University of Leeds, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds LS2 9JT, UK.
J Nutr. 2010 Feb;140(2):366-70. doi: 10.3945/jn.109.114207. Epub 2009 Dec 23.
More research is needed on the socio-environmental determinants of obesity in lower- and middle-income countries. We used generalized estimating equations to evaluate the cross-sectional effect of urban residence and multiple individual-level indicators of socioeconomic status (SES) on the odds of overweight or central adiposity in a birth cohort of young adult (mean age 21.5 y) Filipino males (n = 987) and females (n = 819) enrolled in the Cebu Longitudinal Health and Nutrition Survey. Overweight was defined as BMI >/=25 kg/m(2) and central adiposity was defined as a waist circumference >85 cm for males or >80 cm for females. Community-level urbanicity was measured on a continuous scale. Multiple indicators of SES included assets, income, education, and marital status. In the final multivariable models, assets and being married were positively related to overweight and central adiposity in males (P < 0.05), but being married was the only predictor of these outcomes in females. However, once the modifying effects of urban residence were accounted for, assets were positively related to overweight and central adiposity among the most rural women, but not in more urban women. Our results are consistent with a growing body of literature that suggests the relationship between SES and obesity is positive in lower-income contexts and inverse in higher-income contexts, particularly in females. The pattern of relationships we observed suggests that as the Philippines continues to develop economically, the public health impact of obesity will increase similarly to what has been observed in countries further along in their economic transition.
需要更多研究来探索社会环境因素对中低收入国家肥胖的影响。我们使用广义估计方程评估了城市居住和多个个体社会经济地位(SES)指标对菲律宾青年男性(n = 987)和女性(n = 819)队列中超重或中心性肥胖的横断面影响。超重定义为 BMI>/=25 kg/m(2),中心性肥胖定义为男性腰围>/=85 cm 或女性腰围>/=80 cm。社区层面的城市化程度用连续尺度衡量。SES 的多个指标包括资产、收入、教育和婚姻状况。在最终的多变量模型中,资产和已婚状况与男性的超重和中心性肥胖呈正相关(P < 0.05),但已婚状况是女性这些结果的唯一预测因素。然而,一旦考虑到城市居住的调节作用,资产与最农村女性的超重和中心性肥胖呈正相关,但与更城市化女性的超重和中心性肥胖无关。我们的结果与越来越多的文献一致,这些文献表明 SES 与肥胖之间的关系在低收入环境中是正相关的,而在高收入环境中是负相关的,尤其是在女性中。我们观察到的关系模式表明,随着菲律宾经济的持续发展,肥胖对公共卫生的影响将类似于经济转型过程中更先进国家所观察到的那样增加。