抚顺市城乡居民超重肥胖流行病学调查

目的 了解抚顺市18~75岁城乡居民肥胖流行现状,为采取干预措施提供参考依据。方法 采用随机整群抽样方法对在辽宁省抚顺市4个区抽取的4 752名18~75岁城乡居民进行问卷调查和体格检查,采用SPSS 17.0软件进行一般描述性分析、 t检验、方差分析、 χ²检验。结果 按中国成人超重和肥胖症预防控制指南成人体质指数(BMI)分类标准,抚顺市城乡居民超重率、肥胖率、超重/肥胖率分别为29.1%,9.3%,38.4%,男性和女性居民分别为27.9%和30.3%,9.5%和9.0%,37.4%和39.3%,男性居民超重率、超重/肥胖率均低于女性居民(P=0.02),男性和女性居民肥胖率差异无统计学意义(P>0.05),抚顺市城乡居民中心性肥胖率为39.1%,男性居民中心性肥胖率为19.1%,低于女性居民的20.1%,差异有统计学意义(χ²=56.4,P=0.002);不同年龄女性居民和不同文化程度男性居民超重率均不同(P<0.05);不同年龄、文化程度男性居民和不同文化程度女性居民肥胖率均不同(P<0.05),不同文化程度男性居民和不同年龄、文化程度女性居民中心性肥胖率均不同(P<0.05);不同年龄、文化程度男性和女性居民中心性肥胖率均不同(P<0.05)。结论 抚顺市城乡居民超重率和肥胖率略高,女性居民超重率、超重/肥胖率和中心性肥胖率均高于男性居民。     

Exposure to the Great Famine in Early Life and the Risk of Obesity in Adulthood: A Report Based on the China Health and Nutrition Survey

Intrauterine malnutrition has a long-term effect on human health. This study aimed to evaluate the associations between exposure to famine in early life and obesity in adulthood in Chinese adults. A total of 5033 participants (22,132 observations) of the China Health and Nutrition Survey (CHNS) in 1991–2015 were classified into three famine exposure groups according to their birth year: unexposed (1963–1966), fetal-exposed (1959–1962) and childhood-exposed (1955–1958). Compared with the unexposed group, the fetal-exposed group had higher levels of body-mass-index (BMI) and waist-circumference (WC), and higher prevalence of overweight and central obesity, whereas the childhood-exposed group had lower levels of the measurements. However, the positive associations of fetal exposure with BMI, WC and prevalence of overweight and central obesity were attenuated by additionally adjusting for age at survey. Stratified analysis showed that the adverse effect of fetal exposure to famine was only observed in subjects at several specific age-groups, and in men living in rural areas and in women living in more severe famine exposed areas (p for interaction < 0.05). Our results provide evidence for the weak effect of fetal exposure to famine on body measurements in adulthood, and suggest the importance of severity of famine exposure and timing of exposure.     

Assessment of obesity in children and adolescents: synthesis of recent systematic reviews and clinical guidelines

This review summarises recent systematic reviews and evidence‐based guidelines that deal with the issue of how best to diagnose or define obesity in children and adolescents. A recent systematic review showed that parents typically fail to recognise obesity in their children and adolescents, and a good deal of other evidence suggests that health professionals under‐diagnose obesity in children and adolescents when using informal methods based on observation. There is therefore a need for practical, objective, methods that both identify the fattest children and adolescents adequately, and identify those who are at greatest risk of the ‘co‐morbidities’ of obesity. A large body of consistent evidence shows that a high body mass index (BMI) for age and sex identifies the fattest children adequately, with low–moderate false negative rate and a low false positive rate. Furthermore, children and adolescents at high BMI for age are at much greater risk of the co‐morbidities of obesity. A recent systematic review found that the use of BMI for age with national reference data and cut‐off points (such as the 95th percentile to define obesity) was superior to the Cole–International Obesity Task Force international approach for defining obesity based on BMI for age. The same systematic review also found no evidence that use of waist circumference for age improved the diagnosis of obesity, or the cardio‐metabolic co‐morbidities of obesity, in children and adolescents. Recent systematic reviews are therefore supportive of current guidelines that recommend percentile‐based cut‐offs relative to national reference data to (e.g. BMI at or above the 95th or 98th percentile in the UK) to define obesity for clinical applications in children and adolescents.     

