Sathish Thirunavukkarasu, Kannan Srinivasan, Sarma Sankara P, Razum Oliver, Sauzet Odile, Thankappan Kavumpurathu Raman
Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
PLoS One. 2017 Jun 9;12(6):e0178949. doi: 10.1371/journal.pone.0178949. eCollection 2017.
Nearly three-quarters of global deaths from non-communicable diseases (NCDs) occur in low- and middle-income countries such as India. However, there are few data available on longitudinal change in risk factors for NCDs in India. We conducted a cohort study among 495 individuals (aged 15 to 64 years at baseline) in rural Kerala state, India, from 2003 to 2010. For the present analysis, data from 410 adults (aged 20 to 64 years at baseline) who participated at both baseline and follow-up studies were analyzed. We used the World Health Organization STEPwise approach to risk factor surveillance for data collection. Age-adjusted change in risk factors for NCDs was assessed using the mixed-effects linear regression for continuous variables and the generalized estimating equation for categorical variables. The mean age of participants at baseline was 41.6 years, and 53.9% were women. The mean follow-up period was 7.1 years. There were significant increases in weight (mean change +5.0 kg, 95% confidence interval [CI] 4.2 to 5.8), body mass index (mean change +1.8 kg/m2, 95% CI 1.5 to 2.1), waist circumference (mean change +3.9 cm, 95% CI 3.0 to 4.8), waist-to-height ratio (mean change +0.022, 95% CI 0.016 to 0.027), current smokeless tobacco use (men: odds ratio [OR] 1.6, 95% CI 1.1 to 2.2), alcohol use (men: OR 2.6, 95% CI 1.9 to 3.5; women: OR 4.8, 95% CI 1.8 to 12.6), physical inactivity (OR 2.0, 95% CI 1.3 to 3.0), obesity (OR 2.2, 95% CI 1.7 to 2.8), and central obesity (OR 1.9, 95% CI 1.5 to 2.3). Over a seven-year period, several NCD risk factors have increased in the study cohort. This calls for implementation of lifestyle intervention programs in rural Kerala.
全球近四分之三的非传染性疾病（NCD）死亡发生在印度等低收入和中等收入国家。然而，关于印度非传染性疾病风险因素的纵向变化，可用数据很少。我们于2003年至2010年在印度喀拉拉邦农村地区对495名个体（基线年龄为15至64岁）进行了一项队列研究。对于本次分析，我们分析了410名在基线和随访研究中均参与的成年人（基线年龄为20至64岁）的数据。我们使用世界卫生组织的逐步风险因素监测方法进行数据收集。使用连续变量的混合效应线性回归和分类变量的广义估计方程评估非传染性疾病风险因素的年龄调整变化。参与者在基线时的平均年龄为41.6岁，53.9%为女性。平均随访期为7.1年。体重（平均变化+5.0千克，95%置信区间[CI]4.2至5.8）、体重指数（平均变化+1.8千克/平方米，95%CI1.5至2.1）、腰围（平均变化+3.9厘米，95%CI3.0至4.8）、腰高比（平均变化+0.022，95%CI0.016至0.027）、当前无烟烟草使用（男性：比值比[OR]1.6，95%CI1.1至2.2）、饮酒（男性：OR2.6，95%CI1.9至3.5；女性：OR4.8，95%CI1.8至12.6）、身体活动不足（OR2.0，95%CI1.3至3.0）、肥胖（OR2.2，95%CI1.7至2.8）和中心性肥胖（OR1.9，95%CI1.5至2.3）均有显著增加。在七年时间里，研究队列中的几种非传染性疾病风险因素有所增加。这就要求在喀拉拉邦农村地区实施生活方式干预项目。
