Prevalence of type 2 diabetes mellitus in Taiwan: ethnic variation and risk factors

Is Colectomy Associated with the Risk of Type 2 Diabetes in Patients without Colorectal Cancer? A Population-Based Cohort Study

Type 2 diabetes might be influenced by colonic disease; however, the association between colonic resection and type 2 diabetes has rarely been discussed. This population-based cohort study explored the association between colectomy and type 2 diabetes in patients without colorectal cancer. A total of 642 patients who underwent colectomy for noncancerous diseases at any time between 2000 and 2012 in the National Health Insurance Research Database of Taiwan were enrolled. The enrolled patients were matched with 2568 patients without colectomy at a 1:4 ratio using a propensity score that covered age, sex, and comorbidities. The risk of type 2 diabetes was assessed using a Cox proportional hazards model. The mean (standard deviation) follow-up durations in colectomy cases and non-colectomy controls were 4.9 (4.0) and 5.6 (3.6) years, respectively; 65 (10.1%) colectomy cases and 342 (15.5%) non-colectomy controls developed type 2 diabetes. After adjustment, colectomy cases still exhibited a decreased risk of type 2 diabetes (adjusted HR = 0.80, 95% CI: 0.61–1.04). A stratified analysis for colectomy type indicated that patients who underwent right or transverse colectomy had a significantly lower risk of developing type 2 diabetes (adjusted HR = 0.57, 95% CI: 0.34–0.98). In the present study, colectomy tended to be at a reduced risk of type 2 diabetes in patients without colorectal cancer, and right or transverse colectomies were especially associated with a significantly reduced risk of type 2 diabetes.

Interactive Effect of IGF2BP2 rs4402960 Variant, Smoking and Type 2 Diabetes

PURPOSE

Genetic and environmental factors are related to type 2 diabetes (T2D). Genetic modifiers of T2D have not been widely determined among smoking individuals. In this population-based study, we investigated the interactive association between rs4402960 polymorphism of the insulin-like growth factor 2 mRNA-binding protein 2 (IGF2BP2) gene and smoking with T2D among Taiwanese adults.

MATERIALS AND METHODS

We obtained genetic data collected between 2008 and 2018 for 22,039 participants (aged 30-70 years) from the Taiwan Biobank (TWB) database. These data were analyzed using the t-test, Chi-square (χ 2) test, and multiple logistic regression.

RESULTS

The mean ages for participants with and without diabetes were 58.11±8.75 and 48.58±11, respectively. Compared with the rs4402960 GG genotype, the odds ratio (OR) for T2D was 1.261 among GT and 1.545 among TT genotype individuals (p<0.05). Current smokers compared to nonsmokers were associated with a higher risk of T2D (OR=1.266, p=0.0404). There was a significant interaction between the IGF2BP2 rs4402960 variant and smoking on T2D (p = 0.0497). After stratification by rs4402960 genotypes and smoking status, the OR was substantial only in current smokers with GG genotype (OR, 1.663, p = 0.0008).

CONCLUSION

This population-based study indicated that the risk for T2D was stronger among current smoking rs4402960 GG individuals recruited between 2008 and 2019 in Taiwan.

Socioeconomic Disparity in the Prevalence of Objectively Evaluated Diabetes Among Older Japanese Adults: JAGES Cross-Sectional Data in 2010

Background

Studies on sex-specific socioeconomic gradients in objectively evaluated diabetes among older adults are scarce.

Methods

We used cross-sectional data of 9,893 adults aged 65 years and older in Aichi Prefecture without long-term care insurance from the Japan Gerontological Evaluation Study (JAGES) in 2010 (Response rate: 66.3%). We collected demographic, socioeconomic (income, years of education, and longest occupation) and behavioral information using a mail-in self-reported survey. Blood samples for the objectively evaluated diabetes and self-reported medical history were collected at annual municipal health checkups. Poisson regression analysis stratified by sex with multiple imputations was conducted to calculate prevalence ratio and 95% confidence interval.

Results

A clear income gradient in diabetes prevalence was observed among women, from 11.7% in the lowest income quartile (Q1) to 7.8% in the highest (Q4). Among men, the findings were 17.6% in Q1 to 15.1% in Q4. The prevalence ratios for diabetes with incomes Q1 to Q4 were 1.43 (95% confidence interval [CI], 1.07–1.90) for women and 1.16 (95% CI, 0.90–1.50) for men after adjusting for age and other socioeconomic factors. Even after adjusting for marital status, body mass index, other metabolic risk factors, and lifestyle factors, the income-based gradient remained among women. Education and occupation were not significantly associated with diabetes in the study population.

