Marital status and educational level associated to obesity in Greek adults: data from the National Epidemiological Survey

<p>Abstract</p> <p>Background</p> <p>Obesity is an important public health issue and its prevalence is reaching epidemic proportions in both developed and developing countries. The aim of the present study was to determine associations of overweight (OW), obesity (OB) and abdominal obesity (AO) with marital status and educational level in Greek adults of both genders based on data from the National Epidemiological Survey on the prevalence of obesity.</p> <p>Methods</p> <p>The selection was conducted by stratified sampling through household family members of Greek children attending school during 2003. A total of 17,341 Greek men and women aged from 20 to 70 years participated in the survey and had anthropometric measurements (height, weight, and waist circumference) for the calculation of prevalence of OW, OB and AO. WHO cut-offs were used to define overweight and obesity categories. Waist circumference of more than 102 cm in men and 88 cm in women defined AO. Marital status and educational level were recorded using a specially designed questionnaire and were classified into 4 categories.</p> <p>Results</p> <p>The overall prevalence of OB was 22.3% (25.8% in men, 18.4% in women), that of OW 35.2% (41.0% in men, 29.8% in women) and that of AO 26.4% in men and 35.9% in women. A<b/>higher risk of OB was found in married men (OR: 2.28; 95% CI: 1.85-2.81) and married women (OR: 2.31; 95% CI: 1.73-3.10) than in the respective unmarried ones. Also, a higher risk of AO was found in married men (OR: 3.40; 95% CI: 2.86-4.03) and in married women (OR: 2.40; 95% CI 2.00-2.88) compared to unmarried ones. The risk for being obese was lower among educated women (primary school, OR: 0.76; 95% CI: 0.60-0.96, high school, OR: 0.58; 95% CI: 0.46-0.74 and University, OR: 0.64; 95% CI: 0.49-0.81) than among illiterates. No significant differences were found among men.</p> <p>Conclusions</p> <p>In Greek adults, marital status was significantly associated with obesity and abdominal obesity status in both genders while educational level was inversely associated with obesity status only in women.</p

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI &lt;18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school&#x2;aged children and adolescents, we report thinness (BMI &lt;2 SD below the median of the WHO growth reference) and obesity (BMI &gt;2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

The influence of plasma lipid transfer proteins in the modulation of HDL in obese women during weight loss

