Disparities In Body Mass Index Research Articles

Urban-rural disparity in body mass index: is dietary knowledge a mechanism? Evidence from the China Health and Nutrition Survey 2004-2015.

The co-existence of undernutrition and overweight/obesity has been recognised as a severe challenge in China, with substantial urban-rural disparity. We evaluated short- and long-term associations of urban-rural locality on body mass index (BMI) in Chinese adults overall and stratified by sex, focusing on whether dietary knowledge plays a mediating role. We used cross-sectional and longitudinal study designs with structural equation modelling based on the 2004 (T1) and 2015 (T2) waves of the China Health and Nutrition Survey. We adjusted the models for covariates and performed sensitivity analyses. We cross-sectionally analysed 8932 (53.1% women) and 11 216 adults (54.3% women) at T1 and T2, respectively, and longitudinally investigated 4073 adults (55.6% women) in both T1 and T2. The estimated average dietary knowledge and mean BMI increased from T1 to T2. At each time point, we found significant indications of direct (e.g. urban-rural locality to BMI, urban-rural locality to dietary knowledge, and dietary knowledge to BMI) and indirect associations (e.g. urban-rural locality to dietary knowledge to BMI) overall and for men and women (except that urban-rural locality to BMI) separately. The long-term association between urban-rural locality and BMI attenuated over time and was not mediated by dietary knowledge change alone. Nevertheless, dietary knowledge interacted with BMI, which acted as a pathway from urban-rural locality to BMI in the long term. Urban-rural disparity in BMI persists in Chinese adults and is mediated by dietary knowledge. Policy and educational efforts to improve dietary knowledge among rural people may reduce China's urban-rural disparity in BMI.

A microbial causal mediation analytic tool for health disparity and applications in body mass index

BackgroundEmerging evidence suggests the potential mediating role of microbiome in health disparities. However, no analytic framework can be directly used to analyze microbiome as a mediator between health disparity and clinical outcome, due to the non-manipulable nature of the exposure and the unique structure of microbiome data, including high dimensionality, sparsity, and compositionality.MethodsConsidering the modifiable and quantitative features of the microbiome, we propose a microbial causal mediation model framework, SparseMCMM_HD, to uncover the mediating role of microbiome in health disparities, by depicting a plausible path from a non-manipulable exposure (e.g., ethnicity or region) to the outcome through the microbiome. The proposed SparseMCMM_HD rigorously defines and quantifies the manipulable disparity measure that would be eliminated by equalizing microbiome profiles between comparison and reference groups and innovatively and successfully extends the existing microbial mediation methods, which are originally proposed under potential outcome or counterfactual outcome study design, to address health disparities.ResultsThrough three body mass index (BMI) studies selected from the curatedMetagenomicData 3.4.2 package and the American gut project: China vs. USA, China vs. UK, and Asian or Pacific Islander (API) vs. Caucasian, we exhibit the utility of the proposed SparseMCMM_HD framework for investigating the microbiome’s contributions in health disparities. Specifically, BMI exhibits disparities and microbial community diversities are significantly distinctive between reference and comparison groups in all three applications. By employing SparseMCMM_HD, we illustrate that microbiome plays a crucial role in explaining the disparities in BMI between ethnicities or regions. 20.63%, 33.09%, and 25.71% of the overall disparity in BMI in China-USA, China-UK, and API-Caucasian comparisons, respectively, would be eliminated if the between-group microbiome profiles were equalized; and 15, 18, and 16 species are identified to play the mediating role respectively.ConclusionsThe proposed SparseMCMM_HD is an effective and validated tool to elucidate the mediating role of microbiome in health disparity. Three BMI applications shed light on the utility of microbiome in reducing BMI disparity by manipulating microbial profiles.6ppc1U8Yu1nT7JqzesB9dWVideo

Age, ethnic, and sex disparity in body mass index and waist circumference: a bi-national large-scale study in South Korea and the United States

