Causation or selection – examining the relation between education and overweight/obesity in prospective observational studies: a meta‐analysis

Numerous studies have investigated the association between education and overweight/obesity. Yet less is known about the relative importance of causation (i.e. the influence of education on risks of overweight/obesity) and selection (i.e. the influence of overweight/obesity on the likelihood to attain education) hypotheses. A systematic review was performed to assess the linkage between education and overweight/obesity in prospective studies in general populations. Studies were searched within five databases, and study quality was appraised with the Newcastle–Ottawa scale. In total, 31 studies were considered for meta‐analysis. Regarding causation (24 studies), the lower educated had a higher likelihood (odds ratio: 1.33, 1.21–1.47) and greater risk (risk ratio: 1.34, 1.08–1.66) for overweight/obesity, when compared with the higher educated. However, these associations were no longer statistically significant when accounting for publication bias. Concerning selection (seven studies), overweight/obese individuals had a greater likelihood of lower education (odds ratio: 1.57, 1.10–2.25), when contrasted with the non‐overweight or non‐obese. Subgroup analyses were performed by stratifying meta‐analyses upon different factors. Relationships between education and overweight/obesity were affected by study region, age groups, gender and observation period. In conclusion, it is necessary to consider both causation and selection processes in order to tackle educational inequalities in obesity appropriately.     

Body mass index and waist circumference in Mozambique: urban/rural gap during epidemiological transition

In 2005 we evaluated a nationally representative sample of the Mozambican adult population (n = 2913; 25–64 years old) following the STEPwise approach to chronic disease risk factor surveillance to estimate urban–rural differences in overweight and obesity and waist circumferences. The prevalences of obesity and overweight were, respectively, 6.8% (95% CI: 5.1–8.6) and 11.8% (95% CI: 8.4–15.4) among women, and 2.3% (95% CI: 1.1–3.6) and 9.4% (95% CI: 5.7–13.1) among men. Overweight/obesity was more frequent in urban settings (age‐, income‐ and education‐adjusted prevalence ratios; women, 2.76, 95% CI: 1.82–4.18; men, 1.76, 95% CI: 0.80–3.85). The average waist circumference in Mozambique was 75.2 cm (95% CI: 74.3–76.0) in women, significantly higher in urban than rural areas (age‐, income‐ and education‐adjusted β = 3.6 cm, 95% CI: 1.6–5.5) and 76.1 cm (95% CI: 75.0–77.3) in men, with no urban–rural differences (adjusted β = 1.3 cm, 95% CI: ?0.9 to 3.5). Our results show urban–rural differences, as expected in a country under epidemiological transition, with urban areas presenting a higher prevalence of overweight/obesity, but age‐ and education‐specific estimates suggesting a trend towards smaller divergences. The development and implementation of strategies to manage the foreseeable obesity‐related healthcare demands are needed.     

Risk factors for overweight in urban and rural school girls in Iran: skipping breakfast and early menarche

This study aimed to investigate the predictors of overweight among Iranian 14-17 years adolescent girls in urban and rural areas in Guilan, Iran. Between December 2005 and March 2006 a cross-sectional survey on 2090 high-school girls (1054 in urban and 1036 in rural areas) in Guilan, northern Iran was performed. Data on age, mother's education, age at menarche, physical activity, hours of TV viewing, birth weight, duration of any breast feeding and skipping breakfast were collected using questionnaire and body weight and height of the girls were measured. Logistic regression analysis showed that in urban residents, low age group (14 years) OR=13.9 (1.15-1.61), lower menarcheal age OR=0.76 (0.61-0.95) and skipping breakfast OR=1.96 (1.52-2.35) were independently related to overweight and obesity. In rural residents, low menarcheal age, OR=0.82 (0.69-0.98), skipping breakfast OR=2.23 (1.37-3.65), and high maternal education OR=2.01 (1.62-2.85) were predictors of overweight/obesity. In conclusion, these data indicated that skipping breakfast is a potential risk factor for overweight/obesity in both urban and rural girls. High maternal education as a risk factor for overweight in the rural girls is notable.     

