Prevalence of overweight and obesity in Thai population: results of the National Thai Food Consumption Survey

Associations between maternal overweight/obesity during pregnancy and body composition in young adult offspring

Background

Maternal obesity is associated with an increased risk of large-for-gestational-age births and childhood obesity. However, evidence on its potential associations with long-term offspring body composition remains limited. This prospective cohort study examined associations between maternal body mass index (BMI) during pregnancy and body composition in the young adult offspring.

Methods

Participants were the offspring from a birth cohort in Chiang Mai (Thailand). Maternal BMI was assessed at the first antenatal clinic visit (≤24 weeks of gestation) in 1989-1990. In 2010-2011, we followed up the offspring at approximately 20 years of age, assessing their body composition using whole-body dual-energy X-ray absorptiometry (DXA) scans. Associations between maternal BMI and offspring body composition were explored using unadjusted and adjusted analyses.

Results

We assessed 391 young adults (55% were females). Higher maternal BMI was associated with increased offspring fat mass and lean mass. In adjusted analyses, offspring of mothers with overweight/obesity exhibited total body fat percentages 1.5 (95% CI 0.1, 2.9; p = 0.032) and 2.3 (95% CI 0.2, 4.5; p = 0.036) percentage points higher than offspring of normal-weight and underweight mothers, respectively. Fat mass index was similarly higher: 0.9 kg/m2 (95% CI 0.3, 1.5 kg/m2; p = 0.002) and 1.4 kg/m2 (95% CI 0.5, 2.3 kg/m2; p = 0.002), respectively. However, no differences in visceral adiposity were detected.

Conclusion

Higher maternal BMI during pregnancy was associated with increased adiposity in young adult offspring. Our findings suggest that the cross-generational transmission of maternal obesity-related traits is associated with increased offspring adiposity in the long term.

Incidence of Weaning Failure in Obese Patients in Intensive Care Unit

Background The escalating prevalence of obesity worldwide presents unique challenges in critical care management, especially in the context of mechanical ventilation and weaning processes in intensive care units (ICUs). The present study aimed to determine the incidence of weaning failure in obese patients in an ICU. Methods A prospective observational study was carried out to gather data on patients in the ICU of Shifa International Hospital located in Islamabad, Pakistan. The target population consisted of adult patients who were both male and female, ages 18 years and above. These individuals required intubation procedures as well as mechanical ventilation during their hospitalization. The researchers followed these patients prospectively and observed their medical conditions closely to gather data about how obesity might impact critical care interventions and outcomes. Results The sample size was 288 bearing a median age of 61.0 with an interquartile range of 19 years. Older age manifested a significantly higher frequency of failed extubation (p=0.065). Higher body mass index (BMI) was significantly associated with failed extubation among the study population. It was found that a higher significant difference was associated with BMI > 30 kg/m2 (obese) in failed and successful extubation. One-half of the patients with failed extubation and only 16 (5.9%) patients with successful extubation had end-stage renal disease (p<0.001). It was found that patients who underwent failed extubation had notably increased ICU mortality (p=0.108), 28-day mortality (p=0.067), as well as mean ICU (p<0.001) and hospital stay (p=0.007). Conclusion Our study revealed some insightful correlations between obesity, age, comorbidities, length of hospitalization, ICU stay, and mortality rate in terms of weaning failure among the study population.

Overweight in elderly increases postural instability during sit-to-stand test: a Kinect-based assessment

BACKGROUND

Being overweight increases the risk of falls and subsequent injuries. However, conventional functional balance tests may not be appropriate for this population as body weight can affect test performance. Thus, it is crucial to develop reliable methods for assessing balance ability in overweight individuals.

AIM

The purpose of this study was to utilize a portable gaming device (Kinect Xbox 360) to measure the center of mass (CoM) of elderly individuals and compare the results between normal weight and overweight elderly women.

METHODS

The study included 64 female elderly individuals who were divided into two groups: 32 normal weight and 32 overweight subjects, matched for age (matched pairs design). The study collected the body's CoM during the five-time sit-to-stand test (FTSST) using Kinect camera. Additionally, the participants underwent the time up and go test (TUGT) and one-leg standing balance (OLSB) tests. The Kinect Xbox 360 demonstrated high test-retest reliability for measuring body's center of mass sway, with ICC3,1 value of 0.982 in the vertical direction, 0.983 in the mediolateral (ML) direction, and 0.997 in the anteroposterior (AP) direction. Additionally, the technical error of measurement (TEM) was very low at 0.006, 0.002, and 0.004, respectively. The % coefficient of variation ranged from 1.31% to 5.68%, indicating good measurement consistency.

RESULTS

Overweight individuals took longer to complete FTSST and TUGT compared to normal weight individuals, but no significant difference was observed in OLSB tests. Moreover, overweight elderly individuals had greater sway length in the ML and AP directions compared to normal weight elderly individuals.

DISCUSSION AND CONCLUSION

Overweight elderly individuals had poorer balance than their normal weight counterparts when using Kinect camera. The researchers suggest that Kinect device can be a cost-effective alternative to measure balance performance among overweight elderly in the community-based setting.

Comparison of perioperative outcomes and anesthetic-related complications of morbidly obese and super-obese parturients delivering by cesarean section

OBJECTIVE

To compare the perioperative outcomes and anesthetic-related complications of morbidly obese and super-obese parturients delivering by cesarean section.

METHODS

A retrospective analysis of 6 years of data was performed. Exclusions were cases with gestational ages <24 weeks, placenta accreta spectrum, polyhydramnios, or multiple gestations.

RESULTS

The study included 494 patients whose body mass index (BMI) exceeded 40 kg/m² at delivery. Of these, 469 were morbidly obese (BMI 40-49.9; mean, 42.9 ± 2.4), and 25 were super obese (BMI >50; mean, 54.5 ± 4.2). Twenty-four (5.1%) morbidly obese women received general anesthesia. The other 445 patients (94.9%) in the morbid obesity group underwent cesarean delivery under regional anesthesia; however, some (2.2%; 10/445) received general anesthesia after regional anesthesia failed. In the super-obesity group, 23 patients (92.0%) received regional anesthesia, while two patients (8.0%) received general anesthesia. There were no cases of pulmonary aspiration, maternal deaths, or difficult or failed intubation. There was one episode of cardiac arrest in a patient with a BMI of 47.9. Among the morbidly obese and super-obese women given regional anesthesia, the super-obese patients had significantly greater volumes of ephedrine and norepinephrine consumption (p = 0.027 and 0.030), intravenous fluids (p = 0.006), and bleeding during surgery (p = 0.017). They also had more hypotensive episodes (p = 0.038). The two groups' incidences of neonatal birth asphyxia, postpartum hemorrhage, blood transfusion, and uterine atony did not differ significantly. The lengths of stay in the hospital were also comparable.

CONCLUSIONS

Among the women receiving regional anesthesia, the super-obese parturients had greater intraoperative bleeding, a higher proportion of hypotensive episodes, and a greater vasopressor requirement than the morbidly obese parturients. Anesthesiologists must prepare for the adverse perioperative events that such women risk experiencing during a delivery by cesarean section.

www.clinicaltrials.gov ID: NCT04657692.

Progression of insulin resistance in individuals with type 1 diabetes: A retrospective longitudinal study on individuals from Thailand

AIMS

To investigate temporal changes in glycaemic control and weight contributing to insulin resistance (IR), in Thai individuals with type 1 diabetes (T1D).

METHODS

Longitudinal data of 69 individuals with T1D were retrospectively collected over a median follow-up of 7.2 years. The estimated glucose disposal rate (eGDR), a marker of IR, was calculated using an established formula. Individuals were assigned as insulin-sensitive T1D (the latest eGDR≥8 mg/kg/min), or insulin-resistant T1D/double diabetes (the latest eGDR<8 mg/kg/min). Generalised linear mixed model was employed to compare the temporal patterns of HbA1c, BMI, and eGDR between the two groups.

RESULTS

26 insulin-resistant T1D had a gradual decline in eGDR, corresponding with increased weight and HbA1c. In contrast, 43 insulin-sensitive T1D had stable insulin sensitivity with an improvement in HbA1c over time, associated with a modest weight gain. Fluctuations of glucose levels were observed during the early diabetes course leading to unstable eGDR, thus limiting the use of eGDR to classify insulin-resistant T1D.

CONCLUSION

T1D individuals who eventually develop IR are likely to experience early increasing IR over time. In contrast, those who ultimately do not have IR, maintain their insulin sensitivity throughout their course at least in the medium term.

Metabolic and inflammatory profiles, gut microbiota and lifestyle factors in overweight and normal weight young thai adults

Obesity among young adults, especially those living in developing countries is increasing. A high body mass index (BMI) is one of the major causes of several diseases worldwide, constituting an important risk factor for non-communicable diseases (NCDs). Investigations describing the relationship between BMI, clinical and gut microbiota characteristics and lifestyle factors of overweight young adults, especially from Southeast Asian countries are limited. Metabolic and inflammatory biomarkers, fecal microbiota profiles and lifestyle factors were compared between overweight Thai young adults (n = 30, mean age 33 ± 9.48) and those with normal weight (n = 30, mean age 27 ±7.50). This study was registered with the Thai Clinical Trials Registry (TCTR20220204007). Health status including body composition, fasting glucose and insulin, lipid profiles, liver and kidney function, inflammatory biomarkers, blood pressure and fecal microbiota using 16S rRNA gene sequencing data was determined. Dietary intake was assessed using a 3-day dietary record and a food frequency questionnaire (FFQ), with physical activity levels compared using the international physical activity questionnaire (IPAQ). The overweight group had significantly higher BMI, waist-hip ratio, body fat mass, % body fat, skeletal mass, triglyceride level, C-reactive protein, insulin and blood pressure, with lower levels of high-density lipoprotein cholesterol (HDL-C) and blood urea nitrogen compared to the normal weight group. Significant differences in fecal microbiota composition at the family and genus levels were observed between the two groups. In our clinical setting, we also observed that unhealthy diets with high consumption of food rich in fat and sugar, processed meat and alcohol, and physical inactivity were associated with an increased prevalence of overweight in Thai young adults. Results provided the big picture of health and lifestyle characteristics of overweight young Thai people. Young adults should be encouraged to engage in health-promoting activities that maintain healthy bodyweight.

