Alarmingly high prevalence of obesity in Curaçao: data from an interview survey stratified for socioeconomic status

What is a "high" prevalence of obesity? Two rapid reviews and a proposed set of thresholds for classifying prevalence levels

Categories such as "low" and "high" have been used for several decades to describe the prevalence of stunting and wasting in populations of children aged under 5 years. They provide support for public health risk assessment and policy-making, including alerting health departments and aid agencies to national trends and local needs. In the light of the need for monitoring progress to meet globally agreed targets for overweight and obesity, the classification of their prevalence will be a valuable to aid in policy development, to target resources, and to promote public health interventions. This paper reviews the current use of categories to describe obesity prevalence in policy, advocacy, and research literature. Where prevalence categories have been formally proposed, this paper compares their application on large-scale datasets. The paper then develops a set of recommended threshold values to classify prevalence levels for overweight and obesity among children under age 5 years, children aged 5-19 years, and adults.

Association of Country-wide Coronavirus Mortality with Demographics, Testing, Lockdowns, and Public Wearing of Masks

We studied sources of variation between countries in per-capita mortality from COVID-19 (caused by the SARS-CoV-2 virus). Potential predictors of per-capita coronavirus-related mortality in 200 countries by May 9, 2020 were examined, including age, gender, obesity prevalence, temperature, urbanization, smoking, duration of the outbreak, lockdowns, viral testing, contact-tracing policies, and public mask-wearing norms and policies. Multivariable linear regression analysis was performed. In univariate analysis, the prevalence of smoking, per-capita gross domestic product, urbanization, and colder average country temperature were positively associated with coronavirus-related mortality. In a multivariable analysis of 196 countries, the duration of the outbreak in the country, and the proportion of the population aged 60 years or older were positively associated with per-capita mortality, whereas duration of mask-wearing by the public was negatively associated with mortality (all P < 0.001). Obesity and less stringent international travel restrictions were independently associated with mortality in a model which controlled for testing policy. Viral testing policies and levels were not associated with mortality. Internal lockdown was associated with a nonsignificant 2.4% reduction in mortality each week (P = 0.83). The association of contact-tracing policy with mortality was not statistically significant (P = 0.06). In countries with cultural norms or government policies supporting public mask-wearing, per-capita coronavirus mortality increased on average by just 16.2% each week, as compared with 61.9% each week in remaining countries. Societal norms and government policies supporting the wearing of masks by the public, as well as international travel controls, are independently associated with lower per-capita mortality from COVID-19.

Prevalence of metabolic syndrome and its associated risk factors in an African-Caribbean population with severe mental illness

This cross-sectional study aims to determine the prevalence of metabolic syndrome (MetS) in patients with severe mental illness (SMI) on a Caribbean island, Curaçao, using the modified National Cholesterol Education Program Adult Treatment Panel III criteria. Among 350 patients (240 men and 110 women) with a mean age of 51.9 years (S.D.=13.5) MetS prevalence was 37.4%, significantly higher in female patients (63.6%) compared to male patients (25.4%). Increased waist circumference was present in 51.1%, low HDL in 50.6%, hypertension in 49.4%, hyperglycemia in 28.6% and 25.7% had hypertriglyceridemia. Except for hypertriglyceridemia, all criteria were more prevalent in female patients. Binary logistic regression analysis indicated that female gender, outpatient treatment setting and the absence of substance use disorder were all significant predictors for MetS. Compared to data from the general population obtained by the 2013 National Health Survey Curaçao, this study showed significantly higher prevalence of diabetes and hypertension in patients with SMI. Moreover, female patients had the highest prevalence of diabetes (28.2%), obesity (50.0%) and increased waist circumference (88.2%). This study demonstrates that African-Caribbean patients with SMI are at high-risk for MetS, especially female patients. Our data suggest to focus on modifiable lifestyle risk factors, as promoting physical activity and healthy dietary habits.

The incidence of anorexia nervosa in Netherlands Antilles immigrants in the Netherlands

OBJECTIVE

Previously we found that the incidence of anorexia nervosa (AN) in the general population was much lower in the Netherlands Antilles than in the Netherlands. As a follow-up we compared the incidence of AN in the Netherlands in persons from the Netherlands Antilles to native Dutch.

METHOD

A national register of psychiatric hospital admissions was screened for cases of AN. Incidence rates (IR) and incidence rate ratios (IRR) were computed.

RESULTS

The IR of AN was 1.32 per 100 000 person years (95% confidence interval (CI): 0.53-2.71) for Netherlands Antilleans and 1.09 (95% CI: 1.04-1.15) for native Dutch. The age- and sex-adjusted IRR was 1.21 (95% CI: 0.58-2.54).

