Childhood Overweight, Obesity, and the Metabolic Syndrome in Developing Countries

The incidence of chronic disease is escalating much more rapidlyin developing countries than in industrialized countries. Apotential emerging public health issue may be the increasingincidence of childhood obesity in developing countries and theresulting socioeconomic and public health burden faced by thesecountries in the near future. In a systematic review carriedout through an electronic search of the literature from 1950–2007,the author compared data from surveys on the prevalence of overweight,obesity, and the metabolic syndrome among children living indeveloping countries. The highest prevalence of childhood overweightwas found in Eastern Europe and the Middle East, whereas Indiaand Sri Lanka had the lowest prevalence. The few studies conductedin developing countries showed a considerably high prevalenceof the metabolic syndrome among youth. These findings providealarming data for health professionals and policy-makers aboutthe extent of these problems in developing countries, many ofwhich are still grappling with malnutrition and micronutrientdeficiencies. Time trends in childhood obesity and its metabolicconsequences, defined by uniform criteria, should be monitoredin developing countries in order to obtain useful insights forprimordial and primary prevention of the upcoming chronic diseaseepidemic in such communities. child • developing countries • metabolic syndrome X • obesity • overweight     

山东省中西部农村居民肥胖与高血压和糖尿病的关系

目的 研究超重、肥胖和中心性肥胖与糖尿病(DM)、高血压之间的关系.方法 按照多阶段分层随机抽样原则,对山东省中西部农村居民16 388人进行问卷调查并测量身高、体重、腰围、血压、空腹血糖.空腹血糖在6.1～7.0mmol/L间复做口服葡萄糖耐量试验(OGTT).分析超重肥胖、中心性肥胖与糖尿病和高血压患病率间的关系.结果 超重、肥胖、中心性肥胖患病率分别为35.28%,15.31%,40.63%,DM患病率为4.27%,高血压患病率为43.8%.DM和高血压患病率随BMI和腰围的增加而升高,经X2趋势检验,有统计学意义(P＜0.05).经分层分析,高血压患病率随BMI和腰围增加而升高,DM患病率随腰围增加而升高(P＜0.05),随BMI增加,DM患病率并无上升(P＞0.05).多因素Logistic回归分析证实,高血压患病危险性与BMI和腰围相关(P＜0.05),而DM仅与腰围有关(P＜0.05),与BMI无关(P＞0.05).结论 超重、肥胖和中心性肥胖与高血压、糖尿病关系密切.必须加强超重、肥胖和中心性肥胖的干预控制工作.     

高血压、糖尿病、血脂异常及代谢综合征与超重和肥胖关系

目的 评估北京市农村居民体质指数(BMI)的分布,不同BMI居民高血压、糖尿病、血脂异常及代谢综合征患病率及其与超重和肥胖的关系.方法 对随机抽取的20 655名18～76岁农村居民进行横断面调查,通过问卷调查、体格检查和实验室检查收集资料进行分析.结果 北京市农村居民体重正常、超重和肥胖的年龄别标化率分别为68.1%,24.2%和7.7%.正常体重、超重、肥胖1～3级居民高血压患病率分别为14.4%,27.5%,34.8%,44.3%和50.7%,糖尿病患病率分别为2.9%,5.0%,6.4%,8.1%和11.2%.正常体重居民血脂异常患病率最低(13.8%),肥胖2级最高(35.1%).正常体重居民代谢综合征患病率最低(5.6%),肥胖3级居民最高(15.1%).超重和肥胖1～3级分别是正常体重患高血压危险的2.6、3.1、3.8和4.7倍,肥胖3级糖尿病(OR=4.5)和代谢综合征(OR=3.2)患病危险最高,肥胖2级血脂异常(OR=3.4)患病危险最高.结论 高血压、糖尿病、血脂异常和代谢综合征患病率随超重和肥胖级别增加而升高,超重和肥胖是高血压、糖尿病、血脂异常及代谢综合征的独立危险因素.     