Conclusions

Only women showed an income-based gradient in diabetes. Monitoring income gradient in diabetes is important in public health actions, even in older populations. Future longitudinal and intervention studies should evaluate the causal link of income to diabetes onset, determine the mechanisms of the potential sex differences in the income/diabetes association, and identify ways to mitigate the income-based inequality.

Socioeconomic status and prevalence of type 2 diabetes in mainland China, Hong Kong and Taiwan: a systematic review

BACKGROUND

China is estimated to have had the largest number of people with diabetes in the world in 2015, with extrapolation of existing data suggesting that this situation will continue until at least 2030. Type 2 diabetes has been reported to be more prevalent among people with low socioeconomic status (SES) in high-income countries, whereas the opposite pattern has been found in studies from low- and middle-income countries. We conducted a systematic review to describe the cross-sectional association between SES and prevalence of type 2 diabetes in Chinese in mainland China, Hong Kong and Taiwan.

METHODS

We conducted a systematic literature search in Medline, Embase and Global Health electronic databases for English language studies reporting prevalence or odds ratio for type 2 diabetes in a Chinese population for different SES groups measured by education, income and occupation. We appraised the quality of included studies using a modified Newcastle-Ottawa Scale. Heterogeneity of studies precluded meta-analyses, therefore we summarized study results using a narrative synthesis.

RESULTS

Thirty-three studies met the inclusion criteria and were included in the systematic review. The association between education, income and occupation and type 2 diabetes was reported by 27, 19 and 12 studies, respectively. Most, but not all, studies reported an inverse association between education and type 2 diabetes, with odds ratios (OR) and 95% confidence interval (CI) ranging from 0.39 (CI not reported) to 1.52 (95% CI 0.91 - 2.54) for the highest compared to the lowest education level. The association between income and type 2 diabetes was inconsistent between studies. Only a small number of studies identified a significant association between occupation and type 2 diabetes. Retired people and people working in white collar jobs were reported to have a higher risk of type 2 diabetes than other occupational groups even after adjusting for age.

CONCLUSIONS

This first systematic review of the association between individual SES and prevalence of type 2 diabetes in China found that low education is probably associated with an increased prevalence of type 2 diabetes, while the association between income and occupation and type 2 diabetes is unclear.

Effect of socio-economic status on the prevalence of diabetes

PURPOSE

As Korean society has become industrialized and westernized, the prevalence of diabetes has increased rapidly. Environmental factors, especially socio-economic status (SES), may account for the increased prevalence of diabetes. We evaluated the associations between the prevalence of diabetes and SES as reflected by household income and education level.

MATERIALS AND METHODS

This study was based on data obtained from the fifth Korea National Health and Nutrition Examination Survey, conducted in 2010-2012. Diabetes referred to a fasting plasma glucose ≥126 mg/dL in the absence of known diabetes, previous diagnosis of diabetes made by a physician, and/or current use of oral hypoglycemic agents or insulin.

RESULTS

Household income and education level were inversely associated with the prevalence of diabetes among individuals aged 30 years or older. These associations were more prominent in females aged 30-64 years. According to household income, the odds ratio (OR) [95% confidence interval (CI)] for the lowest quartile group versus the highest quartile group was 4.96 (2.87-8.58). According to education level, the OR (95% CI) for the lowest quartile group versus the highest quartile group was 8.02 (4.47-14.4).

CONCLUSION

Public policies for the prevention and management of diabetes should be targeted toward people of lower SES, especially middle-aged females.

Risk factors for gestational diabetes mellitus: ethnic disparities

OBJECTIVE

Gestational diabetes mellitus (GDM) increases the risk of poor maternal and infant health outcomes; therefore, the objective of this study was to compare the ethnic disparities and identify the risk factors for GDM.

DESIGN

We performed a cross-sectional analysis using patient records from a hospital located in the Puli area of Central Taiwan.

SETTING

A teaching hospital located in a rural mountainous area of Central Taiwan.