Prevalence and time trends in obesity among adult West African populations: a meta-analysis

The objective of this study was to determine the distribution of and trends in obesity in adult West African populations.
Between February and March 2007, a comprehensive literature search was conducted using four electronic databases. Journal hand searches, citations and bibliographic snowballing of relevant articles were also undertaken. To be included, studies had to be population-based, use well-defined criteria for measuring obesity, present data that allowed calculation of the prevalence of obesity and sample adult participants. Studies retrieved were critically appraised. Meta-analysis was performed using the DerSimonian-Laird random effect model.
Twenty-eight studies were included. Thirteen studies were conducted in urban settings, 13 in mixed urban/rural and one in rural setting. Mean body mass index ranged from 20.1 to 27.0 kg². Prevalence of obesity in West Africa was estimated at 10.0% (95% CI, 6.0–15.0). Women were more likely to be obese than men, odds ratios 3.16 (95% CI, 2.51–3.98) and 4.79 (95% CI, 3.30–6.95) in urban and rural areas respectively. Urban residents were more likely to be obese than rural residents, odds ratio 2.70 (95% CI, 1.76–4.15). Time trend analyses indicated that prevalence of obesity in urban West Africa more than doubled (114%) over 15 years, accounted for almost entirely in women.
Urban residents and women have particularly high risk of overweight/obesity and obesity is rising fast in women. Policymakers, politicians and health promotion experts must urgently help communities control the spread of obesity in West Africa.     

1984—1999年北京城乡人群心血管病危险因素变化趋势的研究

目的:描述1984—1999年北京城乡人群心血管病主要危险因素的流行状况,对比并评价心血管病危险因素的变化趋势。方法:分别于1984—1985年,1988—1989年,1993年,1996年和1999年采用相同的方法,在北京市25~64岁人群中进行了5次独立的心血管病危险因素调查。按性别、城乡分组,比较各种危险因素在城乡人群中的不同变化趋势。结果:从1984—1999年,北京市城乡人群心血管病危险因素的变化趋势:1.城市人群的收缩压、舒张压水平和高血压患病率呈下降趋势,城市男性的下降趋势有统计学意义;而农村人群的收缩压、舒张压水平和高血压患病率则均呈上升趋势。2·各组人群的血清总胆固醇水平和高胆固醇血症患病率均呈上升趋势。15年间,城乡男性的血清总胆固醇水平每年分别增加0·06mmol/L(2·3mg/dL)和0·08mmol/L(3·1mg/dL)。3·除城市女性外,其他各组人群的体重指数(BMI)水平、腰围、超重+肥胖率(BMI≥24)、肥胖率(BMI≥28)和腹型肥胖率均呈上升趋势。4·吸烟支数和吸烟率在农村男性中呈上升趋势,在其他各组人群中则呈现下降趋势。尤其在女性中下降趋势有统计学显著性。结论:北京城乡人群的多项心血管病危险因素水平呈不同的变化趋势。农村人群的危险因素水平普遍高于城市人群,均呈上升趋势。今后应加强对农村人群的心血管病防治工作。     

Trends in overweight and obese adults in Malaysia (1996–2009): a systematic review

Like other nations experiencing rapid industrialization, urbanization and a nutrition transition, there is concern in Malaysia of a possible escalation in the prevalence of overweight and obesity. In 1996, the National Health and Morbidity Survey reported a 16.6% and 4.4% prevalence of overweight and obesity, respectively. In the following decade, there have been several national and community surveys on overweight and obesity in Malaysia. The objective of this systematic review is to describe the trend from 1996 to 2009 in the prevalence of overweight and obesity in adults in Malaysia nationally and by gender, age and race. Results indicate that there has been a small rise in overweight adults in the years 1996, 2003 and 2006 (20.7%, 26.7% and 29.1%) and a much more dramatic increase in obesity in 1996, 2003, 2004 and 2006 (5.5%, 12.2%, 12.3% and 14.0%). Evidence showed a greater risk for overweight and obesity among women compared with men. Based on the highest‐quality studies, overweight and obesity levels were highest among adults 40–59 years old. Overweight levels were highest among Indians, followed by Malays, Chinese and Aboriginals, with less consistency across studies on the order of risk or obesity by ethnicity.     

