The prevalence of overweight and obesity among the population was 28.2% and 43.8%, respectively. In a multivariate regression, abdominal overweight and obesity were associated with gender, ethnic group, and smoking (p < 0.05). Abdominal obesity (obesity by waist-hip-ratio (WHR)) was positively associated with female gender (OR 43.64, 95%CI 13.15 - 144.86) and negatively associated with smokers and people in ethnic groups other than Kinh and Tay.
Trang 1PREVALENCE AND RELATED FACTORS OF OVERWEIGHT AND OBESE OLDER ADULTS IN TWO COMMUNES
IN THE NORTHERN MOUNTAINOUS REGION OF VIETNAM
Vo Hoang Long, Bui Van Nhon, Nguyen Si Anh Hao, Tran Minh Hien, Bui Van Tung, Vu Đang Khoi, Pham Van Quyet, Nguyen Hoang Nguyen, Nguyen Thi Lien
Hanoi Medical University, Vietnam
A cross-sectional study was conducted on 354 people aged ≥ 60 in two communes in Chiem Hoa district, Vietnam to describe the prevalence and various factors associated with being overweight or obese A major-ity of the population (n = 218, 61.6%) was female The median age was 67, with 60.4% of the population between 60 - 69 years old More than two-thirds were of the Tay ethnic group Agriculture was the main oc-cupation (88.4%) Half of the population had only primary education The prevalence of overweight and obe-sity among the population was 28.2% and 43.8%, respectively In a multivariate regression, abdominal over-weight and obesity were associated with gender, ethnic group, and smoking (p < 0.05) Abdominal obesity (obesity by waisthipratio (WHR)) was positively associated with female gender (OR 43.64, 95%CI 13.15 -144.86) and negatively associated with smokers and people in ethnic groups other than Kinh and Tay
Keywords: overweight; obesity; older adults; Vietnam Northern Mountainous region
Corresponding author: Vo Hoang Long, Hanoi Medical
University
Email: vohoanglonghmu@gmail.com
Received: 08/3/2018
Accepted: 05/11/2018
I INTRODUCTION
Overweight and obesity have been
increas-ing rapidly in many countries around the world,
including Vietnam According to the World
Health Organization (WHO), overweight and
obesity are defined as abnormal or excessive
fat accumulation that may impair health [1]
The figures for overweight and obesity
world-wide were over 1.9 billion people and over
650 million people, respectively In America,
the prevalence of obesity in men and women
aged above 65 years increased to 40.5% and
40.3% respectively between 1990 and 2010
[2] The Malaysian Health and Disease Survey
2011 reported the prevalence of overweight and obesity in the population was 29.4% and 15.1% respectively, while Thailand was one of the countries with the highest prevalence of obesity in the world (33% in men and 43% in women) in the past two decades alone [3]
In Vietnam, overweight and obesity among older adults accounted for approximately 25%
of the population [4] The Vietnam National Institute of Nutrition reported that the propor-tion of obesity increases with age and that two -thirds of the overweight population is aged over 45 years [4] Although individuals with obesity are evaluated according to their body mass index (BMI), many previous studies have reported that body fat distribution is the direct cause of morbidity and mortality Hence, abdominal obesity (obesity by the waist-hip-ratio (WHR)) is more closely related to risk of
Trang 2morbidity and death than gluteofemoral
obe-sity WHR as an indicator of abdominal obesity
may better predict risk for severe diseases
than BMI, including heart disease, diabetes
mellitus type 2, and Metabolic Syndrome [5]
WHR is also used to diagnose overweight and
obesity WHR is calculated as waist
circumfer-ence divided by hip circumfercircumfer-ence
Kim Binh and Xuan Quang are two
moun-tainous communes in northern Vietnam,
lo-cated in Chiem Hoa district in Tuyen Quang
province Overweight and obesity has not
been studied by WHR in this area, especially
in the elderly population aged ≥ 60 years The
provision of information on overweight and
obesity in the elderly in these two communes
is necessary to suggest appropriate
interven-tions and counseling Therefore, this study
aims to describe the prevalence and related
factors of overweight and obesity by WHR
among older adults in two northern
mountain-ous communes in the Tuyen Quang province
of Vietnam
II METHODS
1 Study design and setting
We conducted a cross-sectional study in
two communes (Kim Binh and Xuan Quang) in
Chiem Hoa district, Tuyen Quang province
People aged 60 or older residing in these two