CONCLUSION

Contrary to the Netherlands Antilles, in the Netherlands AN is as common among Netherlands Antilleans as among native Dutch. Exposure to the Western idealization of thinness is a risk factor for the development of AN, possibly in interaction with migration-related stress.

Ten-yr results of the trans-Atlantic kidney transplant airlift between the Dutch Caribbean and the Netherlands

The prevalence of end-stage renal failure in Curaçao (Dutch Caribbean) is one of the highest in the world. In 1998, the St. Elisabeth Hospital started a unique trans-Atlantic collaboration with the Academic Medical Center in Amsterdam, the Netherlands, and the Eurotransplant Foundation. The partnership aimed to achieve a structured transplantation program for patients in the Dutch Caribbean, who otherwise would need lifelong dialysis. This study is an analysis of the 10-yr transplantation results of this trans-Atlantic program. In 41 consecutive transplantations performed between January 1998 and April 2007, one-yr graft survival and complication rates were retrospectively studied. Twenty-four men and 17 women with a median age of 54 were transplanted. The median dialysis period prior to transplantation was 6.8 yr. The one-yr graft survival rate was 69% (95% confidence interval: 52-80%). Initially 28 grafts functioned (68%); four grafts showed primary non-function (10%) and delayed graft function developed in nine patients (22%). Ten recipients had 16 post-operative complications. Our trans-Atlantic program affords patients with end-stage renal failure, who otherwise would need lifelong dialysis, a chance to be transplanted.

Cardiovascular risk factors in the Mexican population

Chronic degenerative disorders have become a major health problem in Mexico. Cardiovascular diseases represent the first cause of death in our country. Diabetes mellitus (DM) has emerged as the main health problem in Mexico. Its prevalence doubled from < 3% in the 1960s to 6% in the 1980s. Between 1993 and 2000, diabetes mellitus increased from 6.7% to 8.2%, a 22% growth over a seven-year period. In 1995, the cost of the treatment of DM represented 15.48% of the health budget and 0.79% of the GDP. The prevalence of hypertension (HTN) increased from 10% in 1933 to 20% in 1990 and from 23.8% to 30.7% between 1993 and 2000. The expenditures from HTN in 1999 corresponded to 13.9% of the health budget, and 0.71% of GDP. Dyslipidemias are very common. Close to 40% of the population has levels of HDL cholesterol < 35 mg/dL, 24.3% has fasting triglycerides > 200 mg/dL, and 10% has hypercholesterolemia. The prevalence of obesity increased from 21.4% in 1993, to 23.7% in the year 2000. Eight percent of the population has a glomerular filtration rate < 60 mL/min, and 9.1% has proteinuria. Twenty-four percent uses tobacco regularly, and 13% had the habit in the past. Smoking is more frequent among diabetics (34%).In conclusion, cardiovascular risks factors are highly common among the Mexican population and increasing at alarming rates. Preventive programs targeted to decrease their prevalence are urgently needed in Mexico and should become a national priority.

Socio-economic status and abdominal obesity among Finnish adults from 1992 to 2002

OBJECTIVE

To examine 10-year changes in waist circumference (WC) and identify socio-economic groups having higher WC than expected by their body mass index (BMI).

DESIGN

Population based cross-sectional surveys carried out in four regions of Finland in 1992, 1997 and 2002.

SUBJECTS

A total of 9026 women and 8173 men, aged 25-64 years.

MEASUREMENTS

Waist circumference, BMI, socio-economic indicators (education, household income, employment status, marital status) and health behaviors (smoking, alcohol use, physical activity).

RESULTS

In 2002, women had about 2.7 cm and men about 1.0 cm higher WC than subjects 10 years previously. Waist circumference increased more than BMI among women, especially among unemployed women. Higher WC among non-employed women was not explained by socio-economic indicators or health behaviors. Among men, smaller WC was associated with lower socio-economic status. However, associations partly disappeared after adjustment for health behaviors including physical activity at work.

CONCLUSION

Socio-economic patterning of WC is divergent and gender-specific. More attention should be paid to increasing waistlines among women.

Socioeconomic deprivation and waist circumference in men and women: The Scottish MONICA surveys 1989 ?1995

Socioeconomic deprivation and waist circumference were measured in three Scottish MONICA cross-sectional surveys of 2233 men and 2516 women aged 25-64 years in 1989-1995. Means of waist circumference, waist/hip ratio (WHR) and body mass index (BMI) increased with level of deprivation (measured by the Carstairs index) more significantly in women than in men, and more significantly in non-smokers than in current-smokers. Their obesity cases defined by conventional cut-points showed similar patterns of relation to deprivation. There appeared to be more obviously consistent and significant increases in the prevalence of large waist circumference with deprivation for both sexes than in the prevalence of WHR and BMI above the 90th centile. Also there was a more significant trend of increase in waist circumference over time than there was in WHR and BMI for both sexes. Residual case-control analysis, controlling for height, showed a 'dose-response' relationship between deprivation and waist circumference. Compared to the most affluent (the first tertile of the Carstairs score), odds ratio for men in the middle group (the second tertile) adjusted for age, survey year and smoking status was 1.37 (95%CI 1.10-1.70) and in the most deprived (the third tertile) 1.46 (1.17-1.82); and for women 1.22 (0.99-1.50) and 1.81 (1.47-2.23). The study suggests that large waist circumference, increasingly prevalent, is directly related to socioeconomic deprivation, and greater attention should be paid to increasing girth in the socially deprived.