Time trends of obesity in pre-school children in China from 1989 to 1997

OBJECTIVE: To examine predictors and time trends of obesity in pre-school children in China. DESIGN: This study was based on data from China Health and Nutrition Survey, a longitudinal survey from 1989 to 1997. SUBJECTS: For cross-sectional analysis, we included 944, 1058, 903 and 483 children aged 2-6 y in 1989, 1991, 1993 and 1997, respectively. For longitudinal analysis, we included 944 children and 3146 measurements during four time periods. MEASURES: Overweight and obesity according to age- and sex-specific BMI cut-off points proposed by International Obesity Task Force. RESULTS: The overall prevalence of obesity increased from 4.2% in 1989 to 6.4% in 1997 among children aged 2-6 y. The increase largely occurred in urban areas, where the prevalence of obesity increased from 1.5% in 1989 to 12.6% in 1997 and prevalence of overweight increased from 14.6 to 28.9% at the same period. Longitudinal analysis shows BMI increased by 0.2 kg/m2 per year in urban areas and 0.1 kg/m2 per year in rural areas. In multivariate analysis, overweight in early childhood (2-6 y), parental overweight, high income and urban areas independently predicted overweight at age 10-14 y. CONCLUSION: A substantial increase in overweight and obesity among children aged 2-6 y was observed in urban areas in China from 1989 to 1997. Overweight in early childhood significantly predicted overweight during adolescence. Urgent public health strategies are needed to prevent childhood obesity in China.     

Risk factors associated with the dramatic increase in the prevalence of diabetes in the adult Chinese population in Qingdao,China

Objective To investigate the major risk factors and their association with the dramatic increase in the prevalence of diabetes from 2001–2002 to 2006 in Qingdao, China. Methods Population‐based cross‐sectional studies on diabetes were performed in 4598 men and 7026 women aged 35–74 years. The 2006 World Health Organization diagnostic criteria for diabetes were used. Results The crude prevalence of diabetes was 11.3% in both men and women in urban areas and 5.3% and 8.9% in rural areas in 2001–2002. This increased to 19.2% and 16.1% in urban areas and 14.2% and 13.8% in rural areas in 2006 for men and women, respectively. The increase in diabetes prevalence from 2001–2002 to 2006 was paralleled by an increased body mass index in rural areas but not in urban areas. The major risk factors associated with diabetes were age, family history of diabetes, obesity, hypertension and high triglycerides. The multivariate adjusted odds ratio and 95% confidence interval for diabetes corresponding to a one standard deviation increase in waist circumference was 1.81 (1.47, 2.23) in urban men, 1.64 (1.26, 2.13) in rural men, 1.98 (1.66, 2.37) in urban women and 2.02 (1.63, 2.51) in rural women. Low socio‐economic classes had a higher risk for diabetes in urban areas but a lower risk in rural areas, both associated with increased waist circumference. Conclusion Established risk factors are of great importance for the prevalence of diabetes in the urban and rural Chinese populations and changes in these factors could explain the recent dramatic increase in diabetes prevalence, particularly in rural areas. Considering the high prevalence of obesity and physical inactivity, intervention is urgently required in China.     

Childhood obesity and early prevention of cardiovascular disease: Iranian families act too late

This study described overweight/obese children and adolescents seeking weight loss treatment regarding their age, gender, severity of obesity and maternal education in Rasht city, northern Iran. Data on 1465 overweight/obese children and adolescents aged 2–18 years engaged in weight loss program were analyzed in this study. These data included age, sex, weight, height, self-reported parental weight and height, history of dieting, and mother's level of education. There were more overweight/obese girls engaged in weight loss program than overweight/obese boys (71.2% vs. 28.8% p < 0.0001). These data showed that only 18.2% of the overweight/obese children and adolescents were from families with low maternal education. These data suggest that parents of overweight/obese children and adolescents from low social level, boys and young children across all maternal educational levels should be warned against the risk of obesity.     