Association of normal weight obesity with lifestyle and dietary habits in young Thai women: A cross-sectional study

Background

The risk of lifestyle-related diseases in normal weight obesity (NWO), a condition, in which the body mass index (BMI) is normal but the body fat mass is high, has attracted a lot of attention. However, there are no reports on the association between NWO and lifestyle, eating habits, and other health risks in Thai people. BMI alone cannot be used to identify individuals with NWO; thus, some students with NWO develop metabolic abnormalities without receiving any intervention. This study aimed to examine the differences in anthropometrics, lifestyle, and eating habits among young Thai women and their association with the BMI and the body fat ratio (BFR).

Methods

A total of 250 female Thai university students of normal body type (18.5 ≤ BMI<25.0 kg/m2) were classified as having non-normal weight obesity (NO-NWO) if their BFR was <30.0% or NWO if their BMI and BFR were >30.0%. The lifestyle and eating habits of the two groups were compared. We conducted logistic analysis with the presence or absence of NWO as the dependent variable, and the dietary habit items of "eating greasy foods," "eating ultra-processed foods (UPF)," and "drinking sweetened beverages" as the objective variables.

Results

Among the study participants who were of normal body type, 46.8% were NWO. The participants in the NWO group consumed UPF more frequently (odds ratio [OR], 2.04; p = 0.014) and sweetened beverages more regularly (OR, 1.92, p = 0.041) than those in the NO-NWO group.

Conclusion

UPF and sweetened beverage consumption was more common in individuals with NWO. Identifying the risk factors for NWO is essential to help individuals make lifestyle changes to prevent its progression and complications.

Slight Changes in the Gut Microbiome in Early-stage Chronic Kidney Disease of Unknown Etiology

Gut dysbiosis and changes in short-chain fatty acids (SCFAs) occur in end-stage chronic kidney disease (CKD); however, the degree of these changes in the gut microbiome and serum SCFA profiles in the early stages of CKD,‍ ‍particularly in‍ ‍CKD‍ ‍of unknown etiology (CKDu), is unclear. We herein investigated the gut microbiome and SCFA profiles of early-stage CKD patients (CKD stages 1-3) in a community in Khon Kaen Province, Thailand. Seventy-two parasite-free participants were distributed among a healthy control group (HC, n=18) and three patient groups (an underlying disease group [UD, n=18], early-stage CKD with underlying disease [CKD-UD, n=18], and early-stage CKD of unknown etiology, [CKDu, n=18]). Fecal DNA was individually extracted and pooled for groups of six individuals (three pools in each group) to examine the composition of the gut microbiome using next-generation sequencing. A SCFA ana-lysis was performed on serum samples from each individual using gas chromatography-mass spectrometry. The results revealed that microbial abundance differed between the healthy group and all patient groups (UD, CKD-UD, and CKDu). [Eubacterium]_coprostanoligenes_group was more abundant in the CKDu group than in the HC and CKD-UD groups. Furthermore, serum concentrations of acetate, a major SCFA component, were significantly lower in all patient groups than in the HC group. The present results indicate that minor changes in the gut microbiome and a significant decrease in serum acetate concentrations occur in early-stage CKDu, which may be important for the development of prevention strategies for CKD patients.

Increased Oral Dryness and Negative Oral Health-Related Quality of Life in Older People with Overweight or Obesity

This cross-sectional study was to evaluate the association between the oral health-related quality of life (OHRQoL) of older Thai people with obesity and oral health indicators. General and oral conditions were assessed. Oral dryness was determined using the Xerostomia Inventory-11 (XI-11) and clinical oral dryness score (CODS). OHRQoL was evaluated by the oral health impact profile (OHIP-14). Participants were aged 60-86 years; 73 (59.3%) were overweight or obese, and 50 (40.7%) were normal weight. Older patients with obesity had almost four times the rate of hypertension (OR = 3.59; 95%CI:1.34-9.60; p = 0.002), more missing teeth (p = 0.025), and higher CODS (p = 0.014) than those without obesity. The total XI-11 scores were positively associated with the total CODS, after adjusting for BMI (r = 0.267, p = 0.003). Those with obesity had almost three times the tendency for a negative OHRQoL compared with the non-obese (OR = 2.73; 95%CI:1.12-6.71; p = 0.04). After adjusting for all related factors, the chances of predicting an OHIP-14 score of four based on obesity and total XI-11 score were 4.42 (95%CI:1.57-12.47; p = 0.005) and 1.11 (95%CI:1.02-1.20; p = 0.013), respectively. Obesity had an increasingly undesirable negative impact on the OHRQoL of older Thai people and was influenced by BMI and oral dryness.

Sleep impairments and quality of life in Thai adolescents with systemic lupus erythematosus

PURPOSE

Adolescents with systemic lupus erythematosus (SLE) are susceptible to sleep impairments. We aimed to determine the prevalence and factors related to sleep impairments, and the associations of sleep impairments with health-related quality of life (HRQOL) in Thai adolescents with SLE.

METHODS

Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire for Adolescents (PHQA), and Pediatric Quality of Life Inventory™ 4.0 Core Scales were administered to 57 participants with SLE aged 13-18 years to evaluate sleep, depression, and HRQOL, respectively. Participants were divided into "good sleep" (PSQI scores <5) and "poor sleep" groups (PSQI scores ≥5). Participants with body mass index (BMI) >23 kg/m² were classified into the high BMI group.

FINDINGS

Eighteen participants (31.6%) were in the poor sleep group. High BMI and PHQA scores were associated with sleep impairments with the odds ratio of 8.00 (95% CI 1.50-42.64; p = 0.02), and 1.25 (95% CI 1.01-1.54; p = 0.04), respectively. In terms of HRQOL, adolescents with SLE had the highest scores in social functioning and the lowest scores in school functioning. Good sleepers had better scores than poor sleepers across all sub-categories except for social functioning, and the difference was significant in emotional functioning (90% (IQR 75-100) vs. 70% (IQR 55-85); p = 0.03).

CONCLUSIONS

A substantial number of adolescents with SLE had sleep impairments, which decreased HRQOL, particularly in emotional functioning. Sleep impairments were associated with obesity and depression.

IMPLICATIONS

Proactive management in addressing weight, mood, and sleep problems should be included in the multidisciplinary care of adolescents with SLE to improve their health and well-being.

Prevalences of Overweight and Obesity in Children and Adolescents: The Comparison of ADHD and Other Clinical Samples

OBJECTIVE

To investigate the prevalence of overweight and obesity in children and adolescents with ADHD and compare to other clinical samples.

METHOD

A retrospective chart reviewing of 165 ADHD and 305 other clinical participants aged 6 to 18 years.

RESULTS

There was no statistically significant difference in terms of the prevalences of overweight and obesity between ADHD and other clinical participants. In ADHD group, the prevalences of overweight, obesity, and combined overweight/obesity were 15.8%, 20.0%, and 35.8%, respectively. In addition, male gender was significantly associated with increasing the prevalences of overweight and obesity in children and adolescents with ADHD.

CONCLUSION

The prevalences of overweight and obesity between ADHD and other clinical samples were not different in a clinical setting. Male gender was significantly associated with increasing the prevalences of overweight and obesity in children and adolescents with ADHD.

Association of Human Intestinal Microbiota with Lifestyle Activity, Adiposity, and Metabolic Profiles in Thai Children with Obesity

Background

Dysbiosis of intestinal microbiota may be linked to pathogenesis of obesity and metabolic disorders.

Objective

This study compared the gut microbiome of obese Thai children with that of healthy controls and examined their relationships with host lifestyle, adiposity, and metabolic profiles.

Methods

This cross-sectional study enrolled obese children aged 7–15. Body composition was evaluated using bioelectrical impedance analysis. Stool samples were analyzed by 16S rRNA sequencing using the Illumina MiSeq platform. Relative abundance and alpha- and beta-diversity were compared with normal-weight Thai children from a previous publication using Wilcoxon rank-sum test and ANOSIM. Relationships of gut microbiota with lifestyle activity, body composition, and metabolic profiles were assessed by canonical correlation analysis (CCA) and Spearman correlation.

Results

The study enrolled 164 obese children with a male percentage of 59%. Mean age was 10.4 ± 2.2 years with a BMI z-score of 3.2 ± 1. The abundance of Bacteroidetes and Actinobacteria were found to be lower in obese children compared to nonobese children. Alpha-diversity indices showed no differences between groups, while beta-diversity revealed significant differences in the family and genus levels. CCA revealed significant correlations of the relative abundance of gut microbial phyla with sedentary lifestyle and certain metabolic markers. Univariate analysis revealed that Actinobacteria and Bifidobacterium were positively correlated with HDL-C and negatively correlated with body weight and screen time. Additionally, Actinobacteria was also negatively associated with fasting insulin and HOMA-IR. Lactobacillus showed positive correlation with acanthosis nigricans and adiposity. Cooccurrence analysis revealed 90 significant bacterial copresence and mutual exclusion interactions among 43 genera in obese children, whereas only 2 significant cooccurrences were found in nonobese children.

