Document Type : Original Article(s)

Authors

1 Nutritionist, Assistant Professor, Ischemic Disorders Research Center, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran

2 Cardiologist, Assistant Professor, Ischemic Disorders Research Center, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran

3 Student, Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran

Abstract

BACKGROUND: Central obesity is a common health disorder, and the main objective of this study was to compare its changings among rural women in the north of Iran, between the years 2004 and 2013. METHODS: Two cross-sectional studies were established on the 2839 and 2478 subjects in 2004 (first stage) and 2013 (second stage), respectively. Among 118 villages, 20 were selected using random sampling; they were the same in two studies. Central obesity was defined as waist circumference (WC) > 88 cm, waist-to-hip ratio (WHR) > 0.8, and waist-to-height ratio (WHtR) > 0.5.RESULTS: The prevalence of central obesity in 2013 based on WC, WHR, and WHtR were 37.4%, 73.5%, and 67.8%, respectively. Compared with 2004, the prevalence of central obesity based on WHR increased as 5.4% (68.1% vs. 73.5%) (P = 0.001), whereas morbid obesity (WHtR > 0.6) based on WHtR decreased as 3.7% in 2013 (28.8% vs. 25.1%) (P = 0.004). Central obesity based on WHR significantly decreased in less or equal 24-year-old group (76.6% vs. 70.1%) (P = 0.003), while it increased in 25-34- (65.1% vs. 74.0%) and in equal or more than 35-year-old group (54.1% vs. 78.9%) (P = 0.001 for all). Moreover, morbid obesity decreased in all age, economic, and education groups (except uneducated one) (P < 0.050 for all). CONCLUSION: Despite the decrease in central obesity based on WC and WHR indices in 2004-2013 duration, we found the evidence of a decline in sever obesity based on WHtR in that period. These trends have an alarm for health policy makers, not only in this area but also in same communities. Comprehensive studies are recommended to determine the best obesity indicator related to health in future. 

