Increases in waist circumference independent of weight in Mongolia over the last decade: the Mongolian STEPS surveys

Trends in bio-behavioural risk factors of non-communicable diseases among adults in Sao Tome and Principe

Background

Understanding national trends in risk factors of noncommunicable diseases (NCDs) may have health policy implications. The aim of the study was to assess the prevalence and social and demographic factors associated with risk factors of NCDs in adults from 2008 to 2019 in Sao Tome and Principe.

Methods

In repeat cross-sectional national STEPS surveys 2,457 adults (median age 37 years) in 2008 and 1,893 adults (median age 38 years) in 2019 in Sao Tome and Principe responded to structured interviews, physical and biochemical measures. Logistic regressions were applied to estimate predictors of NCD risk factors.

Results

Having three to seven NCD risk factors significantly decreased among men but not women from 36.6% in 2008 to 26.8% in 2019. The proportion of specific risk factors of NCD increased significantly for low physical activity from 17.4% in 2008 to 30.9% in 2019, and overweight/obesity from 37.3% in 2008 to 51.0% in 2019. Insufficient fruit/vegetable consumption decreased from 83.1% in 2008 to 53.3% in 2019, frequent alcohol use from 32.6% in 2008 to 24.8% in 2019, and diabetes from 3.1% in 2008 to 1.2% in 2019, while the proportion of current tobacco use and hypertension remained unchanged from 2008 to 2019. Men engaged more often than women in current tobacco use and frequent alcohol use, and women had higher rates of low physical activity and overweight/obesity than men. Higher educational levels were positively associated with overweight/obesity, and inversely associated with frequent alcohol use and inadequate fruit/vegetable intake.

Conclusion

Between 2008 and 2019, the prevalence of seven risk factors for NCDs in Sao Tome and Principe declined among men, but not among women. Several associated variables have been identified for each individual risk factor of NCD that may help guide interventions.

Behavioural and biological risk factors of non-communicable diseases among adults in Cabo Verde: a repeated cross-sectional study of the 2007 and 2020 national community-based surveys

OBJECTIVE

The aim of the study is to estimate trends in the prevalence and associated factors of non-communicable disease (NCD) risk factors in adults from 2007 to 2020 in Cabo Verde.

DESIGN

Population-based cross-sectional study.

SETTING

Nationally representative samples of adult population in Cabo Verde from the 2007 and 2020 STEPwise approach to NCD risk factor surveillance (STEPS) surveys.

PARTICIPANTS

The sample included 1760 adults in 2007 and 3721 in 2020.

OUTCOME MEASURES

Included fruit/vegetable consumption, low physical activity, sedentary behaviour, current tobacco use, hazardous alcohol use, diabetes, total elevated cholesterol, hypertension and overweight/obesity. Logistic regressions adjusted for sociodemographic factors were applied to estimate predictors of each of the nine NCD risk factors.

RESULTS

Compared with participants in the study year 2007, participants in the study year 2020 had a significantly higher prevalence of low physical activity (adjusted OR (AOR): 2.21, 95% CI: 1.15 to 4.25) and overweight/obesity (AOR: 1.68, 95% CI: 1.26 to 2.23) and significantly lower rate of hypertension (AOR: 0.77, 95% CI: 0.64 to 0.93). Low physical activity (AOR: 1.61, 95% CI: 1.23 to 2.10), overweight/obesity (AOR: 2.59, 95% CI: 2.10 to 3.20), current tobacco use (AOR: 1.94, 95% CI: 1.36 to 2.75), hypertension (AOR: 5.45, 95% CI: 4.24 to 7.00), diabetes (AOR: 8.40, 95% CI: 4.65 to 15.18) and elevated total cholesterol (AOR: 4.58, 95% CI: 2.83 to 7.39) were more common among the 50-64-year-olds. Being male increased the odds of current tobacco use (AOR: 3.64, 95% CI: 2.75 to 4.81) and hazardous alcohol use (AOR: 4.79, 95% CI: 3.15 to 7.27), and decreased the odds of low physical activity (AOR: 0.48, 95% CI: 0.39 to 0.58) and overweight/obesity (AOR: 0.47, 95% CI: 0.40 to 0.56).

