Most cited article - PubMed ID 18251227
Obesity and education in three countries of the Central and Eastern Europe: the HAPIEE study
BACKGROUND: The inverse association between education and obesity was previously found in numerous studies. This study aims to assess several possible mediators in the educational disparities in adiposity. We hypothesize the potential mediating role of lifestyle, socioeconomic, and mental health factors in the association between education and adiposity. METHODS: Cross-sectional population-based sample from Czechia included 2,154 25-64 years old subjects (54.6% women). Education was classified as high, middle, and low. Adiposity was assessed as a latent variable based on body fat percentage, BMI, waist circumference, and visceral fat. The mediation potential of unhealthy dietary behavior, alcohol intake, smoking, sedentary behaviors, income, stress, depression, and quality of life was assessed in age-adjusted sex-specific multiple mediation models. RESULTS: The negative direct effect of education on adiposity was statistically significant at 5% level of significance in both sexes. For men, the indirect effect was statistically significant via sedentary behavior (β = 0.041; 95% CI [0.025-0.062]) with a mediation ratio of 23.7%. In women, the indirect effect was statistically significant via dietary risk (β = -0.023, 95% CI [-0.037, -0.013]), alcohol intake (β = -0.006; 95% CI [-0.014, -0.001]), sedentary behavior (β = 0.012, 95% CI [0.004,0.023]), income (β = -0.022; 95% CI [-0.041, -0.004]), and mental health (β = -0.007; 95% CI [-0.019, -0.001]). The total mediation ratio in women was 30.5%. CONCLUSIONS: Sedentary behaviors had mediating role in the association between education and adiposity in both sexes, with more important role in men. In addition, unhealthy diet and lower income partially mediated the educational gradient in adiposity in women.
- MeSH
- Adiposity * MeSH
- Mediation Analysis MeSH
- Health Status Disparities MeSH
- Adult MeSH
- Mental Health * MeSH
- Middle Aged MeSH
- Humans MeSH
- Obesity epidemiology psychology MeSH
- Cross-Sectional Studies MeSH
- Sedentary Behavior MeSH
- Socioeconomic Factors * MeSH
- Educational Status * MeSH
- Life Style * MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Czech Republic MeSH
BACKGROUND: In older adults, sedentary behaviors increase while physical activity decreases over time following the compositional nature of 24-h behaviors. These changes in movement-related behaviors (MRBs) might be associated with unhealthy weight gain and several health comorbidities. However, information is lacking on how obesity influences longitudinal changes in the composition of MRBs in older adults. Furthermore, the moderating effect of the built environment on prospective associations between obesity and MRBs in older adults is not fully understood. Therefore, using an integrated time-use approach, this study aims to identify prospective associations between obesity and MRBs together with an assessment of the moderating effect of the built environment in elderly women. METHODS: The study was designed as a prospective 7-year follow-up study. It is based on two previous cross-sectional studies that enable the use of participant data (women aged 60+ years, n = 409) as a baseline dataset in the current study. All methods designed for 7-year follow-up are based on previous studies. The data collection comprises device-based measurement of MRBs (ActiGraph GT1M accelerometer), objective assessment of body adiposity (multi-frequency bioelectrical impedance analysis), subjective assessment of the built environment (NEWS-A questionnaire), and other possible confounding factors. Time spent in sedentary behavior, light physical activity, and moderate-to-vigorous physical activity will be used as three components in a composition reflecting individual MRBs. In linear multiple compositional regression analysis assessing the prospective association between obesity and MRBs, the 7-year follow-up composition of the three mentioned components represents the dependent variable. The 7-year changes in the percentage of body fat (body adiposity), baseline composition of MRBs, and parameters of the built environment represent regressors. DISCUSSION: This study will use an integrated time-use approach to explore causality from obesity to device-measured behaviors in older women. The design and respective analysis consider the compositional nature of MRBs data and the potential moderating effects of various factors. A comprehensive assessment of causality may help to develop multilevel interventional models that enhance physical activity in older adults.
- Keywords
- Causality, Health risk behaviors, Healthy aging, Regression analysis, Risk factors,
- MeSH
- Adiposity * MeSH
- Exercise * MeSH
- Weight Gain MeSH
- Body Mass Index MeSH
- Middle Aged MeSH
- Humans MeSH
- Linear Models MeSH
- Follow-Up Studies MeSH
- Obesity complications MeSH
- Prospective Studies MeSH
- Cross-Sectional Studies MeSH
- Sedentary Behavior * MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Adipose Tissue metabolism MeSH
- Research Design MeSH
- Health Behavior * MeSH
- Environment Design * MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
This study is the first to use compositional data analysis to investigate movement behaviors of elderly women and their relationships with fat mass percentage (FM%). The focus of the study is on the associations of time reallocations from sedentary behavior (SB) to light physical activity (LIPA) or moderate-to-vigorous physical activity (MVPA) with adiposity. Over 400 older adult women were recruited as part of the cross-sectionally conducted measurements of older adults aged 60+ in Central European countries. An accelerometer was used to assess daily movement behaviors. Body mass index (BMI) and fat mass percentage (FM%) were assessed as adiposity indicators using InBody 720 MFBIA. Using LS-regression, we found positive relationships of BMI and FM% with SB (relative to remaining movement behaviors) (p < 0.001 for both), while their relationship with MVPA (relative to remaining movement behaviors) were negative (p < 0.001 for both). The estimated BMI and FM% associated with a 30-min SB-to-MVPA reallocation were reduced by 1.5 kg/m² and 2.2 percentage points, respectively, whereas they were not reduced significantly with the reallocation of 30 min from SB to LIPA. The findings highlight that SB and MVPA, but not LIPA, are significantly associated with adiposity in elderly women. The reallocation of time from SB to MVPA could be advocated in weight loss interventions in older women.