PARTICIPANTS

Between 2002 and 2012, the hospital admitted 154 patients (107 non-aborigines, 30 aborigines, and 17 non-Taiwanese) who exhibited glucose intolerance during their pregnancy.

MAIN OUTCOME MEASURES

GDM was confirmed using the oral-glucose-tolerance-test administered in dose of either 100 g or 75 g. The incidence and risk factors for GDM in the aboriginal and non-aboriginal women was compared.

RESULTS

We excluded the patients who had overt diabetes or were non-Taiwanese. Thus, 132 patients (28 aboriginal and 104 non-aboriginal women; mean age 30 years) were enrolled in the final study. A total of 51 patients (15 aboriginal, 36 non-aboriginal women) had GDM, which was more prevalent among the aboriginal mothers (53.6% versus 34.6%). The risk factors for GDM among the aboriginal women were persistent glycosuria and prior macrosomia.

CONCLUSION

The Taiwanese aboriginal women exhibited higher incidence of GDM; thus, we recommend that early screening and health education for pregnant aboriginal women be provided.

Variations in aging, gender, menopause, and obesity and their effects on hypertension in taiwan

Aim. We assessed obesity, sex, menopause, and gender differences on hypertension in a Hakka-majority Taiwanese sample. Methods. 9621 subjects aged 20 and over participated in this community-based study. Trained nurses collected blood pressure (BP) measurements and anthropometric indices, including weight, height, hip circumference (HC), waist circumference (WC), body mass index (BMI), waist to height ratio (WHtR), and waist to hip ratio (WHR). Results. Levels of systolic and diastolic BP significantly increased at a dose-dependent relationship based on four anthropometric indices (BMI, WC, WHR, and WHtR); the slopes for SBP and DBP differed. After controlling for other covariates using multivariate logistic regression, we found the adjusted odds ratios (OR) of hypertension to be significantly related to the four anthropometric indices. Notably, the effect of obesity on the ORs for hypertension was considerably higher in premenopausal women, but we found no such phenomenon among men. BMI, WC, WHR, and WHtR had significant linear associations with BP. Conclusion. Obesity indices are significantly correlated with the risk of hypertension across gender and age, with BMI having the highest relative potency. The effect of obesity on the risk of hypertension is especially high in premenopausal women, implying a relationship between hormones and hypertension.

Prevalence of diabetes mellitus among non institutionalized elderly in Monastir City

BACKGROUND

Diabetes is a major public health problem worldwide. This problem is particularly relevant to the elderly. The prevalence of each condition increase with age. The present study aimed to determine the prevalence of Diabetes Mellitus (DM) among elderly; we also examined socio-economic factors and life style that are likely to be associated with DM.

METHODS

A cross-sectional study was conducted in 2008-2009, and used a multistage cluster sampling method to select a representative sample among non institutionalized elderly in Monastir City. A total of 598 elderly aged 65 to 95 years were included.

RESULTS

The prevalence of DM was 27.4% (29.2% in males' vs 26.5% in females). Elderly with DM showed higher prevalence of hypertension, obesity and abdominal obesity. DM prevalence decreased with advancing ages in both men and women. Urban residents had a higher prevalence than did their rural counterparts. In multivariate analysis, DM was associated with abdominal obesity (OR [95% CI], 2.6 [1.1-6]; p <0.01), co-existing diseases (3.8 [2.4-6]; p <0.01), and hypertension (2.7 [1.6-4.5] ; p <0.01).

CONCLUSION

The study highlights the DM problem in Tunisia. An ageing population together with social, economic and lifestyle changes have led to a dramatic increase in DM. These data emphasize the urgent need for a comprehensive integrated population-based intervention program to ameliorate the growing problem of DM.

Prevalence of diabetes among Han, Manchu and Korean ethnicities in the Mudanjiang area of China: a cross-sectional survey

Background

Rapid socioeconomic development resulting in changing lifestyles and life expectancy appears to be accompanied by an increasing prevalence of type 2 diabetes. Genetic predisposition related to ethnicity is a major determinant of diabetes risk. This study investigates the prevalences of diabetes and prediabetes in different ethnic populations residing in the Mudanjiang area located in the northeast of China.

Methods

A cross-sectional survey was carried out among Han, Manchu and Korean Chinese aged 20 years or older. Diabetes and prediabetes were diagnosed using standard oral glucose tolerance tests.

