School of Public Health, Taipei Medical University, No. 250, Wu-Hsing St, Taipei City, Taiwan.
NBS House Corner Chipembere Highway & Johnstone Roads, Ginnery Corner Blantyre, PO Box 32251, Chichiri Blantyre 3, Malawi.
Int Health. 2019 Nov 13;11(6):496-506. doi: 10.1093/inthealth/ihy093.
Overweight and obesity are well-known risk factors for non-communicable diseases such as cardiovascular disease, diabetes, some cancers and musculoskeletal disorders. In Malawi, the proportion of women who are overweight/obese has doubled, from 10% in 1992 to 21% in 2015-16. Therefore we aimed to explore the individual- and community-level factors associated with overweight and obesity among non-pregnant women of child-bearing age.
Secondary analysis of the 2015-16 Malawi Demographic and Health Survey was conducted. Overweight was defined as a body mass index (BMI) of 25 to <30 kg/m2, while obesity was defined as a BMI ≥30 kg/m2. Two-level multilevel multivariable logistic regression models were constructed using a logit-link function with a binomial distribution on 7326 women living in 850 different communities.
At the individual level, the adjusted multilevel regression results showed that women 15-19 y of age as well as women from the poorest households had reduced odds of being overweight/obese. However, women with white collar jobs and women who were affiliated with the Church of Central Africa Presbyterian and the Roman Catholic church had increased odds of being overweight/obese. At the community level, women from urban areas and women who resided in communities with a low percentage of media exposure had increased odds of being overweight or obese. While women from poor communities had reduced odds of being overweight and obese, the proportion change in variance showed that 56, 77 and 78% of total variations in the odds of overweight, obese and overweight/obese across the communities were explained by both individual- and community-level factors. The median odds ratio showed that the likelihood of maternal overweight, obese and overweight/obese increased by 63, 39 and 84% when the women moved from low- to high-risk neighbourhoods.
Older women, Christian women, women with white collar jobs and women from the richest households should be targeted during policy formulation. At the community level, media coverage should be spread evenly so that health awareness messages, consequences and means of overweight and obesity prevention are getting to the targeted women. Our study revealed evidence of clustering effects of overweight and obesity at the community level, hence neighbourhood variations with respect to maternal overweight and obesity should be taken into account when designing nutritional policies.
超重和肥胖是心血管疾病、糖尿病、某些癌症和肌肉骨骼疾病等非传染性疾病的已知危险因素。在马拉维，超重/肥胖妇女的比例从 1992 年的 10%增加到 2015-16 年的 21%。因此，我们旨在探讨与育龄非孕妇超重和肥胖相关的个体和社区层面因素。
对 2015-16 年马拉维人口与健康调查进行了二次分析。超重定义为体重指数（BMI）为 25 至<30kg/m2，肥胖定义为 BMI≥30kg/m2。使用二项分布的对数链接函数，对居住在 850 个不同社区的 7326 名妇女进行了两级多水平多变量逻辑回归模型构建。
在个体层面上，调整后的多水平回归结果显示，15-19 岁的妇女以及来自最贫困家庭的妇女超重/肥胖的可能性降低。然而，从事白领工作的妇女和隶属于中非长老会教堂和罗马天主教堂的妇女超重/肥胖的可能性增加。在社区层面上，来自城市地区的妇女和居住在媒体曝光率低的社区的妇女超重或肥胖的可能性增加。而来自贫困社区的妇女超重和肥胖的可能性降低，但比例变化表明，社区之间超重、肥胖和超重/肥胖的总变异的 56%、77%和 78%可以由个体和社区层面的因素来解释。中位数优势比表明，当妇女从低风险社区转移到高风险社区时，母亲超重、肥胖和超重/肥胖的可能性分别增加了 63%、39%和 84%。
应在制定政策时针对老年妇女、基督教妇女、白领妇女和最富裕家庭的妇女。在社区层面上，应均匀传播媒体报道，以便向目标妇女传播健康意识信息、超重和肥胖的后果以及预防措施。我们的研究揭示了超重和肥胖在社区层面的聚类效应的证据，因此在设计营养政策时应考虑到与母亲超重和肥胖有关的社区差异。
