Socioeconomic disparities in abdominal obesity over the life course in China

The effects of intermittent fasting on anthropometric indices, glycemic profile, chemotherapy-related toxicity, and subjective perception in gynecological and breast cancer patients: a systematic review and meta-analysis

BACKGROUND

Mounting evidence supports the health benefits of intermittent fasting (IF) in general. This study evaluates its impact on patients with gynecological or breast cancer specifically.

METHODS

A thorough search for studies comparing IF with either nonintervention diets or calorie restriction (CR) in patients with either gynecological or breast cancer and published prior to October 5, 2024 was carried out on the PubMed, Web of Science, Cochrane Library, Scopus, Embase, China National Knowledge Infrastructure (CNKI), and Chinese Biomedical Literature databases (CBM). Extracted data included but not limited to body mass index (BMI), body weight, waist circumference (WC), fasting glucose, insulin levels, chemotherapy-related toxicity, and subjective perceptions.

RESULTS

A total of 625 subjects were included across 7 randomized controlled trials, and 2 nonrandomized trials. Meta-analysis revealed that IF significantly reduced body weight (Effect Size [ES]: -0.611; 95% Confidence Interval [CI]: -0.886 to -0.356; p < 0.001; I² = 0%), blood glucose levels (standardized mean difference [SMD]: -0.347 mmol/L; 95% CI: -0.533 to -0.140; p < 0.001), and insulin concentrations (SMD: -0.395 mU/L; 95% CI: -0.674 to -0.116; p = 0.005). Sensitivity analysis indicated that the overall effect sizes were stable. However, it remains uncertain whether IF increases chemotherapy-related adverse effects (relative risk [RR]: 1.038; 95% CI: 0.844 to 1.278; p = 0.723). Furthermore, three studies indicated that IF reduced fatigue and two studies indicated that IF improved quality of life.

CONCLUSION

This systematic review and meta-analysis suggests that IF has a beneficial effect on reducing body weight, blood glucose, and insulin concentrations in gynecological and breast cancer patients. IF may also reduce fatigue and improve quality of life. However, the effect on chemotherapy-related adverse effects is uncertain. Further high-quality studies with long-term follow-ups are needed to confirm these findings.

Characteristics of cardiopulmonary exercise capacity in adults with different degrees of obesity

Objective

To explore the characteristics of cardiopulmonary exercise capacity in adults with different degrees of obesity through cardiopulmonary exercise test (CPET).

Methods

From September 2019 to January 2024, the data of patients undergoing CPET in the Rehabilitation Department of the Affiliated Wuxi People's Hospital of Nanjing Medical University were analyzed retrospectively. A total of 231 cases were included. They were categorized into five groups based on their body mass index (BMI): the control group (18.5 ≤ BMI < 24 kg/m2, n = 28), the overweight group (24.0 ≤ BMI < 28 kg/m2, n = 48), the mild obesity group (28 ≤ BMI < 35 kg/m2, n = 75), the moderate obesity group (35.0 ≤ BMI < 40 kg/m2, n = 47), and the severe obesity group (BMI ≥ 40 kg/m2, n = 33). Collected informations on the age, gender, height, and weight of five groups of participants. The VO2 at anaerobic threshold (VO2AT), percentage of predicted VO2AT (VO2AT% Pred), peak oxygen consumption (VO2peak), percentage of predicted VO2peak (VO2peak% Pred), peak kilogram oxygen consumption (VO2peak/kg), maximum exercise power (WRmax), breathing reserve (BR), maximum heart rate (HRmax), percentage of predicted HRmax (HRmax% Pred), maximum O2 pulse (VO2/HRmax), percentage of predicted maximum O2 pulse (VO2/HRmax%Pred), maximum relative O2 pulse (VO2/HRmax/kg),heart rate response (HRr), forced vital capacity (FVC), ratio of forced expiratory volume to vital capacity in 1 s (FEV1/FVC), percentage of predicted forced vital capacity (FVC% Pred), percentage of predicted forced expiratory volume ratio of 1 s (FEV1% Pred), peak expiratory flow rate (PEF), maximum exercise ventilation (VEmax), maximum voluntary ventilation (MVV) and other indicators during the CPET were collected. Single factor analysis of variance was used to compare the mean of each index between groups. Spearman correlation analysis was used to analyze the correlation between BMI and various indicators.

