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1.
Int Urol Nephrol ; 50(5): 845-850, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29611145

RESUMO

PURPOSE: To examine the association between CT measures of visceral obesity and short-term postoperative outcomes in renal clear cell carcinoma (RCCC) patients. METHODS: In this retrospective study, 76 patients treated with unilateral laparoscopic radical nephrectomy for stage I-III renal cancer were classified as obese or non-obese by preoperative CT-based measures of adiposity [obese: visceral fat area (VFA) > 100 cm2, BMI ≥ 28 kg/m2]. Clinical variables, Fuhrman grade, operation time, estimated blood loss (EBL), postoperative complications, postoperative stay, drainage time and hospitalization expenses were compared between the two groups. RESULTS: Viscerally obese patients significantly had higher Fuhrman grade than the non-obese (p = 0.018). The operation time of obese patients by VFA or BMI was more than the non-obese (171.6 ± 68.9 vs. 140.8 ± 35.5 min, p = 0.012 and 197.2 ± 67.2 vs. 153.2 ± 57.7 min, p = 0.013, respectively). And obese patients by VFA or BMI tended to have more EBL than non-obese (132.0 ± 120.7 vs. 83.8 ± 53.4 ml, p = 0.018 and 215.3 ± 165.0 vs. 92.5 ± 68.8 ml, p = 0.013, respectively). Viscerally obese patients by VFA (not BMI) were more likely to develop postoperative complications as compared to patients classified as non-obese: VFA (26.9 vs. 4.2%, p = 0.045) and BMI (33.3 vs. 16.4%, p =0.265). Furthermore, obese patients by VFA (not BMI) were more likely to have longer postoperative stay: VFA (8.7 ± 2.5 vs. 7.5 ± 1.4 dollars, p = 0.013) and BMI (9.1 ± 2.9 vs. 8.1 ± 2.1 dollars, p = 0.209). Obese patients expensed more than non-obese: VFA (7570.9 ± 2674.3 vs. 6368.8 ± 1289.8 dollars, p = 0.040) and BMI (8390.8 ± 2929.7 vs. 6896.3 ± 2159.1 dollars, p = 0.029). CONCLUSIONS: Elevated visceral obesity by VFA is associated with increased surgical complexity, postoperative morbidity, postoperative stay and hospitalization expenses for RCCC patients and may be superior to BMI for renal cancer outcome assessment. VFA may be a useful index for the evaluation and calculation of RCCC aggressiveness.


Assuntos
Carcinoma de Células Renais/cirurgia , Gordura Intra-Abdominal/diagnóstico por imagem , Neoplasias Renais/cirurgia , Nefrectomia/efeitos adversos , Obesidade Abdominal/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Adiposidade , Idoso , Perda Sanguínea Cirúrgica , Índice de Massa Corporal , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/economia , Carcinoma de Células Renais/patologia , Feminino , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/economia , Neoplasias Renais/patologia , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/complicações , Obesidade Abdominal/economia , Duração da Cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
2.
Dig Dis Sci ; 63(6): 1620-1630, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29549473

RESUMO

BACKGROUND: With the increased prevalence of obesity and sarcopenia, those patients with both visceral obesity and sarcopenia were at higher risk of adverse outcomes. AIM: The aim of this study was to ascertain the combined impact of visceral obesity and sarcopenia on short-term outcomes in patients undergoing colorectal cancer surgery. METHODS: We conducted a prospective study from July 2014 to February 2017. Patients' demographic, clinical characteristics, physical performance, and postoperative short-term outcomes were collected. Patients were classified into four groups according to the presence of sarcopenia or visceral obesity. Clinical variables were compared. Univariate and multivariate analyses evaluating the risk factors for postoperative complications were performed. RESULTS: A total of 376 patients were included; 50.8 and 24.5% of the patients were identified as having "visceral obesity" and "sarcopenia," respectively. Patients with sarcopenia and visceral obesity had the highest incidence of total, surgical, and medical complications. Patients with sarcopenia or/and visceral obesity all had longer hospital stays and higher hospitalization costs. Age ≥ 65 years, visceral obesity, and sarcopenia were independent risk factors for total complications. Rectal cancer and visceral obesity were independent risk factors for surgical complications. Age ≥ 65 years and sarcopenia were independent risk factors for medical complications. Laparoscopy-assisted operation was a protective factor for total and medical complications. CONCLUSION: Patients with both visceral obesity and sarcopenia had a higher complication rate after colorectal cancer surgery. Age ≥ 65 years, visceral obesity, and sarcopenia were independent risk factors for total complications. Laparoscopy-assisted operation was a protective factor.


