Overweight and Obesity in the Eastern Mediterranean Region
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- Abstract BACKGROUND
- Abstract OBJECTIVE
- Obesity and the risk of hyperuricemia in Gadap Town, Karachi
- The Association of Sugar-Sweetened Beverage Consumption and Inadequate Physical Activity with Overweight and Obesity in School-Going Children and
- MATERIAL AND METHODS
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METHOD: In this cross-sec onal study, 337 healthy adults (108 males and 229 females, mean age 40.7 ± 14.2 years) par cipated. The subjects were randomly selected in Lyari Town in Karachi using a geographical imaging system (GIS). Their demographic, anthropometric [body mass index (BMI), hip and waist circumferences, waist-to-hip circumference ratio (W-HR), and
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biochemical (fasting blood glucose, fasting insulin, fasting lipid profile, and hsCRP)] parameters were recorded. Insulin resistance was calculated by the homeostasis model assessment (HOMA-IR). Metabolic syndrome was diagnosed according to the International Diabetes Federation (IDF) criteria. Correlation of CRP and fasting insulin levels with various parameters of metabolic syndrome were calculated using Pearson correlation. RESULTS: Median CRP levels were found to be higher in females 0.81 (0.20- 1.38) compared with males 0.77 (0.19-1.35). Metabolic syndrome was diagnosed in 108 (31.12%) subjects. No significant difference between CRP levels in the metabolic syndrome-positive and metabolic syndrome- negative groups was observed. Similarly, no correlation was observed between hsCRP and fasting insulin levels, insulin resistance, and other parameters of MS.
various risk factors for metabolic syndrome in our urban population. Further large-scale prospective studies are needed to confirm these findings.
BMC Public Health. 2011 May 23;11:363. Underestimation of Weight and Its Associated Factors among Overweight and Obese Adults in Pakistan: A Cross Sectional Study. Bhanji S, Khuwaja AK, Siddiqui F, Azam I, Kazmi K. Department of Family Medicine, The Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan. seema.bhanji@aku.edu Abstract BACKGROUND: Weight loss is known to decrease the health risks associated with being overweight and obese. Awareness of overweight status is an important determinant of weight loss attempts and may have more of an impact on one's decision to lose weight than objective weight status. We therefore investigated the perception of weight among adults attending primary care clinics in Karachi, Pakistan, and compared it to their weight categories based on BMI (Body Mass Index), focusing on the underestimation of weight in overweight and obese individuals. We also explored the factors associated with underestimation of weight in these individuals. 411
METHODS: This was a cross sectional study conducted on 493 adults presenting to the three primary care clinics affiliated with a tertiary care hospital in Karachi, Pakistan. We conducted face to face interviews to gather data on a pre-coded questionnaire. The questionnaire included detail on demographics, presence of comorbid conditions, and questions regarding weight assessment. We measured height and weight of the participants and calculated the BMI. The BMI was categorized into normal weight, overweight and obese based on the revised definitions for Asian populations. Perception about weight was determined by asking the study participants the following question: Do you consider yourself to be a) thin b) just right c) overweight d) obese. We compared the responses with the categorized BMI. To identify factors associated with underestimation of weight, we used simple and multiple logistic regression to calculate crude odds Ra os (OR) and adjusted Odds Ra os (AOR) with 95% Confidence Intervals.
18% (n = 89) were overweight. There was poor agreement between self percep on and actual BMI (Kappa = 0.24, SE = 0.027, p < 0.001). Among obese participants a large propor on (73%) did not perceive themselves as obese, although half (n = 102) of them thought they may be overweight. Among the overweight par cipants, half (n = 41) of them didn't recognize themselves as overweight. Factors associated with misperception of weight in overweight and obese participants were age ≥ 40 years (AOR = 3.4; 95% CI: 1.8-6.4), male gender (AOR = 2.97; 95% CI: 1.6-5.5), being happy with ones' weight (AOR = 6.4; 95% CI: 3.4-12.1), and not knowing one's ideal weight (AOR = 2.45, 95% CI: 1.10-5.47).
discordance between the actual and perceived weight. Underestimation of individual weight was more common in older participants (≥ 40 years), men, participants happy with their weight and participants not aware of their ideal weight. Accurate perception of one's actual weight is critical for individuals to be receptive to public health messages about weight maintenance or weight loss goals. Therefore educating people about their correct weight, healthy weights and prevention of weight gain are important steps towards addressing the issue of obesity in Pakistan.