Overweight and obesity in preschool children from developing countries

OBJECTIVES: To estimate levels and trends in overweight and obesity in preschool children from developing countries; to study how overweight varies by the educational level of the mother, by urban or rural residence, and by gender; to investigate how these relationships are related to the gross national product (GNP). DESIGN: 71 national nutrition surveys since 1986 from 50 countries were used. SUBJECTS: 150,482 children 12 to 60 months from the most recent survey from each country were the primary sample. MEASUREMENTS: Overweight and obesity were defined as weight-for-height (>1 or >2 s.d., respectively) of the WHO/NCHS reference curves. Stunting was <-2 s.d. of the same reference. Urban was as defined in each of the surveys and higher education was defined as at least one year of secondary schooling or higher. RESULTS: 32 of 50 countries had a prevalence of obesity below 2.3%, the value in the reference population. The prevalences of overweight and obesity were lowest in Asia and in Sub-Saharan Africa. In 17 countries with serial data, no consistent regional trends could be detected. Overweight was more common in urban areas, in children of mothers with higher education, and in girls; these relationships did not differ by GNP but GNP was related negatively to stunting and positively to overweight. CONCLUSIONS: Obesity does not appear to be a public health problem among preschool children in Asia and Sub-Saharan Africa. In a number of countries in Latin America and the Caribbean, the Middle East and North Africa, and the region of Central Eastern Europe/Commonwealth of Independent States, levels are as high as in the United States.     

The expanding burden of cardiometabolic risk in China: the China Health and Nutrition Survey

China faces a major increase in cardiovascular disease, yet there is limited population‐based data on risk factors, particularly in children. Fasting blood samples, anthropometry and blood pressure were collected on 9,244 children and adults aged ≥7 years in late 2009 as part of the national China Health and Nutrition Survey. Prevalent overweight, elevated blood pressure, and cardiometabolic risk factors: glucose, HbA1c, triglycerides (TG), total cholesterol (TC), high‐ and low‐density lipoprotein cholesterol (HDL‐C and LDL‐C), and C‐reactive protein (CRP) are presented. We found that 11% of Chinese children and 30% of Chinese adults are overweight. Rates of diabetes, dyslipidaemia, hypertension and inflammation are high and increased with age and were associated with urbanization. Approximately 42% of children have at least one of the following: pre‐diabetes or diabetes, hypertension, high TC, LDL‐C, TG, and CRP and low HDL‐C, as do 70% men and 60% women aged 18–40 years and >90% of men and women ≥60 years. In sum, the HbA1c findings suggest that as many as 27.7 million Chinese children and 334 million Chinese adults may be pre‐diabetic or diabetic. The high prevalence in less urban areas and across all income levels suggests that cardiometabolic risk is pervasive across rural and urban China.     

Prevalence of cardiovascular risk factors in schoolchildren in a rural Georgia community

BACKGROUND: In the context of a national childhood obesity epidemic, this study sought to document the cardiovascular risk status of children in a rural Georgia community. METHODS: Anthropometrics and blood pressure were measured in 211 children, and fasting glucose and lipid profile in 160, recruited from schools in 2002 (grades 2 to 11, ages 7 to 18 years). RESULTS: Nearly half the schoolchildren (48%) were overweight or at risk of overweight; 15% had metabolic syndrome. Overweight children were at higher risk for metabolic syndrome and had more risk factors. Blood pressure: 19% had elevated systolic blood pressure; 4% had elevated diastolic blood pressure. Glycemia: 14% had impaired fasting glucose levels; no diabetes cases were detected. Lipid profile: 26% had high total cholesterol (>170 mg/dL), 20% had high low-density lipoprotein (>110 mg/dL), 13% had high triglycerides (>150 mg/dL), 43% had low high-density lipoprotein (females, <50 mg/dL; males, <40 mg/dL). Ethnicity, gender, and grade level were not predictive of risk except that fewer black children had low high-density lipoprotein, and blood pressure and body mass index increased with grade, as expected. CONCLUSIONS: Results from this study indicate a significant problem with overweight and cardiovascular risk in rural schoolchildren. Notably, younger children were just as likely to have risk factors as adolescents, suggesting that screening and intervention ought to begin by school age. Ethnic and gender differences in prevalence were not found, suggesting that contextual factors in a rural setting may outweigh demographic influences on risk.     