Results

There was no statistical significance in gender composition, age, height, and exercise habit of the five groups of participants (P > 0.05). The body mass and BMI of the five groups had significant differences (P < 0.001). In terms of cardiopulmonary exercise capacity, there were statistical differences among the five groups in the overall distribution of VO2AT (H = 37.370,P < 0.001), VO2AT/kg (H = 34.747, P < 0.001), VO2peak (H = 23.018,P< 0.001), VO2peak/kg (H = 66.606, P < 0.001) and WRmax%Pred (H = 45.136, P < 0.001). There was no significant difference among the five groups in the overall distribution of VO2AT%Pred, VO2peak%Pred and WRmax. There were statistical significant difference among the five groups in HRmax (F = 2.443, P = 0.048), HRmax%Pred (F = 6.920, P < 0.001), VO2/HRmax (F = 8.803, P < 0.001), VO2/HRmax%Pred (F = 11.354, P < 0.001), VO2/HRmax/kg (F = 18.688, P < 0.001) and BR (F = 6.147, P < 0.001) and HRr (F = 9.467, P < 0.001). There were no significant differences among the five groups in RERmax (F = 0.336, P > 0.05). In terms of static pulmonary function, there were significant differences among the five groups in FVC%Pred (F = 4.577, P = 0.001), FEV1%Pred (F = 3.681, P = 0.006) and FEV1/FVC (F = 3.344, P = 0.011). There was no differences among the five groups in MVV(P> 0.05), and there were significant differences among the five groups in VEmax (P = 0.005) In terms of correlation analysis, BMI was positively correlated with VO2AT,VO2peak, VEmax and VO2/HRmax, and negatively correlated with VO2AT/kg, VO2peak/kg,WRmax%Pred, HRmax%Pred, VO2/HRmax%Pred, VO2/HRmax/kg,BR and HRr. In terms of static pulmonary function, BMI was negatively correlated with FVC%Pred, FEV1%Pred.

Conclusion

With the aggravation of obesity, the maximum exercise ability of adults decreases, VO2peak/kg and VO2/HRmax%Pred decreases, and the breathing reserve decreases.

Prevalence, associated factors, and gene polymorphisms of obesity in Tibetan adults in Qinghai, China

OBJECTIVES

To explore the prevalence and associated factors of obesity in Tibetan adults in Qinghai, China, and to determine the association between the FTO (rs1121980 and rs17817449) and MC4R gene (rs17782313 and rs12970134) polymorphisms with obesity.

METHODS

A cross-sectional survey was conducted in 2015 in Qinghai to selected Tibetan adults aged 20 to 80 years. Prevalence of obesity (BMI ≥ 28 kg/m2) and overweight (BMI 24 ~ 27.9 kg/m2) were evaluated. Multivariable logistic models were used to determine the associated factors. Pair-matched subjects of obesity cases and normal-weight controls were selected for the gene polymorphism analyses. Conditional logistic models were used to assess the association between gene polymorphisms with obesity. Additive and multiplicative gene-environment interactions were tested.

RESULTS

A total of 1741 Tibetan adults were enrolled. The age- and sex- standardized prevalence of obesity and overweight was 18.09% and 31.71%, respectively. Male sex, older age, heavy level of leisure-time exercise, current smoke, and heavy level of occupational physical activity were associated with both obesity and overweight. MC4R gene polymorphisms were associated with obesity in Tibetan adults. No significant gene-environment interaction was detected.

CONCLUSION

The prevalence of obesity and overweight in Tibetan adults was high. Both environmental and genetic factors contributed to the obesity prevalent.

Associations between socioeconomic status and risk of obesity and overweight among Chinese children and adolescents

BACKGROUND

In China, the threat of obesity and overweight in children and adolescents is developing quickly. It may be possible to lower the risk of obesity and overweight in children and adolescents by understanding the factors that drive these conditions. Therefore, this study aimed to investigate the association between SES and risk of obesity and overweight among children and adolesecnts in China's provinces of Jiangsu, Anhui, Zhejiang, and Shanghai.