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J Cardiometab Syndr. 2008 Fall;3(4):254-7. Surgical Treatment of the Cardiometabolic Syndrome and Obesity. Khan KA, Sowers JR. Post Graduate Medical Institute, Lahore General Hospital, University of Health Sciences Lahore, Lahore, Pakistan. khan-7@hotmail.com Abstract Prevalence of overweight and obesity has reached a pandemic proportion worldwide and is increasingly contributing to premature morbidity and mortality. Lifestyle changes including behavioral modification, exercise, different dietary plans, and medications have very poor outcome on long- term weight loss. Bariatric surgery has shown to be very effective for morbidly obese patients. Surgery in these patients not only decreases their body weight but also may improve comorbid conditions associated with obesity. These pa ents on average lose 61% of excess body weight depending on the procedure performed. Diabetes, hyperlipidemia, and hypertension are normalized in these pa ents by 77%, 70%, and 62%, respectively. Patients need to be selected carefully for surgical treatment of obesity and have to be monitored closely over the long term for nutritional deficiencies and other complications.
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BMC Res Notes. 2011 Jun 6;4(1):174. Prevalence of Physical Inactivity and Barriers to Physical Activity among Obese Attendants at a Community Health- Care Center in Karachi, Pakistan. Samir N, Mahmud S, Khuwaja AK. Department of Community Health Sciences, The Aga Khan University, Karachi, PO Box 3500, Stadium Road, Karachi 74800 Pakistan. sadia.mahmud@aku.edu.
problems worldwide with serious health consequences. With increasing urbanization and modernization there has been an increase in prevalence of obesity that is attributed to reduced levels of physical activity (PA). However, little is known about the prevalence of physical inactivity and factors that prohibit physical activity among Pakistani population. This cross-sectional study is aimed at estimating the prevalence of physical inactivity, and determining associated barriers in obese attendants accompanying patients coming to a Community Health Center in Karachi, Pakistan. FINDINGS: PA was assessed by using international physical activity questionnaire (IPAQ). Barriers to PA were also assessed in inactive obese attendants. A pre-tested questionnaire was used to collect data from a total of 350 obese a endants. Among 350 study par cipants 254 (72.6%) were found to be physically inac ve (95% CI: 68.0%, 77.2%). Mul variable logis c regression analysis indicated that age greater than 33 years, BMI greater than 33 kg/m2 and family history of obesity were independently and significantly associated with physical inactivity. Moreover, there was a significant interaction between family structure and gender; females living in extended families were about twice more likely to be inactive, whereas males from extended families were six times more likely to be inactive relative to females from nuclear families. Lack of information, motivation and skills, spouse & family support, accessibility to places for physical activity, cost effective facilities and time were found to be important barriers to PA.
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CONCLUSIONS: Considering the public health implications of physical inactivity it is essential to promote PA in context of an individual's health and environment. Findings highlight considerable barriers to PA among obese individuals that need to be addressed during counseling sessions with physicians.
J Coll Physicians Surg Pak. 2011 Mar;21(3):146-50. Hyperinsulinemia and Waist Circumference in Childhood Metabolic Syndrome. Lone SW, Atta I, Ibrahim MN, Leghari TM, Khan YN, Raza J. Department of Paediatrics, National Institute of Child Health, Karachi. saira_akm@hotmail.com Abstract OBJECTIVE: To determine the characteristics of obese children presenting at a tertiary care hospital and the frequency of metabolic syndrome (MS) in them using two paediatric definitions.