Associations Between Nonnutritive Sweetener Intake and Metabolic Syndrome in Adults

Objective: Individuals looking to improve their health or weight status often use nonnutritive sweeteners (NNS), yet NNS consumption has been associated with increased risk factors for metabolic syndrome (MetS). Most studies examining NNS only assess total intake using diet soda as a proxy for NNS consumption, without distinguishing potential risks associated with individual sweeteners. The objective of this cross-sectional investigation was to identify whether there were associations between NNS consumption (total or individual) and risk factors for MetS in adults (n = 125) from Southwest Virginia.

Methods: Participants provided three 24-hour dietary recalls and blood pressure, waist circumference, fasting glucose, triglycerides, and high-density lipoprotein cholesterol were assessed. Linear regression models, adjusted for age, sex, caloric intake, dietary quality, and physical activity, examined associations between total and individual types of NNS with MetS and MetS risk factors.

Results: Sixty-three participants were classified as NNS consumers and eighteen met the criteria for MetS. While no significant associations between MetS and NNS consumption were found, waist circumference was positively associated with total NNS, saccharin, sucralose, and acesulfame potassium, and both fasting glucose and triglyceride values were positively associated with total NNS and aspartame consumption.

Conclusion: While these cross-sectional data are consistent with previous work implicating NNS in development of MetS, additional research using randomized controlled trials is needed to clarify whether and how NNS in general or specific NNS might contribute to risk factors for MetS. This trial was registered at clinicaltrials.gov (NCT03364452).     

Longitudinal Association of Dietary Energy Density with Abdominal Obesity among Chinese Adults from CHNS 1993–2018

Few studies have explored the longitudinal association between dietary energy density and waist circumference and abdominal obesity in adults in China. This study aimed to analyze the relationship between dietary energy density and waist circumference and abdominal obesity in Chinese residents aged 18–64. Using data from the CHNS from 1993 to 2018, 25,817 adult residents aged 18 to 64 were selected for the study. Three consecutive 24-h dietary recalls and home-weighed seasonings were used to assess food intake. A multilevel model was used to analyze the relationship between dietary energy density and waist circumference and abdominal obesity. The results showed that compared with the lowest dietary energy density group, females had an increased risk of abdominal obesity (OR = 1.16, 95% CI: 1.05, 1.29), and females’ waist circumference increased significantly by 0.24 cm (95% CI: 0.39–1.09) in the highest dietary energy density group. No association between dietary energy density and waist circumference and abdominal obesity was observed in males. This study shows that higher dietary energy density is significantly associated with females’ waist circumference and abdominal obesity. Further research on high dietary energy density and abdominal obesity will provide scientific basis for the effective control of abdominal obesity.     

A review of the indices and references used to assess overweight and obesity in Australian children and adolescents

Aim: The study aims to undertake a narrative review examining the indices and references used for the assessment of overweight and obesity in children and adolescents in Australia. This review also summarises current international opinion on choice of indices and reference values. Methods: A systematic search for articles was conducted to examine indices and references used to define overweight and obesity in recent research studies carried out in Australia and published between January 2002 and January 2010. Results: Three hundred ninety papers were retrieved, of which 86 were reviewed. Body mass index (BMI) is the most common method used to measure overweight/obesity in children and adolescents in Australia. The International Obesity Task Force reference charts defining overweight and obesity for gender and age‐specific BMI are the most widely used. Waist circumference and the waist‐to‐height ratio are indices used to determine central adiposity, but these are not yet in widespread use. Conclusions: Body mass index‐for‐age and ‐gender is the most common method used in Australia to measure overweight or obesity in children and adolescents and should be used for most future studies. As recommended by the National Health and Medical Research Council, the Centers for Disease Control and Prevention reference charts should be used for children aged 2–18 years. For children aged <2 years, there is a choice between an idealized standard (World Health Organization chart, based on breastfed infants) or a national standard (Centers for Disease Control and Prevention chart, more suitable for formula‐fed infants).     

