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Overweight and Obesity in Samples
of 4 Provinces (Tobaco or Health Study)

Morlans, Jesús; Dueñas, Alfredo; González, Juan;
De la Noval, Reinaldo; Debbs, Giselle

Instituto De Cardiología, La Habana, Cuba

SUMMARY
Introduction: The obesity is considered a coronary risk factor. Besides it is associated with arterial hypertension, diabetes mellitus, stroke and others chronic diseased.
Objectives: To characterize obesity as a risk factor in some Cuban regions using the data of the study "Tobacco or Health" (It is a current Cuban investigation)
Methods: This cross sectional study utilized data from a community based survey carried out in 1996. It was surveyed 16,099 men and women aged >34 years in 4 health area of the following provinces: P.del Rio; Habana; Ciudad de la Habana; Camaguey respectively.
Percents frequencies of socio-demographic variables and the different BMI categories (low weight, normal, overweight, obesity) were determined in the population .The association of obesity and diabetes mellitus, arterial hypertension, myocardial infarction, angina and stroke were analyzed by estimating the prevalence ratios. All calculations were performed using the Epi Info 6 software.
Results: Table 1, Table 2



Conclusions: It was confirmed that obesity is an important risk factor, although the prevalence was at a low level during the study period (1996), the prevalence of overweight was to be considered as a potential health hazard

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INTRODUCTION
   The data of the Framingham Heart Study show obesity as an independent cardiovascular risk factor (1). It is associated with acute myocardial infarction (AMI), arterial hypertension (AHT), stroke, diabetes mellitus and other chronic diseases (2). At present the World Health Organization (WHO) consider obesity a pandemic affecting both developed and developing countries and report a estimate of 1200 millions of persons in overweight in 1999 (3). According to PAHO Latin America does not escape this situation (4). It was observed in a national epidemiological studied in 1982, a greater tendency to overweight and obesity than to low weight (5). On the other hand, it is known that Cuba underwent an important economic crisis in the 90 decade when disappeared the European socialist countries affecting the nutrition of the Cuban population.

OBJECTIVES
   To characterize overweight and obesity in some Cuban regions in a year that the economic crisis was been surpassing.

MATERIALS AND METHODS
   It was examined the data of the initial survey of the prospective study Tobacco or Health in an urban health area of each of the following provinces: Pinar del Rio; Habana; Ciudad de la Habana; and Camagüey. The survey was conducted in 1996, it was surveyed 16099 men and women aged>34 years.

   Using body mass index (BMI) or Quetelet index {weight (kg)/height (m2)} the population was classified by WHO (6) in: low weight <20 kg/m2; normal >=20 and <25 kg</m2; overweight >=25 and <30 kg/m2 ;obesity>30 kg/m2. Body weight measurements were made using calibrated scales to the nearest 100g (subject wore light clothes) and height in bare feet to the nearest millimeter.

   Percents frequencies of socio-demographic variables were determined. To analyze the association between obesity and diabetes mellitus, arterial hypertension, acute myocardial infarction, angina and stroke the prevalence ratio and associated 95% confidence interval was performed. All analyses were performed with Epi Info (version 6.04c, Centers for Disease Control-WHO).

RESULTS
   Table 1 shows the characteristics of the studied population by provinces, the mean age was 57 years and the median 56, 30 % of the sample were older than 60 years. 58% (range 56-60%) were women and 42% (range 40-44) were men. 78% were white (from 66% in Ciudad de la Habana to 87% in Pinar del Rio) 13% were black and 9% were mulatto.66% of population were married. 18% had higher education level, 12% technical education, high school (9 grades), 4% qualified workmen and workingwomen, and 40% elementary school graduated or not completed.


   This same table shows the BMI in the sample of each province and in the total population: Obesity (range 7-10%); overweight (range 24-29%); normal (range 52-61%); and low weight (range 8-13%). The major frequency of the sum of obesity and overweight (BMI>= 25 kg/m2) corresponds to Ciudad de la Habana and the lowest to Pinar del Rio.