CONCLUSIONS

Of the nine NCD risk factors evaluated from 2007 to 2020 in Cabo Verde, two increased (overweight/obesity and low physical activity) and one decreased (hypertension). Several associated variables were identified for each individual NCD risk factor that can help in guiding interventions.

Trends in behavioral and biological risk factors for non-communicable diseases among adults in Bhutan: results from cross-sectional surveys in 2007, 2014, and 2019

Background

The study aimed to evaluate trends in the prevalence and correlates of risk factors for non-communicable diseases (NCDs; low physical activity, insufficient fruit/vegetable intake, current tobacco use, problem alcohol use, diabetes, hypertension, increased total cholesterol, and obesity) in Bhutan.

Methods

Three repeat cross-sectional Bhutan STEPS surveys (N = 9,281) in 2007, 2014, and 2019 were analyzed.

Results

The proportion of people with 3-8 NCD risk factors significantly decreased from 62.8% in 2007 to 32.6% in 2019 (p < 0.001), and the mean number of NCD risk factors significantly decreased from 3.0 in 2007 to 2.1 in 2019 (p < 0.001). In linear regression analyses by study year, older age (p < 0.001) was positively associated with eight NCD risk factors across all study years. Furthermore, male subjects were negatively (p < 0.01) and positively (p < 0.001) associated with eight NCD risk factors, respectively. Higher education levels (p < 0.05) were positively associated with eight NCD risk factors in 2007 and negatively associated with eight NCD risk factors in 2019 (p < 0.05). Employment (p < 0.001) and urban residence (p < 0.001) were positively associated with eight risk factors for NCD in 2019, while urban residence (p < 0.001) was negatively associated with eight NCD risk factors in 2014.

Conclusion

The prevalence of eight NCD risk factors decreased in Bhutan over the past 13 years. Inadequate fruit and vegetable intake, problem alcohol use, and hypertension increased, current tobacco use, low physical activity, obesity, diabetes, and elevated total cholesterol decreased from 2007 to 2019. Several factors associated for eight and each individual NCD risk factor were identified, which can help guide interventions.

Trends in Behavioral and Biological Non-Communicable Diseases Risk Factors among Adults in Mongolia: Results from National Cross-Sectional Surveys in 2005, 2009, 2013 and 2019

Background

Understanding national trends in noncommunicable disease (NCD) risk factors may have health policy implications. We aimed to evaluate trends in the prevalence and correlates of eight risk factors for NCD from 2005 to 2019 in Mongolia.

Methods

Cross-sectional data were analyzed from 9,356 individuals (15-64/69 yr, mean age=37.3 yr) who participated in the Mongolia STEPS 2005, 2009, 2013 or 2019 surveys and had complete measurement of the risk factor for NCD.

Results

The proportion of having 3-8 NCD risk factors significantly decreased from 59.1% in 2005 to 49.4% in 2019, and the mean number of NCD risk factors significantly decreased from 2.8 in 2005 to 2.6 in 2019. In linear regression analyses by study year, older age and male sex were across all study years positively associated with eight NCD risk factors. The prevalence of low physical activity increased from 8.2% in 2005 to 28.4% in 2019, overweight/obesity from 49.6% in 2005 to 64.0% in 2019, and raised total cholesterol from 23.9% in 2005 to 27.6% in 2019, there was a significant decrease in inadequate fruit and vegetable intake from 85.1% in 2005 to 79.5% in 2019, current smoking from 26.6% in 2005 to 24.1% in 2019, hypertension from 28.2% in 2005 to 23.2% in 2019, while the prevalence of diabetes remained unchanged from 2005 to 2019.

Conclusion

The prevalence of eight risk factors for NCD decreased in the last 15 years in Mongolia. Several associated variables for eight and individual NCD risk factors were identified that can help guide interventions.