Results

The prevalence of diabetes in Manchu (8.39%) and Korean Chinese (9.42%) was significantly lower than that in Han (12.10%). The prevalence of prediabetes was 18.96%, 19.36% and 20.47% in Han, Manchu and Korean populations, respectively. Korean Chinese had a lower prevalence of isolated impaired fasting glucose and higher prevalence of isolated impaired glucose tolerance than the other two ethnic groups. Most patients with diabetes, especially ethnic minority patients, were undiagnosed. A multiple logistic regression analysis showed that age, family history of diabetes, control of diet, self-monitoring of weight, central obesity, increased heart rate, hypertension, elevated plasma triglyceride level, elevated plasma low-density lipoprotein cholesterol, and Han ethnicity were significantly associated with an increased risk of diabetes. Further, Manchu Chinese were found to have the lowest risk of diabetes.

Conclusions

Our study indicates that diabetes is a major public health problem in the Mudanjiang area of China. Ethnicity plays a role in the different prevalences of diabetes and prediabetes among the three ethnic groups. Diabetes is less prevalent among Manchu Chinese compared with Han and Korean Chinese.

Relationships among depression, anxiety, self-care behaviour and diabetes education difficulties in patients with type-2 diabetes: a cross-sectional questionnaire survey

BACKGROUND

Since psychosocial issues appear to be common among people with diabetes, addressing these problems may improve outcomes. Specifically, it is important to understand the factors associated with anxiety and depression in patients with diabetes.

OBJECTIVE

The purpose of this study was to investigate the relationships between self-care behaviour, diabetes education difficulties, depression and anxiety among patients with type-2 diabetes in Taiwan.

DESIGN

This study was cross-sectional and consisted of descriptive statistics and correlations in terms of analyses.

SETTING

Three teaching hospitals, one from each of the northern, middle and southern parts of Taiwan, were selected for data collection.

PARTICIPANT

A total of 312 patients diagnosed with type-2 diabetes were recruited to participate in this study. The inclusion criteria of the study subjects included a diagnosis of type-2 diabetes beyond the age of 18 years and the ability to communicate in Mandarin.

METHODS

Various questionnaires were used to assess demographic, disease characteristics, self-care behaviour, diabetes education difficulty, depression and anxiety data.

RESULTS

(1) Rates of disturbance for depression (10.6%) and anxiety (20.5%) among type-2 diabetes patients were lower than those in Western countries. (2) Anxiety was positively correlated with age (r=0.15, p<0.01), complications (r=0.27, p<0.01), diabetes education difficulty (r=0.39, p<0.01) and depression (r=0.54, p<0.01), but negatively correlated with body mass index (BMI) (r=0.20, p<0.01). (3) A total of 50.5% of variance in anxiety was explained by age, complications, BMI, diabetes education difficulty and depression. (4) A total of 42.8% of variance in depression was explained by BMI, diabetes education difficulty and anxiety.

CONCLUSION

Depression and anxiety are common among patients with diabetes and can have significant effects on the outcome of their medical illness. Addressing psychosocial factors of people with diabetes may improve effects of patient education and disease self-management.

High prevalence of gouty arthritis among the Hmong population in Minnesota

OBJECTIVE

The prevalence of gout is on the rise worldwide, especially among newly industrialized populations. We evaluated the prevalence of gout in the recently established Hmong of Minneapolis/St. Paul (MSP) compared with that in non-Hmong populations.

METHODS

The prevalence of self-reported gout in the Hmong population was estimated from 2 cross-sectional community surveys and compared with national data extrapolated from the Third National Health and Nutrition Examination Survey. The prevalence of physician-diagnosed gout in Hmong and non-Hmong MSP residents was separately estimated from the diagnosis codes of 11 MSP primary care clinics.

RESULTS

The prevalence of self-reported gout among MSP Hmong was 2-fold higher than in the general US population (6.5% versus 2.9%; P < 0.001). Although women of both groups reported gout at a rate of 1.9%, Hmong men were significantly more likely than their non-Hmong counterparts to report gout (11.5% versus 4.1%; P < 0.001). Similar results were observed when investigating physician-diagnosed gout in MSP (2.8% Hmong versus 1.5% non-Hmong; P < 0.001). No difference was observed between the women of the 2 groups (0.8% versus 0.7%; P = 0.833), whereas Hmong men were more than twice as likely to be diagnosed with gout compared with their non-Hmong counterparts (6.1% versus 2.5%; P < 0.001). Among Hmong men, advancing age was associated with a considerably higher likelihood of being diagnosed with gout.