Conclusions

The composition and diversity of gut microbiota in obese Thai children were different from those of their normal-weight peers. Specific gut microbiota were associated with lifestyle, adiposity, and metabolic features in obese children. An interventional study is needed to support causality between specific gut microbiota and obesity.

Association between nutritional status and dengue severity in Thai children and adolescents

Most cases of dengue virus infection are mild, but severe cases can be fatal. Therefore, identification of factors associated with dengue severity is essential to improve patient outcomes and reduce mortality. The objective of this study was to assess associations between nutritional status and dengue severity among Thai children and adolescents. This retrospective cross-sectional study was based on the medical records of 355 patients with dengue treated at the Hospital for Tropical Disease (Bangkok, Thailand) from 2017 to 2019. Subjects were Thai children aged less than 18 years with dengue virus infection confirmed by positive NS1 antigen or IgM. The 1997 and 2009 World Health Organization (WHO) dengue classifications were used to define disease severity and body mass index for age while the WHO growth chart was used to classify nutritional status. The proportions of patients with dengue fever who were underweight, normal weight, and overweight were 8.8%, 61.5%, and 29.7%, respectively. The proportions of patients with dengue haemorrhagic fever (DHF) who were underweight, normal weight, and overweight were 10.2%, 66.1%, and 23.7%, respectively. The proportions of patients with non-severe dengue who were underweight, normal weight, and overweight were 8.6%, 60.9%, and 30.5%, respectively; the same proportions of patients with severe dengue were 10.5%, 67.1%, and 22.4%, respectively. Higher proportions of patients with severe plasma leakage (DHF grade III and IV) were overweight compared with those with mild plasma leakage (DHF grade I and II) (45.5% vs. 18.8%). No difference in nutritional status was observed in patients with different dengue severity.

Dengue is a rapid spreading mosquito-borne viral infection. Infections cause mild to severe diseases, including dengue haemorrhagic fever (DHF), a severe form that may kill infants and young children. One potential factor associated to dengue severity is the patients’ nutritional status. For dengue severity, World Health Organization (WHO) dengue case classification criteria in 1997 and revised version in 2009 were used. While body mass index for age and WHO growth chart were used to classify nutritional status. In this study, we would like to demonstrate the association of underweight/overweight and severity of dengue infection using both WHO classifications in 355 Thai children and adolescents. We compared the proportions of patients with dengue fever with different nutritional status to those with dengue haemorrhagic fever (DHF), and also compared non-severe dengue to severe dengue. Nevertheless, we could not demonstrate an association of nutritional status and dengue severity. It was noted that higher proportions of patients with severe plasma leakage (DHF grade III and IV) were overweight compared to those with mild plasma leakage (DHF grade I and II) (45.5% vs. 18.8%).

Association between pesticide exposure and obesity: A cross-sectional study of 20,295 farmers in Thailand

Background: Obesity is a serious condition because it is associated with other chronic diseases which affect the quality of life. In addition to problems associated with diet and exercise, recent research has found that pesticide exposure might be another important risk factor. The objective of this study was to determine the association between pesticide exposure and obesity among farmers in Nakhon Sawan and Phitsanulok province, Thailand. 

Methods: This study was a population-based cross-sectional study. Data on pesticide use and obesity prevalence from 20,295 farmers aged 20 years and older were collected using an in-person interview questionnaire. The association was analysed using multivariable logistic regression, adjusted for its potential confounding factors. 

Results: Obesity was found to be associated with pesticide use in the past. The risk of obesity was significantly predicted by types of pesticides, including insecticides (OR = 2.10, 95% CI 1.00-4.38), herbicides (OR = 4.56, 95% CI 1.11-18.62), fungicides (OR = 2.12, 95% CI 1.34-3.36), rodenticides (OR = 2.55, 95% CI 1.61-4.05), and molluscicides (OR = 3.40, 95% CI 2.15-5.40). Among 35 surveyed individual pesticides, 22 were significantly associated with higher obesity prevalence (OR = 1.78, 95% CI 1.10-2.88 to OR = 8.30, 95% CI 2.54-27.19), including herbicide butachlor, 15 insecticides (two carbamate insecticides, five organochlorine insecticides, and eight organophosphate insecticides), and six fungicides. 

Conclusion: This study found obesity in farmers in Nakhon Sawan and Phitsanulok province, Thailand, to be associated with the long-term use of several types of pesticides. The issue should receive more public attention, and pesticide use should be strictly controlled.

Comparison of Race and Non-Race Based Equations for Kidney Function Estimation in Critically Ill Thai Patients for Vancomycin Dosing

Empiric antibiotic dosing frequently relies on an estimate of kidney function based on age, serum creatinine (SCr), sex, and race (on occasion). New non-Race based estimated glomerular filtration rate (eGFR) equations have been published but their role to support dosing is not known. Here, we report on a population pharmacokinetic model of vancomycin that serves as a useful probe substrate of eGFR in critically ill Thai patients. Data were obtained from medical records during a 10-year period. A nonlinear mixed-effects modeling approach was conducted to estimate vancomycin parameters. Data from 208 critically ill patients (58.2% male and 36.0% septic shock) with 398 vancomycin concentrations were collected. Twenty-three covariates including 12 kidney function estimates were tested and ranked based on the model performance. The median [min, max] age, weight, and SCr was 69 [18, 97] years, 60.0 [27, 120] kg, and 1.53 [0.18, 7.15] mg/dL. The best base model was a one-compartment linear with zero-order input and proportional error model. A Thai specific eGFR equation not indexed to body surface area (BSA) model best predicted vancomycin clearance (CL). The typical value for volume of distribution and CL was 67.5 L and 1.22 L/h, respectively. A loading dose of 2000 mg followed by maintenance dose regimens based on eGFR is suggested. The Thai-GFR not indexed to BSA model best predicts vancomycin CL and dosing in the critically ill Thai population. A 5-10% absolute gain in the vancomycin probability of target attainment is expected with the use of this population specific GFR equation. This article is protected by copyright. All rights reserved.

Association between television viewing and overweight and obesity among women of reproductive age in Timor-Leste: evidence from the demographic health survey 2016

OBJECTIVE

This study aimed to assess the possible relationship between television viewing and overweight and obesity among Timorese women of reproductive age.

METHODS

This cross-sectional study analysed the Timor-Leste Demographic and Health Survey 2016 dataset. A weighted sample of 11 398 Timorese women aged 15-49 years was chosen using a two-stage stratified random sampling technique. Asian criteria-based body mass index (BMI) cut-offs were used to define overweight (BMI 23.0 to <27.5 kg/m²) and obesity (BMI ≥27.5 kg/m²). Frequency of TV viewing was categorised into three groups: (1) not at all, (2) less than once a week and (3) at least once a week. Multilevel ordered logistic regression was performed to identify the correlates of overweight and obesity. Both crude and adjusted odds ratios (AOR) along with a 95% CI were calculated to show the strength of association.

RESULTS

Among 11 398 respondents, 19.4% were overweight or obese (overweight: 15.7% and obese: 3.8%). Although about half of the respondents reportedly did not watch TV at all, just over two-thirds watched TV at least once a week. Women who watched TV at least once a week were found to have 1.3 times the odds of being overweight or obese compared with those who never watched TV (AOR: 1.3, 95% CI: 1.1 to 1.5; p<0.001). However, when stratified by settlement type, the statistical significance stood for the rural women only (AOR: 1.5, 95% CI: 1.2 to 1.8; p<0.001), after adjusting for the covariates.

CONCLUSION

Watching TV at least once a week was found to be a significant correlate of overweight and obesity in rural Timorese women of reproductive age. Further studies need to be undertaken to assess physical activity, sedentary and dietary patterns to clarify the possible mechanism through which TV viewing may influence BMI in those groups.

Correlation Between Mini Nutritional Assessment and Anthropometric Measurements Among Community-Dwelling Elderly Individuals in Rural Southern Thailand

Purpose

The Mini Nutritional Assessment (MNA) can be applied to assess nutrition status among community-dwelling elderly individuals by health care professionals. This study aimed to evaluate the correlation of MNA score and anthropometric measurements, gait speed, and handgrip strength among elderly community members. The secondary outcome was to compare the performance of the MNA-SF with the full MNA.

Materials and Methods

The study was a cross-sectional study with 176 elderly individuals aged ≥60 years living in rural southern Thailand. The MNA-SF and full MNA scores were obtained by using the standard form in the Thai version of the MNA. We collected anthropometric measurements, gait speed, handgrip strength, and MNA data.

Results

There was a significant positive correlation between body weight, BMI, waist circumference, hip circumference, waist-to-height ratio, waist-to-hip ratio, mid-upper arm circumference, calf circumference, triceps skinfold thickness, handgrip strength and full MNA total score using the partial correlation coefficient after controlling for age and sex. The MNA-SF had sensitivity of 78.79%, specificity of 81.82%, PPV of 50%, NPV of 94.35%, LR+ of 4.33, LR- of 0.26, accuracy of 81.25% and AUC 0.901 when using the full MNA as a reference standard.

Conclusion

The MNA correlated with many anthropometric measurements. The MNA-SF had a high specificity, NPV and accuracy of more than 80% when compared with the full MNA.

Obesity among Health-Care Workers: Which Occupations Are at Higher Risk of Being Obese?