农村居民体质指数、腰围与血压变化趋势分析

目的 研究山东省居民体质指数（BMI）、腰围与血压的关系。方法 采用多阶段随机抽样的方法抽取样本，对确定的调查人群进行问卷调查，测量身高、体重、腰围、臀围和血压，并计算出体质指数和腰臀比。用描述性流行病学方法进行分析。结果 当体质指数（kg／m2）在18．5～23．9，24～27．9，≥28时，血压均值分别是123．5／76．1，128．8／80．0，134．5／85．6mmHg，高血压的患病率分别是15．65％，26．38％和43．78％。当体质指数≥24和／或腰围≥85cm（女性≥80cm），血压增长的速度明显加快，高血压的患病率也明显上升。结论 血压均值和高血压的患病率随着体质指数和腰围的增加而上升．二者是高血压的主要危险因素。     

Efficacy of a Multi-Component m-Health Diet,Physical Activity,and Sleep Intervention on Dietary Intake in Adults with Overweight and Obesity: A Randomised Controlled Trial

This three-arm randomised controlled trial evaluated whether (1) a multi-component weight loss intervention targeting diet, physical activity (PA), and sleep was effective at improving dietary intake over six months and 12 months, compared with a control, and (2) the enhanced diet, PA, and sleep intervention was more effective at improving dietary intake than the traditional diet and PA intervention. A total of 116 adults (70% female, 44.5 years, BMI 31.7 kg/m²) were randomised to either traditional diet and PA intervention; enhanced diet, PA, and sleep intervention; or wait-list control. To examine between-group differences, intervention groups were pooled and compared with the control. Then, the two intervention groups were compared. At six months, the pooled intervention group consumed 1011 fewer kilojoules/day (95% CI −1922, −101), less sodium (−313.2 mg/day; 95% CI −591.3, −35.0), and higher %EI from fruit (+2.1%EI; 95% CI 0.1, 4.1) than the controls. There were no differences in intake between the enhanced and traditional groups at six months. At 12 months, the pooled intervention and control groups reported no significant differences. However, compared to the traditional group, the enhanced reported higher %EI from nutrient-dense foods (+7.4%EI; 95% CI 1.3, 13.5) and protein (+2.4%EI; 95% CI 0.1, 4.6), and reduced %EI from fried/takeaway foods (−3.6%EI; 95% CI −6.5, −0.7), baked sweet products (−2.0%EI; 95% CI −3.6, −0.4), and packaged snacks (−1.1%EI; 95% CI −2.2, −0.3). This weight loss intervention reduced total energy and sodium intakes as well as increased fruit intake in adults at six months. The enhanced intervention group reported improved dietary intake relative to the traditional group at 12 months.     

Body composition and morphological assessment of nutritional status in adults: a review of anthropometric variables

Evaluation of body composition is an important part of assessing nutritional status and provides prognostically useful data and an opportunity to monitor the effects of nutrition‐related disease progression and nutritional intervention. The aim of this narrative review is to critically evaluate body composition methodology in adults, focusing on anthropometric variables. The variables considered include height, weight, body mass index and alternative indices, trunk measurements (waist and hip circumferences and sagittal abdominal diameter) and limb measurements (mid‐upper arm and calf circumferences) and skinfold thickness. The importance of adhering to a defined measurement protocol, checking measurement error and the need to interpret measurements using appropriate population‐specific cut‐off values to identify health risks were highlighted. Selecting the optimum method for assessing body composition using anthropometry depends on the purpose (i.e. evaluating obesity or undernutrition) and requires practitioners to have a good understanding of both practical and theoretical limitations and to be able to interpret the results wisely.     

