The prevalence of overweight and obesity among the population was 28.2% and 43.8%, respectively. In a multivariate regression, abdominal overweight and obesity were associated with gender, ethnic group, and smoking (p < 0.05). Abdominal obesity (obesity by waist-hip-ratio (WHR)) was positively associated with female gender (OR 43.64, 95%CI 13.15 - 144.86) and negatively associated with smokers and people in ethnic groups other than Kinh and Tay.
JOURNAL OF MEDICAL RESEARCH PREVALENCE AND RELATED FACTORS OF OVERWEIGHT AND OBESE OLDER ADULTS IN TWO COMMUNES IN THE NORTHERN MOUNTAINOUS REGION OF VIETNAM Vo Hoang Long, Bui Van Nhon, Nguyen Si Anh Hao, Tran Minh Hien, Bui Van Tung, Vu Đang Khoi, Pham Van Quyet, Nguyen Hoang Nguyen, Nguyen Thi Lien Hanoi Medical University, Vietnam A cross-sectional study was conducted on 354 people aged ≥ 60 in two communes in Chiem Hoa district, Vietnam to describe the prevalence and various factors associated with being overweight or obese A majority of the population (n = 218, 61.6%) was female The median age was 67, with 60.4% of the population between 60 - 69 years old More than two-thirds were of the Tay ethnic group Agriculture was the main occupation (88.4%) Half of the population had only primary education The prevalence of overweight and obesity among the population was 28.2% and 43.8%, respectively In a multivariate regression, abdominal overweight and obesity were associated with gender, ethnic group, and smoking (p < 0.05) Abdominal obesity (obesity by waist-hip-ratio (WHR)) was positively associated with female gender (OR 43.64, 95%CI 13.15 144.86) and negatively associated with smokers and people in ethnic groups other than Kinh and Tay Keywords: overweight; obesity; older adults; Vietnam Northern Mountainous region I INTRODUCTION Overweight and obesity have been increas- 2011 reported the prevalence of overweight ing rapidly in many countries around the world, and obesity in the population was 29.4% and including Vietnam According to the World 15.1% respectively, while Thailand was one of Health Organization (WHO), overweight and the countries with the highest prevalence of obesity are defined as abnormal or excessive obesity in the world (33% in men and 43% in fat accumulation that may impair health [1] women) in the past two decades alone [3] The figures for overweight and obesity world- In Vietnam, overweight and obesity among wide were over 1.9 billion people and over older adults accounted for approximately 25% 650 million people, respectively In America, of the population [4] The Vietnam National the prevalence of obesity in men and women Institute of Nutrition reported that the propor- aged above 65 years increased to 40.5% and tion of obesity increases with age and that two 40.3% respectively between 1990 and 2010 -thirds of the overweight population is aged [2] The Malaysian Health and Disease Survey over 45 years [4] Although individuals with obesity are evaluated according to their body Corresponding author: Vo Hoang Long, Hanoi Medical University mass index (BMI), many previous studies Email: vohoanglonghmu@gmail.com direct cause of morbidity and mortality Hence, Received: 08/3/2018 abdominal obesity (obesity by the waist-hip- Accepted: 05/11/2018 ratio (WHR)) is more closely related to risk of 116 have reported that body fat distribution is the JMR 116 E3 (7) - 2018 JOURNAL OF MEDICAL RESEARCH morbidity and death than gluteofemoral obe- In which: sity WHR as an indicator of abdominal obesity n is sample size; may better predict risk for severe diseases than BMI, including heart disease, diabetes mellitus type 2, and Metabolic Syndrome [5] WHR is also used to diagnose overweight and obesity WHR is calculated as waist circumference divided by hip circumference Kim Binh and Xuan Quang are two mountainous communes in northern Vietnam, located in Chiem Hoa district in Tuyen Quang province Overweight and obesity has not been studied by WHR in this area, especially in the elderly population aged ≥ 60 years The provision of information on overweight and obesity in the elderly in these two communes is necessary to suggest appropriate