The study investigated age, ethnic, and sex disparities in body mass index (BMI) and waist circumference (WC) in South Korea and the United States. We conducted a bi-national large-scale study and analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES) and the National Health and Nutrition Examination Survey in the United States (NHANES). The study found significant differences in BMI and WC between the two countries, as well as within each country based on age, ethnic, and sex groups. In both countries, men had higher BMIs and WCs than women. Among ethnic groups in the United States, non-Hispanic Black individuals had the highest BMIs and WCs, while Mexican American individuals had the highest BMIs and WCs in the South Korean population. The study also found that age was associated with higher BMIs and WCs in both countries, with the highest BMI and WC observed in the 60-69 age group in both South Korea and the United States. Additionally, the study revealed that the prevalence of obesity was higher in the United States than in South Korea, while abdominal obesity was more prevalent in South Korea than in the United States. Overall, the study suggests that there are significant differences in BMI and WC across age, ethnic, and sex groups in both South Korea and the United States, highlighting the importance of considering these factors in efforts to prevent and address obesity and its associated health risks.

Body Mass Index Trajectories among the Healthy Communities Study Children: Racial/Ethnic and Socioeconomic Disparities in Childhood Obesity.

The purpose of this study is to identify statistically distinguishable trajectories of childhood body mass index (BMI), an important indicator of developmental status of children, and to provide a summary description of demographic characteristics of children based on these distinctive trajectories. Using data from the Healthy Communities Study (HCS), a large longitudinal dataset with oversamples of Hispanic and Black children across 130 communities in the USA, a group-based trajectory analysis approach was used to estimate trajectories of children based on their BMI-z scores. The three most distinguishable BMI trajectory groups identified for the HCS children show no marked increase or decrease in standardized BMI over an age range of 2 to 11. Approximately 28.5% of children were in a trajectory group with consistently obese BMI-z scores for their sex and age. The patterns of BMI trajectory groups identified for boys and girls are similar, but BMI-z scores for boys tend to be slightly higher than those for girls. These BMI trajectories are characterized by racial/ethnic and socioeconomic status disparities. Hispanic and Black children were more likely to be in the obese trajectory group than White children. Children with parents having less education, or children from low family income level, were more likely to be in the obese trajectory group than counterpart children. The findings suggest that BMI disparities exist from the early years of childhood and persist across childhood, with higher BMI associated with Black and Hispanic children as well as those from low socioeconomic status backgrounds.

Sex differences in overweight and obesity among Mexican Americans in the National Health and Nutrition Examination Survey: A comparison of measures

The increasing prevalence of overweight and obesity in the United States, and disparities by race, ethnicity, and gender, have caused concern among public health practitioners, health care providers, and others, in part because overweight and obesity may be linked to chronic health problems and weight stigma. Researchers have traditionally relied upon body mass index (BMI) as a measure of overweight and obesity, despite its limitations. In this study we apply an intersectional framework and use data from the 2011–2018 waves of the nationally representative National Health and Nutrition Examination Survey (NHANES) to study sex differences in the risk of overweight and obesity among Mexican Americans, triangulating three measures that proxy for overweight and obesity: BMI, high waist circumference, and high percent body fat. We assess heterogeneity across nativity, education, income by parenthood status, food security, time in the United States (for immigrants), and receipt of SNAP/WIC benefits (for the low-income sample). Results from logistic regression models indicate choice of cutoff values and measure are critical to determining whether sex disparities exist. We find no evidence of disparities in BMI but evidence of greater risk for females using traditional cutoff values for high waist circumference and high percent body fat. Adjusted cutoff values provide differing results. Minimal heterogeneity is seen. Results reinforce the importance of considering sex disparities and emphasize the importance of critically examining measures that proxy for overweight and obesity risk, given the high stakes surrounding weight stigma.