National trends in prevalence, awareness, treatment, and control of hypertension among adults in Mongolia from 4 cross-sectional surveys in 2005, 2009, 2013, and 2019

This study aimed to analyze trends in the prevalence, awareness, treatment, and control of hypertension and associated factors in persons 15 years and older from 2005 to 2019 in Mongolia. National data were analyzed from 21,342 people (≥15 years) who participated in 4 cross-sectional STEPwise Approach to NCD Risk Factor Surveillance surveys in Mongolia (2005, 2009, 2013, or 2019) and had complete blood pressure measurements. The prevalence, awareness, treatment, and control of hypertension were calculated using sociodemographic factors within each study year. Logistic regression was employed to assess the associations between sociodemographic and health factors and status of hypertension, awareness, treatment, and control by study year and pooled sample. Trend analyzes showed that the prevalence of hypertension decreased significantly from 28.4% in 2005 to 23.2% in 2019 (P < .001). The prevalence of awareness among hypertensives remained unchanged, the treatment among aware decreased, and the control rate increased. In adjusted logistic regression analysis with the pooled sample, male sex (adjusted odds ratio [AOR]: 1.49, 95% confidence intervals [CI]: 1.32-1.68), older age (≥45 years) (AOR: 5.90, 95% CI: 4.90-7.10), obesity (AOR: 4.29, 95% CI: 3.77-4.88), more frequent alcohol use (≥1-2 days/week) (AOR: 1.69, 95% CI: 1.39-2.05) were positively, and higher educational level (≥12 years) (AOR: 0.77, 95% CI: 0.68-0.87) and urban residence (AOR: 0.84, 95% CI: 0.74-0.97) were negatively associated with hypertension prevalence. The prevalence of hypertension among Mongolian adults has decreased in recent years. Levels of hypertension awareness were unchanged, treatment decreased, and control increased. Increased health promotion, detection, and treatment of hypertension in Mongolia are indicated.

Prevalence of general and abdominal obesity in 2015-2016 and 8-year longitudinal weight and waist circumference changes in adults and elderly: the Tromsø Study

OBJECTIVES

To describe the prevalence of general (body mass index (BMI) ≥30 kg/m²) and abdominal (waist circumference women >88 cm, men >102 cm) obesity in Tromsø 7 (2015-2016), and the secular change from Tromsø 6 (2007-2008). Furthermore, to study longitudinal changes in body weight and waist circumference from Tromsø 6 to Tromsø 7.

SETTING

A population study in Tromsø, Norway.

PARTICIPANTS

The cross-sectional analyses included 20 855 participants in Tromsø 7 (aged ≥40 years) and 12 868 in Tromsø 6 (aged ≥30 years). The longitudinal analyses included 8592 participants with repeated measurements, aged 35-79 in Tromsø 6.

OUTCOME MEASURES

Mean age-specific and sex-specific BMI, waist circumference, prevalence of general and abdominal overweight and obesity, as well as longitudinal changes in body weight and waist circumference according to sex and birth cohort.

RESULTS

Over 8 years, the age-adjusted prevalence of general obesity increased (p<0.0001) from 20.1% to 23.0% in women and from 20.7% to 25.2% in men. The age-adjusted prevalence of abdominal obesity did not increase in women (from 54.7% to 53.4%), and the increase in men was modest (from 36.8% to 38.6%, p=0.003). Longitudinal analyses showed an increase in body weight, by 1.1 kg (95% CI 0.9 to 1.2) in women and 0.7 kg (95% CI 0.6 to 0.9) in men, and also waist circumference, by 1.3 cm (95% CI 1.0 to 1.5) in women and 1.4 cm (95% CI 1.2 to 1.6) in men. There were inverse relationships (p<0.001) between age at baseline and change in weight and waist circumference.

CONCLUSIONS

Repeated cross-sectional analyses showed that the prevalence of general obesity increased, whereas the increase in abdominal obesity was less marked. Longitudinal analyses showed increases in both body weight and waist circumference. The youngest age groups have the largest increase.