- Keywords
- BMI, Central Europe, adiposity, compositional data analysis, fat mass, movement behaviors,
- MeSH
- Adiposity * MeSH
- Time Factors MeSH
- Exercise * MeSH
- Body Mass Index * MeSH
- Middle Aged MeSH
- Humans MeSH
- Cross-Sectional Studies MeSH
- Sedentary Behavior * MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Europe epidemiology MeSH
The occurrence of overweight, obesity and physical activity (PA) belongs to major factors influencing health. However, information on the longitudinal development of PA in Europe has been, up until now, insufficient. The aim of the study was to describe the changes in PA, sedentary behavior and BMI in the inhabitants of the Liberec region during the surveybetween 2002 - 2009. The data were obtained in 2002-2004 using the short version of the IPAQ questionnaire, in 2005-2009 using the long version of the IPAQ. The sample of participants comprised 957 males and 1066 females aged 25-60 years. A significant decrease in sitting accounting for minutes on working days has been recorded both in men and women. A significant increase of PA both in men and women was reported, however the interpretation of the increase needs to be done cautiously due to the application of the short and long version of the IPAQ. Regarding PA intensity, men show more PA in total than women, which can be explained mainly by the differences in vigorous PA. Women show significantly lower values of BMI in all years in which surveys were conducted than men (p<0.001). Based on self-reported data, we have recorded an increase in the number of overweight and obese people. Time spent sitting on working days has had a tendency to decrease, yet a negative trend in the decrease in self-reported total PA has not been confirmed. Despite the fact that there has been an increase in self-reported PA, no decrease in BMI was registered.
- Keywords
- obesity, overweight, physical activity, questionnaire, trends,
- Publication type
- Journal Article MeSH
BACKGROUND: The high cardiovascular mortality in Eastern Europe has often been attributed to poor diet, but individual-level data on nutrition in the region are generally not available. This paper describes the methods of dietary assessment and presents preliminary findings on food and nutrient intakes in large general population samples in Russia, Poland and the Czech Republic. METHODS: The HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study examined random samples of men and women aged 45-69 years at baseline in Novosibirsk (Russia), Krakow (Poland) and six Czech urban centres in 2002-2005. Diet was assessed using a food frequency questionnaire (at least 136 items); complete dietary information was available for 26,870 persons. RESULTS: Total energy intakes among men ranged between 8.7 MJ in the Czech sample and 11.7 MJ in the Russian sample, while among women, energy intakes ranged between 8.2 MJ in the Czech sample and 9.8 MJ in the Russian sample. A Healthy Diet Indicator (HDI), ranging from a score of 0 (lowest) to 7 (highest), was developed using the World Health Organisation's (WHO) guidelines for the prevention of chronic diseases. The mean HDI scores were low, ranging from 1.0 (SD = 0.7) among the Polish subjects to 1.7 (SD = 0.8) among the Czech females. Very few subjects met the WHO recommended intakes for complex carbohydrates, pulses or nuts; intakes of saturated fatty acids, sugar and protein were too high. Only 16% of Polish subjects met the WHO recommendation for polyunsaturated fat intake. Consumption of fruits and vegetables was lower than recommended, especially among those Russian subjects who were assessed during the low intake season. Fewer than 65% of subjects consumed adequate amounts of calcium, magnesium and potassium, when compared with the United Kingdom's Reference Nutrient Intake. CONCLUSION: This first large scale study of individual-based dietary intakes in the general population in Eastern Europe implies that intakes of saturated fat, sugar and complex carbohydrates are a cause for concern. The development of country-specific nutritional tools must be encouraged and nutritional campaigns must undergo continuing development.
- MeSH
- Diet Surveys MeSH
- Diet standards statistics & numerical data MeSH
- Energy Intake * MeSH
- Body Mass Index MeSH
- Cardiovascular Diseases MeSH
- Middle Aged MeSH
- Humans MeSH
- Surveys and Questionnaires MeSH
- Risk Factors MeSH
- Aged MeSH
- Socioeconomic Factors MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Research Support, N.I.H., Extramural MeSH
- Geographicals
- Czech Republic MeSH
- Poland MeSH
- Russia MeSH