BMI disparities in coronary artery bypass grafting outcomes: A single center Society of Thoracic Surgeons (STS) database analysis

Disparities in Body Mass Index (BMI) has been a potential risk factor for intraoperative outcomes, postoperative morbidity and mortality after coronary artery bypass graft (CABG). This study aims to quantify the effect of BMI on early clinical outcomes following CABG. The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database was queried for adult patients who underwent first-time Coronary Artery Bypass Graft (CABG) patients in our center from 2014 to 2020. BMI and gender were investigated as primary risk factors for intraoperative outcomes, in-hospital postoperative outcomes, and hospital readmission using multiple logistic regression models. Propensity score weighting was used due to imbalances in the observational groups. Locally weighted smoothing (LOESS) plots of BMI were inspected for each outcome with a predicted probability plot of the interaction between BMI and gender. Among 591 patients meeting inclusion criteria, 79% were male (n=468) and 21% were female (n=124). Healthy(H), overweight/obese (O), and morbidly obese (MO) BMI was defined as <25, 25–35 and >35 respectively. There were significantly higher proportions of females in the healthy and obese categories, and males in the overweight BMI category (F vs M: H:33.9 vs 66.1% O: 15 vs 85%, MO:35 vs 65%, p < 0.001). Patient demographics and comorbidities are all well-balanced with no significant differences after propensity weighting. There was no significant difference in intraoperative outcomes including operating room time, cross clamp time, by-pass time and intraoperative blood loss requiring blood transfusion (p >0.05). Approximately half (49.16%) of patients had one or more in-hospital postoperative events, and 62 (10.56%) had hospital readmission follow discharge. After propensity weighting, the incidence of surgical site infection (SSI) was significantly higher in the morbidly obese group (H: 1.5%, O: 0.6%, MO: 4.5%, p = 0.016) and pneumothorax requiring intervention appears to be significantly higher also for those in the morbidly obese group (H: 0.3%, O: 1%, MO: 2%, p = 0.028). Death at discharge was found to be significantly higher in the healthy group (H: 2.5%, O: 0.3%, MO: 0.3%, p = 0.028, p = 0.008). Loess plots for in-hospital postoperative events and hospital readmission by BMI and gender showed a slight downward trend in postoperative events as BMI increases. Healthy and morbidly obese patient appear to have slightly higher values of hospital readmission for both genders. There was no difference in perioperative outcomes among the cohort. Morbidly obese patients undergoing CABG have a higher risk of SSI. Mortality was higher in the underweight patients. In general, BMI disparities did not affect the risk of perioperative death and other adverse outcomes.

Birth cohort, sex and educational disparities in the trajectories of body mass index in Taiwan: a longitudinal study

BackgroundTaiwan has gone through rapid industrialization, urbanization and economic growth in the 20th and early 21st centuries. Therefore, the population has experienced significant changes in the physical and social environment during the life course, which may affect the overall adiposity. Our aim was to examine the age trajectories of height, weight and body mass index (BMI) in the Taiwanese population and to explore the influences of sex, birth cohort and education.MethodsThe sample comprised 572,358 residents between 20 and 94 years of age in Taiwan who attended at least one health examination during 1996 to 2017 in a cohort study. Repeated measures of body weight and height were collected using an auto-anthropometer. We conducted a series of linear mixed-effects growth curve models to examine the trajectory of height, weight, and BMI across the life course with stratification by sex.ResultsAge-related trajectories of BMI differed between men and women and stronger cohort effects were observed among men, with younger cohorts having higher BMI. After holding cohort and age variables constant, men with junior high or lower education were shorter, thinner and had higher BMI than men with university or higher education (effect sizes: − 3.138 cm, p < 0.001; − 2.277 kg, p < 0.001; 0.121 kg/m2, p < 0.001, respectively). Women with junior high or lower education were shorter, heavier and had higher BMI than women with university or higher education (effect sizes: − 2.368 cm, p < 0.001; 2.417 kg, p < 0.001; 1.691 kg/m2, p < 0.001, respectively). The educational disparities in BMI were found to be larger among women.ConclusionsOur findings suggest that younger generations, especially men, and lower educational level individuals, particularly women, have increasing levels of BMI. The influence of age and cohort effects together with sex and educational disparities on adiposity should be highlighted when designing future interventions and policies regarding overweight and obesity.