Assuntos
Colectomia , Neoplasias Colorretais/cirurgia , Laparoscopia , Obesidade Abdominal/epidemiologia , Sarcopenia/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , China/epidemiologia , Colectomia/efeitos adversos , Colectomia/economia , Colectomia/métodos , Neoplasias Colorretais/economia , Neoplasias Colorretais/epidemiologia , Comorbidade , Feminino , Custos Hospitalares , Humanos , Incidência , Laparoscopia/efeitos adversos , Laparoscopia/economia , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Obesidade Abdominal/economia , Razão de Chances , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/epidemiologia , Prevalência , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Proteção , Fatores de Risco , Sarcopenia/economia , Fatores de Tempo , Resultado do Tratamento
3.
Clin Transplant ; 31(9)2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28678411

RESUMO

To evaluate the cost-effectiveness of a lifestyle modification program targeting long-term survivors of hematological malignancy treated with hemopoietic stem cell transplantation, a multistate life table Markov model was used to calculate health outcomes for both the intervention and no intervention. Cost per health-adjusted life year (HALY) saved was reported for four scenarios: all participants with/without standard weight regain, and participants who at baseline were overweight with/without standard weight regain. The program recruited 53 participants and was associated with reductions in body weight of 2.2 kg and BMI 0.8 units on intervention completion (12 months) at a cost of $1233/participant. These adipose reductions were sustained and remained significant at 24 months. The incremental cost-effectiveness ratios varied from $118 418 per HALY to dominant, depending on the weight regain assumption. The program may be cost-effective in transplant survivors, with the results most sensitive to the weight regain assumption and intervention cost.


Assuntos
Análise Custo-Benefício , Promoção da Saúde/economia , Transplante de Células-Tronco Hematopoéticas , Estilo de Vida , Obesidade Abdominal/terapia , Sobreviventes , Programas de Redução de Peso/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dieta , Exercício , Feminino , Seguimentos , Promoção da Saúde/métodos , Neoplasias Hematológicas/terapia , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Obesidade Abdominal/economia , Projetos Piloto , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Resultado do Tratamento , Vitória , Perda de Peso , Programas de Redução de Peso/métodos , Adulto Jovem
4.
J Epidemiol ; 27(8): 354-359, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28258883

RESUMO

BACKGROUND: The aim of this study was to examine the attribution of each cardiovascular risk factor in combination with abdominal obesity (AO) on Japanese health expenditures. METHODS: The health insurance claims of 43,469 National Health Insurance beneficiaries aged 40-75 years in Ibaraki, Japan, from the second cohort of the Ibaraki Prefectural Health Study were followed-up from 2009 through 2013. Multivariable health expenditure ratios (HERs) of diabetes mellitus (DM), high low-density lipoprotein cholesterol (LDL-C), low high-density lipoprotein cholesterol (HDL-C), and hypertension with and without AO were calculated with reference to no risk factors using a Tweedie regression model. RESULTS: Without AO, HERs were 1.58 for DM, 1.06 for high LDL-C, 1.27 for low HDL-C, and 1.31 for hypertension (all P < 0.05). With AO, HERs were 1.15 for AO, 1.42 for DM, 1.03 for high LDL-C, 1.11 for low HDL-C, and 1.26 for hypertension (all P < 0.05, except high LDL-C). Without AO, population attributable fractions (PAFs) were 2.8% for DM, 0.8% for high LDL-C, 0.7% for low HDL-C, and 6.5% for hypertension. With AO, PAFs were 1.0% for AO, 2.3% for DM, 0.4% for low HDL-C, and 5.0% for hypertension. CONCLUSIONS: Of the obesity-related cardiovascular risk factors, hypertension, independent of AO, appears to impose the greatest burden on Japanese health expenditures.


