期刊论文详细信息
BMC Public Health
Diet, physical activity and socio-economic disparities of obesity in Lebanese adults: findings from a national study
Nahla Hwalla4  Abla Mehio Sibai1  Hani Tamim3  Carolyn Summerbell2  Helen J Moore2  Marie Claire Chamieh4 
[1] Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Riad El-Solh, Beirut 1107-2020, Lebanon;School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK;Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon;Department of Nutrition, Faculty of Agriculture and Food Sciences, American University of Beirut, Riad El-Solh, Beirut 1107-2020, Lebanon
关键词: Lebanon;    Gender;    Adults;    Socioeconomic status;    Physical activity;    Diet;    Prevalence;    Obesity;   
Others  :  1159547
DOI  :  10.1186/s12889-015-1605-9
 received in 2014-06-18, accepted in 2015-03-02,  发布年份 2015
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【 摘 要 】

Background

The prevalence of obesity within countries varies by gender, age, lifestyle and socioeconomic factors. Identification of behavioural factors that are associated with obesity within the country’s context is critical for the development of effective public health programs which aim to prevent and manage obesity. The objective of this study was to assess age and gender differentials in the prevalence of obesity in Lebanon and examine correlates of obesity with a focus on socioeconomic disparities.

Methods

Following the WHO STEPwise guidelines, a national survey was conducted in Lebanon in 2008–2009. Households were selected randomly from all Governorates based on stratified cluster sampling method. One adult aged 20 years and over was randomly selected from each household for the interview. Anthropometric measurements and 24 hour recall dietary intake were obtained. The final sample included 1244 men and 1453 women. Descriptive statistics were computed for BMI, waist circumference, and percent body fat. Multivariate logistic regression analysis was carried out to assess the relationship between energy intake and obesity adjusted for relevant co-variables.

Results

The prevalence of obesity among Lebanese adults was 26.1%. Gender differences in obesity estimates were observed across age groups and the three obesity classes, with men showing higher prevalence rates at the younger age groups (20–49 years), and women showing higher prevalence rates in older age groups (50 years and above). Obesity showed significant associations with socio-economic status in women; it decreased with higher educational attainment (OR = 0.54, 95% CI: 0.32, 0.91), greater household assets (OR = 0.26; 95% CI: 0.10, 0.72) and lower crowding index (OR = 0.62; 95% CI: 0.39, 0.98), net of the effect of other co-variates. There was a significant positive association between obesity and energy intake in both genders, and a negative association between obesity and physical activity, significantly among women.

Conclusion

Lifestyle and socioeconomic determinants of obesity are identified in this Lebanese population. Policy makers and service providers need to tailor public health strategies to tackle obesity accordingly.