The association between sexual orientation, BMI, obesity diagnosis, and provider recommendation for weight management

BackgroundNational data show that lesbian and bisexual women are more likely to be obese compared to straight women. However little is known about whether provider recommendation for weight management varies across these populations. Furthermore, health care providers have explicit and implicit preferences for straight people in comparison to lesbian or gay people. There is little research that exists depicting how this preference affects quality of patient care. The purpose of the study is: to compare, among lesbian, bisexual, and straight females with BMIs ≥ 30: (1) the average Body Mass Index (BMI); (2) receipt of a diagnostic code for obesity; and (3) receipt of a provider recommendation for weight management.MethodsWe performed a cross-sectional study of 534 patient records from four outpatient academic internal medicine practices at the University of Pennsylvania between January 1, 2019 to December 31, 2019 to determine variations in average BMI, proportion of International Classification of Diseases (ICD)-10 codes for obesity, and proportion of weight management recommendations offered by providers among lesbian, bisexual and straight females with BMIs ≥ 30. We classified provider recommendations as definite, possible, and absent. Multivariable median (BMI outcome only) or logistic regression was used to evaluate the associations between sexual orientation and each of the following outcomes: BMI, receipt of obesity diagnosis, and weight management recommendations.ResultsThere were no significant differences in BMI, receipt of obesity diagnoses, or weight management recommendations between lesbian, bisexual, and straight females with BMIs ≥ 30. However, only about half the patients with BMIs ≥ 30, regardless of sexual orientation, received a weight management recommendation as recommended by the United States Preventive Services Task Force (USPSTF) guidelines.ConclusionWe did not observe disparities in BMI, receipt of obesity diagnoses, or receipt of weight management recommendations between sexual orientation minority and heterosexual females among this sample from an urban population of patients receiving care in a university medical system. However, provider recommendation for weight management was suboptimal in all the groups.

Clinicopathological characteristics and longterm survival of patients with synchronous multiple primary gastrointestinal stromal tumors: A propensity score matching analysis.

BACKGROUNDMultiple gastrointestinal stromal tumors (MGISTs) are specific and rare. Little is known about the impact of MGISTs on the survival of patients with gastrointestinal stromal tumors (GIST). The diagnosis, treatment and follow-up strategies of MGISTs is not specifically described in guidelines.AIMTo compare the clinicopathological characteristics and prognosis of MGISTs and solitary GISTs (SGISTs)METHODSPatients diagnosed with primary GISTs from March 2010 to January 2020 were included. Due to the inhomogeneous distribution of several baseline characteristics and uneven MGIST and SGIST group sizes, propensity score matching was performed according to comorbidities, body mass index, tumor location, mitotic index, sex, age and American Society of Anesthesiologists score. Differences in clinicopathological characteristics and prognosis between patients with MGISTs and patients with SGISTs were compared.RESULTSAmong the entire cohort of 983 patients, the incidence of MGISTs was 4.17%. Before matching, patients with MGISTs and those with SGISTs had disparities in body mass index, surgical approach, tumor size and mitotic index. After 1:4 ratio matching, the clinical baseline data were comparable. The 5-year progression-free survival rate was 52.17% in the MGIST group and 75.00% in the SGIST group (P = 0.031). On multivariate analysis, tumor location, tumor size, mitotic index, imatinib treatment and MGISTs (hazard ratio = 2.431, 95% confidence interval = 1.097-5.386, P = 0.029) were identified as independent prognostic factors of progression-free survival. However, overall survival was similar between the SGIST and MGIST groups.CONCLUSIONPatients with MGISTs had poorer progression-free survival than patients with SGISTs. Risk criteria and diagnostic and treatment strategies should be developed to achieve personalized precision therapy and maximize the survival benefit.

Parental Education or Household Income? Which Socioeconomic Status Indicator Can Better Reduce Body Mass Index Disparities among Latino Children?