Keywords

  1. World Health Organization. Global strategy for the prevention and control of noncommunicable diseases [Online]. [cited 2000]; Available from: URL: http://www.who.int/nmh/publications/wha_resolution53_14/en
  2. Sinaiko AR, Jacobs DR Jr, Steinberger J, Moran A, Luepker R, Rocchini AP, et al. Insulin resistance syndrome in childhood: Associations of the euglycemic insulin clamp and fasting insulin with fatness and other risk factors. J Pediatr 2001; 139(5): 700-7.
  3. World Health Organization. Obesity and overweight [Online]. [cited 2013]; Available from: URL: http://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
  4. Rashidi A, Mohammadpour-Ahranjani B, Vafa MR, Karandish M. Prevalence of obesity in Iran. Obes Rev 2005; 6(3): 191-2.
  5. Malekzadeh R, Mohamadnejad M, Merat S, Pourshams A, Etmadi A. Obesity pandemic: An Iranian perspective. Arch Iran Med 2005; 8(1): 1-7.
  6. Veghari G, Sedaghat M, Joshaghani H, Hoseini A, Niknajad F, Angizeh A, et al. The prevalence and associated factors of central obesity in Northern Iran. Iran Cardiovasc Res J 2010; 4(4): 164-68.
  7. Janghorbani M, Amini M, Willett WC, Mehdi Gouya M, Delavari A, Alikhani S, et al. First nationwide survey of prevalence of overweight, underweight, and abdominal obesity in Iranian adults. Obesity (Silver Spring) 2007; 15(11): 2797-808.
  8. Kelishadi R, Alikhani S, Delavari A, Alaedini F, Safaie A, Hojatzadeh E. Obesity and associated lifestyle behaviours in Iran: findings from the First National Non-communicable Disease Risk Factor Surveillance Survey. Public Health Nutr 2008; 11(3): 246-51.
  9. Kok P, Seidell JC, Meinders AE. The value and limitations of the body mass index (BMI) in the assessment of the health risks of overweight and obesity. Ned Tijdschr Geneeskd 2004; 148(48): 2379-82.
  10. Mirmiran P, Esmaillzadeh A, Azizi F. Detection of cardiovascular risk factors by anthropometric measures in Tehranian adults: Receiver operating characteristic (ROC) curve analysis. Eur J Clin Nutr 2004; 58(8): 1110-8.
  11. Zhu S, Heymsfield SB, Toyoshima H, Wang Z, Pietrobelli A, Heshka S. Race-ethnicity-specific waist circumference cutoffs for identifying cardiovascular disease risk factors. Am J Clin Nutr 2005; 81(2): 409-15.
  12. Huang KC, Lee MS, Lee SD, Chang YH, Lin YC, Tu SH, et al. Obesity in the elderly and its relationship with cardiovascular risk factors in Taiwan. Obes Res 2005; 13(1): 170-8.
  13. Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr 2004; 79(3): 379-84.
  14. Despres JP. Body fat distribution and risk of cardiovascular disease: An update. Circulation 2012; 126(10): 1301-13.
  15. Statistical Statistical Center of Iran. Population and housing census [Online]. [cited 2012]; Available from: URL:
  16. https://www.amar.org.ir/Portals/1/Iran/census-2.pdf
  17. de Sousa TF, Nahas MV, Silva DA, Del Duca GF, Peres MA. Factors associated with central obesity
  18. in adults from Florianopolis, Santa Catarina: A population based-study. Rev Bras Epidemiol 2011; 14(2): 296-309.
  19. Bhatta MP, Assad L, Shakya S. Socio-demographic and dietary factors associated with excess body weight and abdominal obesity among resettled Bhutanese refugee women in Northeast Ohio, United States. Int J Environ Res Public Health 2014; 11(7): 6639-52.
  20. Veghari GR, Mansourian AR. The comparative study of obesity among mothers with different ethnic groups in Northern IRAN. Iran J Pub Health 2007; 36(3): 71-6.
  21. Fouque D, Vennegoor M, ter Wee P, Wanner C, Basci A, Canaud B, et al. EBPG guideline on nutrition. Nephrol Dial Transplant 2007; 22(Suppl 2): ii45-ii87.
  22. Dalton M, Cameron AJ, Zimmet PZ, Shaw JE, Jolley D, Dunstan DW, et al. Waist circumference, waist-hip ratio and body mass index and their correlation with cardiovascular disease risk factors in Australian adults. J Intern Med 2003; 254(6): 555-63.
  23. Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: Systematic review and meta-analysis. Obes Rev 2012; 13(3): 275-86.
  24. Schneider HJ, Friedrich N, Klotsche J, Pieper L, Nauck M, John U, et al. The predictive value of different measures of obesity for incident cardiovascular events and mortality. J Clin Endocrinol Metab 2010; 95(4): 1777-85.
  25. Barzin M, Keihani S, Hosseinpanah F, Serahati S, Ghareh S, Azizi F. Rising trends of obesity and abdominal obesity in 10 years of follow-up among Tehranian adults: Tehran Lipid and Glucose Study (TLGS). Public Health Nutr 2015; 18(16): 2981-9.
  26. Kasper NM, Herran OF, Villamor E. Obesity prevalence in Colombian adults is increasing fastest in lower socio-economic status groups and urban residents: Results from two nationally representative surveys. Public Health Nutr 2014; 17(11): 2398-406.
  27. Garnett SP, Baur LA, Cowell CT. The prevalence of increased central adiposity in Australian school children 1985 to 2007. Obes Rev 2011; 12(11): 887-96.
  28. Veghari G. The comparison of under-five-children's nutrition status among ethnic groups in North of Iran, 1. Iran J Pediatr 2015; 25(4): e2004.
  29. Veghari G, Vakili M. Trend of stunting, overweight and obesity among children under five years in a rural area in northern Iran, 1998-2013: Results of three cross-sectional studies. Arch Iran Med 2016; 19(6): 397-402.
  30. Veghari G, Sedaghat M, Maghsodlo S, Banihashem S, Moharloei P, Angizeh A, et al. The correlation between educational levels and central obesity in the north of Iran: An epidemiologic study. ARYA Atheroscler 2013; 9(4): 217-22.
  31. R A, S H, Ruma D. The waist circumference measurement: A simple method for assessing the abdominal obesity. J Clin Diagn Res 2012; 6(9): 1510-3.
  32. Cheong SM, Kandiah M, Chinna K, Chan YM, Saad HA. Prevalence of obesity and factors associated with it in a worksite setting in Malaysia. J Community Health 2010; 35(6): 698-705.
  33. Katulanda P, Jayawardena MA, Sheriff MH, Constantine GR, Matthews DR. Prevalence of overweight and obesity in Sri Lankan adults. Obes Rev 2010; 11(11): 751-6.
  34. Siddiquee T, Bhowmik B, Da Vale Moreira NC, Mujumder A, Mahtab H, Khan AK, et al. Prevalence of obesity in a rural Asian Indian (Bangladeshi) population and its determinants. BMC Public Health 2015; 15: 860.
  35. Rashidy-Pour A, Malek M, Eskandarian R, Ghorbani R. Obesity in the Iranian population. Obes Rev 2009; 10(1): 2-6.
  36. Al-Riyami AA, Afifi MM. Prevalence and correlates of obesity and central obesity among Omani adults. Saudi Med J 2003; 24(6): 641-6.
  37. Rafraf M, Mohamadi E, Gargari BP. Prevalence of overall and abdominal obesity among adolescent high school girls in Tabriz, Iran. International Medical Journal Malaysia 2013; 12(1): 27-32.
  38. Kowalkowska J, Poinhos R, Franchini B, Afonso C, Correia F, Pinhao S, et al. General and abdominal adiposity in a representative sample of Portuguese adults: Dependency of measures and socio-demographic factors' influence. Br J Nutr 2016; 115(1): 185-92.
  39. Ghassemi H, Harrison G, Mohammad K. An accelerated nutrition transition in Iran. Public Health Nutr 2002; 5(1A): 149-55.
  40. Kee CC Jr, Jamaiyah H, Noor Safiza MN, Khor GL, Suzana S, Jamalludin AR, et al. Abdominal obesity in Malaysian adults: National health and morbidity survey III (NHMS III, 2006). Malays J Nutr 2008; 14(2): 125-35.
  41. Razak F, Corsi DJ, Slutsky AS, Kurpad A, Berkman L, Laupacis A, et al. Prevalence of body mass index lower than 16 among women in low-and middle-income countries. JAMA 2015; 314(20): 2164-71.
  42. Veghari G, Saeedi M. The comparative study of body mass index distribution among preschool children in a 7 years period in north of Iran. J Appl S 2007; 7(18): 2681-5.