【 授权许可】

   
2015 Chamieh et al.; licensee BioMed Central.

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【 参考文献 】
  • [1]Rokholm B, Baker JL, Sorensen TI: The leveling off of the obesity epidemic since the year 1999: a review of evidence and perspectives. Obes Rev 2010, 11:835-46.
  • [2]Popkin BM: Recent dynamics suggest selected countries catching up to US obesity. Am J Clin Nutr 2010, 91:s284-8.
  • [3]Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al.: National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 2011, 377:557-67.
  • [4]Ng SW, Zaghloul S, Ali HI, Harrison G, Popkin BM: The prevalence and trends of overweight, obesity and nutrition-related non-communicable diseases in the Arabian Gulf states. Obes Rev 2011, 12:1-13.
  • [5]World Health Organization. Draft nutrition strategy and plan of action for countries of the Eastern Mediterranean Region 2010–2019. WHO Regional Office for the Eastern Mediterranean; 2009. www.emro.who.int/docs/EM_RC57_4_en.pdf?ua=1.
  • [6]Ministry of Health: The Epidemiological Surveillance Program and Department of Statistics. Population Estimates in Lebanon. Ministry of Health, Beirut; 2006.
  • [7]World Statistics Pocketbook. Country Profile: Lebanon. United Nations Statistics Division; 2011. http://data.un.org/CountryProfile.aspx?crName=Lebanon.
  • [8]Sibai AM, Hwalla N, Adra N, Rahal B: Prevalence and covariates of obesity in Lebanon: findings from the first epidemiological study. Obes Res 2003, 11:1353-61.
  • [9]Sibai AM, Obeid O, Batal M, Adra N, El Khoury D, Hwalla N: Prevalence and correlates of metabolic syndrome in an adult Lebanese population. Prev Control 2008, 3:83-90.
  • [10]Hanson KL, Sobal J, Frongillo EA: Gender and marital status clarify associations between food insecurity and body weight. J Nutr 2007, 137:1460-5.
  • [11]Naja F, Nasreddine L, Itani L, Chamieh MC, Adra N, Sibai AM, et al.: Dietary patterns and their association with obesity and socio-demographic factors in a national sample of Lebanese adults. Public Health Nutr 2011, 14:1570-8.
  • [12]World Health Organization: WHO STEPS Surveillance Manual: The WHO STEP wise approach to chronic disease risk factor surveillance. WHO, Geneva; 2005.
  • [13]Esteghamati A, Khalilzadeh O, Mohammad K, Meysamie A, Rashidi A, Kamgar M, et al.: Secular trends of obesity in Iran between 1999 and 2007: national surveys of risk factors of non-communicable diseases. Metab Syndr Relat Disord 2010, 8:209-13.
  • [14]IPAQ Research Committee: Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire (IPAQ) - Short and Long Forms. 2005.
  • [15]World Health Organization: Obesity: Preventing and managing the global epidemic: Report of a WHO consultation (WHO Technical Report Series 894). WHO, Geneva; 2000.
  • [16]World Health Organization: Recommended Measurement Protocols and Derivation of Indices: Physical Status: The Use and Interpretation of Anthropometry (pp 424–438). WHO, Geneva; 1995.
  • [17]Durnin JV, Womersley J: Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr 1974, 32:77-97.
  • [18]Lee RD, Nieman DC: Nutritional assessment. 5th edition. McGraw-Hill Companies, New York; 2010.
  • [19]Zimmet P, Magliano D, Matsuzawa Y, Alberti G, Shaw J: The metabolic syndrome: a global public health problem and a new definition. J Atheroscler Thromb 2005, 12:295-300.
  • [20]Moshfegh AJ, Rhodes DG, Baer DJ, Murayi T, Clemens JC, Rumpler WV, et al.: The US department of agriculture automated multiple-pass method reduces bias in the collection of energy intakes. Am J Clin Nutr 2008, 88:324-32.
  • [21]Thompson FE, Subar AF: Dietary assessment methodology. In Nutrition in the prevention and treatment of disease. 2nd edition. Edited by Coulston AM, Boushey CJ. Elsevier Academic Press, San Diego; 2008.
  • [22]Nasreddine L, Sibai A, Mrayati M, Adra N, Hwalla N: Adolescent obesity in Syria: prevalence and associated factors. Child Care Health Dev 2009, 36:404-13.
