1
|
Song Y, Li X, Hu B, Chen Y, Cui P, Liang Y, He X, Yang G, Li J. A study on the configuration of factors influencing overweight and obesity in adolescents based on fuzzy set qualitative comparative analysis. J Adolesc 2024. [PMID: 38946211 DOI: 10.1002/jad.12369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 06/14/2024] [Accepted: 06/20/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE Overweight and obesity among adolescents are grave public health issues around the world. Although the conditions that contribute to obesity have been extensively researched, little is known about how multiple conditions interact to cause overweight and obesity. The current study intends to investigate the histomorphic configuration pathways of several conditions of adolescent overweight and obesity by gender. METHOD The data came from a social survey conducted in June 2021 in Changchun, Jilin Province, China. The sample collected was 14-year-old adolescents, including 167 boys and 137 girls. The school physicians examined the participants' weight and height, and questionnaires were used to collect risk indicators from adolescents, such as sleep duration, electronic screens times, consumption of sugary drinks and fried foods, and physical activity. Simultaneously, a Fuzzy Qualitative Comparative Analysis will be performed to investigate the combinations of diverse conditions. RESULT We found that there is no determining necessary condition that, once present, directly determines that an individual is in a state of overweight and obesity. Simultaneously, this study revealed nine alternative configurational paths of overweight and obesity in teenagers of different genders, with a concordance of 0.805 for six male groupings and 0.916 for three female groupings. The outcomes of overweight obesity in adolescents under different genders are similar but not identical. CONCLUSION This study examined the interactions of a number of conditions from the individual, behavioral, learning and living environment that led to the same overweight obese outcome among adolescents of different genders. Our research will be useful to policymakers in that interventions should take into account the combined effects of a number of different aspects rather than focusing on a single factor that causes overweight and obesity.
Collapse
Affiliation(s)
- Yiwen Song
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Xinru Li
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Bingqin Hu
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Yitong Chen
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Peiyao Cui
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Yifang Liang
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Xin He
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Guofeng Yang
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Jinghua Li
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| |
Collapse
|
2
|
Mohd Saat NZ, Abd Talib R, Alarsan SF, Saadeh N, Shahrour G. Risk Factors of Overweight and Obesity Among School Children Aged 6 to 18 Years: A Scoping Review. NUTRITION AND DIETARY SUPPLEMENTS 2023; Volume 15:63-76. [DOI: 10.2147/nds.s420370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
|
3
|
Yao S, Zhou Y, Xu L, Zhang Q, Bao S, Feng H, Ge W. Association between hyperuricemia and metabolic syndrome: A cross-sectional study in Tibetan adults on the Tibetan plateau. Front Endocrinol (Lausanne) 2022; 13:964872. [PMID: 36339440 PMCID: PMC9632950 DOI: 10.3389/fendo.2022.964872] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/07/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study aimed to assess the relationship of serum uric acid with metabolic syndrome and its components in Tibetan adults on the Tibetan plateau. METHODS A total of 307 participants were enrolled in this study and biochemical parameters including serum uric acid, fasting plasma glucose, white blood cell, lymphocyte count, mononuclear cells, alanine aminotransferase, aspartate aminotransferase, creatinine, and lipid profile were analyzed using standard methods. The IDF criteria were applied to define metabolic syndrome. The association of serum uric acid with metabolic syndrome and its components was evaluated by multivariable logistic regression models. RESULTS The overall prevalence of metabolic syndrome was 17.3% (53/307) with 19.6% (31/158) in females and 14.8% (22/149) in male participants. The prevalence of hyperuricemia was 40.7% (125/307) with significant differences between the male (53.7%,80/149) and female (28.5%,45/158) groups. In regression analysis, we observed that the risk of MetS was higher in participants in the hyperuricemia group (adjusted OR, 4.01; 95% CI, 2.02~7.99) compared with those in the normouricemia group. After adjusting for all confounding factors, a 9% higher risk of MetS could be shown in participants with SUA increased per 10umol/L (adjusted OR, 1.09; 95% CI, 1.04~1.14). These relationships were not affected by sex or age (p >0.05). After adjusting for the confounding factors, hyperuricemia is positively associated with abdominal obesity (adjusted OR, 2.53; 95% CI, 1.41~4.53), elevated blood pressure (adjusted OR, 2.61; 95% CI, 1.37~4.97), and elevated triglycerides(adjusted OR, 2.47; 95% CI, 1.09~5.57). CONCLUSIONS In our study, hyperuricemia is significantly associated with the prevalence of metabolic syndrome and part of its components, and these relationships are not affected by sex or age. Given the high prevalence of MetS and hyperuricemia among Tibetan adults, more studies are required to explore the role of SUA in the pathogenesis of MetS.