communes were enrolled
2 Sample size
The sample size of the study was
calcu-lated according to the following formula
In which:
n is sample size;
p is the expected proportion of overweight and obesity among people aged 60 and older (estimated p = 0.5);
ε: is the margin of error; α is the level of statistical significance (to obtain a 95% confi-dence interval of the proportion, the α is set at 0.05, thus Z is 1.96) To estimate a proportion
of 0.5 with a margin of error of 0.11, the small-est sample size needed is 317 A total of 354 subjects were included in the study A simple random sampling technique was utilized to ensure the representation of older adults living
in these communes In the first stage of sam-pling, all the resident aged 60 and older living
in Kim Binh and Xuan Quang communes were listed The second stage consisted of selecting
354 objects randomly from a list of the elderly
In the third stage, the appointment invitations were sent for medical examination and data collection
3 Data Collection
We collected the data through face-to-face interviews using a structured questionnaire, which included four main parts: personal char-acteristics, physical activity, smoking and alco-hol drinking For overweight and obesity, we measured waist circumference and hip circum-ference
4 Measures and Instruments
4.1 Personal Characteristics
Information regarding gender (male and female), age (60 - 69, 70 - 79, ≥ 80), ethnicity (Kinh, Tay, others), occupation (farmer and others) and education (none, primary, lower
n = Z2(1- α/2)
(p.(1 - p)
(p.ε)2
Trang 3secondary and upper secondary and higher)
was collected
Physical Activity
We used the International Physical Activity
Questionnaire (IPAQ) to measure physical
activity The individuals were considered
capa-ble of physical activity if they reported
partici-pation in moderate-intensity physical activity
and vigorous-intensity physical activity for at
least 60 minutes for 7 days per week
Smoking and Alcohol Use
The status of current smoking or drinking
was reported
Overweight and Obesity
Measurement of waist circumference, hip
circumference: Stand up straight and breathe
out Use a tape measure to check the distance
around the smallest part of the waist, just
above the belly button (waist circumference)
Then measure the distance around the largest
part of the hips to the widest part of the
but-tocks (hip circumference)
Overweight and obesity: WHR was
calcu-lated as waist measurement divided by hip
measurement (same unit of measurement) (i)
0.90 ≤ WHR < 1.00 among men and 0.80 ≤
WHR < 0.85 among women were classified as overweight (ii) Men with WHR ≥ 1.00 and women with WHR ≥ 0.85 were classified as having abdominal obesity (obesity by WHR) (iii) The individuals were classified as normal for men with a WHR < 0.90 and women with a WHR < 0.80 [6; 7] Hence, the subjects with criteria (i) and (ii) were considered as abdomi-nal overweight and obesity
5 Data Analysis
Data entry was performed by Epidata 3.1 (EpiData Association) After data cleaning, statistical analyses were performed using Stata 12.0 (StataCorp) Qualitative variables were described in percentage, and quantita-tive variables were described in mean (standard deviation) and median (min–max) where appropriate Multivariate logistic regres-sion was used to examine the factors
associ-ated with overweight and obesity A p-value of
< 0.05 was considered statistically significant
6 Research ethics
All subjects received an explanation about the purpose of the study Personal information
of the subjects was kept confidential and coded Individuals with overweight or obesity were provided with consultation
III RESULTS
Table 1 Personal characteristics of the research subjects (n = 354)
Gender
Age Group
Trang 4Characteristics n % Age Group
Ethnic Group
Job
Education
*Others: Muong and Nung ethnic;
**Others: Officials, workers, retirees and freelance occupation
was 61.6% The figure for the elderly aged 60 to 69 years was the highest, at 60.4% The Tay ethnic groups constituted 68.9% of the elderly The main occupation was agriculture (88.4%) The figure for older adults with primary education was the highest, at 50.3%
Figure 1 The prevalence of overweight and obesity in the elderly (n = 354)
Trang 5Associated factors Overweight and obesity (n,%) Multivariate
As shown in Figure 1, the prevalence of abdominal obesity among older adults was the high-est, at 43.8% The figures for overweight and normal were 28.2% and 28.0% respectively The figure for average WHR was 0.89 ± 0.07
