Association of household and community socioeconomic position and urbanicity with underweight and overweight among women in Pakistan

Naveed Zafar Janjua, Bushra Mahmood, Junaid A Bhatti, M Imran Khan, Naveed Zafar Janjua, Bushra Mahmood, Junaid A Bhatti, M Imran Khan

Abstract

Background: Similar to other developing countries, Pakistan is going through a rapid nutrition transition where shift from underweight to overweight and obesity is occurring. In this paper, we report on the relationship of household socioeconomic position (SEP), community SEP and urbanicity with under- and over-weight categories of BMI among Pakistani women.

Methods: We analyzed data on 4,767 women ages 15-49 years enrolled in a nationally representative Pakistan Demographic Health Survey (PDHS) conducted in 2012-13 that employed a multistage, stratified cluster sampling design. We assessed the association of urbanicity, household and community SEP derived from household assets and utilities, with categories of body mass index (BMI) using multinomial regression analysis where normal weight (BMI 18.6-22.5) was the reference category.

Results: Thirteen percent of women were underweight (BMI <18.5), 15% pre-overweight (BMI: 22.6-24.9), 25% overweight (BMI: 25.0-29.9) and 14% were obese (BMI≥30). Pre-overweight, overweight and obesity among women increased across household wealth quintiles (HWQs) in a graded fashion whereas there was no significant difference in underweight by household wealth. Women in urban areas were more likely to be obese. There was a pronounced increase in adjusted odds ratios (aORs) for overweight/obesity across HWQs within urban areas compared to rural areas. There was a steeper gradient in aORs for obesity from 1st to 5th HWQs in high income communities compared to the middle- and low income communities. In community-level analyses, communities in urban areas were more likely to have higher levels of obesity while in rural areas, especially in Sindh, more communities were more likely to have a higher level of underweight.

Conclusion: A shift to higher overweight and obesity than underweight in Pakistan is associated with high household and community wealth as well as living in urban areas. Clustering of obesity and underweight in distinct communities afford opportunity for tailored intervention programs.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Distribution of ratio of probability…
Fig 1. Distribution of ratio of probability of being under-weight to obese at community level by urbanization level, DHS Pakistan 2012–13.
A: Major Urban; B: Small City and C: Rural. Ratio of 1 denotes equal percentage of underweight and obesity, below 1 indicates higher obesity and above 1 indicates higher percentage of underweight within a community.