Ins tute of Child Health, Karachi, from November 2005 ll May 2008. METHODOLOGY: A total of 262 obese children aged 4-16 years, with BMI greater than 95th percen le were included. Children having obesity due to syndromes, medications causing weight gain, chronic illness and developmental disability were excluded. Blood pressure, waist circumference, fasting triglycerides, HDL, insulin and glucose levels were obtained. Obesity was defined as BMI > 95th percen le for age and gender according to the UK growth reference charts. The prevalence of metabolic syndrome was estimated using to the De Ferrantis and Lambert definitions. RESULTS: The frequency of MS varied between 16% and 52% depending on whether insulin levels were included in the definition. There was a significant positive correlation(r) when the metabolic parameters were correlated with waist circumference and insulin levels, except HDL which was negatively correlated. All the metabolic parameters like waist circumference, triglycerides, high density lipoprotein cholesterol and systolic blood pressure increased considerably across the insulin quartile (p
were the waist circumference (46.5%) and insulin levels (58%) respec vely. 415
CONCLUSION: There was a marked difference in the frequency of metabolic syndrome according to the definition used. The waist circumference and hyperinsulinemia are significant correlates of MS in obese children. There is a need for establishing normal insulin ranges according to age, gender and pubertal status. The clinical examination and investigations ought to include waist circumference and insulin levels together as a part of the definition of MS, for early detection and intervention of childhood obesity. BMC Public Health. 2011 May 23;11(1):363. [Epub ahead of print] Underestimation of Weight and Its Associated Factors among Overweight and Obese Adults in Pakistan: A Cross Sectional Study. Bhanji S, Khuwaja AK, Siddiqui F, Azam I, Kazmi K. Abstract BACKGROUND: Weight loss is known to decrease the health risks associated with being overweight and obese. Awareness of overweight status is an important determinant of weight loss attempts and may have more of an impact on one's decision to lose weight than objective weight status. We therefore investigated the perception of weight among adults attending primary care clinics in Karachi, Pakistan, and compared it to their weight categories based on BMI (Body Mass Index), focusing on the underestimation of weight in overweight and obese individuals. We also explored the factors associated with underestimation of weight in these individuals. METHODS: This was a cross sec onal study conducted on 493 adults presenting to the three primary care clinics affiliated with a tertiary care hospital in Karachi, Pakistan. We conducted face to face interviews to gather data on a pre-coded questionnaire. The questionnaire included detail on demographics, presence of comorbid conditions, and questions regarding weight assessment. We measured height and weight of the participants and calculated the BMI. The BMI was categorized into normal weight, overweight and obese based on the revised definitions for Asian populations. Perception about weight was determined by asking the study participants the following question: Do you consider yourself to be a)thin b)just right c)overweight d)obese. We compared the responses with the categorized BMI. To identify factors associated with underestimation of 416
weight, we used simple and multiple logistic regression to calculate crude odds Ra os (OR) and adjusted Odds Ra os (AOR) with 95% Confidence Intervals.
18% (n= 89) were overweight. There was poor agreement between self percep on and actual BMI (Kappa= 0.24, SE= 0.027, p < 0.001). Among obese par cipants a large propor on (73%) did not perceive themselves as obese, although half (n=102) of them thought they may be overweight. Among the overweight par cipants, half (n=41) of them didn't recognize themselves as overweight. Factors associated with misperception of weight in overweight and obese par cipants were age >= 40 years (AOR= 3.4; 95% CI: 1.8-6.4), male gender (AOR= 2.97; 95% CI: 1.6-5.5), being happy with ones' weight (AOR= 6.4; 95% CI: 3.4-12.1), and not knowing one's ideal weight (AOR= 2.45, 95% CI: 1.10-5.47).
discordance between the actual and perceived weight. Underestimation of individual weight was more common in older par cipants (>= 40 years), men, participants happy with their weight and participants not aware of their ideal weight. Accurate perception of one's actual weight is critical for individuals to be receptive to public health messages about weight maintenance or weight loss goals. Therefore educating people about their correct weight, healthy weights and prevention of weight gain are important steps towards addressing the issue of obesity in Pakistan.