Table 2 Factors associated with prevalence of overweight and obesity
by WHR in the elderly (n = 354)
*: The significance level was set at p < 0.05; OR: Odds ratio; CI: Confidence interval
Table 2 shows association with the overall prevalence of overweight and obesity The odds ratio of overweight and obesity among women was higher than among men (ORs: 4.60) The odds of overweight and obesity among older adults smoking was less than that of non-smokers (ORs: 0.38) These factors were statistically significant
Trang 6Table 3 Factors associated with prevalence of abdominal obesity in
the elderly (n = 354)
Associated factors Abdominal obesity (n,%) Multivariate
*: The significance level was set at p < 0.05; OR: Odds ratio; CI: Confidence interval
Table 3 shows the association with the prevalence of abdominal obesity among older adults The odds ratio of abdominal obesity among women was higher than that among men (ORs: 43.64) The odds of abdominal obesity among others ethnic groups was less than that for Kinh ethnic group (ORs: 0.35) These factors were statistically significant
Trang 7IV DISCUSSION
This is the first study to assess the
preva-lence of overweight and obesity by WHR
among older adults in two communes of the
northern mountainous areas in Vietnam The
obesity was the highest, at 43.8%, while the
figures for overweight and normal people were
similar (28.2% and 28.0% respectively) The
overall prevalence of overweight and obesity
in our study (72.0%) was much higher
com-pared to the figure in Mo Cay Bac district of
Ben Tre province (28.2%) [8] The obesity
classification between BMI and WHR might
contribute to this difference The explanation
for this may be due to the fact that more than
three quarters of the elderly adult population
belongs to an ethnic minority with an
agricul-tural job The proportion of the elderly with
primary school education was the highest, at
50.3% In particular, Kim Binh and Xuan
Quang are two poor communes in the
north-ern mountainous area, therefore, awareness
of the locals is not only low but access to
health care services for them is also difficult
obesity among women was significantly higher
than among men, at 68.4% and 4.4%
respec-tively The figures for a study among an Indian
population were about 12% in men and 68% in
women [9] Our result was also consistent with
a study among a Malaysian population which
found a higher prevalence of abdominal
obesity among female respondents, at 6.2% in
males and 54.2% in females [10]
In general, the overall prevalence of
over-weight and obesity has been found to be
significantly higher among women than among
men This result was consistent with the
find-ings among Malaysian and Indian populations [9; 10] The prevalence of overweight and obe-sity in older adults who smoke was less than that of non-smokers This may be explained because smoking is associated with lower weight and smoking cessation is associated with weight gain [11; 12] Reductions in smok-ing prevalence have been suggested as one
of the factors associated with an increase in obesity [11; 12] There is a statistically signifi-cant impact of the above factors on the overall prevalence of overweight and obesity among
Particularly, factors associated with ab-dominal obesity in the elderly, including gen-der, ethnic group and smoking were statisti-cally significant The prevalence of abdominal obesity was higher among women than among men The prevalence of abdominal obesity of other ethnic groups including Muong and Nung was 0.35 times less than that of Kinh ethnic group The explanation for this may be becaause the customs and the habits between Kinh and ethnic minorities are different A report of the Vietnam Committee on Ethnic Minority Affairs showed the general poverty concentrated on ethnic majorities such as Muong and Nung, hence the malnutrition rate among Tay and Muong people remains high even in recent years Hence, the prevalence of non-communicable disease among these ethnic majorities are much less than that of the Kinh ethnic group [13] The prevalence of abdominal obesity in older adults who smoke
is less than that of non-smokers This is con-sistent with the results of a study in the United States that the probability of abdominal obesity in nonsmokers was higher than that in smokers [14] A study from data of the 2002 Swiss Health Survey indicated that
Trang 8ex-smokers had higher ORs of being overweight
or obese with respect to non-smokers [15] A
national survey in Brazil found a higher