沿海社区居民超重和肥胖及中心性肥胖与高血压关系的研究

目的了解沿海社区居民超重、肥胖、中心性肥胖分布特征与高血压的发病关系,为探索查、防、治、管的慢病社区综合防治模式提供科学依据。方法采用多阶段分层随机整群抽样的方法,从烟台市芝罘区8个社区居委会抽取320个样本居民户,按照KISH表法,每户随机抽取1名调查对象。并实行全程严格的质量控制。采用Excel建立数据库,应用SPSS16.0软件进行统计学分析。结果社区居民超重率、肥胖率、中心性肥胖率、高血压患病率分别为40.31%、19.06%、63.13%、38.44%,标化率分别为30.13%、11.71%、46.37%、21.19%。上述病症≥40岁人群现患比重,分别占社区15～69岁居民的86.05%、90.16%、85.15%和87.37%,并且从40岁开始,这些病症现患率均呈随年龄增长而明显增长的变化趋势。离退休人员的超重、肥胖、中心性肥胖现患比重,分别占社区所有职业人群的56.92%、62.90%和57.21%。不同体重指数(BMI)、腰围(WC)水平年龄、血压均值比较,差异均有统计学意义(F=24.202,17.550,19.987,35.009,15.662,13.857,P=0.000)。高血压组与非高血压组的超重率、肥胖率、中心性肥胖率分别比较,差异均有统计学意义(χ2=3.887,P0.05;χ2=26.373、28.356、P0.01;OR=1.584,4.425,4.049)。BMI、WC与SBP和DBP呈高度线性正相关(r0.7),并能建立有统计学意义的线性回归方程。结论烟台市社区居民超重、肥胖以及中心性肥胖与高血压发病呈密切正相关,这些病症从40岁开始明显随年龄增长而增长,离退休人员属现患高峰人群,在社区实时、动态、准确地对居民BMI、WC均值进行主动监测,是综合防治高血压的重要措施之一。     

Soft Drink Consumption and Mental Health in Adolescents: A Longitudinal Examination

PurposePrevious studies showed associations between soft drink consumption and mental health problems in adolescents, but the direction of these effects is unknown. This study examines the hypotheses that soft drink consumption predicts aggression and depressive symptoms over time and that these mental health problems predict soft drink consumption.MethodsInterviews were conducted with 5,147 children and their caregivers from three sites at child ages 11, 13, and 16. At each time point, youth reported on their frequency of consuming soft drinks, aggressive behavior, and depressive symptoms. An autoregressive cross-lagged path model tested reciprocal relationships between soft drink consumption, aggressive behavior, and depressive symptoms over time.ResultsMore frequent consumption of soft drinks was associated with more aggressive behavior at each time point and depressive symptoms at ages 11 and 13 (r = .04 to .18, p ≤ .002). After adjusting for covariates and stability of each behavior over time, soft drink consumption at ages 11 and 13 predicted more aggressive behavior at the next time point (β = .08 and .06, p < .001). Aggressive behavior at age 13 also predicted more soft drink consumption at age 16 (β = .06, p = .002). Soft drink consumption at age 13 predicted fewer depressive symptoms (β = ?.04, p = .007), but depressive symptoms did not predict soft drink consumption.ConclusionsMore frequent consumption of soft drinks may contribute to aggressive behavior in adolescents over time; there is some support for reciprocal relationships. There is no evidence for soft drink consumption contributing to adolescents' depression. Future research should examine longitudinal effects over shorter intervals.     