A descriptive study of ten-year longitudinal changes in weight and waist circumference in the multi-ethnic rural Northern Norway. The SAMINOR Study, 2003-2014

The obesity epidemic is dynamic with varying secular trends and differences between countries and ethnic groups. The objective of this study was to describe the age- and sex-specific longitudinal changes in weight and waist circumference in a rural Norwegian population with a high proportion of the indigenous Sami population. Based on two population-based surveys, SAMINOR 1 (2003-2004) and SAMINOR 2 (2012-2014), we present longitudinal changes in weight and waist circumference according to age at baseline in the SAMINOR 1 Survey and sex during the 10-year period. The analyses included 1538 men and 1958 women aged 36 to 69 at baseline (birth year 1934 to 1967). Forty-one percent of the population were Sami. Both weight and waist circumference were measured. The mean weight increased 0.8 kg (95% confidence interval: 0.5, 1.1) in men and 0.3 kg (95% confidence interval: 0, 0.5) in women. In both men and women, younger individuals gained significantly more weight during the 10-year follow-up than older participants (p < 0.001). The mean weight showed a statistically significant increase in men aged 36-54 and women aged 36-49 at baseline and was statistically significantly reduced in men and women aged 60-69. The mean waist circumference increased by 6.3 cm (95% confidence interval: 6.0, 6.6) in men and 8.4 cm (95% confidence interval 8.1, 8.8) in women. The mean waist circumference increased statistically significantly from SAMINOR 1 to SAMINOR 2 in all age groups, and there was an inverse relationship between age at baseline and change in waist circumference (p < 0.001). Waist circumference increased more than can be explained by changes in weight and age during the 10-year period. The inverse relationships between age at baseline in SAMINOR 1 and the 10-year change in weight and waist circumference were found in both Sami and non-Sami participants. The findings underline the need for prevention of obesity, particularly in younger people, as it is difficult to achieve permanent weight loss.

Changes in the configuration and patterns of physical activity among Mongolian adults, 2005-2013

Objective: This study examined the change in physical activity status and patterns and their associations with urban and rural residence and employment status in Mongolia.

Methods: We analyzed data from 7,738 adults aged from 20 to 64 years (n = 2,877 and 4,861 for 2005 and 2013, respectively) from the Mongolian STEPS Survey on the Prevalence of Non-Communicable Disease Risk Factors (NCD-STEPS survey). Physical activity in three domains, including work (occupational and household work); transport (walk or cycling); and leisure (sport or fitness) was measured by Global Physical Activity Questionnaire (GPAQ). Physical activity levels were classified into three groups: low, moderate, and high according to the GPAQ analysis framework. The associations between physical activity time, residential area, and employment status were examined using a multivariate negative binomial regression model.

Results: The percentage of respondents with low-level physical activity increased from 10.9% in 2005 to 27.2% in 2013. The median minutes of physical activity time per week were 1,020 in 2005 and 600 in 2013. Physical activity time at work, transport and overall decreased in 2013. Work-related physical activity was the most dominant component of physical activity time (55.6% in 2005 and 54.6% in 2013), the transport domain was the second-highest contributor of physical activity time in 2005 (24.0%) and was replaced by the leisure domain (26.8%) in 2013. Rural residents practiced more physical activity at work, transport, and leisure than urban residents did in 2005 (prevalence ratio [PR]: 1.33, 95% confidence interval [CI]: 1.20–1.47; PR: 1.21, 95%CI: 1.14–1.29; and PR: 1.21, 95%CI: 1.13–1.30, respectively), but there was no significant difference by residential area in 2013. Mongolian adults with higher educational attainment, employee status, and non-employment status were less likely to engage in physical activity compared to those among adults with lower educational attainment and self-employed status.

Antihypertensive treatment and blood pressure trends among South African adults: A repeated cross-sectional analysis of a population panel survey

BACKGROUND

Recent findings suggest a decline in mean blood pressure and prevalence of uncontrolled hypertension in the South African adult population in the last decade, in contrast with the increase previously observed. This study aimed at quantifying the contribution of antihypertensive treatment to this decline.

METHODS

We used data from the four waves of the National Income Dynamics Study between 2008 and 2015 and analysed changes in systolic (SBP) and diastolic blood pressure (DBP) and prevalence of uncontrolled hypertension among South African adults (15 years and above). We compared the observed changes with a counterfactual scenario in which the impact of antihypertensive treatment was estimated by censored regression and removed, with and without adjustment for BMI, waist circumference, alcohol use and smoking.