African Journal of Biotechnology, February, 2011;10(6):996-998. Obesity and the risk of hyperuricemia in Gadap Town, Karachi Muhammad Akram1, H.M.Asif2, Khan Usmanghani1, Naveed Akhtar2, Qaiser Jabeen2, Asadullah Madni2, Tariq saeed3, Riazur Rehman2, Khalil Ahmed2 and S.M. Ali Shah2 1Shifa ul Mulk Memorial Hospital, Hamdard University, Karachi, Pakistan. 2Faculty of Pharmacy and Alterna ve Medicine, Islamia University of Bahawalpur. 3University College of Pharmacy, Punjab University, Lahore, Pakistan. Abstract Obesity is a known risk factor for hyperuricemia. However, the effect of the interaction between obesity and hyperuricemia is not well understood. Previous study has shown a relationship between hyperuricemia and 417
obesity, but the evidence from prospective studies of an association between obesity and uric acid risk is limited. We prospectively evaluated the association between obesity and the incidence of uric acid in obese individuals.In a population-based cohort, obesity and weight gain was found to be strongly associated with hyperuricemia. Additionally, all patients who developed hyperuricemia were obese at baseline. Obesity is a risk factor for hyperuricemia and may be useful for prediction of incident gout in individuals.
Arch Dis Child. 2011 Jan;96(1):109-11. Epub 2010 Sep 18. The Association of Sugar-Sweetened Beverage Consumption and Inadequate Physical Activity with Overweight and Obesity in School-Going Children and Adolescents in Pakistan. Rizwan A, Akhter J, Jafar TH. Abstract
Obesity in children tracks into adulthood and is associated with premature cardiovascular disease, type II diabetes and premature death. 1 Although the prevalence of childhood obesity is escalating in developing countries including Pakistan, 2 the factors fuelling this trend have not been well studied. We conducted a survey on 339 randomly selected children and adolescents aged 11–17 years from four private schools in Karachi, Pakistan to determine the factors associated with overweight and obesity. Approval to conduct the survey was obtained from the Ethics Review Committee of the Aga Khan University. From each school, a list of all the children in the specified classes was obtained. A random selection of children …
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Gynecol Obstet Invest. 2010;69(3):184-9. Epub 2009 Dec 21. Continuation of Metformin Reduces Early Pregnancy Loss in Obese Pakistani Women with Polycystic Ovarian Syndrome. Nawaz FH, Rizvi J. Department Obstetrics and Gynecology, Aga Khan University Hospital, Karachi, Pakistan. fauzia.nawaz@aku.edu Abstract BACKGROUND: Polycystic ovarian syndrome (PCOS) is the most common cause of anovulatory infertility worldwide. In addition to a poor conception rate, pregnancy loss rates are significantly higher (30-50%) during the first trimester in women with PCOS. Insulin resistance (IR) in this syndrome is not only implicated toward early pregnancy loss (EPL) but also pathognomic for various obstetrical complications during pregnancy. We evaluated the role of Metformin in the reduction of EPL in women with PCOS who conceived spontaneously or after induction ovulation with or without Metformin.
Metformin in the reduction of EPL in women with PCOS. Secondary outcomes like gestational diabetes, pregnancy-induced hypertension and intrauterine growth restriction were also analyzed at the end of the study. MATERIAL AND METHODS: This case-control study was conducted from March 2005 to March 2008 in the infer lity and antenatal clinics of the Department of Obstetrics and Gynecology of Aga Khan University Hospital, Karachi, Pakistan. A total of 197 infer le women with PCOS were included. 'Cases' were women with PCOS who conceived while taking Metformin and it whom it was continued throughout pregnancy. 'Controls' were women in whom Metformin was either stopped in first trimester after confirmation of pregnancy (by serum betaHCG or by ultrasound) or they conceived spontaneously without the use of Metformin.
(Rotterdam criteria). These women were followed till the final outcome of pregnancy was achieved. Both groups were compared for risk of EPL. It was found that continuation of Metformin during pregnancy reduces EPL, i.e. 8.8 vs. 29.4% in cases and controls, respec vely (p < 0.001). In the subset of women with a prior history of miscarriage, the pregnancy loss rate was 12.5% in the Me ormin versus 49.4% in control group (p = 0.002).
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