Social class and metabolic syndrome in populations from Tunisia and Spain

Diabetology & Metabolic Syndrome

Nabil Attia³  Mohsen Sakly³  Fatma Ben Dahmen²  Itahisa Marcelino Rodríguez¹  María Del Cristo Rodríguez Pérez¹  Buenaventura Brito Díaz¹  Antonio Cabrera de León¹  Fadoua Gannar³ 

[1] Research Unit, Nuestra Señora de la Candelaria University Hospital, University of La Laguna, Santa Cruz de Tenerife, Spain;Internal Medicine Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia;Research Unit ‘Integrated Physiology’, Laboratory of Biochemistry-Human Nutrition, Faculty of Sciences of Bizerte, UR11ES33, Carthage University, Tunis, Tunisia

关键词: Islanders;    Tunisian population;    Social class;    Metabolic syndrome;   

Others  :  1229627
DOI  :  10.1186/s13098-015-0084-6

 received in 2015-05-25, accepted in 2015-10-02,  发布年份 2015

【 摘 要 】

Background

There is an increasing prevalence of obesity and metabolic syndrome (MS) in developing countries. It has been shown the relationship between social class and MS in developed countries. The objective of our study was to compare the association of social class with the prevalence of MS in a developing country (Tunisia, region of Cap-Bon) and a developed one (Spain, Canary Islands).

Methods

Cross-sectional study of 6729 Canarian and 393 Tunisian individuals. Social class was measured with the income, crowding and education (ICE) model, which includes family income, household crowding and education level. Logistic regression models adjusted by age estimated the risk by odds ratio (OR) and confidence interval (CI 95 %) of MS according to social class.

Results

MS prevalence was higher in Tunisian (50 %) than in Canarian women (29 %; p = 0.002), with no significant differences between men. For Canarian women, being in the highest social class was a protective factor against MS (OR = 0.39; CI 95 % 0.29–0.53) and all its components. The Canarian population and the Tunisian women, showed a significant linear trend (p < 0.001) of MS to decrease when social class increased.

Conclusion

High social class is a protective factor from MS and its components within the Canarian population and the Tunisian women. Our results suggest that the socioeconomic transition in a developing country like Tunisia can improve the population health in a sex-specific manner.

【 授权许可】

   
2015 Gannar et al.

【 图 表 】

Fig.1.