Obesity among health-care workers (HCWs) is an important issue as it can affect both their health condition and their professional capability. Although adult obesity is attributable to occupational factors, few reports are available on Malaysian health-care workers’ obesity and whether different health-care job categories are related to workers’ obesity. This study aimed to determine the prevalence of obesity among HCWs and the association between various HCW job categories and obesity. A cross-sectional study was conducted by analyzing secondary data from the 2019 annual cardiovascular health screening program, which included information regarding all government health-care workers in the east coast region of Peninsular Malaysia. The subject’s body mass index (BMI) was categorized according to WHO criteria. Only 43% of the subjects had a normal BMI, while 33.1% were categorized as overweight, and 21.1% were obese. Different HCWs’ job categories were shown to be significantly associated with their obesity status, with nurses apparently having a higher risk of being obese (Adj OR = 1.91, 95% CI 1.45, 2.53, p-value < 0.001). This study’s results require further exploration of HCWs’ working condition factors and for different job categories that contribute to obesity. Public health intervention programs to combat obesity should be implemented that primarily target HCW groups at the highest risk of obesity.

Prevalence of musculoskeletal pain and associated disability among professional bus drivers: a cross-sectional study

Purpose

Professional bus drivers risk developing musculoskeletal pain (MSP) and disability due to their working condition. The current study investigates the prevalence rate of MSP and disability among professional bus drivers.

Methods

A cross-sectional study was conducted among 83 professional bus drivers. The prevalence rate of MSP was evaluated using a standardized Nordic musculoskeletal questionnaire. The disabilities due to the MSP were evaluated using neck disability index (NDI), Oswestry disability index (ODI) and shoulder pain and disability index (SPADI) tools. Prevalence of MSP was presented with 95% of confidence interval (CI) at an alpha level of 0.05. The 12 months and 7 days prevalence of MSP were tabulated for analysing the trend of MSP between the upper and lower body regions.

Results

The drivers had a mean driving experience of 10.07 ± 7.26 years. The mean driving hours/week were 50.25 ± 12.82 h. Neck and back were the most affected regions with a prevalence rate of 81.9% (N = 68) and 80.7% (N = 67) at 12 months. Back region recorded the highest 7 days prevalence rate for MSP with 53% (N = 44). Approximately one fourth of the bus drivers population (23.9%, N = 16) had moderate disability in back region. More than half with MSP in the neck region presented mild disability (54.4%, N = 37).

Conclusion

The bus drivers reported a high prevalence rate of MSP in the neck, back and shoulder regions with mild to moderate disabilities. Appropriate health care and rehabilitation programs are necessary for the prevention and management of MSP among the bus drivers.

Higher maternal BMI early in pregnancy is associated with overweight and obesity in young adult offspring in Thailand

Background

Rates of overweight and obesity among women of reproductive age have been steadily increasing worldwide and in Thailand. There is mounting evidence that maternal obesity during pregnancy is associated with an increased risk of obesity and other adverse health outcomes in the offspring, but such data are lacking for Thailand. We examined the associations between maternal body mass index (BMI) and anthropometry (particularly the likelihood of obesity) and cardiometabolic parameters in young adult offspring.

Methods

This was a prospective follow-up study of a birth cohort in Chiang Mai (Thailand). Pregnant women carrying singletons were recruited at their first antenatal visit (< 24 weeks of gestation) and followed until delivery in 1989–1990. Participants were their young adult offspring followed up in 2010. Maternal BMI was recorded at the first antenatal visit. The offspring underwent clinical assessments, including anthropometry, lipid profile, insulin sensitivity (HOMA-IR), blood pressure, and carotid intima-media thickness. The primary outcome of interest was the likelihood of obesity in the offspring.

Results

We assessed 628 young adults (54% were females) at 20.6 ± 0.5 years of age (range 19.1–22.1 years). The young adult offspring of mothers with overweight/obesity was 14.1 kg (95%CI 9.7, 18.5; p < 0.0001) and 9.4 kg (95% CI 6.1, 12.8; p < 0.0001) heavier than those born to mothers with underweight or normal weight, respectively, and had BMI 3.46 kg/m² (95%CI 2.26, 4.67; p < 0.0001) and 5.27 kg/m² (95%CI 3.67, 8.68; p < 0.0001) greater, respectively. For every 1-kg/m² increase in maternal BMI, the adjusted odds ratio (aOR) of offspring obesity was 25% greater (95%CI 1.10, 1.42; p < 0.001). Thus, the aOR of obesity in offspring of mothers with overweight/obesity was 4.6 times greater (95%CI 1.86, 11.26; p < 0.001) and nearly 17-fold greater (95%CI 1.96, 146.4; p = 0.010) compared to young adults born to mothers with normal weight or underweight, respectively. There were no observed associations between maternal BMI status and offspring metabolism or blood pressure.

Discussion

Maternal overweight/obesity early in pregnancy was associated with increased BMI and greater odds of obesity in their young adult offspring in Thailand. These findings highlight the public health importance of fostering healthier lifestyle choices among women of reproductive age.

Echocardiographic Findings Among Virally Suppressed HIV-Infected Aging Asians Compared with HIV-Negative Individuals

OBJECTIVES

Prevalence of cardiovascular disease increases with age. Little is known about the prevalence and risk factors for echocardiographic abnormalities among older people living with HIV (PLHIV) from Asia.

DESIGN

A cross-sectional study was conducted among PLHIV aged >50 years (N = 298) on antiretroviral treatment (ART) and HIV-negative controls (N = 100) frequency matched by sex and age in Thailand.

METHODS

All participants underwent standard 2-dimensional transthoracic echocardiography performed by trained cardiologists who were blinded to the participant's care and HIV status. Logistic regression was used to examine the association between cardiac abnormalities and risk factors.

RESULTS

The median age was 54.7 years (60.8% men) with 37.2% having hypertension and 16.6% having diabetes mellitus. PLHIV was on ART for a median of 16.2 years with current CD4 cell counts of 616 cells per cubic millimeter. Echocardiogram abnormalities did not differ among PLHIV (55%) and the controls (60%). The major abnormalities in PLHIV were following: left ventricular (LV) hypertrophy: 37% men and 42.2% women, LV systolic dysfunction (0.7%), diastolic dysfunction (24.2%), and pulmonary hypertension (3.9%). From the multivariate analyses in PLHIV, being aged >60 years was independently associated with diastolic dysfunction, whereas female sex and left atrial volume index of >34 mL/m were associated with pulmonary hypertension (P < 0.05). None of the ART was significantly associated with any major echocardiographic abnormalities.

CONCLUSIONS

In this long-term, well-suppressed, older, Asian PLHIV cohort, the prevalence of asymptomatic LV systolic dysfunction and pulmonary hypertension were relatively low, whereas the diastolic dysfunction and LV hypertrophy were common. Echocardiographic findings did not differ between PLHIV and HIV-uninfected controls.

Correlation of body visceral fat rating with serum lipid profile and fasting blood sugar in obese adults using a noninvasive machine

Increased visceral fat is associated with an increased mortality rate. Bioelectrical impedance analysis (BIA) is a noninvasive method to assess visceral fat that is easily accessible and avoids exposure to radiation. It is unknown how a visceral fat rating from a noninvasive machine correlates with the serum lipid profile and fasting blood sugar (FBS). The aim of this research is to study the correlation of the visceral fat rating obtained by a noninvasive method with the serum lipid profile and FBS. This cross-sectional study involved 90 obese adults, ranging in age from 18 to 60 years old. The visceral fat rating was measured by BIA. The results demonstrated that significant positive correlations were found between the serum triglycerides and visceral fat rating (r = 0.287, P = 0.006) and between the FBS and visceral fat rating (r = 0.210, P = 0.047). There was a negative correlation between the serum high-density lipoprotein (HDL) cholesterol and visceral fat rating (r = -0.322, P = 0.002). In conclusion, statistically significant positive correlations were found between the serum triglycerides and visceral fat rating and between the FBS and visceral fat rating, and a negative correlation was found between the serum HDL-cholesterol and visceral fat rating.

Impact of Obesity and Being Overweight on the Immunogenicity to Live Attenuated Hepatitis A Vaccine in Children and Young Adults

Prior results investigating a correlation between obesity and hepatitis A virus (HAV) vaccine response have been inconclusive, with limited data involving live attenuated HAV vaccines. The aim of this study is to evaluate the effect of overweight and obesity on the response to live attenuated HAV vaccine in children and young adults. This prospective cohort study was conducted in Thailand with subjects ranging in age from seven to twenty-five years. The subjects were administered 0.5 mL of MEVAC™-A and tested for anti-HAV antibodies before and at 8–9 weeks after vaccination. Baseline seronegative subjects (anti-HAV antibodies < 20 mIU/mL) were divided into non-obese (underweight/normal weight) and obese (overweight/obesity/severe obesity) groups. A total of 212 (117 non-obese and 95 obese) subjects completed the study (mean age (SD) = 13.95 (3.90) years). The seroprotection rates were 100%. Postvaccination geometric mean titers (95% CI) were 429.51 (401.97, 458.94) and 467.45 (424.47, 514.79) mIU/mL in the non-obese and obese groups, respectively. Females (p = 0.013) and subjects with truncal obesity (p = 0.002) had significantly higher titers than other participants. Live attenuated HAV vaccine is safe and has comparably high immunogenicity in both underweight/normal weight and overweight/obese persons.

