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Zhang, Y., Gu, Y., Wang, N., Zhao, Q., Ng, N., Wang, R., . . . Zhao, G. (2019). Association between anthropometric indicators of obesity and cardiovascular risk factors among adults in Shanghai, China. BMC Public Health, 19(1), Article ID 1035.
Open this publication in new window or tab >>Association between anthropometric indicators of obesity and cardiovascular risk factors among adults in Shanghai, China
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2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, no 1, article id 1035Article in journal (Refereed) Published
Abstract [en]

Background: To determine the optimal cut-off values and evaluate the associations of body mass index (BMI), waist circumference (WC) and waist-height ratio (WHtR) with cardiovascular disease (CVD) risk factors. Methods: A large-scale cross-sectional survey was conducted among 35,256 adults aged 20-74 years in Shanghai between June 2016 and December 2017. Receiver operating characteristic (ROC) analyses were conducted to assess the optimal cut-off anthropometric indices of CVD risk factors including hypertension, diabetes, dyslipidemia and hyperuricemia. Multivariate Logistic regression models were preformed to evaluate the odds ratio of CVD risk factors. Results: The area under the curve (AUC) of WHtR was significantly greater than that of BMI or WC in the prediction of hypertension and diabetes, and AUCs were higher in women than men. The optimal cut-off values of WHtR were approximately 0.51 in both sexes, while the cut-off values of BMI and WC were higher for men compared with women. The optimal cutoff values of BMI and WC varied greatly across different age groups, but the difference in WHtR was relatively slight. Among women, the optimal threshold of anthropometric indices appeared to increase with age for hypertension and diabetes. The odds ratio between anthropometric indices and CVD risk factors were attenuated with age. WHtR had the greatest odds ratio for CVD risk factors among adults under 60 years old except for women with hypertension, while among 60-74 years, BMI yielded the greatest odds ratio in terms of all CVD outcomes except for women with diabetes. Conclusions: WHtR had the best performance for discriminating hypertension and diabetes and potentially be served as a standard screening tool in public health. The associations between three anthropometric indices and CVD risk factors differed by sex and decreased with age. These findings indicated a need to develop age- and gender-specific difference and make effective strategies for primary prevention of CVDs.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Cardiovascular diseases, Obesity, Anthropometric indices, Risk factors
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-162865 (URN)10.1186/s12889-019-7366-0 (DOI)000480259500004 ()31375086 (PubMedID)
Available from: 2019-09-05 Created: 2019-09-05 Last updated: 2019-09-05Bibliographically approved
Pujilestari, C. U., Nyström, L., Norberg, M. & Ng, N. (2019). Association between changes in waist circumferences and disability among older adults: WHO-INDEPTH study on global ageing and adult health (SAGE) in Indonesia. Obesity Research and Clinical Practice, 13(5), 462-468
Open this publication in new window or tab >>Association between changes in waist circumferences and disability among older adults: WHO-INDEPTH study on global ageing and adult health (SAGE) in Indonesia
2019 (English)In: Obesity Research and Clinical Practice, ISSN 1871-403X, E-ISSN 1878-0318, Vol. 13, no 5, p. 462-468Article in journal (Refereed) Published
Abstract [en]

Background: There is a lack of evidence regarding the impact of changes in waist circumference on disability among older populations in low- and middle-income countries (LMICs). This research examines the association between changes in waist circumference with disability in the older populations of Indonesia, and whether the associations are dependent on wealth or baseline abdominal obesity levels.

Methods: In 2007 the INDEPTH-WHO Study on global AGEing and adult health (SAGE) was conducted among 11,753 individuals aged 50 years and older in Purworejo District, Central Java Province, Indonesia. Of these, a total of 8,089 were followed up in 2010. On both occasions, individuals’ waist circumferences were measured and the 12-item version of the WHO Disability Assessment Schedule version 2 (WHODAS-II) was implemented to measure disability.

Results: A significant positive association was observed between waist circumference and disability at the baseline (β = 0.066; p < 0.001), and between the increase in waist circumference and the level of disability during the three-year follow-up period (β = 0.094; p < 0.001) after adjusting for baseline variables. This association was also significant among the poor, non-obese men, as well as poor and rich obese women. Among the non-obese women, a decrease in waist circumference was associated with more disabilities.