【 参考文献 】

• [1]Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al.: Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009, 120:1640-1645.
• [2]Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, et al.: The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol 2010, 56:1113-1132.
• [3]Hildrum B, Mykletun A, Hole T, Midthjell K, Dahl AA: Age-specific prevalence of the metabolic syndrome defined by the International Diabetes Federation and the National Cholesterol Education Program: the Norwegian HUNT 2 study. BMC Public Health. 2007, 7:220. BioMed Central Full Text
• [4]Elo IT: Social class differentials in health and mortality: patterns and explanations in comparative perspective. Annu Rev Sociol. 2009, 35:553-572.
• [5]Loucks EB, Rehkopf DH, Thurston RC, Kawachi I: Socioeconomic disparities in metabolic syndrome differ by gender: evidence from NHANES III. Ann Epidemiol 2007, 17:19-26.
• [6]Ben Romdhane H, Haouala H, Belhani A, Drissa H, Kafsi N, Boujnah R, et al.: Epidemiological transition and health impact of cardiovascular disease in Tunisia. Tunis Med 2005, 83:1-7.
• [7]Allal-Elasmi M, Haj Taieb S, Hsairi M, Zayani Y, Omar S, Sanhaji H, et al.: The metabolic syndrome: prevalence, main characteristics and association with socio-economic status in adults living in great Tunis. Diabetes Metab. 2010, 36:204-208.
• [8]Belfki H, Ben Ali S, Aounallah-Skhiri H, Traissac P, Bougatef S, Maire B, et al.: Prevalence and determinants of the metabolic syndrome among Tunisian adults: results of the transition and health impact in North Africa (TAHINA) project. Public Health Nutr. 2013, 16:582-590.
• [9]Scheen AJ: The epidemic of metabolic diseases, a major problem of public health. Rev Med Liege 1999, 54:87-94.
• [10]Brunner EJ, Marmot MG, Nanchahal K, Shipley MJ, Stansfeld SA, Juneja M, et al.: Social inequality in coronary risk: central obesity and the metabolic syndrome. Evidence from the Whitehall II study. Diabetologia 1997, 40:1341-1349.
• [11]Cabrera de León A, Rodríguez Pérez Mdel C, Almeida González D, Domínguez Coello S, Aguirre Jaime A, Brito Díaz B, et al.: Presentation of the “CDC de Canarias” cohort: objectives, design and preliminary results. Rev Esp Salud Publica. 2008, 82:519-534.
• [12]Fernández-Bergés D, Cabrera de León A, Sanz H, Elosua R, Guembe MJ, Alzamora M, et al.: Síndrome metabólico en España: prevalencia y riesgo coronario asociado a la definición armonizada y a la propuesta por la OMS. Estudio DARIOS. Revista Española de Cardiología. 2012, 65:241-248.
• [13]de León AC, Coello SD, González DA, Díaz BB, Rodríguez JC, Hernández AG, et al.: Impaired fasting glucose, ancestry and waist-to-height ratio: main predictors of incident diagnosed diabetes in the Canary Islands. Diabet Med 2012, 29:399-403.
• [14]Cabrera de León A, Rodríguez Pérez MC, Domínguez Coello S, Rodríguez Díaz C, Rodríguez Alvarez C, Aguirre Jaime A, et al.: Validation of the ICE model to assess social class in the adult population. Rev Esp Salud Publica. 2009, 83:231-242.
• [15]Lao XQ, Ma WJ, Sobko T, Zhang YH, Xu YJ, Xu XJ, Yu DM, Nie SP, Cai QM, Wei XL, Xia L, Wong MC: Dramatic escalation in metabolic syndrome and cardiovascular risk in a Chinese population experiencing rapid economic development. BMC Public Health. 2014, 20(14):983. BioMed Central Full Text
• [16]Al-Lawati JA, Mohammed AJ, Al-Hinai HQ, Jousilahti P: Prevalence of the metabolic syndrome among Omani adults. Diabetes Care 2003, 26:1781-1785.
• [17]Azizi F, Salehi P, Etemadi A, Zahedi-Asl S: Prevalence of metabolic syndrome in an urban population: Tehran lipid and glucose study. Diabetes Res Clin Pract 2003, 61:29-37.
• [18]Harzallah F, Alberti H, Ben Khalifa F: The metabolic syndrome in an Arab population: a first look at the new international diabetes federation criteria. Diabet Med 2006, 23:441-444.
• [19]Moreira GC, Cipullo JP, Ciorlia LA, Cesarino CB, Vilela-Martin JF: Prevalence of metabolic syndrome: association with risk factors and cardiovascular complications in an urban population. PLoS One 2014.
• [20]Ghannem H: The challenge of preventing cardiovascular disease in Tunisia. Prev Chronic Dis. 2006, 3:A13.
• [21]Cabrera de León A, Rodríguez-Pérez Mdel C, Rodríguez-Benjumeda LM, Anía-Lafuente B, Brito-Díaz B, Muros de Fuentes M, et al.: Sedentary lifestyle: physical activity duration versus percentage of energy expenditure. Rev Esp Cardiol 2007, 60:244-250.
• [22]Winkleby MA, Jatulis DE, Frank E, Fortmann SP: Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Public Health 1992, 82:816-820.
• [23]Hausmann R, Tyson LD, Bekhouche YB, Zahidi S: The global gender gap report. World Economic Forum, Geneva Switzerland; 2014.
• [24]Charrad Mounira M: Tunisia at the forefront of the Arab world. Wash Lee L Rev 2007, 64:1513-1527.
• [25]Popkin BM, Adair LS, Ng SW: Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 2012, 70:3-21.
• [26]Atek M, Traissac P, El Ati J, Laid Y, Aounallah-Skhiri H, Eymard-Duvernay S, et al.: Obesity and association with area of residence, gender and socio-economic factors in Algerian and Tunisian adults. PLoS One 2013, 8:e75640.
• [27]El Ati J, Traissac P, Delpeuch F, Aounallah-Skhiri H, Béji C, Eymard-Duvernay S, et al.: Gender obesity inequities are huge but differ greatly according to environment and socio-economics in a North African setting: a national cross-sectional study in Tunisia. PLoS One 2012, 7:e48153.
• [28]Omran AR: The epidemiologic transition: a theory of the epidemiology of population change. Milbank Q 2005, 83:731-757.
• [29]Cameron AJ, Shaw JE, Zimmet PZ: The metabolic syndrome: prevalence in worldwide populations. Endocrinol Metab Clin North Am 2004, 33:351-375.