Periodontal Treatment Improves Serum Levels of Leptin, Adiponectin, and C-Reactive Protein in Thai Patients with Overweight or Obesity

Periodontitis and overweight or obesity independently change serum levels of leptin, adiponectin, and C-reactive protein (CRP). The aim of this study is to investigate the alterations of serum levels of leptin, adiponectin, and CRP after nonsurgical periodontal treatment (NSPT) in Thai patients with overweight or obesity (Owt/Ob) who did or did not exhibit severe periodontitis (SP) and normal weight (Nwt) patients with or without SP. Two hundred sixty patients were screened; 29 patients were included in this study. The study participants comprised 6 patients with Owt/Ob who exhibited SP, 11 patients with Owt/Ob who did not exhibit SP, 5 Nwt patients with SP, and 7 Nwt patients without SP. Periodontal disease status was evaluated; serum levels of leptin, adiponectin, and CRP were determined by enzyme-linked immunosorbent assay at baseline, as well as at 3 and 6 months after NSPT. At 3 months after NSPT, periodontal status was improved in all groups (p < 0.05), except Nwt patients without SP. Serum levels of leptin and CRP were significantly reduced, while serum levels of adiponectin were elevated after NSPT, regardless of bodyweight or waist circumference (p < 0.05). Improvement in serum levels of leptin after NSPT was also observed in the Nwt with SP group (p = 0.015); these levels did not significantly differ in Nwt patients without SP. NSPT reduces serum levels of leptin and CRP and enhances serum levels of adiponectin in Thai patients with Owt/Ob, irrespective of periodontitis severity. These results suggest a role for periodontal treatment in the systemic inflammatory response of Thai people with Owt/Ob.

Global associations of national economic wealth are more robust with inflammatory bowel diseases than with obesity

The inflammatory bowel diseases consisting of Crohn's and ulcerative colitis have expanded into previously low incidence areas of the world. The spread follows the relatively recent pandemic of global obesity. Pathological relations have been proposed between these two diseases. Both inflammatory bowel diseases and obesity originated in wealthier western societies marked by high gross domestic product per capita. The pathogenic influence of national wealth on the inflammatory bowel diseases has been recognized but are less clear with obesity. Parallel correlations of national wealth with obesity would further strengthen relations between these two diseases. Alternatively, diverging relations could suggest that obesity is less dependent on wealth. As such it would supports another earlier hypothesis that obesity depends on adoption of western diet which precedes national acquisition of wealth. Previously ecological modifiers of global disease patterns, including latitude and lactose digestion status have shown different influences on IBD compared with obesity. We evaluate. the influence of the Gross Domestic Product on these two diseases taking into consideration the former's relationship with ecological markers. Patterns of correlations could suggest contributing mechanisms how these ecological parameters influence some disease distributions. The literature and internet were searched for national rates of obesity, inflammatory bowel diseases, national gross domestic product per capita and national lactase distribution rates. National average latitudes were calculated previously. Pearson correlations were used to compare variables in three regions; global, European and Asian theaters. SAS statistical package was used and statistical significance was accepted at p < 0.05. Globally and in Europe correlations of gross domestic product were moderate and significant r = 0.55 and r = 0.6 respectively with Crohn's disease but weaker with ulcerative colitis. The results were negligible in Asia. Obesity was weakly correlated with gross domestic product globally r = 0.32 and negligible in Europe and Asia. In addition, gross domestic product was moderately correlated with latitude r = 0.6, and inversely with lactase non persistence r = -0.6 both globally and in Europe. This relationship is similar to that with inflammatory bowel diseases, but less related to obesity. Overall results suggest unequal effect of national wealth and industrialization on obesity and inflammatory bowel diseases. It has been suggested that western type diet precedes full industrialization and this could promote obesity.

The salivary microbiota of Thai adults with metabolic disorders and association with diet

OBJECTIVE

This study aimed to investigate abundance of specific bacterial taxa in the saliva of 105 Thai adults with different BMI (lean, overweight, and obese) and T2DM subjects using qPCR targeting the 16S rRNA gene of various bacteria taxa.

DESIGN

We employed qPCR targeting 16S rRNA genes to explore the bacterial profiles and abundances in the saliva of Thai adult subjects with different BMI and T2DM. Multivariate statistical analyses (multiple factor analysis (MFA) and sparse Partial Least Squares Discriminant Analysis (sPLS-DA) were performed to assess the associations of salivary bacteria with diet, blood profile, gender, age, and use of antibiotics.

RESULTS

We found that abundance profiles of the examined salivary bacteria were similar across the four groups. When diet, blood profile, and gender, age, and use of antibiotics were considered, significant differences were noted between subgroups. A positive correlation was also found between consumption of carbonate soft drinks and Bacteroidetes, Gamma-proteobacteria, Veillonella, Fusobacterium and Fusobacterium nucleatum.

CONCLUSIONS

This is the first study demonstrating the relative abundance of salivary bacteria in adult Thai subjects with different levels of BMI and T2DM. Regardless of the similar pattern of bacterial profiles across groups, sPLS-DA analysis highlighted the influence of host variables (gender, age, and use of antibiotics) on the abundance of salivary microbiota. Our findings pave the way for further hypothesis testing to gain insight into the association between host factors and salivary microbiome.

Impact of Nutritional Status on the Severity of Dengue Infection Among Pediatric Patients in Southern Thailand

BACKGROUND

Given the lack of specific antiviral drugs and effective vaccine for dengue infection, factors such as host nutritional status that may alter disease progression require investigation. This study examined the relationship between baseline nutritional status and severity of dengue infection in pediatric patients.

METHODS

Data from dengue patients 1-14 years of age treated at four hospitals in southern Thailand (2017-2018) were reviewed. Dengue infection was classified as dengue fever, dengue hemorrhagic fever and dengue shock syndrome. Children's nutritional status was assessed based on international and national growth charts. Binary logistic regression was used to identify factors associated with dengue severity and malnutrition.

RESULTS

Overall, 248, 281 and 43 patients had dengue fever, dengue hemorrhagic fever and dengue shock syndrome, respectively. Overweight was associated with increased risk of dengue severity [odds ratio (OR) = 1.76, 95% confidence interval (CI): 1.13-2.75, P = 0.012; OR = 1.84, 95% CI: 1.09-3.09, P = 0.022, per international and national growth criteria, respectively). Stunting was associated with decreased risk of dengue severity (OR = 0.54, 95% CI: 0.33-0.88, P = 0.013; OR = 0.61, 95% CI: 0.39-0.95, P = 0.030, per international and national growth criteria, respectively). Being overweight was significantly and positively associated with levels of hemoglobin >14 g/dL, hematocrit >42%, hemoconcentration ≥20% and platelet count ≤50,000/mm, whereas being stunted was significantly and negatively associated with levels of hemoglobin >14 g/dL and hematocrit >42%.

CONCLUSIONS

These findings support a hypothesis that malnutrition might influence the severity of dengue infection through host immune response. Overweight children with dengue infections should be closely observed for early signs of severe dengue infection.

Risperidone-Induced Obesity in Children and Adolescents With Autism Spectrum Disorder: Genetic and Clinical Risk Factors

Aims: Obesity is a significant problem for patients taking atypical antipsychotics. There were two aims of our study. The first aim was to compare the prevalence of overweight and obesity between children and adolescents with autism spectrum disorder (ASD) treated with risperidone with the general pediatric population. The second aim was to investigate the association of the HTR2C -759C>T, ABCB1 1236C>T, ABCB1 2677G>T/A, and ABCB1 3435C>T polymorphisms with risperidone-induced overweight and obesity in children and adolescents with ASD.

Methods: Body weight and height were measured in 134 subjects. Overweight and obesity in children and adolescents were classified using the International Obesity Task Force (IOTF) criteria. Genotyping was performed by TaqMan real-time polymerase chain reaction (PCR).

Results: Our study found that the prevalence of overweight and obesity was significantly higher in children and adolescents with ASD treated with risperidone compared with healthy individuals (p = 0.01 and p = 0.002). The genetic polymorphisms of HTR2C –759C>T, ABCB1 1236C>T, ABCB1 2677G>T/A, and ABCB1 3435C>T were not associated with overweight/obesity in children and adolescents with ASD treated with risperidone after adjustment for multiple comparisons by the method of Bonferroni. Additionally, haplotype analysis revealed that there was no significant association between ABCB13435T-2677T/A-1236T haplotype and overweight/obesity. In multivariate logistic regression, after adjustment by the Bonferroni correction, there was only the duration of risperidone treatment that was significantly associated with overweight/obesity in children and adolescents with ASD.

Conclusions: The findings suggest that children and adolescents with ASD treated with risperidone are at a higher risk of obesity, especially patients with extended treatment with risperidone. For the pharmacogenetic factors, –759C>T polymorphism of HTR2C gene and 1236C>T, 2677G>T/A, and 3435C>T polymorphisms of ABCB1 gene were not likely to be associated with the susceptibility to overweight/obesity in children and adolescents treated with risperidone. Due to the small sample size, further studies with a larger independent group are needed to confirm these findings.

Predictors for development of complete and incomplete intestinal metaplasia (IM) associated with H. pylori infection: A large-scale study from low prevalence area of gastric cancer (IM-HP trial)

Background

Gastric intestinal metaplasia (IM) is precancerous lesion of gastric cancer related to H. pylori infection. There has been limited data about IM and associated risk factors. This study aimed to determine risk factors related to development of IM to guide proper management.

Methods

1,370 patients undergoing UGI endoscopy at Thammasat University Hospital, Thailand were included between January 2018-August 2019. Patients’ data including baseline characteristics, laboratory results, and histopathology from medical database were extensively reviewed. Immunohistochemical staining for p53 expression from gastric biopsies was also performed.