Major Dietary Patterns in Relation to General and Central Obesity among Chinese Adults

Limited evidence exists for the association between diet pattern and obesity phenotypes among Chinese adults. In the present study, we analyzed the cross-sectional data from 474,192 adults aged 30–79 years from the China Kadoorie Biobank baseline survey. Food consumption was collected by an interviewer-administered questionnaire. Three dietary patterns were extracted by factor analysis combined with cluster analysis. After being adjusted for potential confounders, individuals following a traditional southern dietary pattern had the lowest body mass index (BMI) and waist circumference (WC); the Western/new affluence dietary pattern had the highest BMI; and the traditional northern dietary pattern had the highest WC. Compared to the traditional southern dietary pattern in multivariable adjusted logistic models, individuals following a Western/new affluence dietary pattern had a significantly increased risk of general obesity (prevalence ratio (PR): 1.06, 95% confidence interval (CI): 1.03–1.08) and central obesity (PR: 1.07, 95% CI: 1.06–1.08). The corresponding risks for the traditional northern dietary pattern were 1.05 (1.02–1.09) and 1.17 (1.25–1.18), respectively. In addition, the associations were modified by lifestyle behaviors, and the combined effects with alcohol drinking, tobacco smoking, and physical activity were analyzed. Further prospective studies are needed to elucidate the diet-obesity relationships.     

Food Intake Patterns and Body Mass Index in Older Adults: A Review of the Epidemiological Evidence

The relationship between food intake patterns and obesity remains unclear. The objective of the present review was to evaluate the current body of literature on food intake patterns of older adults and their associations with weight status, including obesity and waist circumference. Eleven observational studies were identified and reviewed. Diets characterized by more favorable dietary scores or indices were generally inversely related to body mass index. Results from data-driven approaches were inconsistent. Findings from this literature review suggest that there is no clear relationship between food intake patterns and body mass index or waist circumference in older adults. Limitations, including heterogeneity of food intake patterns and study populations, hinder the ability to make clear comparisons. Continued efforts to elucidate the relationship between food intake patterns and weight status indicators in older adults, including longitudinal analyses and use of novel statistical approaches for food intake pattern identification, are warranted.     

Cutoff Points of Waist Circumference for Predicting Incident Non-Alcoholic Fatty Liver Disease in Middle-Aged and Older Korean Adults

This study aimed to determine the optimal cutoff value of waist circumference (WC) for predicting incident NAFLD. In this community-based prospective cohort study, we analyzed data from 5400 participants without NAFLD at baseline aged 40–69 years. NAFLD was defined as a NAFLD-liver fat score >−0.640. A Cox proportional hazards regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for an association between body composition and NAFLD incidence. The predictive power of each body composition indicator was assessed by Harrell’s concordance index for Cox models. During a mean follow-up period of 12 years, there were 2366 new-onset NAFLD events. Compared with men with WC < 81 cm, the adjusted HR (95% CI) for incident NAFLD in those with WC ≥ 81 cm was 2.44 (2.23–2.67). Compared with women with WC < 78.5 cm, the adjusted HR (95% CI) for incident NAFLD in those with WC ≥ 78.5 cm was 2.54 (2.25–2.87). WC was the most significant risk factor for predicting incident NAFLD among body composition indicators in middle-aged and older Korean adults. The optimal WC cutoff point for predicting incident NALFD was 81 cm in men and 78.5 cm in women, which might assist in the early detection and prevention of NAFLD.     