  • [23]Pellet PL, Shadarevian S: Food Composition Tables for use in the Middle East. 2nd edition. American University of Beirut, Heidelberg Press-Lebanon; 1970.
  • [24]Prakongsai P: An application of the asset index for measuring household living standards in Thailand. 2006.
  • [25]Galobardes B, Shaw M, Lawlor DA, Lynch JW, Davey Smith G: Indicators of socioeconomic position. J Epidemiol Community Health 2006, 60:7-12.
  • [26]Lebanese Republic Ministry of Social Affairs: Central Administration for Statistics and UNDP: Living Conditions of households - The National Survey of Household Living Conditions 2004:106–107. MOSA, Beirut; 2006.
  • [27]Black AE: Critical evaluation of energy intake using the Goldberg cut-off for energy intake: Basal metabolic rate. A practical guide to its calculation, use and limitations. Int J Obes Relat Metab Disord 2000, 24:1119-30.
  • [28]Livingstone MB, Black AE: Markers of the validity of reported energy intake. J Nutr 2003, 133(Suppl 3):s895-920.
  • [29]United States Department of Agriculture & United States Department of Health and Human Services: Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010. U.S. Department of Agriculture, Agricultural Research Service, Washington, DC; 2010.
  • [30]Galal OM: The nutrition transition in Egypt: obesity, undernutrition and the food consumption context. Public Health Nutr 2002, 5A:141-8.
  • [31]Sibai AM, Nasreddine L, Mokdad AH, Adra N, Tabet M, Hwalla N: Nutrition transition and cardiovascular disease risk factors in Middle East and North Africa countries: reviewing the evidence. Ann Nutr Metab 2010, 57:193-203.
  • [32]Al-Kandari YY: Prevalence of obesity in Kuwait and its relation to sociocultural variables. Obes Rev 2006, 7:147-54.
  • [33]Al-Nozha MM, Al-Mazrou YY, Al-Maatouq MA, Al-Nozha MM, Al-Mazrou YY, Al-Maatouq MA, et al.: Obesity in Saudi Arabia. Saudi Med J 2005, 26:824-9.
  • [34]Al-Tawil NG, Abdulla MM, Abdul Ameer AJ: Prevalence of and factors associated with overweight and obesity among a group of Iraqi women. East Mediterr Health J 2007, 13:420-9.
  • [35]Mousa T, Al-Domi H, Mashal R: Eating disturbances in adolescent girls: a review. Dirasat Agr Sci 2009, 36(Suppl 2):109-21.
  • [36]Fezeu L, Minkoulou E, Balkau B, Kengne AP, Awah P, Unwin N, et al.: Association between socioeconomic status and adiposity in urban Cameroon. Int J Epidemiol 2006, 35:105-11.
  • [37]Al-Lawati JA, Jousilahti PJ: Prevalence and 10-year secular trend of obesity in Oman. Saudi Med J 2004, 25:346-51.
  • [38]Rodriguez E, Lope B, Lopez AM, Ortega RM: Overweight and obesity among Spanish adults. Nutr Hosp 2011, 26:355-63.
  • [39]Flegal KM, Carroll MD, Ogden CL, Curtin LR: Prevalence and trends in obesity among US adults, 1999–2008. JAMA: J Am Med Dir Assoc 2010, 303:235-41.
  • [40]Garcia-Alvarez A, Serra-Majem L, Ribas-Barba L, Castell C, Foz M, Uauy R, et al.: Obesity and overweight trends in Catalonia, Spain (1992–2003): gender and socio-economic determinants. Public Health Nutr 2007, 10A:1368-78.
  • [41]Sanchez-Vaznaugh EV, Kawachi I, Subramanian SV: Do socioeconomic gradients in body mass index vary by race/ethnicity, gender, and birthplace? Am J Epidemiol 2009, 169:1102-12.
  • [42]Yoon YS, Oh SW, Park HS: Socioeconomic status in relation to obesity and abdominal obesity in Korean adults: a focus on sex differences. Obesity (Silver Spring, Md) 2006, 14:909-19.
  • [43]Hajian-Tilaki KO, Heidari B: Association of educational level with risk of obesity and abdominal obesity in Iranian adults. J Public Health 2010, 32:202-9.
  • [44]Assi F, Devaux M, Church J, Cecchini M, Borgonovi F. Education and Obesity in Four OECD Countries. OECD Publishing Papers. http://www.olis.oecd.org/olis/2009doc.nsf/LinkTo/N.
  • [45]Giskes K, Turrell G, van Lenthe FJ, Brug J, Mackenbach JP: A multilevel study of socio-economic inequalities in food choice behaviour and dietary intake among the Dutch population: the GLOBE study. Public Health Nutr 2006, 9:75-83.