昆明市成人超重肥胖流行现状及与血压血糖水平的关系

目的了解昆明市20岁及以上成人超重、肥胖的流行特征,分析超重、肥胖与血压、血糖水平和高血压、糖尿病间的关系。方法采用分层多阶段抽样方法,于2008年1—4月随机抽取昆明市20岁及以上常住居民5195人,进行面对面询问调查和体格检查。结果昆明市20岁及以上城乡居民超重率为25.73%,肥胖率为8.09%。随着体质指数的增加,居民的平均血压和血糖水平均逐渐升高(P0.05),同时,高血压、空腹血糖受损、糖尿病患病率也迅速增高(P0.05),正常体重人群的高血压、空腹血糖受损、糖尿病患病率分别为19.08%,5.35%和4.15%,而超重者高血压、空腹血糖受损和糖尿病患病率分别为30.38%,6.70%和8.23%,肥胖者高血压、空腹血糖受损和糖尿病患病率分别为41.10%,6.36%和14.56%,超重人群的高血压、空腹血糖受损、糖尿病患病率分别是正常体重人群的1.59倍、1.25倍和1.98倍,肥胖人群的高血压、空腹血糖受损、糖尿病患病率分别是正常体重人群的2.15倍、1.19倍和3.51倍。结论超重、肥胖已成为影响昆明市居民健康的重要公共卫生问题,是高血压、糖尿病等慢性病的重要危险因素,应加强对超重、肥胖的干预和控制。     

Diet Soft Drink Consumption is Associated with the Metabolic Syndrome: A Two Sample Comparison

Comparative analyses of soft drink intakes in samples from the United States and Europe, and assessed intakes in relation to prevalence of metabolic syndrome (MetS) and its individual components are currently lacking. We used data collected on cardiovascular health and dietary intakes in participants from two cross-sectional studies: the Maine-Syracuse Longitudinal Study (MSLS), conducted in Central New York, USA in 2001–2006 (n = 803), and the Observation of Cardiovascular Risk Factors in Luxembourg Study (ORISCAV-LUX), conducted in 2007–2009 (n = 1323). Odds ratios for MetS were estimated according to type and quantity of soft drink consumption, adjusting for demographic, lifestyle and dietary factors, in both studies. In both studies, individuals who consumed at least one soft drink per day had a higher prevalence of MetS, than non-consumers. This was most evident for consumers of diet soft drinks, consistent across both studies. Diet soft drink intakes were also positively associated with waist circumference and fasting plasma glucose in both studies. Despite quite different consumption patterns of diet versus regular soft drinks in the two studies, findings from both support the notion that diet soft drinks are associated with a higher prevalence of MetS.     

Relationship between 25 Hydroxyvitamin D,Overweight/Obesity Status,Pro-Inflammatory and Oxidative Stress Markers in Patients with Type 2 Diabetes: A Simplified Empirical Path Model

Vitamin D deficiency is highly prevalent in patients with overweight/obesity and type 2 diabetes (T2DM). Herein, we investigated the relationship between vitamin D status and overweight/obesity status, insulin resistance (IR), systemic inflammation as well as oxidative stress (OS). Anthropometric and laboratory assessments of 25-hydroxyvitamin D (25(OH)D) and glycemic, pro-inflammatory and OS biomarkers were performed in a sample of 47 patients with T2DM who were divided into categories based on overweight and degree of obesity. The main findings were: the overweight/obesity status correlated negatively with the degree of serum 25(OH)D deficiency (ρ = −0.27) with a trend towards statistical significance (p = 0.069); the homeostasis model assessment of insulin resistance (HOMA-IR) was significantly different (p = 0.024) in patients with 25(OH)D deficiency, as was total oxidant status (TOS) and oxidative stress index (OSI) in patients with severe serum 25(OH)D deficiency as compared to those with 25(OH)D over 20 ng/mL (TOS: p = 0.007, OSI: p = 0.008); and 25(OH)D had a negative indirect effect on TOS by body mass index (BMI), but BMI was not a significant mediator of the studied relationship. In a setting of overweight and increasing degree of obesity, patients with T2DM did not display decreasing values of 25(OH)D. Subjects with the lowest values of 25(OH)D presented the highest values of BMI. Patients with 25(OH)D deficiency were more insulin resistant and showed increased OS but no elevated systemic inflammation. The negative effect of 25(OH)D on TOS did not seem to involve BMI as a mediator.     