METHODS

Chinese children and adolescents (n = 2,746; 46.3% boys) were recruited using multistage sampling. SES was measured using self-reported questionnaires, the specific indicators were parental education, perceived family wealth, and Family Affluence Scale II. Height and weight were measured and used to calculate body mass index (BMI, categorized into obesity or overweight). The definition of obesity or overweight was based on the Chinese standard "Screening for obesity and overweight among school-age children and adolescents". Descriptive statistics, independent sample t-tests, and a Chi-square test were used to report the sample characteristics and analyse BMI differences across different sociodemographic groups. A binary logistic regression was then applied to analyse the association of SES indicators with BMI in children and adolescents.

RESULTS

Overall, 22.5% of children and adolescents were obese or overweight. Participants with medium and high maternal education levels were 1.48 [95% CI 1.15-1.91] and 1.47 [95% CI 1.03-2.11] times more likely to be obese/overweight. Girls with medium maternal education levels were 1.70[95% CI 1.21-2.40] times more likely to be obese/overweight. For boys, no association was observed. Junior middle school students with medium maternal education levels were 1.51[95% CI 1.10-2.07] times more likely to be obese/overweight. Participants with medium or high FAS, perceived family wealth, or paternal education levels were not associated with obesity/overweight.

CONCLUSIONS

The findings of this study indicated a positive association between SES and risk of overweight/obesity in girls, suggesting that maternal education level may have a substantial impact on future prevention efforts for these conditions in girls. To increase the effectiveness of interventions, longitudinal studies are necessary to better understand the causal association between SES and obesity/overweight.

What Drives Abdominal Obesity in Peru? A Multilevel Analysis Approach Using a Nationally Representative Survey

Abdominal obesity (AO) is a serious public health threat due to its increasing prevalence and effect on the development of various non-communicable diseases. A multilevel analysis of the 2019 Demographic and Family Health Survey (ENDES in Spanish) using the Latin American Diabetes Association (ALAD in Spanish) cut-off points was carried out to evaluate the individual and contextual factors associated with AO in Peru. A total of 30,585 individuals 18 years and older were included in the analysis. The prevalence of AO among Peruvians in 2019 was 56.5%. Individuals of older age (aOR 4.64; 95% CI: 3.95-5.45), women (aOR 2.74; 95% CI: 2.33-3.23), individuals with a higher wealth index (aOR 2.81; 95% CI: 2.40-3.30) and having only secondary education (aOR 1.45; 95% CI: 1.21-1.75) showed increased odds of presenting AO compared to their peers. At a contextual level, only the Human Development Index (aOR 1.59; 95% CI: 1.17-2.16) was associated with the development of AO. A high Human Development Index is the contextual factor most associated with AO. It is necessary to formulate and implement new public health policies focused on these associated factors in order to reduce the prevalence of OA and prevent the excessive burden of associated noncommunicable diseases.

Waist Circumference of the Elderly over 65 Years Old in China Increased Gradually from 1993 to 2015: A Cohort Study

Objective

This study aimed to analyze the temporal trends and characteristics associated with waist circumference (WC) among elderly Chinese people.

Methods

We used data from 3,096 adults ≥ 65 years who participated in the China Health and Nutrition Survey (CHNS), an ongoing cohort study, between 1993 and 2015. We used longitudinal quantile regression models to explore the temporal trends and characteristics associated with WC.

Results

WC increased gradually among the elderly Chinese population during the survey. The WC curves shifted to the right with wider distributions and lower peaks in men and women. All WC percentile curves shifted upward with similar growth rates in the 25th, 50th, and 75th percentiles. The WC means increased from 78 cm to 86 cm during the 22 years of our study. WC significantly increased with age and body mass index and decreased with physical activity (PA). These associations were stronger in the higher percentiles than in the lower percentiles.

Conclusions

WC is rising among Chinese adults ≥ 65 years. Factors affecting WC in elderly people may have different effects on different percentiles of the WC distribution, and PA was the most important protective factor in the higher percentiles of the WC distribution. Thus, different interventional strategies are needed.