Conclusions: An increase in waist circumference is associated with increased disability among older people in Purworejo, Indonesia. Health promotion programmes aiming to prevent obesity could have positive effects in preventing and reducing disability among older adults.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Abdominal obesity, Waist circumference, Disability, Older people, Indonesia
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-165103 (URN)10.1016/j.orcp.2019.07.004 (DOI)000492674200007 ()31474381 (PubMedID)
Available from: 2019-11-13 Created: 2019-11-13 Last updated: 2019-11-13Bibliographically approved
diva2:1324147
Open this publication in new window or tab >>Diversity in the Factors Associated with ADL-Related Disability among Older People in Six Middle-Income Countries: A Cross-Country Comparison
2019 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 8, article id 1341Article in journal (Refereed) Published
Abstract [en]

The low- and middle-income countries (LMICs) are experiencing rapid population ageing, yet knowledge about disability among older populations in these countries is scarce. This study aims to identify the prevalence and factors associated with disability among people aged 50 years and over in six LMICs. Cross-sectional data from the World Health Organization (WHO) Study on global AGEing and adult health Wave 1 (2007-2010) in China, Ghana, India, Mexico, the Russian Federation, and South Africa was used. Multivariable logistic regression analyses were undertaken to examine the association between sociodemographic factors, health behaviours, chronic conditions, and activities of daily living (ADL) disability. The prevalence of disability among older adults ranged from 16.2% in China to 55.7% in India. Older age, multimorbidity, and depression were the most common factors related to disability in all six countries. Gender was significant in China (OR = 1.14, 95% CI: 1.01-1.29), Ghana (OR = 1.22, 95% CI: 1.01-1.48) and India (OR = 1.65, 95% CI: 1.37-1.99). Having no access to social capital was significantly associated with ADL disability in China (OR = 2.57, 95% CI: 1.54-4.31) and South Africa (OR = 4.11, 95% CI: 1.79-9.43). Prevalence data is valuable in these six ageing countries, with important evidence on mitigating factors for each. Identifying determinants associated with ADL disability among older people in LMICs can inform how to best implement health prevention programmes considering different country-specific factors.

Place, publisher, year, edition, pages
MDPI, 2019
Keywords
older adults, physical function, disability, ADL, WHO SAGE, LMICs
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-159624 (URN)10.3390/ijerph16081341 (DOI)000467747100034 ()31013975 (PubMedID)
Available from: 2019-06-13 Created: 2019-06-13 Last updated: 2019-06-13Bibliographically approved
Byass, P., Ng, N. & Wall, S. (2019). Nurturing Global Health Action through its first decade. Global Health Action, 12(1), Article ID 1569847.
Open this publication in new window or tab >>Nurturing Global Health Action through its first decade
2019 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1569847Article in journal, Editorial material (Refereed) Published
Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-158193 (URN)10.1080/16549716.2019.1569847 (DOI)000457989300001 ()30727852 (PubMedID)
Available from: 2019-04-16 Created: 2019-04-16 Last updated: 2019-04-24Bibliographically approved
Näslund, U., Ng, N., Wennberg, P. & Norberg, M. (2019). Patient-doctor engagement in cardiovascular prevention: Authors' reply [Letter to the editor]. The Lancet, 394(10199), E27-E27
Open this publication in new window or tab >>Patient-doctor engagement in cardiovascular prevention: Authors' reply
2019 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 394, no 10199, p. E27-E27Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-164539 (URN)10.1016/S0140-6736(19)31335-2 (DOI)000483011200007 ()31448748 (PubMedID)
Available from: 2019-11-14 Created: 2019-11-14 Last updated: 2019-11-14Bibliographically approved
Eriksson, M., Lindgren, U., Ivarsson, A. & Ng, N. (2019). The effect of neighbourhood social capital on child injuries: a gender-stratified analysis. Health & Place, 60, Article ID 102205.
Open this publication in new window or tab >>The effect of neighbourhood social capital on child injuries: a gender-stratified analysis
2019 (English)In: Health & Place, Vol. 60, article id 102205Article in journal (Refereed) Published
Abstract [en]

We designed a longitudinal retrospective cohort study to analyse the associations between neighbourhood social capital and child injures. Register data from the Umeå Simsam Lab in Sweden was used to measure child injuries and demographic and socioeconomic factors at individual, household and neighbourhood level. A social capital score from a previous survey was used to measure neighbourhood social capital. We conducted a three-level multilevel negative binomial regression analysis, with children (level 1, N = 77,193) nested within households (level 2, N = 10,465), and households nested within neighbourhoods (level 3, N = 49). The incidence rate of child injuries was lower in high social capital neighbourhoods. When controlling for factors at individual, household and neighbourhood levels, living in a high social capital neighbourhood was protective of injuries among girls, but not among boys. Promoting social capital in local neighbourhoods could be seen as a prevention strategy for injuries among girls.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Child injury, Social capital, Neighbourhood effects, Gender, Longitudinal analysis
National Category
Pediatrics Public Health, Global Health, Social Medicine and Epidemiology Social Work
Identifiers
urn:nbn:se:umu:diva-163497 (URN)10.1016/j.healthplace.2019.102205 (DOI)31546173 (PubMedID)
Available from: 2019-09-23 Created: 2019-09-23 Last updated: 2019-10-31Bibliographically approved
Näslund, U., Ng, N., Lundgren, A., Fhärm, E., Grönlund, C., Johansson, H., . . . Norberg, M. (2019). Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial. The Lancet, 393(10167), 133-142
Open this publication in new window or tab >>Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial
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2019 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, no 10167, p. 133-142Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Primary prevention of cardiovascular disease often fails because of poor adherence among practitioners and individuals to prevention guidelines. We aimed to investigate whether ultrasound-based pictorial information about subclinical carotid atherosclerosis, targeting both primary care physicians and individuals, improves prevention.