Assuntos
Doenças Cardiovasculares/economia , Efeitos Psicossociais da Doença , Gastos em Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/economia , Obesidade Abdominal/economia , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/epidemiologia , Fatores de Risco
5.
Int J Cardiol ; 227: 89-93, 2017 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-27855292

RESUMO

BACKGROUND: Childhood obesity has increased dramatically during the past decades, both in developing and developed countries. The present study examined the prevalence and regional disparities in general and central obesity among children and adolescents in Shandong, China. METHODS: A total of 30,459 students (15,249 boys and 15,210 girls) aged 7-18years participated in the study. Height, weight and waist circumference (WC) of all subjects were measured, body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. The BMI cutoff points recommended by the International Obesity Task Force (IOTF) were used to define general obesity. Central obesity was defined as WHtR≥0.5. Both BMI and WHtR were used to define three types of obesity as follows: general obesity only, central obesity only and combined obesity. RESULTS: The overall prevalences of general obesity only, central obesity only and combined obesity were 10.99, 8.47 and 8.70% for boys and 9.47, 5.12 and 3.19% for girls, respectively. The sum of the prevalence of the three types of obesity was 28.16% for boys and 17.78% for girls, boys had higher prevalence of obesity than girls (P<0.01). Substantial urban-rural and regional disparities exist in childhood obesity, children and adolescents from urban, coastal and high socioeconomic status (SES) districts showed a higher prevalence of obesity than their counterparts from rural, inland and low SES districts (P<0.01). CONCLUSION: The widespread prevalence of obesity in children and adolescents has become an important public health concern. Results from this study also suggested that the additional measurement of WC (WHtR) is better than BMI alone to identify obese individuals, distinguishing the types of obesity and examining the prevalence of various types of obesity is useful in practice.


Assuntos
Disparidades nos Níveis de Saúde , Obesidade Abdominal/diagnóstico , Obesidade Abdominal/epidemiologia , População Rural , Classe Social , População Urbana , Adolescente , Criança , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Obesidade/diagnóstico , Obesidade/economia , Obesidade/epidemiologia , Obesidade Abdominal/economia , Prevalência , População Urbana/tendências , Circunferência da Cintura/fisiologia
6.
PLoS One ; 11(2): e0148406, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26863443

RESUMO

BACKGROUND: Obesity is becoming a global problem, rather than one found only in developed countries. Although recent studies have suggested a detrimental effect of obesity on cognition, studies of the relationship between obesity and cognition among older adults have been limited to developed countries. We aimed to examine the associations between central obesity, as measured by waist circumference, and cognition level in adults aged 50 years and older in England and Indonesia. METHODS: We used linear regression models to analyse these associations and multiple imputation to manage missing data. The 2006 English Longitudinal Study of Ageing Wave 3 is the source of data from England, while data from Indonesia is sourced from the 2007 Indonesian Family Life Survey Wave 4. FINDINGS: Centrally obese respondents had lower cognition levels than non-centrally obese respondents in England. In contrast, central adiposity had a statistically significant positive association with cognition in Indonesia. Higher levels of education and higher economic status were associated with higher cognitive ability, while age was associated with lower cognition in both countries. Elevated C-reactive protein (CRP) concentrations and smoking behaviour, both linked to higher risk of obesity, were negatively associated with cognitive ability among older adults in England, but they had no statistically significant association with cognition among Indonesians. INTERPRETATION: The contradictory findings on obesity and cognition in England and Indonesia not only create a puzzle, but they may also have different policy implications in these countries. Reducing the prevalence of obesity may be the main focus in England and other developed countries to maintain older adults' cognition. However, Indonesia and other developing countries should place more emphasis on education, in addition to continued efforts to tackle the double burden of malnutrition, in order to prevent cognitive impairment among older adults.