Differences in Nutritional Intake,Total Body Fat,and BMI Score between Twins

The present study aimed to investigate the coincidence of obesity and nutritional intake in monozygotic twins compared to dizygotic twins. The data from the Korean Genome and Epidemiology Study (KoGES) from 2005 through 2014 were analyzed. Participants ≥ 20 years old were enrolled. The 1006 monozygotic twins and 238 dizygotic twins were analyzed for differences in self-reported nutritional intake, total body fat, and body mass index (BMI) using a linear regression model. The estimated values (EV) with 95% confidence intervals (95% CI) of the difference in dietary intake, total body fat, and BMI score were calculated. The monozygotic twin group and the dizygotic twin group showed similar differences in nutritional intake, DEXA fat, and BMI (all p > 0.05). The differences in nutritional intake of total calories and carbohydrates were lower in the monozygotic twin group than in the dizygotic twin group (all p < 0.05). The differences in total body fat were lower in monozygotic twins than in dizygotic twins (adjusted EV = 2427.86 g, 95% CI = 1777.19–3078.53 and adjusted EV = 1.90%, 95% CI = 1.33–2.46). Monozygotic twins had more similar dietary habits for total calories and carbohydrate intake. Other nutritional factors did not show differential similarity between monozygotic and dizygotic twins. Total body fat was more concordant in monozygotic twins.     

Augmenting BMI and Waist-Height Ratio for Establishing More Efficient Obesity Percentiles among School-going Children

Research Questions:

1. Are all the existing methods for estimating the obesity and overweight in school going children in India equally efficient? 2. How to derive more efficient obesity percentiles to determine obesity and overweight status in school-going children aged 7-12 years old?

Objectives:

1. To investigate and analyze the prevalence rate of obesity and overweight children in India, using the established standards. 2. To compare the efficiency among the tools with the expected levels in the Indian population. 3. To establish and demonstrate the higher efficiency of the proposed percentile chart.

Study Design:

A cross-sectional study using a completely randomized design.

Settings:

Government, private-aided, unaided, and central schools in the Thrissur district of Kerala.

Participants:

A total of 1500 boys and 1500 girls aged 7-12 years old.

Results:

BMI percentiles, waist circumference percentiles, and waist to height ratio are the ruling methodologies in establishing the obese and overweight relations in school-going children. Each one suffers from the disadvantage of not considering either one or more of the obesity contributing factors in human growth dynamics, the major being waist circumference and weight. A new methodology for mitigating this defect through considering BMI and waist circumference simultaneously for establishing still efficient percentiles to arrive at obesity and overweight status is detailed here. Age-wise centiles for obesity and overweight status separately for boys and girls aged 7-12 years old were established. Comparative efficiency of this methodology over BMI had shown that this could mitigate the inability of BMI to consider waist circumference. Also, this had the advantage of considering body weight in obesity analysis, which is the major handicap in waist to height ratio. An analysis using a population of 1500 boys and 1500 girls has yielded 3.6% obese and 6.2% overweight samples, which is well within the accepted range for Indian school-going children.

Conclusion:

The percentiles for school-going children based on age and sex were derived by comparing all other accepted standards used for measurement of obesity and overweight status. Hence, augmenting BMI and waist to height ratio is considered to be the most reliable method for establishing obesity percentiles among school-going children.     

Energy and Nutrient Intake of Tongan Adults Estimated by 24-Hour Recall: The Importance of Local Food Items

Tongan adults show one of the highest prevalences of obesity in the world. The present study aims to estimate Tongans' energy and nutrient intakes and food sources using a 24-hour recall survey for 14 days targeting 15 men and 19 women. The mean (SD) daily energy intake was 12.2 (2.3) MJ for men and 10.6 (2.2) MJ for women. Imported foods accounted for about half of their energy and macronutrient intakes, but for much less of their micronutrients. Some local food items, specifically pork, kava, and sea hare, contributed significantly to their vitamin, Fe, and Ca intakes, respectively. These findings suggest that heavy reliance on imported foods can lead not only to a high prevalence of obesity, but also to micronutrient deficiencies.     