Introduction: Beyond body fat increase, obesity is characterized by blood lipid abnormalities that are associated with a higher risk for coronary heart disease. Plasma lipid transfer proteins, cholesteryl ester transfer protein (CETP) and phospholipid transfer protein (PLTP), two new risk factors for cardiovascular disease, are often abnormally elevated in obese patients. Both PLTP and CETP influence the size and structure of HDL, in an opposite way. CETP favors the formation of small HDL at the expense of large-sized HDL2 subclasses, whereas, in turn, PLTP promotes the formation of large HDL and pre-b-HDL. Aim: The aim of the present study was to determine the effect of short and longer term weight loss by a low calorie diet on plasma CETP and PLTP levels in obese women and the consequences on the changes of HDL subclasses. Patients-Methods: Forty-four obese women, 41.0±11.7 years of age with BMI:36.8±5.4kg/m² were evaluated at baseline and most of them after 4 and 16 weeks of a low calorie diet. At baseline, they were also compared to 25 normal weight controls. The following parameters were measured in all women: Body weight, Height, Body Mass Index, Waist Circumference, Waist-to-Hip Ratio, percentage of fat mass (by bioimpedance analysis), serum lipid levels (Total cholesterol, triglycerides, HDL cholesterol, LDL, lipoprotein(a), apolipoprotein A1 and B), parameters of insulin resistance (fasting glucose and insulin levels, HOMA index), serum hormone levels related to obesity (Testosterone, 17-β-estradiol, SHBG, DHEA-S, cortisol and T3), plasma CETP and PLTP levels and percentage of HDL subclasses (HDL2b, 2a, 3a, 3b, 3c). Lipid transfer proteins were measured by ELISA, and the size distribution of HDL by polyacrylamide gel electrophoresis. Results: Obese subjects had significantly higher plasma levels of PLTP than controls (9.04±2.32 vs 7.03±2.66 mg/l, p<0.002), while no difference was found in plasma levels of CETP and the percentage of HDL subclasses between the 2 groups. A mean decrease of body weight and BMI of 10.5% at 16 weeks, was associated with a decrease of CETP levels (0’:2.76±0.79, 4w:2.31±0.69, 16w:2.52±0.62 mg/l, p<0.001) and of PLTP levels (0’:9.01±2.44, 4w:2.31±0.69, 16w:2.52±0.62 mg/l, p<0.02). Changes of CETP and PLTP levels at 4 weeks did not significantly correlate, neither with total energy intake nor with the nutrient composition of the diet. Decreases of CETP and PLTP levels at 4 weeks and 16 weeks correlated positively with decreases of obesity indices, whereas no such correlation was found with parameters of insulin resistance. Interestingly, plasma CETP correlated positively with plasma PLTP levels only in obese women, at baseline (r=0.43, p=0.004) and at 16 weeks (r=0.44, p=0.04) and a positive correlation of their changes was also observed during the initial phase of weight loss at 4 weeks (r=0.47, p=0.003). HDL2 subclasses decreased significantly at 4 weeks (p<0.05) whereas HDL3 subclasses decreased significantly at 16 weeks (p=0.05). The ratio HDL2/ HDL3 showed a significant decrease at 4 weeks (p=0.003), but did not change at the end of the study. Conclusions: According to the findings of our study, obese women have higher levels of PLTP levels than controls. Low-calorie diet and the resulting weight loss at about 10% after the intervention, reduced progressively and significantly plasma CETP and PLTP levels, which correlated positively between each other. This correlation is a key finding of our study and suggests that these 2 proteins are produced and released simultaneously by the adipose tissue in the obese subjects. In terms of HDL size distribution, our results show that, during both the initial and final phase of weight loss, HDL subclasses are more influenced by the changes of PLTP than by the changes of CETP. To our knowledge, weight loss, even of modest degree, arises today as the sole notable intervention that is able to decrease both the CETP and PLTP, two emerging cardiovascular risk factors, in a coordinated way.