Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
Eur J Clin Nutr. 2020 Mar;74(3):472-480. doi: 10.1038/s41430-019-0479-9. Epub 2019 Aug 5.
BACKGROUND/OBJECTIVES: Previous studies about obesity and its associated factors in low- and middle-income countries have been based mostly on women of reproductive age. Furthermore, disproportionally changing BMI distributions have been a challenge for its appropriate modeling. In this context, we assessed the magnitude and rate of change in BMI distribution by socioeconomic and geographic factors in both sexes in Latin American countries, modeling the shape of BMI distributions.
SUBJECTS/METHODS: We used data from national surveys conducted in Mexico, Colombia, and Peru at two time points between 2005 and 2013 (N = 57,414, 13,5403, and 30,811, respectively). We estimated shapes of BMI distributions for 2005 and 2010, and assessed their changes, using the generalized additive model for location, scale, and shape (GAMLSS), in which BMI was assumed to follow a Box-Cox Power Exponential (BCPE) distribution.
In all the three countries, higher education was negatively associated with BMI in women but somewhat positive in men; and household wealth was positively associated in men but not in women. Lower household wealth was associated with higher rates of change in BMI distributions in women.
Education and household wealth were associated with BMI distributions and their change over time. Observed sex differences in these associations have implications for designing relevant policies and programs to approach target populations effectively. The BCPE-GAMLSS method can provide a useful visual assessment of time-varying measures.
背景/目的:以往关于中低收入国家肥胖及其相关因素的研究主要基于育龄妇女。此外,BMI 分布的不成比例变化一直是对其进行适当建模的挑战。在这种情况下,我们评估了拉丁美洲国家中男女 BMI 分布随社会经济和地理因素的变化幅度和变化率,并对 BMI 分布的形状进行了建模。
对象/方法:我们使用了墨西哥、哥伦比亚和秘鲁在 2005 年至 2013 年期间进行的两次全国调查的数据(N=57414、135403 和 30811,分别)。我们使用广义加性模型(GAMLSS)对 2005 年和 2010 年的 BMI 分布形状进行了估计,并评估了其变化情况,其中 BMI 被假设为服从 Box-Cox 幂指数(BCPE)分布。
在所有三个国家中,高等教育与女性的 BMI 呈负相关,但对男性的 BMI 则呈正相关;家庭财富与男性的 BMI 呈正相关,但对女性的 BMI 则没有影响。较低的家庭财富与女性 BMI 分布变化率较高有关。
教育和家庭财富与 BMI 分布及其随时间的变化有关。这些关联在性别上的差异对设计相关政策和计划以有效针对目标人群具有重要意义。BCPE-GAMLSS 方法可以对时变措施进行有用的可视化评估。