超重、肥胖及其与糖尿病的患病风险分析

目的 调查中国40岁以上社区人群超重、肥胖的基线数据，并探讨超重、肥胖与糖尿病(DM)和糖耐量低减(IGT)的患病风险。方法 在1997—1998年随机抽取我国22个社区人群，测量研究对象的体重指数(BMI)，腰围(WC)，腰臀比(WHR)以诊断肥胖。并按WHO标准筛查了DM和IGT。结果 获得了我国≥40岁人群的年龄调整超重率(男34．88％，女34．94％)和年龄调整肥胖率(男9．75％，女15．48％)等指标的基线数据。超重、肥胖率随地区和人群有很大的差别。随超重，肥胖程度增加，可明显加大DM(OR值，男性：1．90；女性：1．75)和IGT(OR值，男性：1．65；女性：1．46)的患病风险，并且这一患病风险与年龄增长无关。WC和WHR的增加，不仅与年龄增长有关，而且与增加DM和IGT的患病风险也有关。结论我国≥40岁人群中的超重和肥胖人数在增加。超过限值的BMI，WC和WHR是易患DM，IGT的危险因素。     

Prevalence of overweight and obesity in Eti-Osa LGA, Lagos, Nigeria

In many of the urban centres of the developing countries, a change in lifestyle due to increased affluence has been observed. It has been shown that change in lifestyle is an important factor in the global epidemic of overweight and obesity. The aim of this study was to assess the influence of lifestyle and socioeconomic class on the prevalence of overweight and obesity amongst adolescents from rural and urban centres in Lagos, Nigeria. This is a cross-sectional prospective survey carried out on a sample of 1504 randomly selected adolescents, aged between 10 and 19 years, from six public secondary schools located in urban and rural areas of the Eti-Osa local government area of Lagos State, Nigeria. A self-designed completed questionnaire was used to determine the participants' socio-demographic characteristics. Anthropometric measurements were taken to calculate their body mass index (BMI). The overall prevalence rates of overweight and obesity in the urban and rural areas, respectively, were 3.7% and 0.4%, and 3.0% and 0.0%. Socioeconomic class did not significantly affect the BMI values. Overweight is an evolving problem, while obesity is seemingly not a problem yet in adolescent school-aged children in Lagos State, Nigeria.     

Migration and child health inequities in Nigeria: a multilevel analysis of contextual- and individual-level factors

Objective To assess the role of rural–urban migration in the risks of under‐five death; to identify possible mechanisms through which migration may influence mortality; and to determine individual‐ and community‐level relationships between migration status and under‐five death. Method Multilevel Cox regression analysis was used on a nationally representative sample of 6029 children from 2735 mothers aged 15–49 years and nested within 365 communities from the 2003 Nigeria Demographic and Health Survey. Hazard ratios with 95% confidence intervals were used to express the measures of association between the characteristics, and intra‐class coefficients were used to express the measures of variation. Results Children of rural non‐migrant mothers had significantly lower risks of under‐five death than children of rural–urban migrant mothers. The disruption of family and community ties, low socio‐economic position and vulnerability, and the difficulties migrants face in adapting into the new urban environment, may predispose the children of rural–urban migrants to higher mortality. Conclusion Our results stress the need for community‐level and socio‐economic interventions targeted at migrant groups within urban areas to improve their access to health care services, maternal education, as well as the general socio‐economic situation of women.     

Morbidity and physical functioning in old age: differences according to living area