Εισαγωγή. Η παχυσαρκία, ιδίως η ανδρικού τύπου, χαρακτηρίζεται από διαταραχές λιποπρωτεϊνών, οι οποίες αυξάνουν τον καρδιαγγειακό κίνδυνο. Οι πρωτεΐνες μεταφοράς λιπιδίων πλάσματος, δηλαδή η πρωτεΐνη μεταφοράς εστέρων χοληστερόλης (CETP) και η πρωτεΐνη μεταφοράς φωσφολιπιδίων (PLTP), θεωρούνται δύο νέοι παράγοντες αγγειακού κινδύνου και συχνά είναι αυξημένες επί παχυσαρκίας. Οι PLTP και CETP επηρεάζουν ιδιαίτερα το μέγεθος και τη δομή των HDL και η μεν CETP ελαττώνει τα επίπεδα των HDL₂ ενώ η PLTP αυξάνει τα επίπεδα των HDL2 και των προ-β-HDL. Σκοπός. Σκοπός της εργασίας ήταν να μελετηθούν σε παχύσαρκες γυναίκες οι μεταβολές των CETP και PLTP πλάσματος μετά από ολιγοθερμιδική δίαιτα και απώλεια βάρους σε 2 χρονικά στιγμιότυπα –μετά από 4 και 16 εβδομάδες– και να εκτιμηθεί η σχέση των μεταβολών των πρωτεϊνών αυτών με τις μεταβολές των επιμέρους υποκλασμάτων των HDL. Υλικό-Μέθοδοι. 44 παχύσαρκες γυναίκες, μέσης ηλικίας 41,0±11,7 χρ. Με Δείκτη Μάζας Σώματος (ΔΜΣ) 36,8±5,4 kg/m² εκτιμήθηκαν σε χρόνο 0’ και –οι περισσότερες από αυτές– σε 4 και 16 εβδομάδες μετά απόολιγοθερμιδική δίαιτα, ενώ στο χρόνο 0’ συγκρίθηκαν με 25 φυσιολογικού βάρους μάρτυρες, παρόμοιας ηλικίας. Σε όλα τα άτομα μετρήθηκαν: Ανθρωπομετρικές παράμετροι (Βάρος, Ύψος, ΔΜΣ, Περίμετρος μέσης, Λόγος περιμέτρων μέσης-ισχίων, Ποσοστό σωματικού λίπους), Λιπίδια ορού (Ολ.χοληστερόλη, Τριγλυκερίδια, HDL, LDL, Λιποπρωτεΐνη(α), Απολιποπρωτεΐνη Β και Α1), Παράμετροι ινσουλινοαντίστασης (Ινσουλίνη και Γλυκόζη νηστείας, Δείκτης ΗΟΜΑ), ορμόνες σχετιζόμενες με παχυσαρκία (Τεστοστερόνη, 17-β-οιστραδιόλη, Σφαιρίνη δεσμεύουσα τις φυλετικές ορμόνες (SHBG), Δεϋδροεπιανδροστερόνη (DHEA-S) και Τριιωδοθυρονίνη (Τ3), οι Πρωτεΐνες μεταφοράς λιπιδίων πλάσματος CETP και PLTP και η ποσοστιαία αναλογία των υποκλασμάτων των HDL (HDL2b, 2a, 3a, 3b, 3c). Οι CETP και PLTP μετρήθηκαν με ανοσοενζυμική μέθοδο και τα υποκλάσματα των HDL με ηλεκτροφόρηση βαθμίδωσης σε πηκτή πολυακρυλαμιδίου. Αποτελέσματα. Στο χρόνο 0’ οι παχύσαρκες είχαν υψηλότερα επίπεδα PLTP από τις μάρτυρες (9,04±2,32 έναντι 7,03±2,66 mg/l, p<0,002), ενώ δεν διέφεραν μεταξύ τους ως προς τα επίπεδα της CETP και την ποσοστιαία αναλογία των υποκλασμάτων των HDL. Μέση ελάττωση του ΒΣ και του ΔΜΣ κατά 10,5% στις 16 εβδομάδες προκάλεσε μείωση της CETP (0’:2,76±0,79, 4ε:2,31±0,69, 16ε:2,52±0,62mg/l, p<0,001) και της PLTP (0’:9,01±2,44, 4ε:8,34±2,57, 16ε:8,19±2,29 mg/l, p<0,02). Τα επίπεδα των CETP και PLTP στις 4 εβδομάδες δεν σχετίσθηκαν με τις θερμίδες της δίαιτας, ούτε με τα επιμέρους θρεπτικά συστατικά της. Η μείωση των CETP και PLTP και στα 2 χρονικά στιγμιότυπα, σχετίσθηκε θετικά με τη μείωση των δεικτών παχυσαρκίας, όχι όμως με τη μείωση των παραμέτρων ινσουλινοαντίστασης. Τα επίπεδα των PLTP και CETP σχετίσθηκαν μεταξύ τους θετικά μόνο στις παχύσαρκες, στο χρόνο 0΄ (r=0,43, p=0,004) και στο χρόνο 16 εβδομάδες (r=0,44, p=0,04), ενώ σχετίσθηκαν θετικά και οι μεταβολές τους, μόνο όμως κατά την αρχική φάση της απώλειας βάρους στις 4 εβδομάδες (r=0,47, p=0,003). Τα υποκλάσματα των HDL2 μειώθηκαν σημαντικά στο χρόνο 4ε (p<0,05) ενώ τα υποκλάσματα των HDL3 αυξήθηκαν στο χρόνο 16ε σε σχέση με τα αρχικά ποσοστά (p=0,05). Ο λόγος HDL2/HDL3 παρουσίασε μία αρχική μείωση στο χρόνο 4ε (p=0,003), αλλά επανήλθε σε επίπεδα παρόμοια με τα αρχικά στο τέλος της μελέτης. Συμπεράσματα. Οι παχύσαρκες γυναίκες παρουσιάζουν υψηλότερα επίπεδα PLTP σε σχέση με τις φυσιολογικού βάρους. Η ολιγοθερμιδική δίαιτα και η επακόλουθη απώλεια βάρους κατά 10% στο τέλος της τετράμηνης παρέμβασης, μείωσε σημαντικά τα επίπεδα πλάσματος των CETP και PLTP, τα οποία συσχετίσθηκαν σημαντικά μεταξύ τους. Η συσχέτιση αυτή συνηγορεί υπέρ της ταυτόχρονης παραγωγής των πρωτεϊνών αυτών από τον υπερτροφικό λιπώδη ιστό των παχύσαρκων γυναικών. Οι παρατηρούμενες μεταβολές των υποκλασμάτων των HDL υποδηλώνουν ότι, και στις δύο φάσεις της εφαρμοσθείσας δίαιτας και απώλειας βάρους, το μέγεθος των HDL επηρεάζεται περισσότερο από τις μεταβολές της PLTP συγκριτικά με τις μεταβολές της CETP. Η απώλεια βάρους, έστω και μικρού βαθμού, αποτελεί το μοναδικό ίσως δόκιμο τρόπο ταυτόχρονης ελάττωσης των CETP και PLTP πλάσματος, οι οποίοι θεωρούνται αναδυόμενοι παράγοντες κινδύνου για αθηρωμάτωση

