a MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.
b Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden.
Glob Health Action. 2018;11(sup2):1549436. doi: 10.1080/16549716.2018.1549436.
Despite increasing obesity in South African adults, data on the prevalence and determinants of body mass index (BMI) from rural communities, home to a significant proportion of the population, are scarce.
To investigate overall and sex-specific determinants of BMI in a rural adult South African population undergoing rapid social and epidemiological transitions.
Baseline cross-sectional demographic, socioeconomic, anthropometric, clinical and behavioural data were collected between 2015 and 2016 from 1388 individuals aged 40-60 years and resident in the Agincourt sub-district of Mpumalanga province, a setting typical of rural northeast South Africa. A Health and Socio-Demographic Surveillance System (HDSS) underpins the sub-district and contributes to the Africa Wits-INDEPTH partnership for Genomic Studies (AWI-Gen). Linear regression was used to investigate univariate associations between log-transformed BMI and individual variables and multiple linear regression was used to investigate independent predictors of BMI overall and in sex-stratified analyses.
Median BMI was significantly higher in females (28.7 kg/m[95% CI 24.2-33.2] vs 23.0 kg/m[95% CI 20.3-26.8];p < 0.001) with male sex associated with 17% lower BMI. In sex-stratified multiple linear regression models, compared to those never married, BMI was 7% higher in currently married males and 6% in currently married females. Current smoking in men and former smoking in women were associated with reductions in BMI of 13% and 26% respectively, compared with non-smokers. Higher educational attainment in women and higher socioeconomic status in men were both associated with higher BMI, while being HIV-positive and alcohol consumption in women were associated lower BMI.
Female sex strongly predicts higher BMI in this rural African population. While some predictors of higher BMI differ by sex, married individuals in both sexes had a higher BMI, suggesting that, in addition to developing sex-specific interventions to combat overweight and obesity, targeting married couples may result in reduction in population BMI.
尽管南非成年人的肥胖率不断上升，但农村社区（居住着该国很大一部分人口）的体重指数（BMI）流行情况和决定因素的数据却很少。
在一个经历快速社会和流行病学转变的农村南非成年人中，研究 BMI 的总体和性别特异性决定因素。
2015 年至 2016 年期间，从居住在南非姆普马兰加省阿格因库尔次区域的 1388 名年龄在 40-60 岁之间的个体中收集了基线横断面人口统计学、社会经济、人体测量学、临床和行为数据。该次区域以非洲威特沃特斯兰德大学-深入发展人群健康研究（AWI-Gen）合作的非洲健康和社会人口监测系统（HDSS）为基础，为该系统做出了贡献。使用线性回归来研究 BMI 与个体变量之间的单变量关联，使用多元线性回归来研究 BMI 的总体和性别分层分析中的独立预测因子。
女性的 BMI 中位数明显较高（28.7 kg/m[95%置信区间 24.2-33.2]比 23.0 kg/m[95%置信区间 20.3-26.8]；p<0.001），男性的 BMI 较低，低 17%。在性别分层的多元线性回归模型中，与从未结婚的人相比，目前已婚的男性 BMI 高 7%，目前已婚的女性 BMI 高 6%。与不吸烟者相比，男性目前吸烟和女性以前吸烟的 BMI 分别降低了 13%和 26%。女性受教育程度较高和男性社会经济地位较高都与 BMI 较高有关，而女性 HIV 阳性和饮酒与 BMI 较低有关。
在这个农村非洲人群中，女性的性别强烈预测 BMI 较高。虽然一些 BMI 较高的预测因素因性别而异，但两性中已婚的人 BMI 较高，这表明，除了制定针对特定性别的干预措施来对抗超重和肥胖外，针对已婚夫妇可能会导致人群 BMI 的降低。