OBJECTIVES: To describe differences in morbidity and functional status according to living area. DESIGN: Community‐based survey. SETTING: A community‐based prospective cohort, the Kungsholmen‐Nordanstig Project. PARTICIPANTS: Adults aged 75 and older living in an urban area of central Stockholm (n=1,222) and in the rural community of Nordanstig in northern Sweden (n=919). MEASUREMENTS: Physicians clinically examined all participants using the same standardized protocols in both living areas; trained nurses directly assessed disability. RESULTS: Cardiovascular disease was the most common disorder in both living areas (39.9% in the urban area and 45.2% in the rural area). There were great area differences in the prevalence of stroke (7.4% and 14.0%), diabetes mellitus 6.3% and 16.1%), and Parkinson's disease (1.0% and 3.7%). It was more common to have two or more diseases than no diseases in the rural area than in the urban area (odds ratio=1.9, 95% confidence interval=1.4–2.4). Significant living area differences (urban vs rural) in population attributable risk (PAR) was found for disability due to stroke (5.6 vs 32.2), diabetes mellitus (1.2 vs 6.1), fractures (1.4 vs 10.7), and hearing impairment (8.7 vs 22.0). CONCLUSION: Differences were found in disability, morbidity, and disease patterns according to living area. The rural elderly population was more disabled and had more diseases than the urban elderly population, despite being slightly younger than the urban cohort. There were significant area differences in the PAR of how specific chronic conditions influenced the risk of disability.     

Prevalence of obesity, central obesity and the associated factors in urban population aged 20–70 years, in the north of Iran: a population-based study and regression approach

Obesity is an undesirable outcome of changing of lifestyle and behaviours. It is also reversible predisposing factor for the development of several debilitating diseases. This study was aimed to determine the prevalence rate of obesity, overweight, central obesity and their associated factors in the north of Iran. We conducted a population-based cross-sectional study with a sample of 1800 women and 1800 men with respective mean ages of 37.5 +/- 13.0 and 38.5 +/- 14.2 years of urban population aged 20-70 years living in the north of Iran. The demographic and lifestyle data, in particular, age, gender, marital status, marriage age, family history of obesity, educational level, occupation, occupational and leisure time physical activity, duration of exercise per week, parity and the number of children were collected with a designed questionnaire. Diagnosis of obesity and central obesity were confirmed by the WHO standard recommended method by determining of body mass index (BMI) and waist circumference (WC). Logistic regression model was used to estimate the adjusted odds ratio (OR) and its 95% confidence interval. Over half of the study subjects were at educational levels of high school or higher; 79.4% of population was married and 35.3% had a family history of parental obesity. The majority of subjects in particular women had none or low levels of physical activity. The overall prevalence rates of obesity and overweight were 18.8% and 34.8% respectively. The overall prevalence rate of central obesity was 28.3%. The rate of obesity in women was higher than men (P < 0.0001). In both genders, particularly in the women, the rate of obesity was raised by increasing age. There was an inverse relation between the risk of obesity and marriage age, the high level of education (OR = 0.19, P < 0.0001), severe occupational activity (OR = 0.44, P < 0.0001), the level of exercise (in subjects with 3-4 h exercise per week, OR = 0.58, P < 0.001) and leisure time activity. Marriage, history of parental obesity and parity > or =5 were associated with increased risk of obesity (OR = 2.2, P < 0.001 and OR = 2.43, P < 0.0001 and OR = 3.73, P < 0.0001 respectively). The results of this study indicate an increased rate of obesity and overweigh in the north population of Iran. With respect to these findings, low level of activity and education, parity, family history of obesity, marriage at earlier age and ageing are responsible for both obesity and central obesity in the north of Iran. Therefore, a community-based multiple strategies are required to combat with increasing rate of obesity and its subsequent complications such as diabetes, coronary artery disease, hypertension and osteoarthritis.     

The risk of overweight and obesity in children with autism spectrum disorders: A systematic review and meta‐analysis

Multiple studies have suggested that autism spectrum disorders seem to increase the risk of overweight and obesity. We examined the pooled prevalence and relative risk of developing overweight or obesity among children with autism spectrum disorders in a systematic review and meta‐analysis. We searched PubMed, Scopus, ProQuest, and Web of Science databases and subsequently screened the records to identify studies that reported prevalence of overweight and/or obesity in children with ASD and matched groups of neurotypical children. DerSimonian‐Laird random‐effects meta‐analyses were performed to examine pooled prevalence and relative risk of obesity in children with autism spectrum disorders using the “meta” package in R software. Among children with autism spectrum disorders, the prevalence of obesity was 22.2%. Children with ASD had a 41.1% greater risk (P = .018) of development of obesity. Non‐Caucasian race, increasing age, female sex, and living in the United States emerged as positive moderators of the association between autism spectrum disorders and prevalence of overweight or obesity. Autism spectrum disorders seem to increase the risk of childhood obesity. Increased awareness of this association may allow the implementation of early interventions to reduce obesity and prevent potential deterioration of quality‐of‐life in this population.     