CONCLUSION

A significant association is observed between Hmong ethnicity and gout, both self-reported and physician diagnosed. This unique population may provide an opportunity to further our understanding of the pathophysiology of gout.

Metabolic syndrome associated with toenail onychomycosis in Taiwanese with diabetes mellitus

BACKGROUND

Onychomycosis is a complication of diabetes mellitus (DM), which has a deleterious impact on the quality of life. Aim To explore the prevalence of onychomycosis amongst Taiwanese diabetics, and to analyze the factors associated with onychomycosis after adjusting for age and sex.

METHODS

A total of 1245 Taiwanese diabetics were enrolled, and a nested case-control study was performed by onychomycosis outcome and the exposures were compared.

RESULTS

The overall prevalence of onychomycosis among DM patients was 30.76% (383/1245), with a significantly higher prevalence in men than in women (P = 0.024). The factors associated with onychomycosis in matched pairs by gender and age were analyzed in 375 pairs. It was found that metabolic syndrome, obesity, triglyceride (TG) levels, and glycosylated hemoglobin (HbA1c) were associated with onychomycosis (P < 0.05).

CONCLUSION

Higher prevalence rates of onychomycosis were found in men and older DM patients. Metabolic syndrome, obesity, high TG levels, and poor glycemic control were associated with onychomycosis.

Prevalence of type 2 diabetes mellitus of Chinese populations in Mainland China, Hong Kong, and Taiwan

This article reviews and describes trends and differences in prevalence of type 2 diabetes mellitus of Chinese populations in Mainland China, Hong Kong and Taiwan based on literatures published in the MEDLINE Advanced database (January 1966-October 2005) in both Chinese and English languages. Chinese populations in Hong Kong and Taiwan have significant higher prevalence rates of diabetes than their Mainland counterparts, with odds ratios 1.5 (95% confidence intervals: 1.4, 1.7) and 2.0 (95% confidence intervals: 1.8, 2.2), respectively in 1995-2003 adjusted for age and diagnostic criteria. Using stratified diagnostic criteria; the odds ratios in Hong Kong and Taiwan were consistently higher than Mainland China for the periods of 1985-1994 and 1995-2003. A large proportion, i.e. 68.6% (95% confidence intervals: 67.4%, 69.7%) of diabetic patients remains undiagnosed in Mainland China as compared to 52.6% (95% confidence intervals: 49.8%, 55.5%) undiagnosed in Hong Kong and Taiwan. The prevalence rates of diabetes and impaired glucose tolerance of the Chinese populations rise in older age groups. In tandem with economic development and change toward lifestyle that is lack of physical activity and rich in high-fat diet, prevalence of diabetes of the Chinese populations are on the rise. If the undiagnosed individuals left uncontrolled, they are subject to higher risks of developing diabetes and its complications. These will increase the burdens of diabetes medically and financially.

Does Arsenic Exposure Increase the Risk for Diabetes Mellitus?

OBJECTIVE

Long-term arsenic exposure has been reported to associated with prevalence, incidence, and mortality of diabetes mellitus (DM). A tap water supply system was implemented in the early 1960s in the blackfoot disease (BFD) endemic areas. The objective of this study is to examine whether DM mortality decreased after the improvement of drinking water supply system through elimination of arsenic exposure from artesian well water.

METHODS

Standardized mortality ratios (SMRs) for DM were calculated for the BFD endemic area for the years 1971-2000.

RESULTS

The study results show that mortality from DM declined in females (but not in males) gradually after the improvement of drinking water supply system.

CONCLUSIONS

Based on the reversibility criterion, the association between arsenic exposure and DM is likely to be casual for females but not in males.

A population-based study of the association between areca nut chewing and type 2 diabetes mellitus in men (Keelung Community-based Integrated Screening programme No. 2)

AIMS/HYPOTHESIS

The aim of this study was to assess whether the diabetogenicity of areca nut (Areca catechu or 'betel-nut'), which has previously been demonstrated experimentally in mice, independently contributes to the risk of hyperglycaemia or type 2 diabetes in men in Taiwan, where the habit has become established relatively recently.