Collapse
|
4
|
Habbab RM, Bhutta ZA. Prevalence and social determinants of overweight and obesity in adolescents in Saudi Arabia: A systematic review. Clin Obes 2020; 10:e12400. [PMID: 32827192 DOI: 10.1111/cob.12400] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/02/2020] [Accepted: 07/26/2020] [Indexed: 11/29/2022]
Abstract
Obesity in adolescents has a serious impact later in life in the form of disturbances in health and wellbeing. We aimed to evaluate the prevalence of overweight and obesity (Ow/Ob) in Saudi adolescents and to construct an ecological model of social determinants (SDs) of Ow/Ob and evaluate current evidence of their effect on Saudi adolescents. A systematic review of literature reported up until 31 December 2018 on Ow/Ob and factors that can influence them in Saudi adolescents was conducted. Fifty-one studies with n = 97 666 adolescents (55.6% males) were reviewed. The prevalence of Ow/Ob started off high and continued to increase over time. Most of the 49 reviewed SDs reports, from 19 studies, showed positive association between SDs constructed ecological model and Ow/Ob in Saudi adolescents. The prevalence of Ow/Ob among adolescents is a major public health problem in Saudi Arabia, is growing at an alarming rate and SDs play a significant role in this problem, and should be considered in all strategies targeting it. The constructed ecological model for SDs of Ow/Ob in adolescents can serve as a useful exploratory tool that helps investigating the multi-faceted aetiology of adolescent Ow/Ob and facilitates the development of effective intervention and prevention programmes.
Collapse
Affiliation(s)
- Reem M Habbab
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Clinical Nutrition, Ministry of National Guard Health Affairs, King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia
| | - Zulfiqar A Bhutta
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Al-Kutbe R, Payne A, de Looy A, Rees GA. A comparison of nutritional intake and daily physical activity of girls aged 8-11 years old in Makkah, Saudi Arabia according to weight status. BMC Public Health 2017. [PMID: 28637444 PMCID: PMC5480144 DOI: 10.1186/s12889-017-4506-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Obesity rates in Saudi Arabia are amongst the highest in the world. It is known that teenage girls are less active than teenage boys, but less is known about the diet and activity patterns in younger girls. Therefore this study sought to investigate dietary intake and daily physical activity in girls aged 8-11 years old in Saudi Arabia. METHODS This was a cross- sectional observational study conducted in seven schools across the city of Makkah. A total of 266 girls had anthropometric measurements taken including height, weight, waist circumference and body fat estimations. Dietary assessment using a 4 day unweighed diet diary was undertaken in 136 of these participants, and 134 agreed to monitor their physical activity for the 4 days using an accelerometer. After exclusion for under-reporting, 109 remained in the dietary analysis and 78 in the physical activity analyses. Differences in means between BMI groups were determined using one-way ANOVA with post hoc Tukey test. Multivariable linear regression analysis was performed to look at the effect of multiple variables on body weight. RESULTS A total of 30% of participants were classified obese or overweight. There was a significant difference in the mean daily energy intake between the BMI groups with the obese group having the highest energy, fat, carbohydrate and protein intake (obese group: 2677 ± 804 kcal/d; healthy weight group: 1806 ± 403 kcal/d, p < 0.001), but the percentage contribution of the macronutrients to energy intake remained the same across the BMI groups. There were no differences in number of steps taken per day or time spent in moderate to vigorous intensity exercise according to BMI category. Most of the girls did not meet daily physical activity guidelines (5969 to 6773 steps per day and 18.5 - 22.5 mins per day of moderate to vigorous activity). Multiple linear regression showed that energy intake positively predicted body weight (Beta = 0.279, p =0 .001), whereas, total energy expenditure per kg of body weight and family income had a significant negative influence on body weight (Beta = -0.661, p < 0.001; -0.131, p = 0.028 respectively). CONCLUSIONS The results of this cross sectional analysis suggest that obesity in girls aged 8-11 years is linked to excessive energy intake from all macronutrients and the majority of girls in all weight categories are inactive. Research should be conducted to further investigate causal relationships in longitudinal studies and develop interventions to promote dietary change and activity that is culturally acceptable for girls in Saudi Arabia.