Prevalence of sustained hypertension and obesity in urban and rural school going children in Ludhiana

BACKGROUND: Increasing trend of hypertension is a worldwide phenomenon. The data on sustained hypertension in school going children is scanty in India. The present study was conducted to evaluate the prevalence of sustained hypertension and obesity in apparently healthy school children in rural and urban areas of Ludhiana using standard criteria. METHODS AND RESULTS: A total of 2467 apparently healthy adolescent school children aged between 11-17 years from urban area and 859 students from rural area were taken as subjects. Out of total 3326 students, 189 were found to have sustained hypertension; in urban areas prevalence of sustained hypertension was 6.69% (n=165) and in rural area it was 2.56% (n=24). Males outnumbered females in both rural and urban areas. The mean systolic and diastolic blood pressure of hypertensive population in both urban and rural population was significantly higher than systolic and diastolic blood pressure in their normotensive counterparts (urban normotensive systolic blood pressure:115.48+/-22.74 mmHg, urban hypertensive systolic blood pressure: 137.59+/-11.91 mmHg, rural normotensive systolic blood pressure: 106.31+/-19.86 mmHg, rural hypertensive systolic blood pressure: 131.63+/-10.13 mmHg, urban normotensive diastolic blood pressure: 74.18+/-17.41 mmHg, urban hypertensive diastolic blood pressure: 84.58+/-8.14 mmHg, rural normotensive diastolic blood pressure: 68.84+/-16.96 mmHg, rural hypertensive diastolic blood pressure: 79.15+/-7.41 mmHg). Overweight populationwas significantly higher in urban area. There were 287 (11.63%) overweight students and 58 (2.35%) were obese. In rural population overweight and obese students were 44 (4.7%) and 34 (3.63%) respectively. There was significant increase in prevalence of hypertension in both rural and urban population with increased body mass index in urban students; those with normal body mass index had prevalence of hypertension of 4.52% (n=96), in overweight it was 15.33% (n=44) and in obese it was 43.10% (n=25). In rural area, the overweight students showed prevalence of sustained hypertension in 6.82% (n=3) and in obese group it was 61.76% (n=21). None of the student with normal body mass index in rural area was found to be hypertensive. The mean body mass index of hypertensive population in both rural and urban areas was significantly higher than respective normotensive population (mean body mass index in urban normotensive group: 20.34+/-3.72 kg/m2, hypertensive group: 24.91+/-4.92 kg/m2; mean body mass index in rural normotensive group: 18.41+/-3.41 kg/m2, hypertensive group: 21.37+/-3.71 kg/m2, p<0.01). CONCLUSIONS: Prevalence of sustained hypertension is on the rise in urban area even in younger age groups. Blood pressure is frequently elevated in obese children as compared to lean subjects. This is possibly related to their sedentary lifestyle, altered eating habits, increased fat content of diet and decreased physical activities.     

Antibiotic exposure in early life and childhood overweight and obesity: A systematic review and meta‐analysis

We conducted a systematic review and meta‐analysis of observational studies investigating the association between antibiotic exposure in infancy and risk of childhood overweight and obesity. Thirteen studies, including a total of 527 504 children, were included in the systematic review and 8 were included in meta‐analyses. Exposure to antibiotics in infancy was associated with an increased odds ratio (OR) of childhood overweight and obesity (OR 1.11, 95% confidence interval [CI] 1.02‐1.20). Whereas exposure to 1 treatment only and exposure between 6 and 24 months were not associated with increased risk of childhood overweight and obesity, exposure to >1 treatment was associated with an OR of 1.24 (95% CI 1.09‐1.43) and exposure within the first 6 months of life was associated with an OR of 1.20 (95% CI 1.04‐1.37). In conclusion, antibiotic exposure in infancy was associated with a slightly increased risk of childhood overweight and obesity, mainly if children were exposed to repeated treatments or treatment within the first 6 months of life. It is unclear whether this association is mediated via direct effects of antibiotics on the gut microbiota.