Janjua Naveed Zafar, Mahmood Bushra, Bhatti Junaid A, Khan M Imran
British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
PLoS One. 2015 Apr 2;10(4):e0122314. doi: 10.1371/journal.pone.0122314. eCollection 2015.
Similar to other developing countries, Pakistan is going through a rapid nutrition transition where shift from underweight to overweight and obesity is occurring. In this paper, we report on the relationship of household socioeconomic position (SEP), community SEP and urbanicity with under- and over-weight categories of BMI among Pakistani women.
We analyzed data on 4,767 women ages 15-49 years enrolled in a nationally representative Pakistan Demographic Health Survey (PDHS) conducted in 2012-13 that employed a multistage, stratified cluster sampling design. We assessed the association of urbanicity, household and community SEP derived from household assets and utilities, with categories of body mass index (BMI) using multinomial regression analysis where normal weight (BMI 18.6-22.5) was the reference category.
Thirteen percent of women were underweight (BMI <18.5), 15% pre-overweight (BMI: 22.6-24.9), 25% overweight (BMI: 25.0-29.9) and 14% were obese (BMI≥30). Pre-overweight, overweight and obesity among women increased across household wealth quintiles (HWQs) in a graded fashion whereas there was no significant difference in underweight by household wealth. Women in urban areas were more likely to be obese. There was a pronounced increase in adjusted odds ratios (aORs) for overweight/obesity across HWQs within urban areas compared to rural areas. There was a steeper gradient in aORs for obesity from 1st to 5th HWQs in high income communities compared to the middle- and low income communities. In community-level analyses, communities in urban areas were more likely to have higher levels of obesity while in rural areas, especially in Sindh, more communities were more likely to have a higher level of underweight.
A shift to higher overweight and obesity than underweight in Pakistan is associated with high household and community wealth as well as living in urban areas. Clustering of obesity and underweight in distinct communities afford opportunity for tailored intervention programs.
与其他发展中国家类似，巴基斯坦正在经历快速的营养转型，即从体重不足转向超重和肥胖。在本文中，我们报告了巴基斯坦女性家庭社会经济地位（SEP）、社区SEP和城市化程度与体重指数（BMI）的体重不足和超重类别之间的关系。
我们分析了2012 - 13年进行的具有全国代表性的巴基斯坦人口健康调查（PDHS）中4767名15 - 49岁女性的数据，该调查采用多阶段分层整群抽样设计。我们使用多项回归分析评估城市化程度、源自家庭资产和设施的家庭及社区SEP与体重指数（BMI）类别之间的关联，其中正常体重（BMI 18.6 - 22.5）为参照类别。
13%的女性体重不足（BMI <18.5），15%为超重前期（BMI：22.6 - 24.9），25%超重（BMI：25.0 - 29.9），14%肥胖（BMI≥30）。女性中超重前期、超重和肥胖在家庭财富五分位数（HWQ）中呈梯度增加，而体重不足在家庭财富方面无显著差异。城市地区的女性更易肥胖。与农村地区相比，城市地区超重/肥胖的调整比值比（aOR）在各HWQ中有明显增加。与中低收入社区相比，高收入社区肥胖的aOR从第1个HWQ到第5个HWQ梯度更陡。在社区层面分析中，城市地区的社区更易有较高肥胖水平，而在农村地区，尤其是信德省，更多社区更易有较高体重不足水平。
在巴基斯坦，超重和肥胖高于体重不足的转变与高家庭和社区财富以及居住在城市地区有关。肥胖和体重不足在不同社区的聚集为量身定制的干预项目提供了机会。
