RESUMO
BACKGROUND: Education and wealth may have different associations with female obesity but this has not been investigated in detail outside high-income countries. This study examines the separate and inter-related associations of education and household wealth in relation to obesity in women in a representative sample of low- and middle-income countries (LMICs). METHODS: The seven largest national surveys were selected from a list of Demographic and Health Surveys (DHS) ordered by decreasing sample size and resulted in a range of country income levels. These were nationally representative data of women aged 15-49 years collected in the period 2005-2010. The separate and joint effects, unadjusted and adjusted for age group, parity, and urban/rural residence using a multivariate logistic regression model are presented. RESULTS: In the four middle-income countries (Colombia, Peru, Jordan, and Egypt), an interaction was found between education and wealth on obesity (P-value for interaction <0.001). Among women with no/primary education the wealth effect was positive whereas in the group with higher education it was either absent or inverted (negative). In the poorer countries (India, Nigeria, Benin), there was no evidence of an interaction. Instead, the associations between each of education and wealth with obesity were independent and positive. There was a statistically significant difference between the average interaction estimates for the low-income and middle-income countries (P<0.001). CONCLUSIONS: The findings suggest that education may protect against the obesogenic effects of increased household wealth as countries develop. Further research could examine the factors explaining the country differences in education effects.
Assuntos
Obesidade/epidemiologia , Fatores Socioeconômicos , Adolescente , Adulto , Colômbia/epidemiologia , Egito/epidemiologia , Feminino , Humanos , Renda/estatística & dados numéricos , Jordânia/epidemiologia , Pessoa de Meia-Idade , Peru/epidemiologia , Pobreza , Adulto JovemRESUMO
Las pocas comunicaciones sobre la asociación de obesidad o sobrepeso con mortalidad en personas con enfermedad coronaria (EC) muestran hallazgos contradictorios. En el estudio Whitehall en el que participaron empleados gubernamentales de sexo masculino de Londres, 18 403 hombres de mediana edad que habían participado en un examen médico entre 1967 y 1970 fueron controlados durante 38 años. En los hombres que presentaban EC al inicio hubo pruebas de un riesgo ligeramente mayor de mortalidad por todas las causas y por EC, pero no por accidente cerebrovascular en los grupos con sobrepeso y obesidad en relación con los hombres de peso normal. Aunque estas tendencias fueron mucho más notables en los hombres sin EC al inicio del estudio, la diferencia según el estado basal de EC no alcanzó significación estadística en los niveles convencionales. Evitar la obesidad y el sobrepeso en la vida adulta tanto en hombres con EC como sin ella puede reducir el riesgo posterior de mortalidad total y mortalidad por cardiopatía coronaria.
The few reports on the association of obesity oroverweight with mortality in persons with existing coronary heart disease (CHD) reveal inconsistent findings.In the Whitehall study of London-based male government employees, 18 403 middle-age men were followed upfor up for a maximum of 38 years having participated in a medical examination between 1967 and 1970. In menwith baseline CHD, there was evidence of a modestelevated risk for mortality from all-causes and coronaryheart disease but not stroke in overweight and obesegroups relative to normal weight men. While these slopeswere markedly steeper in men who were CHD-free atstudy induction, the difference in the gradients accordingto baseline CHD status did not attain statistical significance at conventional levels. Avoidance of obesity and overweight in adult life in both men with and without CHD may reduce their later risk of total and coronary heart disease mortality.