RESULTS

During the study period, the prevalence of antihypertensive treatment rose from 13.1% to 17.6% among women and from 5.3% to 8.2% among men. Concurrently-despite worsening trends in major biobehavioural risk factors for elevated blood pressure-mean SBP decreased in both genders, DBP decreased among women and was stable among men. The odds of uncontrolled hypertension decreased by 4%/year among women and 1%/year among men. After removing the treatment effect, the downward trend in the odds of uncontrolled hypertension was reduced to 1%/year among women and completely offset among men. Among those 55 years and older, but not among younger subjects, treatment effects also explained most of the observed decreases in mean SBP and DBP.

CONCLUSIONS

Among South African adults, we infer that diffusion of antihypertensive treatment contributed substantially to the downward trend in the prevalence of uncontrolled hypertension observed between 2008 and 2015. The marked decrease in SBP and uncontrolled hypertension found among younger participants could not be explained by treatment nor by the changing distribution of the measured risk factors available in this study, and requires further investigation.

Changes in waist circumference independent of weight: Implications for population level monitoring of obesity

Population monitoring of obesity is most commonly conducted using body mass index (BMI). We test the hypothesis that because of increases in waist circumference (WC) independent of increases in weight, BMI alone detects an increasingly smaller proportion of the population with obesity.

METHODS

Australian adults with measured height, weight, and WC were selected from three nationally representative cross-sectional surveys (1989, 1999-2000, 2011-12; n=8313, 5903 & 3904). Participants were defined as having obesity using classifications for an obese BMI (≥30kg·m^-2) and substantially-increased-risk WC (≥88cm [women], ≥102cm [men]). Age-standardised prevalence of obesity according to BMI and/or WC, and the proportion of these detected by BMI and by WC were compared across surveys.

FINDINGS

Between 1989 and 2011-12, weight and WC increased by 5.4kg and 10.7cm (women), and by 7.0kg and 7.3cm (men). For women and men, 63% and 38% of increases in WC were independent of increases in weight. Over this period, the prevalence of obesity according to BMI and/or WC increased by 25.3 percentage-points for women (18.9% to 44.3%) and 21.1 percentage-points for men (17.1% to 38.2%). The proportion of these detected by BMI decreased for women by 20 percentage-points (77% to 57%) with no change for men. The proportion of these detected by WC increased for women and men by 10 percentage-points (87% to 97%) and 6 percentage-points (85% to 91%) respectively.

CONCLUSION

BMI alone is detecting a decreasing proportion of those considered obese by BMI and/or WC. Renewed discussion regarding how we monitor obesity at the population level is required.

Association of divalent cations and insulin resistance with thyroid hormones in patients with type 2 diabetes mellitus

AIM

The study was primarily aimed at investigating the association of Magnesium and Zinc levels in the serum of adult Non- obese and Obese type 2 diabetic patients, with particular reference to thyroid comorbidity.

METHODS

108 patients with T2DM of both genders (24 Non obese and 84 Obese) were enrolled from a tertiary health care unit in Puducherry. The cardio-metabolic risk factors were assessed through body mass index, Waist hip ratio, blood pressure, fasting blood glucose, lipid profile and glycated haemoglobin. Zinc and Magnesium were quantitated. Insulin resistance was by Homeostasis model assessment. Serum free T4, T3 and TSH were also measured.

RESULTS

In non-obese type 2 diabetic group, Glycated haemoglobin had a strong positive correlation with free T4(r=0.784; p=0.003).TSH also depicted a positive association with HOMA-IR (r=0.924; p<0.001); whereas,T3 and Insulin had negative correlation with Magnesium (r=-0.599* and r=-0.620*; p 0.04 and 0.031). The levels of Zinc and Magnesium in the serum of obese diabetic patients had a positive correlation among them (r=0.565#; p<0.001). TAG/HDL ratio a measure of small dense LDL is positively correlated with LDL in both groups (r=0.881 and 0.912) with p value<0.001 for both.

CONCLUSION

Correlation among Glycemic control, Insulin resistance, Thyroid hormones, divalent cations and dyslipidemia depict differential characteristics in obese and non-obese type2 diabetes with Thyroid comorbidity.