Underweight,Overweight and Obesity among Reproductive Bangladeshi Women: A Nationwide Survey

The double burden of malnutrition is becoming more prevalent among Bangladeshi women. Underweight, overweight, and obesity were examined among women aged 15–49 years using the 2017–2018 Bangladesh Demographic and Health Survey (BDHS). A dataset of 20,127 women aged 15–49 years with complete Body Mass Index (BMI) measurements were extracted and categorized as underweight, normal weight, overweight, and obesity. A multiple logistic regression that adjusts for clustering and sampling weights was used to examine underweight, overweight, and obesity among reproductive age Bangladeshi women. Our analyses revealed that the odds of being overweight and obese were higher among women who completed primary and secondary or more levels of education, rich households, breastfeeding women, and women exposed to media (newspapers and television (TV). Women from the poorest households were significantly more likely to be underweight (AOR = 3.86, 95%CI: 2.94–5.07) than women from richer households. The likelihood of being underweight was higher among women with no schooling, adolescent women, and women not using contraceptives. Conclusions: Overweight and obesity was higher among educated and affluent women while underweight was higher among women from low socioeconomic status, indicating that tailored messages to combat overweight and obesity should target educated and affluent Bangladeshi women while improving nutrition among women from low socioeconomic status.     

The Relationship of Adverse Childhood Events to Smoking,Overweight, Obesity and Binge Drinking Among Women in Hawaii

Objectives

To evaluate how the associations of adverse childhood events (ACEs) with smoking, overweight, obesity and binge drinking differ by race/ethnicity among women, including a large, understudied cohort of Asians and Native Hawaiians/Pacific Islanders (NHOPIs).

Methods

The number and type (household dysfunction, and physical, verbal and sexual abuse) of ACEs were examined in relation to adulthood smoking, overweight, obesity and binge drinking among 3354 women in Hawaii using the 2010 Behavioral Risk Factor Surveillance System data using Poisson regression with robust error variance. We additionally investigated for interaction by race/ethnicity. Covariates included age, race/ethnicity, education, emotional support, healthcare coverage, and the other health outcomes.

Results

Overall, 54.9 % reported at least 1 ACE. The prevalence of smoking (PR = 1.40 (1 ACE) to PR = 2.55 [5+ ACEs]), overweight (PR = 1.22 [1 ACE] to PR = 1.31 [5+ ACEs]) and obesity (PR = 1.00 [1 ACE] to PR = 1.85 [5+ ACEs]) increased with increasing ACE count. Smoking was associated with household dysfunction (PR = 1.67, CI = 1.26–2.22), and physical (PR = 2.04, CI = 1.50–2.78) and verbal (PR = 1.62, CI = 1.25–2.10) abuse. Obesity was also significantly related to household dysfunction (PR = 1.22, CI = 1.01–1.48), and physical (PR = 1.36, CI = 1.10–1.70), verbal (PR = 1.35, CI = 1.11–1.64) and sexual (PR = 1.53, CI = 1.25–1.88) abuse. Among Asians, sexual abuse was associated with a lower prevalence of binge drinking (PR = 0.26, CI = 0.07–0.93), which was significantly different from the null association among Whites (interaction p = 0.02).

Conclusion

Preventing/addressing ACEs may help optimize childhood health, and reduce the likelihood of smoking/obesity among women including Asians/NHOPIs. Further studies are warranted to evaluate the sexual abuse-binge drinking association among Asians, which may support the need for culturally-tailored programs to address ACEs.