Income-related health inequality in urban China (1991-2015): The role of homeownership and housing conditions

Unprecedented economic growth has been experienced over the several decades worldwide, but such rapid economic growth wasn't accompanied by equally-substantial improvement in health, especially health inequalities between the rich and poor. This study examines the role of housing in income-related health inequalities (income-health gradient) in urban China. We here analyze 1991-2015 China Health and Nutrition Survey data to ask how housing affects income-related health inequalities in urban China. We find pro-poor inequalities in self-reported bad health but pro-rich inequalities in objective bad health (general overweight/obesity, central obesity and high blood pressure). Housing conditions serve to reduce the health gradient, especially for objective health. On the contrary, homeownership exacerbates the health gradient. Improving housing conditions thus appears to be an effective way of reducing the income-health gradient in urban China.

Metabolism Score for Visceral Fat (METS-VF): A New Predictive Surrogate for CKD Risk

PURPOSE

Metabolic disorders are closely related to the occurrence and development of chronic kidney disease (CKD). We explored the prospective association between the Metabolic Score for Visceral Fat (METS-VF) and CKD in a 5-year follow-up study.

PATIENTS AND METHODS

In this cohort study, 631 adults not suffering from CKD from Wanzhai Town, in China in 2012 were included at baseline and followed up in 2017 and 2018. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between METS-VF and CKD risk. Area under the receiver operating characteristic curve (AUC) analyses were used to evaluate the ability of METS-VF, waist-to-height ratio (WhtR), visceral adiposity index (VAI), homeostatic model assessment of insulin resistance (HOMA-IR), body mass index (BMI) to predict CKD risk.

RESULTS

We identified 103 CKD cases during follow-up. After adjustment for confounding factors, comparing the lowest quartile of METS-VF, the OR (95% CI) of CKD risk in the highest quartile was 3.04 (1.39-6.64). The per Standard deviation (SD) increase in METS-VF was positively correlated with CKD risk. The AUC of METS-VF for predicting CKD risk was, in general, higher than that for WhtR, VAI, HOMA-IR, and BMI.

CONCLUSION

METS-VF may be an indicator for predicting CKD risk.

Socioeconomic Status, Institutional Power, and Body Mass Index among Chinese Adults

Despite the vast literature on the socioeconomic status (SES) gradient of obesity among adult people, no study has investigated the relationship between institutional power and body mass index. Using national survey data from the “China Labor-force Dynamics Survey 2016” (CLDS 2016), multistage cluster-stratified probability proportional to size (PPS) sampling was employed to select cases from 29 provinces, cities, and autonomous regions in China. This study adopts an institutional approach to explore the influences of SES and institutional power on the state of being overweight or severely overweight (obese) among Chinese adults. It is shown that SES has a non-linear influence on being overweight or obese, higher education has a negative effect on being overweight or obese, income has an inverted U-shaped effect on being overweight or obese, and having a managerial or administrative job has a positive effect on being overweight but less so on obesity. These findings reveal that disparities in health outcome and risks are due to inequality in SES. The work unit is a stronger predictor of adults being overweight or obese than occupation. Working in the public sector has a positive effect on being overweight relative to working in the private sector, and only state institutions and government departments have a positive association with obesity. Our results indicate that institutional structure still has effects on individuals’ life chances in the era of China’s market transition.

High waist-to-height ratio and associated factors in adolescents from a city in Southern Brazil: a cross-sectional study

Objective:

To verify the prevalence of abdominal obesity with the waist-to-height ratio (WHtR) and associated factors in adolescents from a city in Southern Brazil.

Methods:

A total of 960 adolescents (494 boys) aged 15–18 years old participated in this study. The dependent variable was WHtR; independent variables were self-reported age, economic level, sexual maturation, physical activity level, screen time, and body fat. Data were analyzed using descriptive statistics and logistic regression.

Results:

It was observed that 36.7% of the adolescents presented high WHtR (50.2% in girls and 23.9% in boys). Regardless of sex, adolescents with high body fat were more likely of having high WHtR (boys: Odds Ratio [OR] 29.79; 95% confidence interval [95%CI] 16.87–52.62; girls: OR 19.43; 95%CI 10.51–35.94). In girls, high WHtR was associated with age (OR 1.83; 95%CI 1.17–2.87), and in boys, with economic level (OR 2.34; 95%CI 1.01–5.45).

Conclusions:

One in each three adolescents has abdominal obesity. Among adolescents with high body fat, girls aged 15–16 and boys with high-income are the groups most exposed to abdominal obesity.