interventions and counseling Therefore, this study aims to describe the prevalence and related factors of overweight and obesity by WHR among older adults in two northern mountainous communes in the Tuyen Quang province of Vietnam p is the expected proportion of overweight and obesity among people aged 60 and older (estimated p = 0.5); ε: is the margin of error; α is the level of statistical significance (to obtain a 95% confidence interval of the proportion, the α is set at 0.05, thus Z is 1.96) To estimate a proportion of 0.5 with a margin of error of 0.11, the smallest sample size needed is 317 A total of 354 subjects were included in the study A simple random sampling technique was utilized to ensure the representation of older adults living in these communes In the first stage of sampling, all the resident aged 60 and older living in Kim Binh and Xuan Quang communes were listed The second stage consisted of selecting 354 objects randomly from a list of the elderly In the third stage, the appointment invitations were sent for medical examination and data collection Data Collection II METHODS We collected the data through face-to-face Study design and setting We conducted a cross-sectional study in two communes (Kim Binh and Xuan Quang) in Chiem Hoa district, Tuyen Quang province People aged 60 or older residing in these two communes were enrolled interviews using a structured questionnaire, which included four main parts: personal characteristics, physical activity, smoking and alcohol drinking For overweight and obesity, we measured waist circumference and hip circumference Measures and Instruments Sample size The sample size of the study was calculated according to the following formula 4.1 Personal Characteristics Information regarding gender (male and female), age (60 - 69, 70 - 79, ≥ 80), ethnicity (p.(1 - p) n = Z2(1- α/2) (p.ε)2 JMR 116 E3 (7) - 2018 (Kinh, Tay, others), occupation (farmer and others) and education (none, primary, lower 117 JOURNAL OF MEDICAL RESEARCH secondary and upper secondary and higher) WHR < 0.85 among women were classified as was collected overweight (ii) Men with WHR ≥ 1.00 and Physical Activity women with WHR ≥ 0.85 were classified as having abdominal obesity (obesity by WHR) We used the International Physical Activity (iii) The individuals were classified as normal Questionnaire (IPAQ) to measure physical for men with a WHR < 0.90 and women with a activity The individuals were considered capa- WHR < 0.80 [6; 7] Hence, the subjects with ble of physical activity if they reported partici- criteria (i) and (ii) were considered as abdomi- pation in moderate-intensity physical activity nal overweight and obesity and vigorous-intensity physical activity for at least 60 minutes for days per week Smoking and Alcohol Use The status of current smoking or drinking was reported Data Analysis Data entry was performed by Epidata 3.1 (EpiData Association) After data cleaning, statistical analyses were performed using Stata 12.0 (StataCorp) Qualitative variables Overweight and Obesity Measurement of waist circumference, hip circumference: Stand up straight and breathe out Use a tape measure to check the distance around the smallest part of the waist, just above the belly button (waist circumference) Then measure the distance around the largest were described in percentage, and quantitative variables were described in mean (standard deviation) and median (min–max) where appropriate Multivariate logistic regression was used to examine the factors associated with overweight and obesity A p-value of < 0.05 was considered statistically significant part of the hips to the widest part of the but- Research ethics tocks (hip circumference) All subjects received an explanation about Overweight and obesity: WHR was calcu- the purpose of the study Personal information lated as waist measurement divided by hip of the subjects was kept confidential and measurement (same unit of measurement) (i) coded Individuals with overweight or obesity 0.90 ≤ WHR < 1.00 among men and 0.80 ≤ were provided with consultation III RESULTS Table Personal characteristics of the research