     

江苏省城乡居民超重与肥胖流行状况

目的了解江苏省超重和肥胖的流行水平及其在人群中的分布特点,为开展相关防治工作提供依据。方法采用多阶段随机整群抽样方法和KISH表法确定15～69岁城乡常住居民4318人为调查对象,通过问卷调查获得人群基本情况和健康状况,并测量体重、腰围。结果江苏省15～69岁城乡居民超重率、肥胖率、中心性肥胖率分别为32.90%,9.94%,42.55%,农村均高于城市(P0.05);男性在20～30岁间、女性在30岁后超重率、肥胖率、中心性肥胖率增速最快;76.65%的中心性肥胖者同时存在超重或肥胖,95.58%的调查对象患肥胖相关疾病的危险度有不同程度升高。结论超重与肥胖是该省当前亟需应对的公共卫生问题,已出现农村高于城市的新的分布特点,应探索体重管理的有效模式。     

Relationship between Ultra-Processed Food Consumption and Risk of Diabetes Mellitus: A Mini-Review

Studying the factors that cause diabetes and conducting clinical trials has become a priority, particularly raising awareness of the dangers of the disease and how to overcome it. Diet habits are one of the most important risks that must be understood and carefully applied to reduce the risk of diabetes. Nowadays, consuming enough home-cooked food has become a challenge, particularly with modern life performance, pushing people to use processed foods. Ultra-processed food (UPF) consumption has grown dramatically over the last few decades worldwide. This growth is accompanied by the increasing prevalence of non-communicable diseases (NCDs) such as cardiovascular diseases, hypertension, and type 2 diabetes. UPFs represent three main health concerns: (i) they are generally high in non-nutritive compounds such as sugars, sodium, and trans fat and low in nutritional compounds such as proteins and fibers, (ii) they contain different types of additives that may cause severe health issues, and (iii) they are presented in packages made of synthetic materials that may also cause undesirable health side-effects. The association between the consumption of UPF and the risk of developing diabetes was discussed in this review. The high consumption of UPF, almost more than 10% of the diet proportion, could increase the risk of developing type 2 diabetes in adult individuals. In addition, UPF may slightly increase the risk of developing gestational diabetes. Further efforts are needed to confirm this association; studies such as randomized clinical trials and prospective cohorts in different populations and settings are highly recommended. Moreover, massive improvement in foods’ dietary guidelines to increase the awareness of UPF and their health concerns is highly recommended.     

初中学生超重与肥胖相关因素分析

目的探讨初中生超重与肥胖的相关因素,为进一步采取干预措施提供依据。方法随机抽取某市742名初一学生,采取询问法进行问卷调查,在膳食和体质调查的基础上,对超重肥胖组和对照组学生进行统计分析。结果超重肥胖组与对照组学生在体育锻炼、就餐地点、坚果摄取频次上存在一定差异。其中体育锻炼每天平均>1 h,即有保护性作用,相对危险度为0.039,而晚餐在餐馆或街头就餐及坚果类食物的摄取频率每周>5 d时,相对危险度则分别为7.435和1.934。结论晚餐在餐馆或街头就餐、坚果摄取频率高为超重与肥胖的危险因素。     

Proportion of Gestational Diabetes Mellitus Attributable to Overweight and Obesity Among Non-Hispanic Black,Non-Hispanic White,and Hispanic Women in South Carolina

Objective was to estimate race-specific proportions of gestational diabetes mellitus (GDM) attributable to overweight and obesity in South Carolina. South Carolina birth certificate and hospital discharge data were obtained from 2004 to 2006. Women who did not have type 2 diabetes mellitus before pregnancy were classified with GDM if a diagnosis was reported in at least one data source. Relative risks (RR) and 95 % confidence intervals were calculated using the log-binomial model. The modified Mokdad equation was used to calculate population attributable fractions for overweight body mass index (BMI: 25.0–29.9 kg/m²), obese (30.0–34.9 kg/m²), and extremely obese (≥35 kg/m²) women after adjusting for age, gestational weight gain, education, marital status, parity, tobacco use, pre-pregnancy hypertension, and pregnancy hypertension. Overall, the adjusted RR of GDM was 1.6, 2.3, and 2.9 times higher among the overweight, obese, and extremely obese women compared to normal-weight women in South Carolina. RR of GDM for extremely obese women was higher among White (3.1) and Hispanic (3.4) women than that for Black women (2.6). The fraction of GDM cases attributable to extreme obesity was 14.0 % among White, 18.1 % among Black, and 9.6 % among Hispanic women. The fraction of GDM cases attributable to obesity was about 12 % for all racial groups. Being overweight (BMI: 25.0–29.9) explained 8.8, 7.8, and 14.4 % of GDM cases among White, Black, and Hispanic women, respectively. Results indicate a significantly increased risk of GDM among overweight, obese, and extremely obese women. The strength of the association and the proportion of GDM cases explained by excessive weight categories vary by racial/ethnic group.     