Collapse
Affiliation(s)
- Rabab Al-Kutbe
- School of Biomedical and Healthcare Sciences, Plymouth University, Drake Circus, Plymouth, Devon, PL4 8AA, UK
| | - Anne Payne
- School of Health Professions, Plymouth University, Plymouth, UK
| | - Anne de Looy
- School of Health Professions, Plymouth University, Plymouth, UK
| | - Gail A Rees
- School of Biomedical and Healthcare Sciences, Plymouth University, Drake Circus, Plymouth, Devon, PL4 8AA, UK.
| |
Collapse
|
6
|
Hammad SS, Berry DC. The Child Obesity Epidemic in Saudi Arabia: A Review of the Literature. J Transcult Nurs 2016; 28:505-515. [PMID: 27655934 DOI: 10.1177/1043659616668398] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To examine prevalence, nutrition and activity, and overweight and obesity prevention and management in Saudi Arabia. DESIGN Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria, PubMed, Web of Science, PyschINFO, Global Health, Family Studies Worldwide, Middle Eastern Studies, and Sociological Abstracts was searched from January 1, 2003 to January 31, 2016. Inclusion criteria included peer-reviewed articles published in Arabic and English that focused on prevalence, overweight or obesity in children 2 to 20 years of age, body mass index percentile, and interventions. FINDINGS Three themes were identified: epidemiological features, where the eastern region had the highest prevalence of overweight and obesity, risk factors, which included higher parental education, and lifestyle factors, which included increased consumption of calorie-dense food and a sedentary lifestyle. CONCLUSION Childhood obesity is increasing in Saudi Arabia at an alarming rate. IMPLICATIONS FOR PRACTICE Practitioners need to consider the cultural influences of the increasing obesity epidemic in Saudi Arabia.
Collapse
Affiliation(s)
- Sama S Hammad
- 1 The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diane C Berry
- 1 The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
7
|
Ahmed HS, Khalid MEM, Osman OM, Ballal MA, Al-Hashem FH. The association between physical activity and overweight and obesity in a population of children at high and low altitudes in Southwestern Saudi Arabia. J Family Community Med 2016; 23:82-7. [PMID: 27186153 PMCID: PMC4859103 DOI: 10.4103/2230-8229.181011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To assess the relationship between overweight and obesity and physical activity in Saudi children born and permanently domiciled at high and low altitudes in Southwestern Saudi Arabia. Subjects and Methods: A cross-sectional study of 145 healthy Saudi children aged 10–15 years who were born and lived permanently at high altitude (3000–3100 m) and 154 healthy Saudi children of comparable age who were born and lived permanently at a relatively low altitude (500 m) was conducted. For each subject selected, body weight and body height were measured using an Avery beam weighing scale and a stadiometer, respectively. Body mass index (BMI) was calculated using the equation BMI = (weight [kg]/height [m2]). Physical activity scores were determined using International Physical Activity Questionnaire-Short Form-A. Resting radial pulse rate (beat/minutes) was determined clinically. Results: Physical activity was significantly and inversely associated with overweight and obesity in boys at both high (χ2 = 15.8, P< 0.001) and low (χ2 = 14.7, P< 0.001) altitudes, but there was no clear trend for girls at either altitude. The lack of association between physical activity and overweight and obesity in girls was attributed to the low and homogeneous level of physical activity. Conclusion: Physical activity should be encouraged as a strategy for weight reduction in the overweight and the obese and the prevention of overweight and obesity in Saudi children at high and low altitudes.
