incidence maximum is reached: around 50 years in low-risk populations and over 60 years in high-risk populations. The interpretation of these differences remains unsettled, one line primarily referring to biological differences, the second one to cohort effects of rapidly increasing rates in young populations, and the third one to incomplete registration of cancer in the elderly. METHODS The nationwide Family-Cancer Database was used to analyze standardized incidence ratios (SIRs) and age at diagnosis of breast cancer in female immigrants to Sweden by their region of origin compared with women native to Sweden matched on birth year and other relevant factors. RESULTS We showed first that the SIRs for breast cancer were lower in many immigrant groups compared with natives of Sweden; women from Turkey had the lowest SIR of 0.45, followed by those from Chile (0.54) and Southeast Asia (0.57). Women from nine regions showed an earlier mean age at diagnosis than their matched Swedish controls, the largest differences being 5.5 years for women from Turkey, 5.1 years for those from Asian Arab and "Other African" countries, 4.3 years for those from Iran, and 4.0 years for those from Iraq. CONCLUSIONS The results show that in many immigrant groups, the diagnostic age is earlier (<50 years) than in natives of Sweden (>50 years), suggesting that true biological factors underlie the differences. These factors may explain much of the international variation in breast cancer incidence. Identifying these factors should advance understanding of breast cancer etiology and prevention.
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Affiliation(s)
- Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center DKFZ, Im Neuenheimer Feld 580, 69120 Heidelberg, Germany
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Sundquist J, Johansson SE, Sundquist K. Levelling off of prevalence of obesity in the adult population of Sweden between 2000/01 and 2004/05. BMC Public Health 2010; 10:119. [PMID: 20214805 PMCID: PMC2847975 DOI: 10.1186/1471-2458-10-119] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 03/09/2010] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The escalating global epidemic of obesity is of worldwide concern because of its association with several chronic diseases and premature mortality. Some subgroups seem to be more affected than others. The aim of this study was to examine whether the mean BMI (adjusted for age) and the prevalence of obesity (adjusted for all the explanatory variables) changed between 2000/01 and 2004/05 in different subgroups of the Swedish population. METHODS This study compared two cross-sectional, nationwide random samples of persons aged 16 to 84 years: the first from 2000/01 (5515 men, 5838 women) and the second from 2004/05 (4681 men, 4821 women). After stratification by gender, a logistic regression model was applied to analyse possible changes in mean BMI and the prevalence of obesity between 2000/01 and 2004/05. RESULTS Total mean BMI remained almost unchanged between 2000/01 and 2004/05 for both men and women. The prevalence of obesity increased slightly in both men and women, but not significantly (from 9.7 to 10.8% and from 9.6 to 10.2%, respectively). The prevalence of obesity in 2004/05 was especially high in some subgroups: men aged 45-54 (14.3%) or 55-64 (16.5%), women aged 65-74 (15.9%) or 75-84 (16.8%), men and women of middle educational level (15.6% and 14.4%, respectively), male former smokers (13.4%), and men from small towns or rural areas (13.1%). CONCLUSIONS Although the mean BMI and obesity were almost unchanged in the Swedish adult population between 2000/01 and 2004/05, obesity levels in Sweden remained unacceptably high, especially in certain subgroups. Primary and secondary intervention actions should strive to decrease the prevalence of obesity in Sweden.
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Affiliation(s)
- Jan Sundquist
- Deparment of Clinical Science, Center for Primary Health Care Research, Lund University, Malmö, Sweden.
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