References

    1. Popkin BM, Adair LS, Ng SW (2012) Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 70: 3–21. 10.1111/j.1753-4887.2011.00456.x
    1. McLaren L (2007) Socioeconomic status and obesity. Epidemiol Rev 29: 29–48.
    1. Ahmed T, Hossain M, Sanin KI (2012) Global burden of maternal and child undernutrition and micronutrient deficiencies. Ann Nutr Metab 61 Suppl 1: 8–17. 10.1159/000345165
    1. Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, et al. (2008) Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 371: 243–260. 10.1016/S0140-6736(07)61690-0
    1. Subramanian SV, Kawachi I, Smith GD (2007) Income inequality and the double burden of under- and overnutrition in India. J Epidemiol Community Health 61: 802–809.
    1. Gersh BJ, Sliwa K, Mayosi BM, Yusuf S (2010) Novel therapeutic concepts: the epidemic of cardiovascular disease in the developing world: global implications. Eur Heart J 31: 642–648. 10.1093/eurheartj/ehq030
    1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. (2012) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380: 2224–2260. 10.1016/S0140-6736(12)61766-8
    1. Pappas G, Akhtar T, Gergen PJ, Hadden WC, Khan AQ (2001) Health status of the Pakistani population: a health profile and comparison with the United States. Am J Public Health 91: 93–98.
    1. (2013) Pakistan Demographic and Health Survey 2012–13. Islamabad: National Institute of Population Studies (NIPS) and Macro International Inc. 1–366 p.
    1. Raza Q, Doak CM, Khan A, Nicolaou M, Seidell JC (2013) Obesity and cardiovascular disease risk factors among the indigenous and immigrant Pakistani population: a systematic review. Obes Facts 6: 523–535. 10.1159/000357176
    1. Zahid N, Meyer HE, Kumar BN, Claussen B, Hussain A (2011) High Levels of Cardiovascular Risk Factors among Pakistanis in Norway Compared to Pakistanis in Pakistan. J Obes 2011: 163749 10.1155/2011/163749
    1. Shera AS, Basit A, Fawwad A, Hakeem R, Ahmedani MY, Hydrie MZ, et al. (2010) Pakistan National Diabetes Survey: prevalence of glucose intolerance and associated factors in the Punjab Province of Pakistan. Prim Care Diabetes 4: 79–83. 10.1016/j.pcd.2010.01.003
    1. Janjua NZ, Iqbal R, Mahmood B (2011) Association of socioeconomic position with under- and overnutrition in Pakistan. Ann Epidemiol 21: 884–891. 10.1016/j.annepidem.2011.08.006
    1. Popkin BM (2006) Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases. Am J Clin Nutr 84: 289–298.
    1. Feeney G, Alam I (2003) New estimates and projections of population growth in Pakistan. Population and Development Review 29: 483–492.
    1. Allender S, Foster C, Hutchinson L, Arambepola C (2008) Quantification of urbanization in relation to chronic diseases in developing countries: a systematic review. J Urban Health 85: 938–951. 10.1007/s11524-008-9325-4
    1. Arambepola C, Allender S, Ekanayake R, Fernando D (2008) Urban living and obesity: is it independent of its population and lifestyle characteristics? Trop Med Int Health 13: 448–457. 10.1111/j.1365-3156.2008.02021.x
    1. Dahly DL, Gordon-Larsen P, Popkin BM, Kaufman JS, Adair LS (2010) Associations between multiple indicators of socioeconomic status and obesity in young adult Filipinos vary by gender, urbanicity, and indicator used. J Nutr 140: 366–370. 10.3945/jn.109.114207
    1. Van de Poel E, O'Donnell O, Van Doorslaer E (2009) Urbanization and the spread of diseases of affluence in China. Econ Hum Biol 7: 200–216. 10.1016/j.ehb.2009.05.004
    1. Durkin MS, Islam S, Hasan ZM, Zaman SS (1994) Measures of socioeconomic status for child health research: comparative results from Bangladesh and Pakistan. Soc Sci Med 38: 1289–1297.
    1. Gwatkin DR, Rustein S, Johnson K, Pande RP, Wagstaff A (2000) Socioeconomic differences in health, nutrition, and population in India Washington (D. C.): World Bank.
    1. Vyas S, Kumaranayake L (2006) Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan 21: 459–468.
    1. (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. The Lancet 363: 157–163.
    1. Corsi DJ, Kyu HH, Subramanian SV (2011) Socioeconomic and geographic patterning of under- and overnutrition among women in Bangladesh. J Nutr 141: 631–638. 10.3945/jn.110.131599
    1. Subramanian SV, Smith GD (2006) Patterns, distribution, and determinants of under- and overnutrition: a population-based study of women in India. Am J Clin Nutr 84: 633–640.
    1. Shafique S, Akhter N, Stallkamp G, de Pee S, Panagides D, Bloem MW (2007) Trends of under- and overweight among rural and urban poor women indicate the double burden of malnutrition in Bangladesh. Int J Epidemiol 36: 449–457.
