RESUMO
BACKGROUND: Although understanding changes in the body weight distribution and trends in obesity inequality plays a key role in assessing the causes and persistence of obesity, limited research on this topic is available for Cuba. This study thus analyzed changes in body mass index (BMI) and waist circumference (WC) distributions and obesity inequality over a 9-year period among urban Cuban adults. METHODS: Kolmogorov-Smirnov tests were first applied to the data from the 2001 and 2010 National Survey on Risk Factors and Chronic Diseases to identify a rightward shift in both the BMI and WC distributions over the 2001-2010 period. A Shapley technique decomposed the increase in obesity prevalence into a mean-growth effect and a (re)distributional component. A univariate assessment of obesity inequality was then derived by calculating both the Gini and generalized entropy (GE) measures. Lastly, a GE-based decomposition partitioned overall obesity inequality into within-group and between-group values. RESULTS: Despite some relatively pronounced left-skewing, both the BMI and WC distributions exhibited a clear rightward shift to which the increases in general and central obesity can be mostly attributed. According to the Gini coefficients, both general and central obesity inequality increased over the 2001-2010 period, from 0.105 [95% confidence interval (CI) = 0.103-0.106] to 0.110 [95% CI = 0.107-0.112] and from 0.083 [95% CI = 0.082-0.084] to 0.085 [95% CI = 0.084-0.087], respectively. The GE-based decomposition further revealed that both types of inequality were accounted for primarily by within-group inequality (93.3%/89.6% and 87.5%/84.8% in 2001/2010 for general/central obesity, respectively). CONCLUSIONS: Obesity inequality in urban Cuba worsened over the 2001-2010 time period, with within-group inequality in overall obesity dominant over between-group inequality. In general, the results also imply that the rise in obesity inequality is immune to health care system characteristics.
Assuntos
Obesidade Abdominal , Adulto , Índice de Massa Corporal , Cuba/epidemiologia , Humanos , Obesidade/epidemiologia , Obesidade Abdominal/epidemiologia , Fatores de Risco , Circunferência da CinturaRESUMO
AIMS: We aimed to review insulin dosing recommendations, insulin regulation and its determinants, glycaemic response to carbohydrates, and the efficacy and safety of insulin therapy in different races/ethnicities. METHODS: We searched for articles in PubMed and Google Scholar databases up to 31 March 2021, with the following keywords: "ethnicity", "diabetes", "insulin", "history of insulin", "insulin therapy", "food/rice", "carbohydrate intake", "insulin resistance", "BMI", "insulin dosing", "insulin sensitivity", "insulin response", "glycaemic index", "glycaemic response", "efficacy and safety", with interposition of the Boolean operator "AND".In addition, we reviewed the reference lists of the articles found. RESULTS: The differential effect of race/ethnicity has not yet been considered in current insulin therapy guidelines. Nevertheless, body size and composition, body mass index, fat distribution, diet, storage, and energy expenditure vary significantly across populations. Further, insulin sensitivity, insulin response, and glycaemicresponse to carbohydrates differ by ethnicity. These disparities may lead to different insulin requirements, adversely impacting the efficacy and safety of insulin therapy among ethnic groups. CONCLUSIONS: Race/ethnicity affects glucose metabolism and insulin regulation.Until now, international guidelines addressing racial/ethnic-specific clinical recommendations are limited. Comprehensive updated insulin therapy guidelines by ethnicity are urgently needed.
Assuntos
Glicemia/metabolismo , Resistência à Insulina/fisiologia , Insulina/uso terapêutico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: To throw light on the under-researched association between socioeconomic position (SEP) and health in Cuba, this study examined SEP gradients in health and their underlying mechanisms among urban Cuban adults aged 18-65. METHODS: By applying linear regressions to data from the 2010 National Survey on Risk Factors and Chronic Diseases, the analysis explored the SEP-health gradient along three SEP dimensions - education, occupation, and skin colour - using ten health measures: self-reported health (SRH), general and abdominal obesity, hypertension, high glucose, high cholesterol, high triglycerides, low high-density lipoprotein cholesterol, metabolic syndrome, and cumulative risk factors. Regressions also included behaviours and health-related risk perceptions (tobacco and alcohol consumption, diet, physical activity, and risk-related behaviours). It thus investigated the SEP-health gradient and its underlying mechanisms via both behaviours and health-related risk perceptions. RESULTS: Once controlling for gender, age, marital status, region and provincial dummies, the analysis detected educational gradients in SRH (estimated coefficient [95% CI]: middle-level education = 3.535 [1.329, 5.741], p < 0.01; high-level education = 5.249 [3.050, 7.448], p < 0.01) that are partially explainable by both health-affecting behaviours (tobacco and alcohol consumption, diet, physical and sedentary activity) and risk perceptions. Using objective measures of health, however, it found no SEP-health gradients other than hypertension among people identified as having Black skin color (adjusted for demographic variables, 0.060 [0.018, 0.101], p < 0.01) and high cholesterol among those identified as having Mulatto or Mestizo skin color (adjusted for demographic variables, - 0.066 [- 0.098, - 0.033], p < 0.01). CONCLUSIONS: In terms of objective health measures, the study provides minimal evidence for an SEP-health gradient in Cuba, results primarily attributable to the country's universal healthcare system - which offers full coverage and access and affordable medications - and its highly developed education system.