METHODS

We used data from a population-based cross-sectional survey and a multiple-disease-screening programme that tested for hyperglycaemia, type 2 diabetes and risk factors related to type 2 diabetes. Data on habitual areca nut chewing were available for 14,816 men. Multiple logistic regression models were used to determine whether areca nut chewing was an independent risk factor for type 2 diabetes.

RESULTS

Compared with non-chewers, areca nut chewers had higher age-adjusted prevalence rates for hyperglycaemia (11.4% vs 8.7%) and type 2 diabetes (10.3% vs 7.8%). Areca nut chewing independently increased the risk of hyperglycaemia (adjusted odds ratio [OR] 1.19, 95% CI 0.97-1.45) and type 2 diabetes (adjusted OR 1.29, 95% CI 1.04-1.60). The independent effects of duration of chewing were dose-dependent for type 2 diabetes (adjusted OR 1.32 for the duration of 10-19 years and 1.41 for the duration of > or =20 years), as were the effects of increased rates of areca nut chewing (adjusted OR 1.14 for <10 pieces/day, 1.30 for 10-19 pieces/day and 2.02 for > or =20 pieces/day); similar findings were noted for hyperglycaemia.

CONCLUSIONS/INTERPRETATION

The habit of chewing areca nut independently contributes to the risk of both hyperglycaemia and type 2 diabetes in Taiwanese men. This association is dose-dependent with respect to the duration of areca nut use and the quantity of areca nut chewed per day.

Body mass index and obesity-related metabolic disorders in Taiwanese and US whites and blacks: implications for definitions of overweight and obesity for Asians

BACKGROUND

Recommendations based on scanty data have been made to lower the body mass index (BMI; in kg/m(2)) cutoff for obesity in Asians.

OBJECTIVE

The goal was to compare relations between BMI and metabolic comorbidity among Asians and US whites and blacks.

METHODS

We compared the prevalence rate, sensitivity, specificity, predictive values, and impact fraction of comorbidities at each BMI level and the BMI-comorbidity relations across ethnic groups by using data from the third National Health and Nutrition Examination Survey and the Nutrition and Health Survey in Taiwan (1993-1996).

RESULTS

For most BMI values, the prevalences of hypertension, diabetes, and hyperuricemia were higher for Taiwanese than for US whites. In addition, increments of BMI corresponded to higher odds ratios in Taiwanese than in US whites for hypertriglyceridemia (P = 0.01) and hypertension (P = 0.075). BMI-comorbidity relations were stronger in Taiwanese than in US blacks for all comorbidities studied. BMIs of 22.5, 26, and 27.5 were the cutoffs with the highest sum of positive and negative predictive value for Taiwanese, US white, and US black men, respectively. The same order was observed for women. For BMIs >27, >85% of Taiwanese, 66% of whites, and 55% of blacks had at least one of the studied comorbidities. However, a cutoff close to the median of the studied population was often found by maximizing sensitivity and specificity. Reducing BMI from >25 to <25 in persons in the United States could eliminate 13% of the obesity comorbidity studied. The corresponding cutoff in Taiwan is slightly <24.

CONCLUSION

These data suggest a possible need to set lower BMI cutoffs for Asians, but where to draw the line is a complex issue.

Diabetes and vascular disease: a new international trial

The prevalence of diabetes is increasing, particularly in developing regions of the world. The social and economic consequences of this disease and its complications are enormous. We discuss the scope and implications of the increasing burden of diabetes and describe the rationale and design of a new international study examining blood pressure lowering and glucose control interventions aimed at reducing the risk of vascular complications in people with type 2 diabetes. This study is the first large-scale randomized trial in diabetes to include participants from both lower- and higher-income regions of the world.

Prevalence of overweight and hypertension in Tanzania: Special emphasis on resting energy expenditure and leptin

1. In the present study we investigated the difference in the distribution of selected cardiovascular disease risk factors among three middle-aged Tanzanian populations with different lifestyles. 2. The prevalence of hypertension and overweight was higher in urban areas than in rural areas. Plasma leptin concentration was also highest in urban areas. Based on these results, we speculated that overweight in the urban population may be partly due to adiposity. 3. Resting energy expenditure was lower in urban areas than in other areas for both genders. These findings suggest that the high prevalence of overweight in the urban population may be partly due to low physical activity levels.