    1. Balarajan Y, Villamor E (2009) Nationally representative surveys show recent increases in the prevalence of overweight and obesity among women of reproductive age in Bangladesh, Nepal, and India. J Nutr 139: 2139–2144. 10.3945/jn.109.112029
    1. (2007) National Family Health Survey (NFHS-3) 2005–06. India Mumbai: International Institute of Population Sciences, Mumbai and Macro International Inc. 1–379 p.
    1. (2009) Bangladesh Demographic and Health Survey 2007. Dhaka: National Institute of Population Research and Training Dhaka, Bangladesh and MEASURE DHS, ICF International, Calverton, Maryland, U.S.A. 1–430 p.
    1. (2013) Bangladesh Demographic and Health Survey 2011. Dhaka: National Institute of Population Research and Training Dhaka, Bangladesh and MEASURE DHS, ICF International, Calverton, Maryland, U.S.A. 1–430 p.
    1. Du S, Mroz TA, Zhai F, Popkin BM (2004) Rapid income growth adversely affects diet quality in China—particularly for the poor! Soc Sci Med 59: 1505–1515.
    1. Zhai F, Wang H, Du S, He Y, Wang Z, Ge K, et al. (2007) Lifespan nutrition and changing socio-economic conditions in China. Asia Pac J Clin Nutr 16 Suppl 1: 374–382.
    1. Thang NM, Popkin BM (2004) Patterns of food consumption in Vietnam: effects on socioeconomic groups during an era of economic growth. Eur J Clin Nutr 58: 145–153.
    1. Janjua N, Mahmood B, Iqbal R (2011) Socioeconomic position and protein/meat consumption pattern in Pakistan. Am J Epidemiol 173: S116–S116.
    1. Song YM (2006) Commentary: varying relation of socioeconomic status with obesity between countries at different stages of development. Int J Epidemiol 35: 112–113.
    1. Neuman M, Kawachi I, Gortmaker S, Subramanian SV (2013) Urban-rural differences in BMI in low- and middle-income countries: the role of socioeconomic status. Am J Clin Nutr 97: 428–436. 10.3945/ajcn.112.045997
    1. Hilmers A, Hilmers DC, Dave J (2012) Neighborhood disparities in access to healthy foods and their effects on environmental justice. Am J Public Health 102: 1644–1654. 10.2105/AJPH.2012.300865
    1. Holsten JE (2009) Obesity and the community food environment: a systematic review. Public Health Nutr 12: 397–405. 10.1017/S1368980008002267
    1. Larson NI, Story MT, Nelson MC (2009) Neighborhood environments: disparities in access to healthy foods in the U.S. Am J Prev Med 36: 74–81. 10.1016/j.amepre.2008.09.025
    1. Aloia CR, Gasevic D, Yusuf S, Teo K, Chockalingam A, Patro BK, et al. (2013) Differences in perceptions and fast food eating behaviours between Indians living in high- and low-income neighbourhoods of Chandigarh, India. Nutr J 12: 4 10.1186/1475-2891-12-4
    1. Naseer M, Khoso A, Naqvi S, Irfan H (2013) Sex-based difference in the perception of exercise and level of physical activity among residents of Karachi City, Pakistan. J Phys Act Health 10: 1039–1047.
    1. Samir N, Mahmud S, Khuwaja AK (2011) Prevalence of physical inactivity and barriers to physical activity among obese attendants at a community health-care center in Karachi, Pakistan. BMC Res Notes 4: 174 10.1186/1756-0500-4-174
    1. Jalil HH, Iqbal M (2010) Urbanisation and Crime: A Case Study of Pakistan. Pakistan Development Review 49.
    1. (2005) Pakistan: Country Gender Assessment, Bridging the gender gap opportunities and challenges Washington, DC: The World Bank.
    1. Khan A (1999) Mobility of women and access to health and family planning services in Pakistan. Reproductive Health Matters 7: 39–48.
    1. Mumtaz Z, Salway S (2005) 'I never go anywhere': extricating the links between women's mobility and uptake of reproductive health services in Pakistan. Soc Sci Med 60: 1751–1765.
    1. (2011) Nutrition for National Development: Pakistan’s Integrated Nutrition Strategy. Islamabad: UNICEF.
    1. Khan A (2014) Pakistan Economic Survey 2012–13: Health and Nutrition. Islamabad: Ministry of Finance, Government of Pakistan. 145–153. p.
    1. Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML, et al. (2011) The global obesity pandemic: shaped by global drivers and local environments. Lancet 378: 804–814. 10.1016/S0140-6736(11)60813-1
    1. Fernald LC, Gertler PJ, Hou X (2008) Cash component of conditional cash transfer program is associated with higher body mass index and blood pressure in adults. J Nutr 138: 2250–2257. 10.3945/jn.108.090506
    1. Fernald LC, Gertler PJ, Neufeld LM (2009) 10-year effect of Oportunidades, Mexico's conditional cash transfer programme, on child growth, cognition, language, and behaviour: a longitudinal follow-up study. Lancet 374: 1997–2005. 10.1016/S0140-6736(09)61676-7
    1. Uauy R, Kain J (2002) The epidemiological transition: need to incorporate obesity prevention into nutrition programmes. Public Health Nutr 5: 223–229.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