体检人群超重／肥胖与代谢综合征的关系

代谢综合征（metabolic syndrome，MS）是多种代谢危险因素在个体内的聚集，其中包括肥胖、血脂紊乱、高血压、糖尿病等多种代谢紊乱。超重／肥胖是指由多种原因引起的脂肪成分过多且超过正常人平均量的病理状态。肥胖不仅本身是一种疾病，而且是血脂异常、高血压、2型糖尿病、心血管疾病（CVD）的重要危险因素。血脂异常产生游离脂肪酸（FFA）升高是MS引起胰岛素抵抗（IR）的重要因素。     

肥胖者内皮功能障碍与心血管危险因素及其聚集性

目的 探讨血管内皮功能与肥胖合并心血管危险因素的关系。方法 对576例体重指数(BMI)≥25kg／m^2的中年肥胖人群检测BMI、腰臀比(WHR)、血压、血糖和胰岛素、血脂及胰岛素抵抗指数(IRI)，并测定血流介导的内皮依赖性舒张功能。按合并的心血管危险因素(高血压、高血脂和高血糖)分组后进行分析。结果 (1)血压、血脂、血糖、IRI及BMI、WHR在合并心血管危险因素的肥胖者较单纯肥胖者显著升高，并随着危险因素增多呈上升趋势。(2)内皮依赖性舒张功能随着危险因素增加逐渐降低，其内皮功能异常的发生率呈明显升高趋势。(3)男性肥胖者合并心血管危险因素较女性多见。(4)合并不同数量心血管危险因素各组中，内皮功能异常者心血管危险因素水平均高于内皮功能正常者。(5)内皮功能异常者合并高血脂、高血糖及代谢综合征的发生率显著高于内皮功能正常者。结论 内皮功能障碍与肥胖者心血管危险因素的发生和聚集密切相关．可能是胰岛素抵抗(IR)的前兆，与IR其同参与代谢相关性心血管病的发病机制。     

The Association of Healthy Lifestyle Behaviors with Overweight and Obesity among Older Adults from 21 Countries

This study aimed to analyze the association of healthy lifestyle behaviors with overweight and obesity among Europeans aged 65+ years. Data were from the 2014 European Social Survey, analyzing 21 countries. Five lifestyle behaviors (physical activity, fruit and vegetable consumption, sleep quality, drinking alcohol, and smoking) were analyzed. Binary logistic regressions were performed. A total of 8938 participants (4099 men) 65 years and older, mean age—73.6 (SD: 6.6) presented prevalence of overweight of 42.3% (95% CI: 41.3 to 43.3) and obesity of 20.9% (95% CI: 20.1 to 21.8). Adopting five healthy behaviors was associated with lower odds of obesity (OR = 0.50, 95% CI: 0.39 to 0.63), but not overweight (OR: 0.93; 95% CI: 0.79 to 1.10). Physical activity (≥5 days/week) was the most protective behavior, reducing by 42% the odds of obesity. Sex moderated the association of fruits and vegetables consumption, alcohol use, and smoking with obesity. Strategies aiming to reduce obesity levels in older adults should focus on the promotion of multiple lifestyle health behaviors, particularly physical activity in order to decrease vulnerability risk in old age.