Not your "typical island woman": anorexia nervosa is reported only in subcultures in Curaçao

Anorexia nervosa (AN), once thought to be a problem of wealthier, Western countries has now been documented in survey studies and case reports across geographic and economic groups; however, few epidemiological studies including interview have been done on these populations. We report on a comprehensive study on Curaçao, a Caribbean island in economic transition, where the majority of the population is of predominantly black African origin. As part of an epidemiological study on the island of Curaçao indigenous cases of AN were identified. Participants were interviewed and asked to complete standardized measures of eating behaviors and cultural attitudes. In addition, matched controls completed the same measures and were seen in a focus group to assess their knowledge of eating disorders and perceived current and future challenges to young Curaçao women. Six of the nine indigenous cases of AN were successfully traced; all were of mixed race. No cases of anorexia were found among the majority black population. The women with AN were from the high-education and high-income sectors of the society and the majority had spent time overseas. The women with a history of anorexia reported higher levels of perfectionism and anxiety than the matched controls. All of the women reported challenges to maintaining an active professional and personal life and viewed themselves as different from the norm. Women who presented with AN evidenced vulnerability to a triple threat to identity formation: (1) they were of mixed race, aspiring to fit into the mobile elite (and mostly white) subgroup while distancing themselves from the black majority; (2) they had the means for education and travel that left them caught between modern and traditional constructs of femininity; and (3) they had lived overseas, and therefore struggled upon reentry with the frustrations of what was possible within the island culture. The race, class and overseas exposures of the women with anorexia were anything but typical on the island. Cases of anorexia in other developing countries may similarly be limited to specific subgroups, which require specialized treatment and planning efforts.

Obesity and inequities in health in the developing world

OBJECTIVE

To update the social distribution of women's obesity in the developing world and, in particular, to identify the specific level of economic development at which, if any, women's obesity in the developing world starts to fuel inequities in health.

DESIGN

Multilevel logistic regression analyses applied to anthropometric and socioeconomic data collected by nationally representative cross-sectional surveys conducted from 1992 to 2000 in 37 developing countries within a wide range of world regions and stages of economic development (gross national product (GNP) from 190 to 4440 US dollars per capita).

SUBJECTS

: In total, 148 579 nonpregnant women aged 20-49 y.

MEASUREMENTS

Body mass index to assess obesity status; quartiles of years of education to assess woman's socioeconomic status (SES), and GNP per capita to assess country's stage of economic development.

RESULTS

Belonging to the lower SES group confers strong protection against obesity in low-income economies, but it is a systematic risk factor for the disease in upper-middle income developing economies. A multilevel logistic model-including an interaction term between the country's GNP and each woman's SES-indicates that obesity starts to fuel health inequities in the developing world when the GNP reaches a value of about 2500 US dollars per capita.

CONCLUSIONS

For most upper-middle income economies and part of the lower-middle income economies, obesity among adult women is already a relevant booster of health inequities and, in the absence of concerted national public actions to prevent obesity, economic growth will greatly expand the list of developing countries where this situation occurs.

Nutrition transition in Mexico and in other Latin American countries

Mexico and other Latin American countries are currently undergoing important demographic, epidemiologic and nutrition transitions. Noncommunicable chronic diseases such as obesity, type 2 diabetes mellitus, and high blood pressure are becoming public health problems as the population experiences an important reduction in physical activity and an increase in energy-dense diets. In contrast, the prevalence of undernutrition is declining in most countries, although several decades will be needed before the prevalence drops to acceptable values. The objective of this article is to discuss the characteristics of the nutrition transition with emphasis in data from Mexico, Brazil, and Chile.

Waist circumference as a measurement of obesity in the Netherlands Antilles; associations with hypertension and diabetes mellitus

OBJECTIVES

To evaluate waist circumference (WC) as a screening tool for obesity in a Caribbean population. To identify risk groups with a high prevalence of (central) obesity in a Caribbean population, and to evaluate associations between (central) obesity and self-reported hypertension and diabetes mellitus.

DESIGN

Cross-sectional.

SETTING

Population-based study.