Results

Overall H. pylori prevalence was 43.8%. Mean age was 60.7 years and 45% of whom were males. Chronic gastritis was observed in 1,064(77.7%) patients, while 223(16.3%) had IM. Of 223 patients with IM, 194(87%) patients had complete IM, while 29 (13%) had incomplete IM. In groups of complete and incomplete IM, current H. pylori infection rates were 66.5% and 58.6%, respectively. The BMI of incomplete IM group(27.4) was significantly higher than BMI of complete IM group (23.6). Overweight and obese patients (BMI ≥23 kg/m²) were significantly associated with higher risk for the development of incomplete IM (OR 3.25; 95%CI 1.14–9.27, p = 0.027). Males, age >50 years, and current H. pylori infection were significantly higher in IM than chronic gastritis group with OR 1.43 (95%CI 1.01–2.03, p = 0.048), OR 1.67 (95% CI 1.08–2.57, p = 0.021), and OR 3.14 (95% CI 2.29–4.30, p<0.001), respectively. During 20 months of study, there were 15 patients (1.1%) diagnosed with gastric cancer and 1-year survival rate was only 60%.

Conclusions

Males, age >50 years, and current H. pylori infection are significant predictors for the presence of intestinal metaplasia. BMI might be beneficial for using as a predictive risk factor to reduce the development of incomplete intestinal metaplasia. H. pylori eradication could be an effective way to prevent the development of gastric precancerous lesions.

Gut microbiota of obese and diabetic Thai subjects and interplay with dietary habits and blood profiles

Obesity and type 2 diabetes mellitus (T2DM) have become major public health issues globally. Recent research indicates that intestinal microbiota play roles in metabolic disorders. Though there are numerous studies focusing on gut microbiota of health and obesity states, those are primarily focused on Western countries. Comparatively, only a few investigations exist on gut microbiota of people from Asian countries. In this study, the fecal microbiota of 30 adult volunteers living in Chiang Rai Province, Thailand were examined using next-generation sequencing (NGS) in association with blood profiles and dietary habits. Subjects were categorized by body mass index (BMI) and health status as follows; lean (L) = 8, overweight (OV) = 8, obese (OB) = 7 and diagnosed T2DM = 7. Members of T2DM group showed differences in dietary consumption and fasting glucose level compared to BMI groups. A low level of high-density cholesterol (HDL) was observed in the OB group. Principal coordinate analysis (PCoA) revealed that microbial communities of T2DM subjects were clearly distinct from those of OB. An analogous pattern was additionally illustrated by multiple factor analysis (MFA) based on dietary habits, blood profiles, and fecal gut microbiota in BMI and T2DM groups. In all four groups, Bacteroidetes and Firmicutes were the predominant phyla. Abundance of Faecalibacterium prausnitzii, a butyrate-producing bacterium, was significantly higher in OB than that in other groups. This study is the first to examine the gut microbiota of adult Thais in association with dietary intake and blood profiles and will provide the platform for future investigations.

Changing Patterns of Relationships Between Geographic Markers and IBD: Possible Intrusion of Obesity

Background

Latitude and lactase digestion status influence incidence and prevalence rates of some noncommunicable diseases. Latitudinal correlations helped define beneficial roles of vitamin D in many diseases like inflammatory bowel disease (IBD). In view of recent global expansion of IBD and population migrations, we reexamine relations with these markers. As these changes also paralleled the pandemic of obesity, we explore possible interactions with IBD.

Methods

We undertook a literature review to compare rates of obesity, Crohn's disease and ulcerative colitis with the geographic markers of lactase digestion status, average population-weighted national latitude, and national yearly sunshine exposure. Pearson correlations were used throughout to determine r correlation factors. Statistical significance was accepted at P <0.05 using 2-tailed tests.

Results

Forty-seven countries were matched with various data sets that could be analyzed (range of availability was 49%-85%). While global correlations of IBD with latitude and lactase status remain similar to previous analyses, in Europe and Asia, outcomes were different. Global outcome contains a statistical paradox related to combining countries from Europe and Asia. Obesity showed moderate global correlations with IBD but weak and negligible correlations in Europe and Asia. There was also a weak global correlation with latitude.

Conclusions

It is suggested that global correlations point to parallel geographic spread of IBD and obesity. The lack of latitudinal relations with obesity suggests reduced vitamin D effect. The paradox supports epidemiological differences in western and eastern IBD. Obesity combined with IBD may contribute to different relations, partly due to variable vitamin D effects.

The prevalence of underweight and overweight/obesity and its correlates among adults in Laos: a cross-sectional national population-based survey, 2013

PURPOSE

The study aimed to assess the prevalence of underweight and overweight or obesity and their sociodemographic, lifestyle, and health factors in a national adult population in Lao People's Democratic Republic (PDR) (Laos).

METHODS

A national cross-sectional study based on a stratified cluster random sampling was conducted in 2013. The total sample included 2531 individuals 18-64 years, (females = 59.3%; mean age 38.7 years, SD = 12.8) from Laos. Questionnaire interview, blood pressure and anthropometric measurements, and biochemistry tests were conducted. Multinomial logistic regression was utilized to determine the association between sociodemographic, lifestyle and health status factors, and underweight and overweight or obesity relative to normal weight.

RESULTS

Using Asian criteria for body mass index (BMI) classification, 9.7% of the population was underweight (BMI < 18.5, kg/m²), 47.5% had normal weight (BMI 18.5-22.9 kg/m²), 17.5% overweight (23.0-24.9 kg/m²), 19.6% class I obesity (BMI 25.0-29.9 kg/m²), and 5.6% class II obesity (BMI ≥ 30.0 kg/m²) (or 42.8% overweight, class I or class II obesity). In adjusted multinomial logistic regression, female sex (adjusted relative risk ratio-ARRR 0.67, confidence interval-CI 0.45, 0.99), current tobacco use (ARRR 1.57, CI 1.02, 2.41), and having no hypertension (ARRR 0.50, CI 0.26, 0.97) were associated with underweight, and middle and older age (ARRR 1.79, CI 1.41, 2.25), being Lao-Tai (ARRR 1.37, CI 1.06, 1.76), urban residence (ARRR 1.62, CI 1.20, 2.17), having meals outside home (ARRR 1.36, CI 1.04, 1.77), no current tobacco use (ARRR 0.57, CI 0.34, 0.59), low physical activity (ARRR 1.39, CI 1.01, 1.92), having hypertension (ARRR 2.52, CI 1.94, 3.26), and dyslipidaemia (ARRR 1.56, CI 1.21, 2.00) were associated with overweight or obesity.

CONCLUSION

A dual burden of both adult underweight and overweight or obesity was found in Laos. Sociodemographic, lifestyle, and health status risk factors were identified for underweight and overweight or obesity, which can help in guiding public health programmes to address both these conditions.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional survey.

Evaluation of a questionnaire to assess nutritional knowledge, attitudes and practices in a Thai population

Background

The rapid increase in non-communicable chronic diseases in people of working age has had a major effect on health care utilization, productivity and economy. Lifestyle and diet are recognized as being major risk determinants involved. Disease prevention strategies need to be based on people’s understanding of nutritional knowledge, attitudes and practice. This study evaluates the validity of a new nutritional knowledge and practice questionnaire specifically developed for assessing individuals of working age in a Thai population.

Methods

The questionnaire was constructed and based on previous relevant literature and its content validity was scrutinized by an expert panel. An exploratory factor analysis (EFA) was performed to reduce the number of questions included. Subsequently, data from a cross-sectional study of 1,032 participants were used to evaluate the reliability and validity of this questionnaire. The validity of the questionnaire constructed for assessing knowledge and attitude was evaluated using Confirmatory Factor Analysis (CFA). For the practice component, set criteria were applied to determine the final variables used.

Results

CFA of the nutritional knowledge component suggested that all the variables in the model fitted with the data (χ² = 80.17, df = 66, p > 0.05, CFI = 0.99, RMSEA = 0.01, SRMR = 0.02). The CFA final model for the nutritional knowledge included three factors (food recommendation, nutrients related to diseases, and healthy diet) with a total of 14 questions. For nutrition attitude, CFA also revealed a good fit (χ² = 178.14, df = 93, p < 0.001, CFI = 0.99, RMSEA = 0.03, SRMR = 0.03). The final CFA model for nutritional attitude included three factors (food choice, healthy diet and food recommendation) with a total of 16 questions. For practice items, the number of questions was reduced from 76 to 60.

Conclusions

Questionnaire development should use a logical, systematic and structured approach. Results from our evaluation process demonstrates the construction validity of the nutritional knowledge and practice questionnaire developed. This questionnaire can be further modified for use in other countries within the region.

Electronic supplementary material

The online version of this article (10.1186/s12937-019-0463-1) contains supplementary material, which is available to authorized users.

Correlation between body mass index and ocular parameters

Purpose: To investigate the relationship between BMI and selected ocular parameters.

Subjects and methods: Fifty-three left eyes of normal weight subjects and 67 age-sex matched overweight subjects were studied. Inclusion criteria for the normal weight and overweight groups included BMI between 18.5–22.9 and 23.0–29.9 kg/m², respectively. Subjects with a history of systemic disease, ocular disease or surgery, or disability were excluded. All subjects underwent a medical history interview, arterial blood pressure, height, weight, waist circumference and hip circumference measurements, and BMI and waist-hip ratio calculation. The intraocular pressure (IOP) and anterior corneal curvature were measured by non-contact tonometry and corneal topography, respectively. Measurement of anterior and posterior segment parameters of the eye, including central corneal thickness, anterior chamber depth (ACD), anterior chamber angle, macular thickness (MT), ganglion cell thickness (GCT), retinal nerve fiber layer thickness, cup to disc ratio, and choroidal thickness was performed by enhanced depth-imaging optical coherence tomography.