Assuntos
Cognição , Desnutrição/epidemiologia , Obesidade Abdominal/epidemiologia , Classe Social , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/metabolismo , Inglaterra/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Indonésia/epidemiologia , Modelos Lineares , Estudos Longitudinais , Masculino , Desnutrição/economia , Desnutrição/fisiopatologia , Pessoa de Meia-Idade , Obesidade Abdominal/economia , Obesidade Abdominal/fisiopatologia , Prevalência , Fatores de Risco , Fumar/fisiopatologia , Circunferência da Cintura
7.
J Epidemiol Community Health ; 69(6): 580-7, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25691273

RESUMO

BACKGROUND: Low socioeconomic status (SES) has been associated with higher risk of cardiometabolic diseases in developed societies, but investigation of SES and cardiometabolic risk in children in less economically developed populations is sparse. We aimed to examine associations among SES and cardiometabolic risk factors in Colombian children. METHODS: We used data from a population-based study of 1282 children aged 6-10 years from Bucaramanga, Colombia. SES was classified according to household wealth, living conditions and access to public utilities. Anthropometric and biochemical parameters were measured at a clinic visit. Cardiometabolic risk factors were analysed continuously using linear regression and as binary outcomes-according to established paediatric cut points-using logistic regression to calculate OR and 95% CIs. RESULTS: Mean age of the children was 8.4 (SD 1.4) and 51.1% of the sample were boys. Odds of overweight/obesity, abdominal obesity and insulin resistance were greater among higher SES. Compared with the lowest SES stratum, children in the highest SES had higher odds of overweight/obesity (OR=3.25, 95% CI 1.89 to 5.57), abdominal obesity (OR=2.74, 95% CI 1.41 to 5.31) and insulin resistance (OR=2.60, 95% CI 1.81 to 3.71). In contrast, children in the highest SES had lower odds of hypertriglyceridaemia (triglycerides ≥90th centile; OR=0.28, 95% CI 0.14 to 0.54) and low (≤10th centile) high-density lipoprotein (HDL) cholesterol (OR=0.35, 95% CI 0.15 to 0.78). CONCLUSIONS: In Colombian children, SES is directly associated with obesity and insulin resistance, but inversely associated with dyslipidaemia (hypertriglyceridaemia and low HDL cholesterol). Our findings highlight the need to analyse cardiometabolic risk factors separately in children and to carefully consider a population's level of economic development when studying their social determinants of cardiometabolic disease.


Assuntos
Adiposidade , Doenças Cardiovasculares/epidemiologia , Dislipidemias/epidemiologia , Resistência à Insulina , Obesidade Pediátrica/epidemiologia , Classe Social , Determinantes Sociais da Saúde/economia , Análise de Variância , Doenças Cardiovasculares/economia , Criança , Estudos Transversais , Países em Desenvolvimento/economia , Países em Desenvolvimento/estatística & dados numéricos , Dislipidemias/economia , Feminino , Humanos , Entrevistas como Assunto , Modelos Lineares , Modelos Logísticos , Masculino , Obesidade Abdominal/economia , Obesidade Abdominal/epidemiologia , Obesidade Pediátrica/economia , Exame Físico , Fatores de Proteção , Fatores de Risco
8.
PLoS One ; 9(9): e106723, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25188373

RESUMO

BACKGROUND: The global pandemic of obesity has become a disastrous public health issue that needs urgent attention. Previous studies have concentrated in high-income urban settings and few cover low-income rural settings especially nomadic residents in mountain areas. This study focused on low-income rural and nomadic minority people residing in China's far west and investigated their prevalence and ethnic differences of obesity. METHODS: A questionnaire-based survey and physical examination of 8,036 individuals were conducted during 2009-2010, using stratified cluster random sampling method in nomadic Kazakhs and rural Uyghur residents (≥ 18 years old) in 18 villages, Xinjiang, China, about 4,407 km away from capital Beijing. Obesity was defined by BMI and WC. RESULTS: The overall prevalence of general and abdominal obesity in Kazakh adults were 18.3% and 60.0%, respectively and in Uyghur, 7.6% and 54.5%, respectively. Female's prevalence of obesity was higher than male's for general obesity (45-54 age group in Uyghur, P = 0.041) and abdominal obesity (≥ 55 years in Kazakhs, P(55 ∼) = 0.010, P(65 ∼) = 0.001; and ≥ 18 years in Uyghurs, P<0.001). Kazakh's prevalence of obesity was higher than Uyghur's (general obesity: ≥ 35 years, P<0.001; abdominal obesity: ≥ 25 years in males and ≥ 65 years in females, P<0.01). The prevalence of obesity increased after 18 years old and subsequently decreased after 55 years old. Meat consumption, older age, and female gender had a higher risk of obesity in these two minorities. CONCLUSIONS: Both general and abdominal obesity were common in rural ethnic Kazakhs and Uyghurs. The prevalence rates were different in these two minorities depending on ethnicity, gender, and age. Kazakhs, females and elderly people may be prioritized in prevention of obesity in western China. Because of cost-effectiveness in measuring BMI and WC, we recommend that BMI and WC be integrated into local preventive policies in public health toward screening obesity and related diseases in low-income rural minorities.