SUBJECTS

A random sample of adults (18 y or older) was selected from the Population Registries of three islands of the Netherlands Antilles. Response was over 80%. Complete data were available for 2025 subjects.

INTERVENTION

A questionnaire and measurements of weight, height, waist and hip.

MAIN OUTCOME MEASUREMENT

Central obesity indicator (WC > or =102 cm men, > or =88 cm women).

RESULTS

WC was positively associated with age (65-74 y vs 18-24 y) in men (OR=7.7, 95% CI 3.4-17.4) and women (OR=6.4, 95% CI 3.2-12.7). Women with a low education had a higher prevalence of central obesity than women with a high education (OR=0.5, 95% CI 0.3-0.7). However, men with a high income had a higher prevalence of a central obesity than men with a low income (OR=1.7, 95% CI=1.1-2.6). WC was the strongest independent obesity indicator associated with self-reported hypertension (OR=1.7, 95% CI 1.4-2.0) and diabetes mellitus (OR=1.6, 95% CI 1.3-1.9).

CONCLUSIONS

The identified risk groups were women aged 55-74 y, women with a low educational level and men with a high income. WC appears to be the major obesity indicator associated with hypertension and diabetes mellitus.

SPONSORSHIP

Island Governments of Saba, St Eustatius and Bonaire, the Federal Government of the Netherlands Antilles, Dutch Directorate for Kingdom relationships.

[The changing relationship between education and risk of obesity in Brazil (1975-1997)]

Based on three comparable surveys conducted in the last quarter of the 20th century in the most heavily populated areas of Brazil, a substantial change was observed in the secular trend towards obesity based on levels of schooling in the population. While during the first period (1975-1989) there was an increasing risk of obesity for all levels of schooling, with the greatest upward trend for men and women with more schooling, during the second period (1989-1997) the increase in obesity was the greatest for individuals with no schooling, along with a stabilization or even decrease in this condition among groups of females with medium or higher education. As a result of the upward trend, the positive relationship decreased between schooling and risk of obesity in men, and the inverse relationship already observed in the female population was further increased. The main potential implications of these findings are for public health.

Obesity in African women in the North West Province, South Africa is associated with an increased risk of non-communicable diseases: the THUSA study. Transition and Health during Urbanisation of South Africans

The objective of the present study was to assess the relationship between anthropometric measurements and risk factors for non-communicable diseases (NCD) in South African black women. A cross-sectional sample of 1040 apparently healthy black female volunteers, 15-70 years old, was recruited from thirty-seven randomly selected sites in the North West Province, stratified according to level of urbanisation. We analysed the association between BMI, waist:hip (WHR), waist circumference (WC) and skinfold measurements and the following risk factors for NCD: blood pressure, serum lipids, fasting serum glucose and insulin and plasma fibrinogen, by using age-adjusted correlation analyses and stepwise regression analysis. Of the subjects, 28.6 % were obese (BMI>30). After adjustment for age and smoking status, BMI correlated significantly with diastolic blood pressure (r 0.21, P=0.037), serum triacylglycerols (TG) (r 0.30, P=0.003), fasting glucose (r 0.29, P=0.005) and log fasting insulin (r 0.24, P=0.02). There was a significant negative correlation between BMI and HDL-cholesterol (r -0.38, P<0.001). Similar but stronger correlations were found between both WC and WHR and these risk factors. Together with age, WC was a significant predictor of TG, HDL-cholesterol and fasting glucose in regression analysis, while subscapular skinfold was a significant predictor of diastolic blood pressure and fasting glucose concentration. Triceps skinfold was a significant predictor of total serum cholesterol, LDL-cholesterol, plasma fibrinogen and the insulin sensitivity index. Measures of obesity, particularly WC, are associated with the risk for NCD in black South African women, in which a high rate of obesity has been found.

Assessment of weight gain during pregnancy in general prenatal care services in Brazil

Obesity is an emerging major health risk for women around the world. In this regard, little attention has been given to pregnancy, a moment of risk not only for major weight gain in these women, but also for macrosomia in their offspring. The objective of this study is to evaluate weight gain during pregnancy. Data pertains to a cohort of pregnant women attending general prenatal care clinics in six state capitals in Brazil, from 1991 to 1995. We studied women aged 20 years and over with singleton pregnancies and no diagnosis of diabetes outside pregnancy, enrolled at approximately 20 - 28 weeks of gestation. According to the Institute of Medicine criteria, 38% (95%CI: 36-40%) of the women studied gained less and 29% (95%CI: 28-31%) had more than the recommended total weight gain. These proportions vary according to pre-pregnancy nutritional status. Given the increasing epidemic of obesity, the high prevalence of overweight and obesity in Brazilian women prior to pregnancy, and the lack of achievement of recommended weight gain during pregnancy, more effective means of managing weight gain during pregnancy are necessary.