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

Abstract Background 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. Methods 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. Results 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. Ahigher 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. Conclusions 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

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 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 obesity. Funding: UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union

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

Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants

Background Underweight and severe and morbid obesity are associated with highly elevated risks of adverse health outcomes. We estimated trends in mean body-mass index (BMI), which characterises its population distribution, and in the prevalences of a complete set of BMI categories for adults in all countries. Methods We analysed, with use of a consistent protocol, population-based studies that had measured height and weight in adults aged 18 years and older. We applied a Bayesian hierarchical model to these data to estimate trends from 1975 to 2014 in mean BMI and in the prevalences of BMI categories (<18.5 kg/m(2) [underweight], 18.5 kg/m(2) to <20 kg/m(2), 20 kg/m(2) to <25 kg/m(2), 25 kg/m(2) to <30 kg/m(2), 30 kg/m(2) to <35 kg/m(2), 35 kg/m(2) to <40 kg/m(2), = 40 kg/m(2) [morbid obesity]), by sex in 200 countries and territories, organised in 21 regions. We calculated the posterior probability of meeting the target of halting by 2025 the rise in obesity at its 2010 levels, if post-2000 trends continue. Findings We used 1698 population-based data sources, with more than 19.2 million adult participants (9.9 million men and 9.3 million women) in 186 of 200 countries for which estimates were made. Global age-standardised mean BMI increased from 21.7 kg/m(2) (95% credible interval 21.3-22.1) in 1975 to 24.2 kg/m(2) (24.0-24.4) in 2014 in men, and from 22.1 kg/m(2) (21.7-22.5) in 1975 to 24.4 kg/m(2) (24.2-24.6) in 2014 in women. Regional mean BMIs in 2014 for men ranged from 21.4 kg/m(2) in central Africa and south Asia to 29.2 kg/m(2) (28.6-29.8) in Polynesia and Micronesia; for women the range was from 21.8 kg/m(2) (21.4-22.3) in south Asia to 32.2 kg/m(2) (31.5-32.8) in Polynesia and Micronesia. Over these four decades, age-standardised global prevalence of underweight decreased from 13.8% (10.5-17.4) to 8.8% (7.4-10.3) in men and from 14.6% (11.6-17.9) to 9.7% (8.3-11.1) in women. South Asia had the highest prevalence of underweight in 2014, 23.4% (17.8-29.2) in men and 24.0% (18.9-29.3) in women. Age-standardised prevalence of obesity increased from 3.2% (2.4-4.1) in 1975 to 10.8% (9.7-12.0) in 2014 in men, and from 6.4% (5.1-7.8) to 14.9% (13.6-16.1) in women. 2.3% (2.0-2.7) of the world's men and 5.0% (4.4-5.6) of women were severely obese (ie, have BMI = 35 kg/m(2)). Globally, prevalence of morbid obesity was 0.64% (0.46-0.86) in men and 1.6% (1.3-1.9) in women. Interpretation If post-2000 trends continue, the probability of meeting the global obesity target is virtually zero. Rather, if these trends continue, by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women; severe obesity will surpass 6% in men and 9% in women. Nonetheless, underweight remains prevalent in the world's poorest regions, especially in south Asia.Wellcome Trust, Grand Challenges Canada

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