Collapse
Affiliation(s)
- Humeda S Ahmed
- Department of Physiology, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Mohammed E M Khalid
- Department of Physiology, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Osama M Osman
- Department of Physiology, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Mansour A Ballal
- Department of Physiology, College of Medicine, University of Science and Technology, Omdurman, Sudan
| | - Fahaid H Al-Hashem
- Department of Physiology, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| |
Collapse
|
8
|
Abstract
Objectives: To compare the levels of blood pressure (BP) between male and female adolescents in the Eastern Province of Saudi Arabia and reference percentiles for Saudi adolescents. A secondary aim was to explore the distribution of BP among the participants based on age and gender. Methods: This cross-sectional study was conducted among 146 boys and girls attending intermediate and secondary schools in 2 regions (Al-Mallaha and Al-Mubarraz) in the Eastern Province of Saudi Arabia. Weight, random blood glucose, and BP were collected by a team of health educators in the morning of the school day between April and May 2014. Results: Of the current sample of adolescents originally from the Eastern Province, 30% had systolic blood pressure (SBP) of ≥140 mm Hg and 22% had diastolic blood pressure of ≥90 mm Hg. For girls between 13 and 16 years old, the SBP was greater than the 95th percentile of Saudi national norms. Participants were classified by gender and school stage, and one-way analysis of variance showed significant differences in the means of SBP between intermediate boys (127±2.5 mm Hg) and secondary boys (136±2.1 mm Hg) (p<0.05), and between intermediate boys and intermediate girls (138±1.6 mm Hg) (p<0.01). Conclusion: The increased level of BP among adolescents originally from the Eastern Province raises the need to update the current BP nomograms, considering possible differences for specific geographic areas across the country. Implementing therapeutic life style management in girls’ schools is recommended.
Collapse
Affiliation(s)
- Shaea A Alkahtani
- Department of Exercise Physiology, College of Sport Sciences and Physical Activity, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
| |
Collapse
|
9
|
Woolcott OO, Ader M, Bergman RN. Glucose homeostasis during short-term and prolonged exposure to high altitudes. Endocr Rev 2015; 36:149-73. [PMID: 25675133 PMCID: PMC4399271 DOI: 10.1210/er.2014-1063] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Most of the literature related to high altitude medicine is devoted to the short-term effects of high-altitude exposure on human physiology. However, long-term effects of living at high altitudes may be more important in relation to human disease because more than 400 million people worldwide reside above 1500 m. Interestingly, individuals living at higher altitudes have a lower fasting glycemia and better glucose tolerance compared with those who live near sea level. There is also emerging evidence of the lower prevalence of both obesity and diabetes at higher altitudes. The mechanisms underlying improved glucose control at higher altitudes remain unclear. In this review, we present the most current evidence about glucose homeostasis in residents living above 1500 m and discuss possible mechanisms that could explain the lower fasting glycemia and lower prevalence of obesity and diabetes in this population. Understanding the mechanisms that regulate and maintain the lower fasting glycemia in individuals who live at higher altitudes could lead to new therapeutics for impaired glucose homeostasis.
Collapse
Affiliation(s)
- Orison O Woolcott
- Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048
| | | | | |
Collapse
|
10
|
Energy and nutrient intake, and number of steps taken per day according to body mass index of girls aged 8–11 years in Saudi Arabia. Proc Nutr Soc 2015. [DOI: 10.1017/s0029665115003912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
11
|
Laiyemo AO. The risk of colonic adenomas and colonic cancer in obesity. Best Pract Res Clin Gastroenterol 2014; 28:655-63. [PMID: 25194182 PMCID: PMC4159619 DOI: 10.1016/j.bpg.2014.07.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 06/10/2014] [Accepted: 07/05/2014] [Indexed: 01/31/2023]
Abstract
Increasing body fatness has been associated with an increased burden from colorectal cancer. An increased susceptibility spanning the entire continuum from precancerous adenomatous polyps to the development of colorectal cancer, poor outcome with treatment, and reduced survival when compared to those with normal body weight has been described. It is unknown which age period and which degree and duration of excess weight are associated with increased colorectal cancer risk. It is uncertain whether weight loss can reverse this risk. If it can, how long will the new lower or normal weight be maintained to effect enduring risk reduction? Furthermore, it is controversial whether the increased burden of colorectal cancer warrants earlier and/or more frequent screening for obese persons. This article reviews the relationship between obesity and colorectal neoplasia, explores the postulated mechanism of carcinogenesis, discusses interventions to reduce the burden of disease, and suggests future directions of research.