Assuntos
Grupos Étnicos , Obesidade Abdominal/etnologia , Obesidade Abdominal/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , China/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/economia , Obesidade Abdominal/fisiopatologia , Pobreza , Prevalência , Saúde Pública , População Rural , Distribuição por Sexo , Inquéritos e Questionários
10.
J Nutr ; 144(1): 87-97, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24198310

RESUMO

In North Africa, overnutrition has dramatically increased with the nutrition transition while micronutrient deficiencies persist, resulting in clustering of opposite types of malnutrition that can present a unique difficulty for public health interventions. We assessed the magnitude of the double burden of malnutrition among urban Moroccan and Tunisian women, as defined by the coexistence of overall or central adiposity and anemia or iron deficiency (ID), and explored the sociodemographic patterning of individual double burden. In cross-sectional surveys representative of the region around the capital city, we randomly selected 811 and 1689 nonpregnant women aged 20-49 y in Morocco and Tunisia, respectively. Four double burdens were analyzed: overweight (body mass index ≥25 kg/m(2)) or increased risk abdominal obesity (waist circumference ≥80 cm) and anemia (blood hemoglobin <120 g/L) or ID (C-reactive protein-corrected serum ferritin <15 µg/L). Adjusted associations with 9 sociodemographic factors were estimated by logistic regression. The prevalence of overweight and ID was 67.0% and 45.2% in Morocco, respectively, and 69.5% and 27.0% in Tunisia, respectively, illustrating the population-level double burden. The coexistence of overall or central adiposity with ID was found in 29.8% and 30.1% of women in Morocco, respectively, and in 18.2% and 18.3% of women in Tunisia, respectively, quite evenly distributed across age, economic, or education groups. Generally, the rare, associated sociodemographic factors varied across the 4 subject-level double burdens and the 2 countries and differed from those usually associated with adiposity, anemia, or ID. Any double burden combining adiposity and anemia or ID should therefore be taken into consideration in all women. This trial was registered at clinicaltrials.gov as NCT01844349.


Assuntos
Adiposidade , Anemia/epidemiologia , Efeitos Psicossociais da Doença , Desnutrição/epidemiologia , Obesidade Abdominal/epidemiologia , Sobrepeso/epidemiologia , Adulto , Anemia/complicações , Anemia/economia , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Análise por Conglomerados , Estudos Transversais , Feminino , Ferritinas/sangue , Hemoglobinas/metabolismo , Humanos , Ferro/sangue , Desnutrição/complicações , Desnutrição/economia , Pessoa de Meia-Idade , Marrocos/epidemiologia , Estado Nutricional , Obesidade Abdominal/complicações , Obesidade Abdominal/economia , Sobrepeso/complicações , Sobrepeso/economia , Prevalência , Fatores Socioeconômicos , Tunísia/epidemiologia , Adulto Jovem
11.
Plast Reconstr Surg ; 131(5): 681e-92e, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23629107