subjects (n = 354) Characteristics n % Women 218 61.6 Men 136 38.4 214 60.4 Gender Age Group 60 - 69 118 JMR 116 E3 (7) - 2018 JOURNAL OF MEDICAL RESEARCH Characteristics n % 70 - 79 83 23.5 ≥ 80 57 16.1 Age Group Median (min –max) 67 (60 - 90) Mean±SD 69.5 ± 8.1 Ethnic Group Kinh 59 16.7 Tay 244 68.9 Others* 51 14.4 313 88.4 41 11.6 None 44 12.4 Primary 178 50.3 Lower secondary 102 28.8 Upper secondary or higher 30 8.5 Job farmers Others ** Education *Others: Muong and Nung ethnic; **Others: Officials, workers, retirees and freelance occupation The characteristics of the study sample are described in Table The proportion of women was 61.6% The figure for the elderly aged 60 to 69 years was the highest, at 60.4% The Tay ethnic groups constituted 68.9% of the elderly The main occupation was agriculture (88.4%) The figure for older adults with primary education was the highest, at 50.3% Figure The prevalence of overweight and obesity in the elderly (n = 354) JMR 116 E3 (7) - 2018 119 JOURNAL OF MEDICAL RESEARCH As shown in Figure 1, the prevalence of abdominal obesity among older adults was the highest, at 43.8% The figures for overweight and normal were 28.2% and 28.0% respectively The figure for average WHR was 0.89 ± 0.07 Table Factors associated with prevalence of overweight and obesity by WHR in the elderly (n = 354) Associated factors Overweight and obesity (n,%) Multivariate OR 95%CI Gender Men 65 (47.8) - Women 189 (85.7) 4.60* 2.27 - 9.33 60 - 69 152 (71.0) - 70 - 79 60 (72.3) 1.05 0.55 - 2.00 ≥ 80 42 (73.7) 0.96 0.44 - 2.07 Kinh 38 (64.4) - Tay 181 (74.2) 1.84 0.91 - 3.70 Other 35 (68.6) 1.16 0.47 - 2.89 Yes 67 (69.1) - No 187 (72.8) 1.06 0.57 - 1.96 No 231 (79.9) - Yes 23 (35.4) 0.38* 0.19 - 0.78 No 231 (79.93) - Yes 23 (35.38) 0.95 0.47 - 1.95 Age group Ethnic groups Physical activity Smoking Drinking alcohol *: The significance level was set at p < 0.05; OR: Odds ratio; CI: Confidence interval Table shows association with the overall prevalence of overweight and obesity The odds ratio of overweight and obesity among women was higher than among men (ORs: 4.60) The odds of overweight and obesity among older adults smoking was less than that of non-smokers (ORs: 0.38) These factors were statistically significant 120 JMR 116 E3 (7) - 2018 JOURNAL OF MEDICAL RESEARCH Table Factors associated with prevalence of abdominal obesity in the elderly (n = 354) Associated factors Multivariate Abdominal obesity (n,%) OR 95%CI (4.4) - 149 (68.4) 43.64* 13.15 - 144.86 60 - 69 91 (42.5) - 70 - 79 36 (43.4) 1.08 0.55 - 2.14 ≥ 80 28 (49.1) 1.49 0.66 - 3.34 Kinh 27 (45.8) - Tay 113 (46.3) 1.19 0.57 - 2.50 * Gender Men Women Age group Ethnic group 15 (29.4) 0.35 0.13 - 0.91 Yes 36 (37.1) - No 119 (46.3) 1.44 0.76 - 2.73 No 153 (52.9) - Yes (3.1) 0.53 0.09 - 3.09 No 147 (54.0) - Yes (9.8) 1.16 0.34-3.90 Other Physical activity Smoking Drinking alcohol *: The significance level was set at p < 0.05; OR: Odds ratio; CI: Confidence interval Table shows the association with the prevalence of abdominal obesity among older adults The odds ratio of abdominal obesity among women was higher than that among men (ORs: 43.64) The odds of abdominal obesity among others ethnic groups was less than that for Kinh ethnic group (ORs: 0.35) These factors were statistically significant JMR 116 E3 (7) - 2018 121 JOURNAL OF MEDICAL RESEARCH IV DISCUSSION This is the first study to assess the prevalence of overweight and obesity by WHR among older adults in two communes of the northern mountainous areas in Vietnam The results indicated the prevalence of abdominal obesity was the highest, at 43.8%, while the figures for overweight and normal people were similar (28.2% and 28.0% respectively) The overall prevalence of overweight and obesity in our study (72.0%) was much higher compared to the figure in Mo Cay Bac district of Ben Tre province (28.2%) [8] The obesity classification between BMI and WHR might contribute to this difference The explanation for this may be due to the fact that more than three quarters of the elderly adult population belongs to an ethnic minority with an agricultural job The proportion