Socioeconomic inequalities in abdominal obesity among Peruvian adults

Objectives

Abdominal obesity (AO) has become a public health issue due to its impact on health, society and the economy. The relationship between socioeconomic disparities and the prevalence of AO has yet to be studied in Peru. Thus, our aim was to analyze the socioeconomic inequalities in AO distribution defined using the International Diabetes Federation (IDF) cut-off points in Peruvian adults in 2018–2019.

Methods

This was a cross-sectional study using data from the 2018–2019 Demographic and Family Health Survey (ENDES) of Peru. We analyzed a representative sample of 62,138 adults over 18 years of age of both sexes from urban and rural areas. Subjects were grouped into quintiles of the wealth to calculate a concentration curve and the Erreygers Concentration Index (ECI) in order to measure the inequality of AO distribution. Finally, we performed a decomposition analysis to evaluate the major determinants of inequalities.

Results

The prevalence of AO among Peruvian adults was 73.8%, being higher among women than men (85.1% and 61.1% respectively, p < 0.001). Socioeconomic inequality in AO was more prominent among men (ECI = 0.342, standard error (SE) = 0.0065 vs. ECI = 0.082, SE = 0.0043). The factors that contributed most to inequality in the prevalence of AO for both sexes were having the highest wealth index (men 37.2%, women 45.6%, p < 0.001), a higher education (men 34.4%, women 41.4%, p < 0.001) and living in an urban setting (men 22.0%, women 57.5%, p < 0.001).

Conclusions

In Peru the wealthy concentrate a greater percentage of AO. The inequality gap is greater among men, although AO is more prevalent among women. The variables that most contributed to inequality were the wealth index, educational level and area of residence. There is a need for effective individual and community interventions to reduce these inequalities.

Changes in the age-specific body mass index distribution among urban children between 2002 and 2018 in Changsha, China

BACKGROUND

It had been reported that the increase in the prevalence of childhood overweight and obesity in several developed countries over the decade was largely a consequence of changes in the upper end of the body mass index (BMI) distribution. We speculated that the change in BMI distribution among Chinese children is different from that in developed countries. Therefore, we investigated the changes in the BMI distribution among urban children in Changsha, China.

METHODS

A secondary data analysis of the 2002 and 2018 Annual Survey on Students' Constitution and Health from Yuhua District, Changsha City, China was performed. The BMI distribution of children aged 6-15 years (n=72,061) was examined by calculating the BMI value at 5th, 50th, 85th, and 95th percentiles. Differences in the BMI value at the 5th, 50th, 85th, and 95th percentiles between 2002 and 2018 according to age and sex were calculated.

RESULTS

From 2002 to 2018, the standardized rate of underweight decreased from 6.9% to 3.4%, whereas that of obesity increased from 6.1% to 13.8%. The BMI of the population increased over the 16-year period. The greatest change between the years was seen in the 85th percentile, and moderate changes were seen in the 5th and 50th BMI percentiles. Also, the greatest changes in the BMI percentiles were evident at age 12-14 years.

CONCLUSIONS

The whole spectrum of BMI distribution among school-aged children shifted over the 16-year study period, although the increases were more marked in the upper than lower percentiles. Health professionals and health policymakers should develop strategies and interventions aimed at preventing adverse health effects caused by this change.

Changes in distributions of waist circumference, waist-to-hip ratio and waist-to-height ratio over an 18-year period among Chinese adults: a longitudinal study using quantile regression

BACKGROUND

Little is known about the long-term shifts in distributions of three abdominal-obesity-related indicators, waist circumference (WC), waist-to-hip ratio (WHpR) and waist-to-height ratio (WHtR) among Chinese adults. Traditional mean regression models used in the previous analyses were limited in their ability to capture cross-distribution among effects. The current study aims to describe the shift in distribution of WC, WHpR, and WHtR over a period of 18 years (1993-2011) in China, and to reveal quantile-specific associations of the three indicators with key covariates.

METHODS

Longitudinal data from seven waves of the China Health and Nutrition Surveys (CHNS) in 1993, 1997, 2000, 2004, 2006, 2009 and 2011 were analyzed. The LMS method was used to illustrate the gender-specific quantile curves of WC, WHtR and WHpR over age. Separate gender-stratified longitudinal quantile regressions were employed to investigate the effect of important factors on the trends of the three indicators.