RESUMO

BACKGROUND: The authors' institution has seen an increase in obese and morbidly obese patients seeking autologous breast reconstruction. The authors provide a comprehensive outcome analysis of patients undergoing abdominally based autologous breast reconstruction. METHODS: The authors identified obese patients receiving free tissue transfer for breast reconstruction. World Health Organization body mass index criteria were used: nonobese (body mass index, 20 to 29.9 kg/m), class I (30 to 34.9 kg/m), class II (35 to 39.9 kg/m), and class III (>40 kg/m). Patient comorbidities, body mass index, complications (medical and surgical), and hospital resource use were examined. RESULTS: Eight-hundred twelve patients undergoing 1258 free tissue transfers for breast reconstruction were included. Overall, 66.5 percent (n = 540) were considered nonobese, 22.9 percent (n = 186) had class I obesity, 5.0 percent (n = 41) had class II, and 5.7 percent (n = 45) had class III. Obesity was associated with a significant increase in minor (p = 0.001) and major (p = 0.013) complications. Morbidly obese patients had significantly higher rates of total flap loss (p = 0.006) and longer operative times (p = 0.0002). Complications translated into greater cost and resource consumption (p < 0.001). Muscle-sparing transverse rectus abdominis myocutaneous flap experienced a significantly higher rate of hernia compared with other flaps (p = 0.02), without a difference in flap loss rate (p = 0.61). CONCLUSIONS: Increasing obesity is associated with increased perioperative risk in free abdominally based autologous breast reconstruction, which translated into greater perioperative morbidity, higher hospital cost, and increased health care resource consumption. Higher body mass index is directly related to intraoperative technical difficulty, flap loss, donor-site morbidity, and cost use. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Retalhos de Tecido Biológico/patologia , Complicações Intraoperatórias/epidemiologia , Mamoplastia/métodos , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/epidemiologia , Gordura Abdominal/patologia , Gordura Abdominal/cirurgia , Músculos Abdominais/cirurgia , Adulto , Comorbidade , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Retalhos de Tecido Biológico/economia , Custos Hospitalares/estatística & dados numéricos , Humanos , Modelos Logísticos , Estudos Longitudinais , Mamoplastia/economia , Microcirurgia/economia , Microcirurgia/métodos , Pessoa de Meia-Idade , Análise Multivariada , Obesidade Abdominal/economia , Obesidade Abdominal/epidemiologia , Obesidade Abdominal/cirurgia , Obesidade Mórbida/economia , Obesidade Mórbida/epidemiologia , Fatores de Risco
12.
Eur J Prev Cardiol ; 20(2): 368-75, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22345688

RESUMO

BACKGROUND: This study aimed to estimate the prevalence of cardiovascular risk factors and its clustering. The findings are to help shape the Malaysian future healthcare planning for cardiovascular disease prevention and management. METHODS: Data from a nationally representative cross-sectional survey was used. The survey was conducted via a face-to-face interview using a standardised questionnaire. A total of 37,906 eligible participants aged 18 years and older was identified, of whom 34,505 (91%) participated. Focus was on hypertension, hyperglycaemia (diabetes and impaired fasting glucose), hypercholesterolaemia and central obesity. RESULTS: Overall, 63% (95% confidence limits 62, 65%) of the participants had at least one cardiovascular risk factor, 33% (32, 35%) had two or more and 14% (12, 15%) had three risk factors or more. The prevalence of hypertension, hyperglycaemia, hypercholesterolaemia and central obesity were 38%, 15%, 24% and 37%, respectively. Women were more likely to have a higher number of cardiovascular risk factors for most age groups; adjusted odds ratios ranging from 1.1 (0.91, 1.32) to 1.26 (1.12, 1.43) for the presence of one risk factor and 1.07 (0.91, 1.32) to 2.00 (1.78, 2.25) for two or more risk factors. CONCLUSIONS: Cardiovascular risk-factor clustering provides a clear impression of the true burden of cardiovascular disease risk in the population. Women displayed higher prevalence and a younger age shift in clustering was seen. These findings signal the presence of a cardiovascular epidemic in an upcoming middle-income country and provide evidence that drastic measures have to be taken to safeguard the health of the nation.


Assuntos
Doenças Cardiovasculares/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Renda/estatística & dados numéricos , Fatores Etários , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/prevenção & controle , Distribuição de Qui-Quadrado , Análise por Conglomerados , Estudos Transversais , Países em Desenvolvimento/economia , Feminino , Inquéritos Epidemiológicos , Humanos , Hipercolesterolemia/economia , Hipercolesterolemia/epidemiologia , Hiperglicemia/economia , Hiperglicemia/epidemiologia , Hipertensão/economia , Hipertensão/epidemiologia , Modelos Logísticos , Malásia/epidemiologia , Masculino , Análise Multivariada , Obesidade Abdominal/economia , Obesidade Abdominal/epidemiologia , Razão de Chances , Prevalência , Características de Residência/estatística & dados numéricos , Medição de Risco , Fatores de Risco , Saúde da População Rural/estatística & dados numéricos , Fatores Sexuais , Inquéritos e Questionários , Saúde da População Urbana/estatística & dados numéricos
13.
Maturitas ; 69(3): 220-9, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21592692