Collapse
Affiliation(s)
- Adeyinka O. Laiyemo
- Division of Gastroenterology, Department of Medicine, Howard University College of Medicine, Washington DC
| |
Collapse
|
12
|
Sherpa LY, Deji, Stigum H, Chongsuvivatwong V, Nafstad P, Bjertness E. Prevalence of metabolic syndrome and common metabolic components in high altitude farmers and herdsmen at 3700 m in Tibet. High Alt Med Biol 2013; 14:37-44. [PMID: 23537259 DOI: 10.1089/ham.2012.1051] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To estimate the prevalence of metabolic syndrome, its associated factors and components in 30-80-year-old Tibetans living at high altitude. METHOD Multistage sampling of 692 participants. We used IDF criteria for estimation of the metabolic syndrome, and a questionnaire based on the WHO MONICA protocol. RESULTS The prevalence of metabolic syndrome was 8.2% (Confidence interval (CI):6.1-10.2) while the common components were: fasting hyperglycemia 57.5% (53.8-61.1); abdominal obesity 46% (42.2-49.7); and high blood pressure 37% (33.4-40.5). Metabolic syndrome was significantly lower for males, those with higher education and physical activity >2000 Kcal/week. Self awareness, treatment and control were low for both diabetes and lipid abnormality. CONCLUSION The overall prevalence of metabolic syndrome in high altitude farmers and herdsmen in Tibet was lower compared to other high altitude natives, while its components (hyperglycemia, obesity, and high blood pressure) were higher than in other high altitude communities. Implications of the findings of high prevalence of smoking (among men), obesity, and hypertension and low rates of awareness, treatment, and control of the components of the metabolic syndrome among rural highlanders propels the need for health programs targeting risk factors.
Collapse
Affiliation(s)
- Lhamo Y Sherpa
- Section for Preventive Medicine and Epidemiology, Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | | | | | | | | | | |
Collapse
|
13
|
Association of elevation, urbanization and ambient temperature with obesity prevalence in the United States. Int J Obes (Lond) 2013; 37:1407-12. [PMID: 23357956 DOI: 10.1038/ijo.2013.5] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 12/10/2012] [Accepted: 12/19/2012] [Indexed: 01/25/2023]
Abstract
BACKGROUND The macrogeographic distribution of obesity in the United States, including the association between elevation and body mass index (BMI), is largely unexplained. This study examines the relationship between obesity and elevation, ambient temperature and urbanization. METHODS AND FINDINGS Data from a cross-sectional, nationally representative sample of 422603 US adults containing BMI, behavioral (diet, physical activity, smoking) and demographic (age, sex, race/ethnicity, education, employment, income) variables from the 2011 Behavioral Risk Factor Surveillance System were merged with elevation and temperature data from WorldClim and with urbanization data from the US Department of Agriculture. There was an approximately parabolic relationship between mean annual temperature and obesity, with maximum prevalence in counties with average temperatures near 18 °C. Urbanization and obesity prevalence exhibited an inverse relationship (30.9% in rural or nonmetro counties, 29.2% in metro counties with <250000 people, 28.1% in counties with population from 250000 to 1 million and 26.2% in counties with >1 million). After controlling for urbanization, temperature category and behavioral and demographic factors, male and female Americans living <500 m above sea level had 5.1 (95% confidence interval (CI) 2.7-9.5) and 3.9 (95% CI 1.6-9.3) times the odds of obesity, respectively, as compared with counterparts living ≥ 3000 m above sea level. CONCLUSIONS Obesity prevalence in the United States is inversely associated with elevation and urbanization, after adjusting for temperature, diet, physical activity, smoking and demographic factors.
Collapse
|
14
|
A study on BMI among the Bhotia of Uttaranchal, India. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2011. [DOI: 10.1016/s2222-1808(11)60014-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
15
|
|