  • [46]Zhang Q, Wang Y: Socioeconomic inequality of obesity in the United States: do gender, age, and ethnicity matter? Soc Sci Med 2004, 58:1171-80.
  • [47]Reynolds SL, Hagedorn A, Yeom J, Saito Y, Yokoyama E, Crimmins EM: A tale of two countries-the United States and japan: are differences in health due to differences in overweight? J Epidemiol 2008, 18:280-90.
  • [48]Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML, et al.: The global obesity pandemic: shaped by global drivers and local environments. Lancet 2011, 378:804-14.
  • [49]Sobal J, Hanson KL, Frongillo EA: Gender, ethnicity, marital status, and body weight in the United States. Obesity (Silver Spring, Md) 2009, 17:2223-31.
  • [50]Tzotzas T, Vlahavas G, Papadopoulou SK, Kapantais E, Kaklamanou D, Hassapidou M: Marital status and educational level associated to obesity in Greek adults: data from the national epidemiological survey. BMC Public Health 2010, 10:732. BioMed Central Full Text
  • [51]Gordon-Larsen P: The NS: Entry into romantic partnership is associated with obesity. Obesity (Silver Spring, Md) 2009, 17:1441-7.
  • [52]Bell S, Lee C: Emerging adulthood and patterns of physical activity among young Australian women. Int J Behav Med 2005, 12:227-35.
  • [53]Burke V, Beilin LJ, Dunbar D, Kevan M: Changes in health-related behaviours and cardiovascular risk factors in young adults: Associations with living with a partner. Prev Med 2004, 39:722-30.
  • [54]World Health Organization: Diet, Nutrition and the Prevention of Chronic Diseases. Report of the joint WHO/FAO expert consultation. (WHO Technical Report Series 916). WHO, Geneva; 2003.
  • [55]Dietary Reference Intakes (DRIs): Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (2002/2005). 2002.
  • [56]Rolls BJ: The relationship between dietary energy density and energy intake. Physiol Behav 2009, 97:609-15.
  • [57]Drewnowski A: The real contribution of added sugars and fats to obesity. Epidemiol Rev 2007, 29:160-71.
  • [58]Kopelman PG: Obesity as a medical problem. Nature 2000, 40:635-64.
  • [59]Hall KD, Sacks G, Chandramohan D, Chow CC, Wang YC, Gortmaker SL, et al.: Quantification of the effect of energy imbalance on bodyweight. Lancet 2011, 378:826-37.
  • [60]Skidmore P: Macronutrient intakes and their role in obesity. Nutr Bull 2007, 32:4-13.
  • [61]Maureen T, Mark A: Breakfast frequency and quality in the etiology of adult obesity and chronic diseases. Nutr Rev 2007, 65:268-81.
  • [62]Farshichi HR, Taylor MA, Macdonald IA: Decreased thermic effect of food after an irregular compared with a regular meal pattern in healthy lean women. Int J Obes 2004, 28:653-60.
  • [63]Center of Disease Control Database. [www.cdc.gov/features/familyhealthhistory]
  • [64]Howe LD, Hargreaves JR, Gabrysch S, Huttly SR: Is the wealth index a proxy for consumption expenditure? A systematic review. J Epidemiol Community Health 2009, 63:871-80.
  • [65]Yu IT, Tse SL: Clinical epidemiology workshop 4-Sources of bias in case-referent studies. Hong Kong Med J 2012, 18:46-7.
  • [66]Mendez MA, Popkin BM, Buckland G, Schroder H, Amiano P, Barricarte A, et al.: Alternative methods of accounting for underreporting and overreporting when measuring dietary intake-obesity relations. Am J Epidemiol 2011, 173:448-58.
  • [67]Maddison R, Ni Mhurchu C, Jiang Y, Vander Hoorn S, Rodgers A, Lawes CM, et al.: International physical activity questionnaire (IPAQ) and New Zealand physical activity questionnaire (NZPAQ): a doubly labelled water validation. Int J Behav Nutr Phys Act 2007, 4:62. BioMed Central Full Text
  • [68]World Health Organization: Expert Consultation-Geneva. WHO, Geneva; 2008.
  • [69]Zamboni M, Mazzali G, Zoico E, Harris TB, Meigs JB, Di Francesco V, et al.: Health consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes (Lond) 2005, 29:1011-29.
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