RESUMO

This review aims to provide an update on economic costs of obesity in Europe with a focus on costs in subgroups defined by relevant third variables such as sex, age, socio-economic status, and morbidity factors. A structured search using MeSH-vocabulary and Title/Abstract-searches was conducted in PubMed for 2007 to 2010. All cost categories except intangible costs were considered. N = 19 primary cost of illness studies on adults from Europe which had included at least one cost category as an outcome were identified. Nine studies reported costs in specific subgroups. Two studies (both from Germany) took a societal perspective, with total (direct and indirect) costs of obesity accounting for 0.47-0.61% of gross domestic product. Excess per-capita direct costs ranged from € 117 to € 1873, depending on cost categories and comparison group (normal weight, non-obese). One study estimated lower lifetime health care costs given obesity. Regarding subgroups, higher costs of obesity were generally found in men, groups with higher socio-economic status (regarding costs of severe obesity), and groups with co-existing abdominal obesity, diabetes (especially type 1), elevated HbA1c (among patients with type 2 diabetes), and physical co-morbidities given BMI ≥ 27 (compared to a "BMI ≥ 30 only"-group). In conclusion, while substantial obesity costs were found in most studies, subgroup analyses and lifetime perspectives call for a differentiated approach to the costs of obesity. Findings such as the higher health care costs in severely obese groups with higher socio-economic status (despite fewer co-morbidities), and lower lifetime long-term care costs in obese groups (due to reduced life expectancy), may generate hypotheses both on under- vs. overuse of services, and target groups for interventions.


Assuntos
Diabetes Mellitus/economia , Custos de Cuidados de Saúde , Obesidade/economia , Adulto , Fatores Etários , Índice de Massa Corporal , Comorbidade , Complicações do Diabetes/economia , Europa (Continente) , Feminino , Hemoglobina A Glicada/metabolismo , Produto Interno Bruto , Humanos , Masculino , Obesidade/complicações , Obesidade Abdominal/economia , Classe Social
14.
Prev Med ; 51(6): 460-5, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20955726

RESUMO

OBJECTIVE: To examine national trends in prevalence and socioeconomic inequalities in both general (measured by body mass index) and abdominal obesity (measured by waist circumference) by gender and socioeconomic position (SEP) indicators. METHODS: Data were from four rounds of nationally representative cross-sectional surveys for Korean men and women aged 25-64 (6,286 in 1998, 4,839 in 2001, 4,181 in 2005, and 2,006 in 2007). We calculated age-adjusted prevalence rates of overweight and abdominal obesity by gender and SEP indicators (education, occupational class, employment status and income) and examined trends of prevalence and its inequalities. RESULTS: Overweight and abdominal obesity has significantly increased in Korean men (P for linear trend <0.01), not in women. For men, high SEP was associated with overweight and abdominal obesity, but the magnitude of socioeconomic differences in obesity measures generally remained unchanged during the study period. Among women, low SEP was associated with overweight. Interestingly, increasing inequalities in abdominal obesity according to education and income were found in women. CONCLUSIONS: Clear gender differences were noted in (1) time trends of overweight and abdominal obesity, (2) relationships between the obesity measures and various SEP indicators, and (3) linear time trends of socioeconomic differentials in obesity.


Assuntos
Obesidade Abdominal/epidemiologia , Sobrepeso/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/economia , Sobrepeso/economia , Prevalência , República da Coreia/epidemiologia , Fatores Sexuais , Fatores Socioeconômicos , Circunferência da Cintura
15.
Int J Obes (Lond) ; 34(4): 751-9, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20065964