Plasma phospholipid transfer protein (PLTP): review of an emerging cardiometabolic risk factor

International audiencePlasma phospholipid transfer protein (PLTP) is a lipid transfer glycoprotein that binds to and transfers a number of amphipathic compounds. In earlier studies, the attention of the scientific community focused on the positive role of PLTP in high-density lipoprotein (HDL) metabolism. However, this potentially antiatherogenic role of PLTP has been challenged recently by another picture: PLTP arose as a pro-atherogenic factor through its ability to increase the production of apolipoprotein B-containing lipoproteins, to decrease their antioxidative protection and to trigger inflammation. In humans, PLTP has mostly been studied in patients with cardiometabolic disorders. Both PLTP and related cholesteryl ester transfer protein (CETP) are secreted proteins, and adipose tissue is an important contributor to the systemic pools of these two proteins. Coincidently, high levels of PLTP and CETP have been found in the plasma of obese patients. PLTP activity and mass have been reported to be abnormally elevated in type 2 diabetes mellitus (T2DM) and insulin-resistant states, and this elevation is frequently associated with hypertriglyceridemia and obesity. This review article presents the state of knowledge on the implication of PLTP in lipoprotein metabolism, on its atherogenic potential, and the complexity of its implication in obesity, insulin resistance and T2DM

Prevalence and geographic variation of abdominal obesity in 7- and 9-year-old children in Greece; World Health Organization Childhood Obesity Surveillance Initiative 2010

Abstract Background In children, abdominal obesity is a better predictor of the presence of cardiovascular risk factors than body mass index (BMI)-defined obesity. We aimed to evaluate the prevalence of abdominal obesity in the Greek pediatric population and to assess the impact of residence on the prevalence of both BMI-defined and abdominal obesity. Methods In the context of the Childhood Obesity Surveillance Initiative of the World Health Organization (WHO) Regional Office for Europe, a national representative sample of 7.0–7.9 and 9.0–9.9-year-old children was evaluated (n = 2,531 and 2,700, respectively). Overweight and obesity according to BMI were estimated using both the WHO and International Obesity Task Force cut-off points. Abdominal obesity was defined as waist circumference/height ratio >0.5. Results The prevalence of abdominal obesity did not differ between 7-year-old boys and girls (25.2 and 25.3%, respectively; p = NS). Among 9-year-old children, abdominal obesity was more prevalent in boys than in girls (33.2 and 28.2%, respectively; p = 0.005). Among normal weight and overweight children, the prevalence of abdominal obesity was 1.6–6.8 and 21.8–49.1%, respectively. The prevalence of abdominal and BMI-defined obesity did not differ between children living in the mainland, in Crete and in other islands except in 7-year-old girls, where the prevalence of BMI-defined obesity was highest in those living in Crete, intermediate in those living in other islands and lowest in those living in the mainland. In 9-year-old boys and in 7- and 9-year-old girls, the prevalence of abdominal obesity was highest in children living in Athens and lowest in children living in Thessaloniki, whereas children living in other cities and in villages showed intermediate rates. The prevalence of abdominal obesity in 7-year-old boys and the prevalence of BMI-defined obesity did not differ between children living in cities and villages. Conclusions The prevalence of pediatric abdominal obesity in Greece is among the highest worldwide. Boys and children living in the capital are at higher risk for becoming obese. Given that abdominal obesity is more prevalent than BMI-defined obesity and appears to be more sensitive in identifying cardiovascular risk, measurement of waist circumference might have to be incorporated in the screening for childhood obesity