Diet, Activity and BMI in Preschool-Aged Children: Differences Across Settings

In the present study, children who attended either a University Preschool (UP) or a Head Start (HS) program were studied to determine if they differed in diet, activity, or body mass index (BMI) across settings. Dietary intake over 3 days and motor activity during a free-play period equivalent across settings were measured for 40 children age 4-5 years. Compared to the UP children, the HS children had a higher average food energy intake and lower motor activity. More than half of the HS children were determined to be at the 85th percentile or above on BMI for age and sex compared to little more than a third of the UP children. Apart from the socio-economic and racial/ethnic differences between the two groups of children, the physical environment may also have exerted an impact on activity levels, as the UP classroom and playground were twice as large in square feet in comparison to the HS facilities.     

扬州市城区学龄前儿童腰围特征及影响因素分析

目的 研究扬州市城区学龄前儿童腰围特征,并分析其影响因素,为我国学龄前儿童腹型超重/肥胖筛查与防治提供依据。方法 于2015年4-5月分层整群抽取7所幼儿园2 531名儿童,对家长进行问卷调查;采用集中体检的方式,测量儿童体重、身高、腰围等;对其腰围和腰围身高比进行描述性分析,并通过单因素和多因素Logistic回归分析腰围的影响因素。结果 扬州市城区学龄前儿童腰围随年龄增长逐渐增加,各年龄组男童均大于女童;女童腰围身高比随年龄增长逐渐减低,男童则有波动。单因素分析结果显示,父母体重指数(BMI)、母亲学历、儿童每日睡眠时间、户外活动时间、视屏时间等对儿童腰围有影响(P<0.05)。多因素Logistic回归分析结果显示,父母高BMI是学龄前儿童高腹围的危险因素(母亲BMI:OR=1.15,95%CI:1.09~1.18,P＜0.001;父亲BMI:OR=1.12,95%CI:1.07~1.15,P＜0.001)。结论 需逐步建立我国学龄前儿童腰围正常范围与腹型超重/肥胖腰围筛查界值点,为学龄前儿童腹型超重/肥胖筛查与防治提供依据;要控制腹型肥胖需进行以家庭为中心的饮食、生活方式的综合性干预。     

Salt and obesity: a systematic review and meta-analysis of observational studies

Background: Existing research has investigated the association between sodium intake and obesity. We aim to conduct a systematic review and meta-analysis of reported evidence regarding the association between sodium intake and obesity.

Methods: Multiple electronic databases (PubMed, Scopus, and Google Scholar) were searched for observational studies published until August 2016. A systematic literature review identified 11 cohort and 21 cross-sectional studies.

Result: Among the 32 studies identified in the systematic literature search, only 18 cross-sectional reports had sufficient data to be included in the meta-analysis. Higher sodium consumption was associated with greater BMI (weighed mean difference (WMD)?=?1.24?kg/m², 95%CI: 0.80, 1.67; I^2?=^?98.4%; p?p?<.0001) greater waist circumference (WC).

Conclusion: The present meta-analysis suggests that sodium consumption was associated with greater BMI and WC.     

Diet,Activity and BMI in Preschool-Aged Children: Differences Across Settings

In the present study, children who attended either a University Preschool (UP) or a Head Start (HS) program were studied to determine if they differed in diet, activity, or body mass index (BMI) across settings. Dietary intake over 3 days and motor activity during a free-play period equivalent across settings were measured for 40 children age 4–5 years. Compared to the UP children, the HS children had a higher average food energy intake and lower motor activity. More than half of the HS children were determined to be at the 85th percentile or above on BMI for age and sex compared to little more than a third of the UP children. Apart from the socio-economic and racial/ethnic differences between the two groups of children, the physical environment may also have exerted an impact on activity levels, as the UP classroom and playground were twice as large in square feet in comparison to the HS facilities.