Results: There was a positive correlation between ACD and BMI (Univariate analysis; β =0.198, P=0.030, Multivariate analysis; β =0.410, P=0.005) and between BMI and IOP (Univariate analysis; β =0.269, P=0.003). The IOP of the overweight group was found to be significantly higher than of the normal weight group (12.80±3.40 and 11.86±2.12 mm Hg, respectively, P=0.002). Also, there was a significant difference found between the GCT and the MT of the two groups (P=0.036 and 0.009, respectively).

Conclusion: It was found that BMI strongly correlated with ACD and IOP. Also, the degree of obesity was found to be a significant factor; therefore, the relationship between these ocular parameters and the severity of obesity should be further investigated.

Prevalence and associates of obesity and overweight among school-age children in a rural community of Thailand

Purpose

Information about overweight and obesity among students in rural areas of Thailand is limited. Therefore, we aimed to determine overweight and obesity prevalences and associated factors among school-aged children in a rural community of Thailand.

Methods

We selected 9 public schools through cluster sampling in 2 provinces located in central Thailand in 2016. Anthropometric measurements were measured using standard techniques, classified as overweight (>1 standard deviation [SD]) and obese (>2 SD) with respect to their age and sex using 2007 World Health Organization reference charts. Standardized questionnaires on risk factors were sent to parents to be completed together with their child.

Results

Among 1,749 students, 8.98% had overweight and 7.26% had obesity. Mean age (range) was 11.5 years (5–18 years). Independent factors associated with overweight and obesity included primary school student (reference as secondary school) (adjusted odds ratio [aOR], 2.25; 95% confidence interval [CI], 1.24–4.08; P=0.07), mother’s body mass index (aOR, 1.07; 95% CI, 1.02–1.12; P=0.001), self-employed father (aOR, 1.99; 95% CI, 1.12–3.55; P=0.018), number of siblings (aOR, 0.61; 95% CI, 0.47–0.81; P=0.001), having sibling(s) with obesity (aOR, 1.82; 95% CI, 1.20–2.77; P=0.005), more than one (aOR, 7.16; 95% CI, 2.40–21.32; P<0.001), consuming 2–3 ladles of rice/meal (aOR, 2.14; 95% CI, 1.38–3.32; P=0.001), consuming >3 ladles of rice/meal (aOR, 2.69; 95% CI, 1.11–6.46; P= 0.27), watching <2 hours of television/day (aOR, 2.18; 95% CI, 1.19–4.01; P=0.012), and watching >2 hours of television/day (aOR, 2.60; 95% CI, 1.36–4.96; P=0.004).

Conclusion

Many sociodemographic, dietary, and behavioral factors were related to overweight and obesity among school-aged children not only in urban but also rural communities of Thailand.

Prevalence of islet autoantibodies in Thai juvenile-onset type 1 diabetes

BACKGROUND

Type 1 diabetes mellitus (T1DM) is caused by autoimmune destruction of islet β-cells of the pancreas. There are overlapping phenotypes in a significant proportion of youth with type 1 and 2 diabetes. Thus, positive pancreatic autoantibodies are helpful to diagnose T1DM. Zinc transporter 8 antibody (ZnT8A) is a recently identified autoantibody in T1DM and no data on ZnT8A in the Thai population have been reported. The aim of this study was therefore to estimate the prevalence of ZnT8A in Thai juvenile-onset T1DM and to evaluate its diagnostic value relative to glutamic acid decarboxylase and insulinoma-2 antigen antibodies (GADA and IA2A).

METHODS

In this cross-sectional study, patients with T1DM diagnosed before age 15 years, and disease duration <10 years were enrolled. Serum ZnT8A, GADA, and IA2A were measured using commercial enzyme-linked immunosorbent assay kits.

RESULTS

The subjects consisted of 81 youths (30 boys, 51 girls) aged 12.3 ± 4.5 years with T1DM. The median diabetes duration was 3 years (range, 0-10 years). The prevalence of ZnT8A, GADA, and IA2A was 54.3%, 75.3%, and 45.7%, respectively. ZnT8A were detected in 16% of T1DM patients negative for both GADA and IA2A. A combination of ZnT8A, GADA and IA2A could detect 80.2% of patients with T1DM. Combined use of ZnT8A and GADA identified 100% of antibody-positive patients.

CONCLUSION

The prevalence of ZnT8A in Thai juvenile-onset T1DM appears to be higher than in previous studies from Asia. ZnT8A could replace IA2A as an autoimmunity marker in Thai pediatric T1DM patients, with better diagnostic performance.

Anthropometric Status among 6⁻9-Year-Old School Children in Rural Areas in Hai Phong City, Vietnam

A double burden of malnutrition in Vietnamese children has emerged as a key challenge: childhood undernutrition remains a public health concern while childhood overweight/obesity has gradually increased. This study aimed to (1) estimate the prevalence of undernutrition and overnutrition among 6–9-year-old primary school children in rural areas of Vietnam, and (2) identify sociodemographic factors associated with undernutrition and overnutrition in this population. A cross-sectional survey was conducted in October 2016 in 2334 children from eight primary schools in rural areas in Hai Phong City, Vietnam. Anthropometric and demographic data were collected. The prevalence of underweight, stunting, wasting, and anthropometric failure was 8.0%, 5.1%, 5.3%, and 11.9%, respectively. Up to 22.1% of children were affected by overweight/obesity, and 31.0% by abdominal overweight/obesity. Low maternal education was associated with higher odds of underweight and anthropometric failure, whereas overweight/obesity or abdominal overweight/obesity were more likely in boys and children of mothers with a high education level. This study provides evidence for a double burden of diseases among primary school children in rural areas in Hai Phong City. Future interventions for the prevention and control of childhood undernutrition and overweight/obesity should take into account child sex and maternal education level.

Breast Cancer Incidence Trends and Projections in Northeastern Thailand

BACKGROUND

The northeast has the lowest incidence of breast cancer of all regions in Thailand, although national rates are increasing. The heterogeneity in subnational trends necessitates a comprehensive evaluation of breast cancer incidence trends and projections to provide evidence for future region-specific strategies that may be employed to attenuate this growing burden.

METHODS

Joinpoint regression and age-period-cohort modeling were used to describe trends from 1988-2012. Data was projected from three separate models to provide a range of estimates of incidence to the year 2030 by age group.

RESULTS

Age-standardized rates (ASRs) increased significantly for all women from 1995-2012 by 4.5% per year. Rates for women below age 50 increased by 5.1% per year, while women age 50 years and older increased by 6% per year from 1988-2012. Projected rates show that women age 50 years and older have the largest projected increase in ASRs by 2030 compared to younger women and all women combined.

CONCLUSIONS

Breast cancer trends in Khon Kaen are presently lower than other regions but are expected to increase and become comparable to other regions by 2030, particularly for women ages 50 years and older.

The Prevalence of Underweight, Overweight/Obesity and Their Related Lifestyle Factors in Indonesia, 2014-2015

Objective

To quantify the prevalence of underweight and overweight or obesity and its related factors (socio-demographic, health behavior, health status) in a national adult population in Indonesia.

Material and Methods

In a national cross-sectional population-based survey in 2014–15 in Indonesia, 29509 adults (median age 41.0 years, Inter Quartile Range = 22.0, age range of 18–103 years) completed questionnaires and anthropometric measurements. Multinomial logistic regression modelling was used to determine the association between socio-demographic, health behavior and health status factors and underweight and overweight or obesity.

Results

Of total sample (n = 29509), 11.2% measured underweight (13.5% among men and 9.1% among women) (<18.5 kg/m²), 39.8% normal weight (48.1% among men and 32.0% among women) and 49.0% had overweight or obesity (≥23 kg/m²) (38.3% among men and 58.9% among women); 24.6% of the overall sample had class I obesity (25–29.9 kg/m²), and 8.5% had class II obesity (30 or more kg/m²). Among different age groups, underweight was the highest among 18–29 year-olds (20.0%) and those 70 years and older (29.8%), while overweight or obesity was the highest in the age group 30 to 59 years (more than 53%). In adjusted multinomial logistic regression, having less education, living in rural areas and not having chronic conditions were associated with underweight status. While better education, higher economic status, urban residency, dietary behavior (infrequent meals, frequent meat, fried snacks and fast food consumption), physical inactivity, not using tobacco, having chronic conditions (diabetes, hypertension, hypercholesterol), and better perceived health and happiness status were associated with overweight or obesity.

Conclusions

A dual burden of both adult underweight and having overweight or obesity was found in Indonesia. Sociodemographic, health risk behavior and health status risk factors were identified, which can guide public health interventions to address both these conditions.

Cross-sectional STEPwise Approach to Surveillance (STEPS) Population Survey of Noncommunicable Diseases (NCDs) and Risk Factors in Brunei Darussalam 2016

This article provides a cross-sectional weighted measurement of noncommunicable diseases (NCDs) and risk factors prevalence among Brunei adult population using WHO STEPS methodology. A 2-staged randomized sampling was conducted during August 2015 to April 2016. Three-step surveillance included (1) interview using standardized questionnaire, (2) blood pressure and anthropometric measurements, and (3) biochemistry tests. Data weighting was applied. A total of 3808 adults aged 18 to 69 years participated in step 1; 2082 completed steps 2 and 3 measurements. Adult smoking prevalence was 19.9%, obesity 28.2%, hypertension 28.0%, diabetes 9.7%, prediabetes 2.1%, and 51.3% had fasting cholesterol level ≥5 mmol/L. Inadequate consumption of fruits and vegetables prevalence was high at 91.7%. Among those aged 40 to 69 years, 8.9% had a 10-year cardiovascular disease (CVD) risk ≥30%, or with existing CVD. Population strategies and targeted group interventions are required to control the NCD risk factors and morbidities.