METHODS: Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) is a pragmatic, open-label, randomised controlled trial that was integrated within the Västerbotten Intervention Programme, an ongoing population-based cardiovascular disease prevention programme in northern Sweden. Individuals aged 40, 50, or 60 years with one or more conventional risk factors were eligible to participate. Participants underwent clinical examination, blood sampling, and ultrasound assessment of carotid intima media wall thickness and plaque formation. Participants were randomly assigned 1:1 with a computer-generated randomisation list to an intervention group (pictorial representation of carotid ultrasound plus a nurse phone call to confirm understanding) or a control group (not informed). The primary outcomes, Framingham risk score (FRS) and European systematic coronary risk evaluation (SCORE), were assessed after 1 year among participants who were followed up. This study is registered with ClinicalTrials.gov, number NCT01849575.

FINDINGS: 3532 individuals were enrolled between April 29, 2013, and June 7, 2016, of which 1783 were randomly assigned to the control group and 1749 were assigned to the intervention group. 3175 participants completed the 1-year follow-up. At the 1-year follow-up, FRS and SCORE differed significantly between groups (FRS 1·07 [95% CI 0·11 to 2·03, p=0·0017] and SCORE 0·16 [0·02 to 0·30, p=0·0010]). FRS decreased from baseline to the 1-year follow-up in the intervention group and increased in the control group (-0·58 [95% CI -0·86 to -0·30] vs 0·35 [0·08 to 0·63]). SCORE increased in both groups (0·13 [95% CI 0·09 to 0·18] vs 0·27 [0·23 to 0·30]).

INTERPRETATION: This study provides evidence of the contributory role of pictorial presentation of silent atherosclerosis for prevention of cardiovascular disease. It supports further development of methods to reduce the major problem of low adherence to medication and lifestyle modification.

Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-154318 (URN)10.1016/S0140-6736(18)32818-6 (DOI)000455437100026 ()30522919 (PubMedID)
Funder
Västerbotten County Council, Dnr ALFVLL-298001Swedish Research Council, Dnr 521-2013-2708Swedish Research Council, 2016-01891Swedish Heart Lung Foundation, Dnr 20150369Swedish Heart Lung Foundation, 20170481
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2019-02-22Bibliographically approved
diva2:1251429
Open this publication in new window or tab >>Waist circumference and all-cause mortality among older adults in rural Indonesia
2019 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, article id 116Article in journal (Refereed) Published
Abstract [en]

Waist circumference, a measure of abdominal obesity, is associated with all-cause mortality in general adult population. However, the link between abdominal obesity with all-cause mortality in the studies of older adults is unclear. This study aims to determine the association between waist circumference and all-cause mortality in older adults in Indonesia. The association between waist circumference and all-cause mortality was examined in 10,997 men and women aged 50 years and older, in the World Health Organization (WHO) and International Network of field sites for continuous Demographic Evaluation of Populations and their Health in developing countries (INDEPTH) collaboration Study on global AGEing and adult health (SAGE) in Purworejo District Central Java, Indonesia during 2007–2010. Multivariate Cox regression analysis with restricted cubic splines was used to assess the non-linear association between waist circumference and all-cause mortality. During the 3-year follow-up, a total of 511 men and 470 women died. The hazard ratio plot shows a pattern of U-shape relationship between waist circumference and all-cause mortality among rich women, though the result was significant only for women in the lower end of waist circumference distribution (p < 0.05). Poor men with a low waist circumference (5th percentile) have a two times higher mortality risk (HR = 2.1; 95% CI = 1.3, 3.3) relative to those with a waist circumference of 90 cm. Poor women with a low waist circumference (25th percentile) have a 1.4 times higher mortality risk (HR = 1.4; 95% CI = 1.1, 1.8) relative to those with a waist circumference of 80 cm. This study shows a significant association between low waist circumference measure and mortality, particularly among poor men and women. Though the association between large waist circumference and mortality was not significant, we observed a trend of higher mortality risk particularly among rich women with large waist circumference measure. Public health intervention should include efforts to improve nutritional status among older people and promoting healthy lifestyle behaviours including healthy food and active lifestyle.

Place, publisher, year, edition, pages
MDPI, 2019
Keywords
abdominal obesity, deaths, Indonesia, older people, waist circumference
National Category
Gerontology, specialising in Medical and Health Sciences Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-152117 (URN)10.3390/ijerph16010116 (DOI)000459111400116 ()30609857 (PubMedID)
Note

Originally included in thesis in manuscript form

Available from: 2018-09-27 Created: 2018-09-27 Last updated: 2019-03-20Bibliographically approved