Assuntos
Doença Crônica/epidemiologia , Autoavaliação Diagnóstica , Disparidades nos Níveis de Saúde , Classe Social , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Idoso , Cuba/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto JovemRESUMO
The aim of the study was to estimate the association between maternal perception of their child's health status and (mis)classification of their child's actual weight with future weight change. We present cross-sectional and longitudinal analyses from the Peruvian younger cohort of the Young Lives Study. For cross-sectional analysis, the exposure was maternal perception of child health status (better, same or worse); the outcome was underestimation or overestimation of the child's actual weight. Mothers were asked about their perception of their child's weight (same, lighter or heavier than other children). Actual weight status was defined with IOTF BMI cut-off points. For longitudinal analysis, the exposure was (mis)classification of the child's actual weight; the outcome was the standardized mean difference between follow-up and baseline BMI. A Generalized Linear Model with Poisson family and log-link was used to report the prevalence ratio (PR) and 95% confidence intervals (95% CI) for cross-sectional analyses. A Linear Regression Model was used to report the longitudinal analysis as coefficient estimates (ß) and 95% CI. Normal weight children who were perceived as more healthy than other children were more likely to have their weight overestimated (PR = 2.06); conversely, those who were perceived as less healthy than other children were more likely to have their weight underestimated (PR = 2.17). Mean follow-up time was 2.6 (SD: 0.3) years. Overall, underweight children whose weight was overestimated were more likely to gain BMI (ß = 0.44); whilst overweight children whose weight was considered to be the same of their peers (ß = -0.55), and those considered to be lighter than other children (ß = -0.87), lost BMI. Maternal perception of the child's health status seems to influence both overestimation and underestimation of the child's actual weight status. Such weight (mis)perception may influence future BMI.
Assuntos
Peso Corporal/fisiologia , Mães/psicologia , Distorção da Percepção , Percepção de Tamanho , Adulto , Índice de Massa Corporal , Criança , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Modelos Lineares , Masculino , Peru , Estudos Prospectivos , Percepção de Tamanho/fisiologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To evaluate whether large for gestational age (LGA) etiological subgroups have differential growth trajectories during early childhood. STUDY DESIGN: Approximately 10,700 infants and their parents were included in the Early Childhood Longitudinal Study-Birth Cohort in 2001-2002. Research staff collected data in 5 waves when participating children were approximately 9 months and 2, 4, 5, and 6 years of age. We analyzed 2950 LGA and appropriate-for-gestational-age (AGA) children with at least 1 growth outcome at ages 9 months, 2 years, and 4 years. We divided 600 LGA newborns into 8 subgroups by maternal overweight or obesity before pregnancy (OW/OB), diabetes mellitus (DM), and excessive gestational weight gain (ExGWG). We used mixed effect regression models to compare trajectories of height (length)-for-age or body mass index (BMI) z scores across LGA subgroups and the AGA reference group. RESULTS: Relative to the reference group, the LGA subgroup with maternal OW/OB and DM but normal gestational weight gain had "continuous high rising" BMI z-score trajectory from 9 months to 4 years and the greatest mean z score at 4 years (2.14 [95% CI, 1.29, 2.98]). The LGA subgroup free of maternal OW/OB, DM, or ExGWG had a similar BMI z-score trajectory ("stable low") from 9 months to 4 years and a similar 4-years mean z score (0.97 [95% CI, 0.75, 1.18] vs 0.72 [95% CI, 0.67, 0.78]) relative to the AGA reference group. CONCLUSIONS: The LGA subgroup with co-occurrence of maternal OW/OB and DM had the greatest 4-year BMI, whereas the LGA subgroup free of maternal OW/OB, DM, or ExGWG were tall but lean ("a healthy phenotype").
Assuntos
Desenvolvimento Infantil , Macrossomia Fetal/fisiopatologia , Índice de Massa Corporal , Criança , Pré-Escolar , Feminino , Macrossomia Fetal/complicações , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Obesidade/fisiopatologia , Sobrepeso/fisiopatologia , Gravidez , Fatores de Risco , Aumento de PesoRESUMO
BACKGROUND: Few studies have used the same references across countries to examine the trends of over- and underweight in older children and adolescents. OBJECTIVE: Using international references, we examined the trends of overweight and underweight in young persons aged 6-18 y from 4 countries. DESIGN: Nationally representative data from Brazil (1975 and 1997), Russia (1992 and 1998), and the United States (1971-1974 and 1988-1994) and nationwide survey data from China (1991 and 1997) were used. To define overweight, we used the sex- and age-specific body mass index cutoffs recommended by the International Obesity Task Force. The sex- and age-specific body mass index fifth percentile from the first US National Health and Nutrition Examination Survey was used to define underweight. RESULTS: The prevalence of overweight increased during the study periods in Brazil (from 4.1 to 13.9), China (from 6.4 to 7.7), and the United States (from 15.4 to 25.6); underweight decreased in Brazil (from 14.8 to 8.6), China (from 14.5 to 13.1), and the United States (from 5.1 to 3.3). In Russia, overweight decreased (from 15.6 to 9.0) and underweight increased (from 6.9 to 8.1). The annual rates of increase in the prevalence of overweight were 0.5% (Brazil), 0.2% (China), -1.1% (Russia), and 0.6% (United States). CONCLUSIONS: The burden of nutritional problems is shifting from energy imbalance deficiency to excess among older children and adolescents in Brazil and China. The variations across countries may relate to changes and differences in key environmental factors.