RESUMO

OBJECTIVES: To test the hypothesis that lower birth order amplifies the positive association between socioeconomic status and central adiposity in young adult males from a lower income, developing country context. DESIGN: The Cebu Longitudinal Health and Nutrition Survey is an ongoing community-based, observational study of a 1-year birth cohort (1983). SUBJECTS: 970 young adult males, mean age 21.5 years (2005). MEASUREMENTS: Central adiposity measured by waist circumference; birth order; perinatal maternal characteristics including height, arm fat area, age and smoking behavior; socioeconomic status at birth and in young adulthood. RESULTS: Lower birth order was associated with higher waist circumference and increased odds of high waist circumference, even after adjustment for socioeconomic status in young adulthood and maternal characteristics that could impact later offspring adiposity. Furthermore, the positive association between socioeconomic status and central adiposity was amplified in individuals characterized by lower birth order. CONCLUSIONS: This research has failed to reject the mismatch hypothesis, which posits that maternal constraint of fetal growth acts to program developing physiology in a manner that increases susceptibility to the obesogenic effects of modern environments.


Assuntos
Ordem de Nascimento , Peso ao Nascer/fisiologia , Obesidade Abdominal/economia , Classe Social , Índice de Massa Corporal , Feminino , Humanos , Estudos Longitudinais , Masculino , Inquéritos Nutricionais , Obesidade Abdominal/epidemiologia , Obesidade Abdominal/etiologia , Filipinas/epidemiologia , Gravidez , Adulto Jovem
16.
Public Health Nutr ; 12(11): 2225-35, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19656435

RESUMO

OBJECTIVE: Obesity is an increasingly prevalent nutritional disorder throughout the world. In particular, abdominal obesity is associated with cardiovascular and metabolic risk. The present study aimed to evaluate the effects of skin colour and life-course socio-economic indicators on waist circumference (WC), hip circumference (HC) and waist:hip ratio (WHR) in young adults. DESIGN: Population-based birth cohort study. Individuals born in 1982 in Pelotas (southern Brazil) were visited on a number of occasions from birth to age 23-24 years. A sample of the cohort was sought in 2006 and 972 individuals were located. The analysis was restricted to individuals with complete data available (442 males, 414 females). RESULTS: In men, family income at birth and in 2004-5 were positively associated with WC and HC, but not with WHR. Regardless of current income, men born to wealthier families had larger WC and HC as adults. Skin colour was not associated with any of the outcomes. In women, early poverty was associated with smaller HC, and current poverty with larger WC. Poverty at any age thus led to higher WHR. Black women had larger WC and HC than white women, but there were no differences in WHR. All the associations were partially mediated by education and behavioural variables. CONCLUSIONS: The effects of early socio-economic position on WC and HC persist even after adjustment for adult socio-economic position, highlighting the importance of interventions during the first years of life.


Assuntos
Grupos de Populações Continentais , Renda , Obesidade Abdominal/economia , Obesidade Abdominal/etnologia , Circunferência da Cintura , Relação Cintura-Quadril , Adulto , Brasil/epidemiologia , Feminino , Quadril , Humanos , Masculino , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Circunferência da Cintura/etnologia , Adulto Jovem
17.
Obes Facts ; 1(3): 146-54, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-20054174

RESUMO

BACKGROUND: To examine the relationship between waist circumference and future health care costs across a broad range of waist circumference values based on individual level data. METHOD: A prospective cohort of 31,840 subjects aged 50-64 years at baseline had health status, lifestyle and socio-economic aspects assessed at entry. Individual data on health care consumption and associated costs were extracted from registers for the subsequent 7 years. Participants were stratified by presence of chronic disease at entry. RESULTS: Increased waist circumference at baseline was associated with higher future health care costs. For increased and substantially increased waist circumference health care costs rise at a rate of 1.25% in women and 2.08% in men, per added centimetre above normal waistline. Thus, as an example, a woman with a waistline of 95 cm and without co-morbidities can be expected to incur an added future cost of approximately USD 397.- per annum compared to a woman in the normal waist circumference group, corresponding to 22% higher health care costs. CONCLUSIONS: Future health care costs are higher for persons who have an increased waist circumference, which suggests that there may be a potential for significant resource savings through prevention of abdominal obesity.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Obesidade Abdominal/economia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Dinamarca/epidemiologia , Complicações do Diabetes/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/complicações , Obesidade Abdominal/epidemiologia , Estudos Prospectivos , Fatores Sexuais , Circunferência da Cintura
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