of the elderly with primary school education was the highest, at 50.3% In particular, Kim Binh and Xuan Quang are two poor communes in the northern mountainous area, therefore, awareness of the locals is not only low but access to health care services for them is also difficult ings among Malaysian and Indian populations [9; 10] The prevalence of overweight and obesity in older adults who smoke was less than that of non-smokers This may be explained because smoking is associated with lower weight and smoking cessation is associated with weight gain [11; 12] Reductions in smoking prevalence have been suggested as one of the factors associated with an increase in obesity [11; 12] There is a statistically significant impact of the above factors on the overall prevalence of overweight and obesity among older adults Particularly, factors associated with abdominal obesity in the elderly, including gender, ethnic group and smoking were statistically significant The prevalence of abdominal obesity was higher among women than among men The prevalence of abdominal obesity of other ethnic groups including Muong and Nung was 0.35 times less than that of Kinh ethnic group The explanation for this may be becaause the customs and the habits between Kinh and ethnic minorities are different A report of the Vietnam Committee on Ethnic Minority Affairs showed the general poverty In this study, the prevalence of abdominal concentrated on ethnic majorities such as obesity among women was significantly higher Muong and Nung, hence the malnutrition rate than among men, at 68.4% and 4.4% respec- among Tay and Muong people remains high tively The figures for a study among an Indian even in recent years Hence, the prevalence of population were about 12% in men and 68% in non-communicable women [9] Our result was also consistent with ethnic majorities are much less than that of the a study among a Malaysian population which Kinh ethnic group [13] The prevalence of found a higher prevalence of abdominal abdominal obesity in older adults who smoke obesity among female respondents, at 6.2% in is less than that of non-smokers This is con- males and 54.2% in females [10] sistent with the results of a study in the United disease among these In general, the overall prevalence of over- States that the probability of abdominal weight and obesity has been found to be obesity in nonsmokers was higher than that in significantly higher among women than among smokers [14] A study from data of the 2002 men This result was consistent with the find- Swiss 122 Health Survey indicated that ex- JMR 116 E3 (7) - 2018 JOURNAL OF MEDICAL RESEARCH smokers had higher ORs of being overweight and obesity The results of our study also sug- or obese with respect to non-smokers [15] A gest that there is a need for further research in national survey in Brazil found a higher preva- other areas among older adults in Vietnam lence of abdominal obesity in adolescents who ACKNOWLEDGMENTS smoke than in nonsmokers [16] It is likely that these studies are conducted on the working The authors would like to thank the Hanoi age population and the prevalence of over- Medical University and Hospital for recom- weight and obesity is based on BMI, while our mending the physicians who examined the findings only focus on overweight and obesity patients in this study, especially the elderly in by WHR in the elderly aged 60 and older the two communes of Kim Binh and Xuan This is the first study in an area of Viet- Quang who participated in this study nam’s northern mountainous region However, REFERENCES this study has some limitations which should be considered while interpreting the results World Health Organization (2014) The survey used a cross-sectional design, Global strategy on diet, physical activity and which prevented any interpretation about the health causal relationship Sample size in this study is representative of two communes in this area only V CONCLUSION Fakhouri TH, Ogden CL, Carroll MD, Kit BK, Flegal KM (2012) Prevalence of obesity among older adults in the United States, 2007 - 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