preva-lence of abdominal obesity in adolescents who
smoke than in nonsmokers [16] It is likely that
these studies are conducted on the working
age population and the prevalence of
over-weight and obesity is based on BMI, while our
findings only focus on overweight and obesity
by WHR in the elderly aged 60 and older
This is the first study in an area of
this study has some limitations which should
be considered while interpreting the results
The survey used a cross-sectional design,
which prevented any interpretation about the
causal relationship Sample size in this study
is representative of two communes in this area
only
V CONCLUSION
Using the WHR for abdominal overweight
and obesity, our findings highlight a
remarka-bly high overall prevalence of abdominal
over-weight and obesity among the population aged
above 60 years The prevalence of abdominal
obesity is significantly higher among women
than among men Gender, ethnic group and
smoking are known as factors which are
asso-ciated with abdominal overweight and obesity
We suggest that the local authorities of the
two communes should transmit messages
(electronic and print media) related to
over-weight and obesity to the entire population of
older adults, not only to broadcast media such
as radio, the internet and television but also to
print media such as papers, magazines,
leaf-lets and wall posters Regular health
examina-tion for all older adults should be organized for
timely prevention and treatment of overweight
sug-gest that there is a need for further research in other areas among older adults in Vietnam
ACKNOWLEDGMENTS
The authors would like to thank the Hanoi Medical University and Hospital for recom-mending the physicians who examined the patients in this study, especially the elderly in the two communes of Kim Binh and Xuan Quang who participated in this study
REFERENCES
1 World Health Organization (2014)
Global strategy on diet, physical activity and health
2 Fakhouri TH, Ogden CL, Carroll MD, Kit BK, Flegal KM (2012) Prevalence of
obe-sity among older adults in the United States,
2007 - 2010: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics
3 Teerawattananon Y., Luz A (2017)
Obesity in Thailand and its economic cost esti-mation ADBI Working Paper Series
4 Viện Dinh Dưỡng Quốc Gia (2017)
Kết quả điều tra thừa cân - béo phì và một số yếu tố liên quan ở người Việt Nam 25 - 64 tuổi
5 Price GM, Uauy R, Breeze E, Bulpitt
CJ, Fletcher AE (2006) Weight, shape, and
mortality risk in older persons: elevated waist-hip ratio, not high body mass index, is
associ-ated with a greater risk of death The Ameri-can journal of clinical nutrition, 84(2), 449 - 60
6 World Health Organization (2000)
Obesity: preventing and managing the global epidemic: World Health Organization
Trang 97 Australia HW (1995) A National
Obe-sity Strategy Australian Society for the Study
of Obesity
8 Hà Thị Ninh, Lê Hoàng Ninh, Nguyễn
Thị Kim Tiến (2014) Suy dinh dưỡng ở
người cao tuổi tại huyện Mỏ Cày Bắc tỉnh Bến
Tre năm 2011 Tạp chí nghiên cứu Y học Hồ
Chí Minh, 18(6)
9 Kurpad SS, Tandon H, Srinivasan K
(2003) Waist circumference correlates better
with body mass index than waist-to-hip ratio in
Asian Indians The National medical journal of
India, 16(4),189 - 192
10 Ahmad N, Adam SI, Nawi AM,
Has-san MR, Ghazi HF (2016) Abdominal Obesity
Indicators: Waist Circumference or Waist-to-hip
Ratio in Malaysian Adults Population
Interna-tional journal of preventive medicine, 7, 82
11 Albanes D, Jones DY, Micozzi MS,
Mattson ME (1987) Associations between
smoking and body weight in the US
popula-tion: analysis of NHANES II American journal
of public health, 77(4), 439 - 444
12 Flegal KM, Troiano RP, Pamuk ER, Kuczmarski RJ, Campbell SM (1995) The
influence of smoking cessation on the
preva-lence of overweight in the United States The New England journal of medicine, 333(18),
1165 - 1170
13 Hai-Anh Dang (2012) Vietnam: A
widening poverty gap for ethnic minorities
14 Flegal KM (2007) The effects of
changes in smoking prevalence on obesity
prevalence in the United States American journal of public health, 97(8), 1510 - 1514
15 Chiolero A, Jacot‐Sadowski I, Faeh
D, Paccaud F, Cornuz J (2007) Association
of cigarettes smoked daily with obesity in a
general adult population Obesity J, 15(5),
1311 - 1318
16 Bertoni N, de Almeida LM, Szklo M, Figueiredo VC, Szklo AS (2018) Assessing
the relationship between smoking and abdomi-nal obesity in a Natioabdomi-nal Survey of
Adoles-cents in Brazil Preventive medicine, 111,
1 - 5