RESULTS

A total of 11,923 participants aged 18-65 years with 49,507 observations were included in the analysis. The density curves of WC, WHtR and WHpR shifted to right and became wider. The three outcomes all increased with age and increased more at upper percentiles. From the multivariate quantile regression, physical activity was negatively associated in both genders; smoking only had a negative effect on male indicators. Education and drinking behavior both had opposite effects on the three indicators between men and women. Marital status and income were positively associated with the shifts in WC, WHtR and WHpR in male and female WC, while urbanicity index had a positive effect on three outcomes in men but inconsistent effect among female outcomes.

CONCLUSIONS

The abdominal-obesity related indicators of the Chinese adults experienced rapid growth according to our population-based, age- and gender-specific analyses. Over the 18-year study period, major increases in WC, WHtR and WHpR were observed among Chinese adults. Specifically, these increases were greater at upper percentiles and in men. Age, physical activity, energy intake, drinking, smoking, education, income and urbanicity index were associated with elevated abdominal obesity indicators, and the effects differed among percentiles and between genders.

Acupuncture Regulating Gut Microbiota in Abdominal Obese Rats Induced by High-Fat Diet

Objective

To investigate the effects of acupuncture on metabolic health and gut microbiota dysbiosis in diet-induced abdominal obese model.

Materials and Methods

Male Sprague-Dawley rats were randomly distributed into normal chow diet (NCD) group and high-fat diet (HFD) group. After 12 weeks of HFD feeding, an abdominal obese rat model was established. The abdominal obese rats were further assigned to acupuncture group (n=7) and nontreated HFD group (n=7). Acupuncture was applied to bilateral GB 26 of rats for 8 weeks. Subsequently, the body weight, waist circumference (WC), visceral fat mass, and liver weight were measured weekly in all rats. Metabolic parameters such as total cholesterol, triglyceride, alanine aminotransferase, aspartate transaminase, and blood glucose were measured by an automatic biochemical analyzer. The serum levels of insulin (INS) were determined using Rat INS ELISA Kit. Analysis of gut microbiota was carried out by 16S rRNA gene sequencing.

Results

Acupuncture decreased the body weight, WC, and visceral adipose tissues of HFD-induced abdominal obese rats. In addition, insulin sensitivity, glucose homeostasis, and lipid metabolism were improved by this treatment. Furthermore, electroacupuncture effectively modified the composition of gut microbiota, mainly via decreasing Firmicutes/Bacteroidetes ratio and increasing Prevotella_9 abundance.

Conclusions

Electroacupuncture can ameliorate abdominal obesity and prevent metabolic disorders in HFD-induced abdominal obese rats, via the modulation of gut microbiota.

Association Between Different Indicators of Obesity and Depression in Adults in Qingdao, China: A Cross-Sectional Study

Background: This study was designed to investigate the perceived relationship between body weight and depression risk in a Chinese population in Qingdao, China. Methods: A population-based cross-sectional survey was performed with 4,573 participants (between 35 and 74 years) from the year 2009 to 2012 in Qingdao, China. We applied the Zung self-rating depression scale to ascertain the level of depression in participants. The associations between different indicators of obesity [body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR)] and depression were assessed by logistic regression based on the Chinese criteria of obesity. Sensitivity analysis was done based on the Asian and WHO criteria of obesity. Results: The Zung scores for the 243 participants (5.2%) were over 45 and they were entitled as depression. Furthermore, multivariable logistic analyses revealed that being overweight [odds ratios (OR): 1.48, 95% confidence intervals [95% CI]: 1.08-2.03] and having abdominal obesity (WC category in Chinese criteria) (OR: 1.47, 95% CI: 1.08-2.00) were often associated with a higher risk for depression compared to normal weight subjects. Sensitivity analysis revealed that abdominal obesity (Asian criterion) (OR: 1.41, 95% CI: 1.03-1.91) was a significant risk factor for depression. Similarly, being overweight (WHO criterion) (OR: 1.39, 95% CI: 1.03-1.87) was an obvious risk factor for depression. Conclusion: Being overweight and having abdominal obesity (WC category) were found to be linked with a higher risk of depression. However, abdominal obesity (WHR category) was not associated with depression.