Choy Courtney C, Hawley Nicola L, Naseri Take, Reupena Muagututi'a Sefuiva, McGarvey Stephen T
Department of Epidemiology and International Health Institute, Brown University School of Public Health, Providence, RI, 02903, USA.
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06510, USA.
SSM Popul Health. 2020 Feb 7;10:100556. doi: 10.1016/j.ssmph.2020.100556. eCollection 2020 Apr.
In low- and middle-income countries, earlier in economic development, obesity tends to be more prevalent in high socioeconomic resource groups compared to low. Later in development, the distribution of obesity tends to show the opposite pattern, becoming more prevalent in those with low socioeconomic resources. This shift in obesity prevalence tends to occur between a gross national income per capita (GNI) of US$1,000 to $4,000 dollars. Whether a similar pattern occurs in Pacific Island countries has not been well documented. In Samoa, the GNI rose to US$3,200 dollars in 2010 at which time over 80% of adults were overweight or obese. We aimed to understand the association of socioeconomic resources, assessed by household assets, with adult body mass index (BMI) and abdominal circumference (AC) in Samoa. Data were from a genome-wide association study for obesity among 3,370 Samoans aged 24.5-<65 years in 2010. Household asset scores were calculated based on ownership of consumer durables, housing construction, and access to basic services. Sex-stratified multivariate linear regressions were used to assess adiposity trait differences by household asset ownership, after controlling for age, education, and household urbanicity. Higher asset ownership was associated with higher BMI and AC and the positive relationship remained robust after controlling for potential confounders. Despite significant economic growth preceding the year 2010 in Samoa, the obesity burden had not shifted to low socioeconomic groups in a similar way that has been observed in countries further along in the economic transition. The mechanism by which socioeconomic resources influence adiposity is complex and may be particularly complicated in Samoa by migrant remittances received both as cash and household assets. Social and physical environments may constrain the positive health behavior change necessary to reduce obesity even in the context of high socioeconomic position, a situation that requires further investigation.
在低收入和中等收入国家，在经济发展的早期阶段，与社会经济资源较少的群体相比，肥胖在社会经济资源丰富的群体中往往更为普遍。在经济发展后期，肥胖的分布往往呈现相反的模式，在社会经济资源较少的人群中更为普遍。肥胖患病率的这种转变往往发生在人均国民总收入（GNI）为1000美元至4000美元之间。太平洋岛国是否也出现类似模式尚未有充分记录。在萨摩亚，2010年人均国民总收入升至3200美元，当时超过80%的成年人超重或肥胖。我们旨在了解在萨摩亚，以家庭资产评估的社会经济资源与成年人体重指数（BMI）和腹围（AC）之间的关联。数据来自2010年对3370名年龄在24.5至65岁以下的萨摩亚人进行的肥胖全基因组关联研究。家庭资产得分是根据耐用消费品的拥有情况、住房建设以及基本服务的获取情况计算得出的。在控制了年龄、教育程度和家庭城市化程度后，采用按性别分层的多元线性回归来评估家庭资产拥有情况对肥胖特征差异的影响。较高的资产拥有量与较高的BMI和AC相关，在控制了潜在混杂因素后，这种正相关关系仍然稳健。尽管萨摩亚在2010年前经济有显著增长，但肥胖负担并未像在经济转型更深入的国家那样以类似方式转移到社会经济地位较低的群体。社会经济资源影响肥胖的机制很复杂，在萨摩亚可能因以现金和家庭资产形式收到的移民汇款而变得尤为复杂。社会和物理环境可能会限制即使在社会经济地位较高的情况下减少肥胖所需的积极健康行为改变，这种情况需要进一步调查。