   Table 2 summarizes the distribution of the categories of BMI among the socio-demographic variables. Ages 55-64 years group had the major prevalence of BMI>=25 kg/m2 followed in a decremented BMI order: incomplete elementary school, mulatto, women, and a married civil status.

   The prevalence ratios of some diseases with respect to the presence of obesity or not is shown in table 3. It is observed the major ratio in myocardial infarction, followed by diabetes mellitus, stroke, arterial hypertension and finally angina.

DISCUSSION
   The analyzed samples are not representative of the chosen provincial populations and therefore of the country, but their size allows to have an insight of the nutrition situation in the first half of the 90-decade, at least in the provinces studied.

   30% of the subjects had an age of more than 60 years, while in Cuba 12% of the population then had this age (7) reflecting the character of community based study.

   Obesity is considered conceptually as an excess of body fat, but its direct measurement is somewhat complex. In this study is used the BMI or Quetelet index criteria of the World Health Organization (6) to define obesity and overweight. By the other hand it has been reported few studies of health risks that achieve the WHO criteria for overweight and obesity (8).

   Compared the BMI>=25 kg/m2 prevalence of this study with the urban adults group in a national sample in 1982(5) were higher both in men and women in this last study (36% vs. 31% and 42% vs37%, respectively) as it was expected. A similar difference more pronounced (56% vs.31%) was observed comparing the BMI>=25 in both sexes with the result of a study performed by our Epidemiology Department in the 10 de Octubre county in La Ciudad de la Habana, in 1988, just before the critical economic situation, it is evident a diminution of the BMI with respect to the 80 decade. A difference as high as the above mentioned is present if it is compared with BMI in USA(10) in 1998 (more than 50% vs. 31%).

   The prevalence of obesity (BMI>=30) found in this study (8%) is rather low compared with developed countries as USA in 1991 (12%) and in1998 (17%)8.

CONCLUSIONS
   Although the limitations of this study, particularly in relation to the non representative of the Cuban population and the important weight of age>60 years in it, it shows an important diminution of obesity and overweight at the moment of the survey as consequence of the especial economic situation of the 90 decade, however the observed values of overweight suggest the need of a surveillance of BMI because of its potential health risk in the future.

   The prevalence ratios for some non-transmissible diseases in obese and non-obese subjects show an association between obesity and those analyzed diseases.

REFERENCES

1. Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: a 26 years follow up of participants in the Framingham Heart Study .Circulation 1983; 67(5): 968-77.

2. Lean MEJ. Obesity a clinical issue. London: Science press, 1996:16-17.

3. WHO. Informe sobre el estado del mundo. Geneva: World Health Organization, 2000.

4. Seminario-Taller sobre obesidad y pobreza en América Latina. Rev cubana Aliment Nutr 1996; 10(1).

5. Berdasco A. Body mass index values in the Cuban adult population. European J Clin Nutr 1994; 48 (suppl 3):S155-S164.

6. WHO. Physical Status: The use and interpretation of anthropometry. Geneva CH.WHO 1995, technical report 854.

7. Anuario Estadístico 1996. Ministerio de Salud Publica. La Habana. 1996

8. Lean MEJ, Han TS, Seidell JC. Impairment of Health and Quality of Life using New Federal Guidelines for the identification of Obesity. Arch Intern Med, 1999; 159(8):837-843

9. Mokdad AH, Serdula MK, Dietz WH, Bowman BA, Marks JS, Koplan JP. The spread of Obesity Epidemic in the United States, 1991-1998. JAMA 1999; 282(16): 1519-1522

10. Flegal KM, Carroll MD, Kuczmarski RJ, Jonson CL. Overweight and Obesity in United States. Int J Obes Relat Metab Disord.1998; 22:39-47.

 

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2nd Virtual Congress of Cardiology

Dr. Florencio Garófalo
Steering Committee
President
Dr. Raúl Bretal
Scientific Committee
President
Dr. Armando Pacher
Technical Committee - CETIFAC
President
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