Preliminary Results: Colorectal Cancer Screening Using Fecal Immunochemical Test (FIT) in a Thai Population Aged 45-74 Years: A Population-Based Randomized Controlled Trial

Objective:

The aim of this paper is to provide some details and the results to date of a colorectal cancer screening trial using a fecal immunochemical test (FIT).

Methods:

A population-based randomized controlled trial began in May, 2016. All people aged 45 to 74 years living in Nam Phong District, Khon Kaen Province, Thailand, and willing to participate are being recruited using an outreach method. Enrolled participants are randomly allocated by a computer-generated randomization program either to a study arm (receive sample kit for FIT) or to a control arm (no provision of kit). Positive FIT cases are subsequently confirmed by a colonoscopy examination, and negative FIT cases are re-tested with FIT every two years. The preliminary results to date were analysed using descriptive statistics.

Results:

A total of 1,060 enrolled participants provided a complete set of data. Of those randomly assigned to the study arm and tested by FIT, 92 (8.7%) were found to be positive, 39 (11.5%) males and 53 (7.4%) females. The f-Hb concentrations at the 75th, 90th and 95th percentiles for all age groups were higher in males than in females, and the distributions of f-Hb concentration varied with age, especially at the 95th percentile where f-Hb concentrations increased with age.

Conclusion:

The preliminary results of our screening trial have indicated that the prevalence of positive FIT cases is higher than in a similar recent and, at the time unique, previous study in Thailand. This finding is especially the case for males and those in the older age groups.

A population-based survey on physical inactivity and leisure time physical activity among adults in Chiang Mai, Thailand, 2014

Background

Reducing physical inactivity among the population is a challenge for many nations. Targeting leisure time physical activity (LTPA) may be useful in increasing overall physical activity as it is assumed it is associated with a higher degree of free choice and personal preference than physical activity at work and during travel. The study explored the prevalence of physical inactivity and focused on the overall level of energy expenditure and energy level spent during leisure time among those who were physically inactive and assessed the stages of change for LTPA among those who were physically inactive.

Methods

A population-based survey was conducted in 2014 in Chiang Mai, Thailand using a stratified two-stage cluster sampling technique. The Global Physical Activity Questionnaire (GPAQ) was used to collect the data on physical activity. Sufficient levels of physical activity (PA) were defined as ≥150 min/week of moderate-intensity PA or ≥75 min/week of vigorous-intensity PA or ≥600 metabolic equivalent of task (MET)-minutes/week. Weighted analyses were used to estimate the prevalence of physical inactivity, the total energy expenditure and expenditure during LTPA as well as stages of change among the physically inactive population.

Results

A total of 1744 people (808 men and 936 women), aged 15 to 64 years, participated in the study. We estimated that a quarter (26%) of the population were physically inactive. Physical inactivity was more commonly found among women than men in most age groups. LTPA contributed a small proportion of overall PA. On average, physically inactive men spent 132.8 MET-minutes/week and inactive women spent 208.2 MET-minutes/week in overall PA which is well below the 600 MET-minutes/week recommend by the World Health Organization. Around 75% of physically inactive people had no intention of engaging in regular LTPA.

Conclusion

About a quarter of the investigative population were physically inactive. Most physically inactive members of the population participate in low levels of LTPA, but the majority has no intention of increasing PA during leisure time. A large-scale health promotion program is needed, and it should focus on an approach for the pre-contemplated population.

National and Subnational Population-Based Incidence of Cancer in Thailand: Assessing Cancers with the Highest Burdens

In Thailand, five cancer types-breast, cervical, colorectal, liver and lung cancer-contribute to over half of the cancer burden. The magnitude of these cancers must be quantified over time to assess previous health policies and highlight future trajectories for targeted prevention efforts. We provide a comprehensive assessment of these five cancers nationally and subnationally, with trend analysis, projections, and number of cases expected for the year 2025 using cancer registry data. We found that breast (average annual percent change (AAPC): 3.1%) and colorectal cancer (female AAPC: 3.3%, male AAPC: 4.1%) are increasing while cervical cancer (AAPC: -4.4%) is decreasing nationwide. However, liver and lung cancers exhibit disproportionately higher burdens in the northeast and north regions, respectively. Lung cancer increased significantly in northeastern and southern women, despite low smoking rates. Liver cancers are expected to increase in the northern males and females. Liver cancer increased in the south, despite the absence of the liver fluke, a known factor, in this region. Our findings are presented in the context of health policy, population dynamics and serve to provide evidence for future prevention strategies. Our subnational estimates provide a basis for understanding variations in region-specific risk factor profiles that contribute to incidence trends over time.

Increasing walking steps daily can reduce blood pressure and diabetes in overweight participants

Background

High blood pressure (BP) and diabetes have been suggested to be non-communicable diseases (NCDs), and they are components in the definition of metabolic syndrome. Further, several studies have reported that the risk of developing NCDs can be reduced by increased physical activity. In addition, a daily target of 10,000 steps has been generally suggested to increase physical activity in sedentary lifestyles. Therefore, the purpose of this study was to determine the effect of an accumulation of 10,000 steps daily on BP and blood glucose in overweight participants.

Methods

Participants were recruited from males and females, aged 35-59 years, with sedentary lifestyles. A longitudinal quasi-experimental study was designed with 35 participants who had body mass indices ≥25 kg/m². These volunteers were assigned to the 12-week pedometer-based walking program (an accumulation of at least 10,000 steps daily). Blood glucose and BP were measured before and after the intervention.

Results

Systolic blood pressure (SBP) was significantly lower in 30 individuals who accumulated 10,000 steps daily (-13.74 mmHg). In addition, the reduction of blood glucose levels (-14.89 mg/dl) in the intervention participants was statistically significant (p < 0.001).

Conclusion

The accumulation of at least 10,000 steps daily resulted in decreased SBP and blood glucose in overweight Thai subjects. It could also reduce the risk of cardiovascular disease (e.g., hypertension and diabetes).

Original article. Trends and characteristics of childhood diabetes in a tertiary care center in Thailand

Background: Reports on characteristics of pediatric diabetes in children from Southeast Asian countries are limited.

Objectives: To describe the clinical characteristics, prevalence, glycemic control, and current treatment regimens of diabetes in Thai children.

Materials and Methods: Data from 132 patients seen at our pediatric diabetes clinic at Chulalongkorn University during 2001−2013 were retrospectively reviewed.

Results: We found an increasing number of patients newly-diagnosed with type 1- (T1DM) or type 2- diabetes mellitus (T2DM). The overall proportion of T1DM was 69.7%, T2DM 23.4%, and other types 6.9%. Children with T1DM were younger at diagnosis, had higher initial glucose and glycated hemoglobin A1c (HbA1c), a lower body mass index z-score, lower C-peptide and insulin levels, and were more likely to have classic diabetes symptoms and ketoacidosis, compared with children with T2DM. Mixed diabetes phenotypes were found in about 12%−14% of these children. Glutamic acid decarboxylase and islet antigen-2 autoantibodies were found in 70% and 54% of T1DM patients, respectively, and not in T2DM patients. HbA1c in T1DM was 9.6 ± 2.2% total hemoglobin, and in T2DM was 7.9 ± 2.6%. There were no differences in HbA1c levels between different insulin regimens in the T1DM group.

Conclusion: The number of children with T1DM or T2DM has been increasing and there are overlapping phenotypes in a significant proportion of these children. Correct diagnosis requires clinical evaluation and monitoring of the clinical course. Further research is needed to determine the risk factors for the poor glycemic control found in children with T1DM.

Trends in adult overweight and obesity prevalence in Mongolia, 2005-2013

OBJECTIVE

To analyze trends in the prevalence of overweight and obesity among Mongolian adults during the past decade as measured by body mass index (BMI) and waist circumference (WC).

METHODS

Data from the repeated cross-sectional surveys on the prevalence of noncommunicable disease risk factors conducted in 2005, 2009, and 2013 in Mongolia were used. Linear regression was used to quantify trends in mean BMI and WC, adjusted for age group, sex, and survey year.

RESULTS

The age-standardized prevalence of obesity, denoted by the international BMI cutoff values, in men and women between 2005 and 2013 increased from 10.8% to 17.6% and from 18.9% to 26.4%, respectively. Using Asian-specific BMI cutoff values for men and women, the age-standardized prevalence of obesity between 2005 and 2013 increased from 20.0% to 32.8% and 33.4% to 43.7%, respectively.

CONCLUSIONS

The prevalence of overweight and obesity has increased markedly between 2005 and 2013 similarly across all age groups and sexes. It is important to consider the use of Asian-specific cut-offs as the burden of obesity is twice as high as when using international BMI cutoffs. These data demonstrate the urgent need for obesity treatment, prevention, and monitoring in Mongolia.

The impact of obesity towards prostate diseases

Evidence has supported obesity as a risk factor for both benign prostate hyperplasia (BPH) and prostate cancer (PCa). Obesity causes several mechanisms including increased intra-abdominal pressure, altered endocrine status, increased sympathetic nervous activity, increased inflammation process, and oxidative stress, all of which are favorable in the development of BPH. In PCa, there are several different mechanisms, such as decreased serum testosterone, peripheral aromatization of androgens, insulin resistance, and altered adipokine secretion caused by inflammation, which may precipitate the development of and even cause high-grade PCa. The role of obesity in prostatitis still remains unclear. A greater understanding of the pathogenesis of prostate disease and adiposity could allow the development of new therapeutic markers, prognostic indicators, and drug targets. This review was made to help better understanding of the association between central obesity and prostate diseases, such as prostatitis, BPH, and PCa.