We compared the effects of parental education and household income on children's body mass index (BMI) in Hispanic White (HW) and non-Hispanic White (NHW) families. In this cross-sectional study, we borrowed data from the Adolescent Brain Cognitive Development (ABCD) study and analyzed data of 5100 children between the ages of 9 and 10. The independent variables were parental education and household income. The primary outcome was BMI value. Ethnicity was the moderating variable. Confounders were age, sex, and family structure. Three mixed-effects regression models were used for data analysis. Overall, higher parental education and household income were associated with lower BMI levels in children. While an interaction was found between ethnicity and parental education, no interaction was noted between ethnicity and household income regarding BMI. The interaction indicated weaker protective effects of high parental education on BMI in HW children than NHW children. Household income showed similar protective effects on children's BMI in HW and NHW families. Parental education but not household income loses some of its protective effects on childhood BMI among HW families compared to NHW families. Distal social determinants of health may be more vulnerable to the MDRs (minorities' diminished returns) than proximal ones. As a result, closing the income gap may be a good strategy towards closing the childhood BMI gap between highly educated HW and NHW families. Policies that raise the minimum wage and those that help HW families save money (e.g., earned income tax policies) maybe more promising strategies to eliminate the ethnic gap in BMI than increasing the education level of ethnic minority families.

Third-variable effect analysis with multilevel additive models.

Third-variable effect refers to the effect transmitted by third-variables that intervene in the relationship between an exposure and a response variable. Third-variable effect analysis has been broadly studied in many fields. However, it remains a challenge for researchers to differentiate indirect effect of individual factor from multiple third-variables, especially when the involving variables are of hierarchical structure. Yu et al. (2014) defined third-variable effects that were consistent for all different types of response (categorical or continuous), exposure, or third-variables. With these definitions, multiple third-variables can be considered simultaneously, and the indirect effects carried by individual third-variables can be separated from the total effect. In this paper, we extend the definitions of third-variable effects to multilevel data structures, where multilevel additive models are adapted to model the variable relationships. And then third-variable effects can be estimated at different levels. Moreover, transformations on variables are allowed to present nonlinear relationships among variables. We compile an R package mlma, to carry out the proposed multilevel third-variable analysis. Simulations show that the proposed method can effectively differentiate and estimate third-variable effects from different levels. Further, we implement the method to explore the racial disparity in body mass index accounting for both environmental and individual level risk factors.

Minorities’ Diminish Returns of Parental Education in Reducing Childhood Body Mass Index

Background: Considerable research has documented the effects of race and socioeconomic status (SES) on childhood body mass index (BMI) and obesity. However, less is known about the intersectional effects of race and family SES on childhood BMI. Purpose: This study tested racial by SES variation in BMI among American 9-10 years old children. Built on Minorities’ Diminished Returns (MDRs), we expected a weaker family SES effect on childhood BMI for non-White than White and children. Methods: For this cross-sectional study, data came from the Children Brain Cognitive Development (ABCD) study, a national multi-center investigation of child development in the US. This study included 14881 BMI observations, 9-11-year-old children. The independent variables were family SES (parental education). Moderator was race. The primary outcome was BMI. Age, sex, ethnicity, and parental marital status were the covariates. To analyze the data, we used mixed-effect regression models. Results: High parental education and race were associated with BMI. We found an interaction between race and parental education with non-White children with highly educated parents still having a high BMI. Conclusions: For American children, BMI is shaped by the intersection of race, gender, and family SES. Children from highly educated families remain at risk of high BMI. Disparities in BMI and obesity should be approached through an intersectionality lens.

Regional and Geographical Disparities in Body Mass Index (BMI) Among Chinese Older Adults: The Chinese Longitudinal Healthy Longevity Survey.

This study examined the regional and geographical disparities in body mass index (BMI) among Chinese older adults. Using panel data from the Chinese Longitudinal Healthy Longevity Survey, participants included 3,740 older adults (age ≥ 65 years) who answered all three waves of the survey (2009-2014). Sex-stratified and multistate Cox regression was used to examine the disparities in BMI change. Results showed that both older males and older females who resided in the central-south had lower rates of weight change from nonobese to obese, compared with those from the east. Older females from urban regions had higher rate of weight change from nonobese to obese, compared with rural participants (hazard ratio [HR]: 1.35, 95% confidence interval [CI] = [1.13, 1.60]; p < .01). However, there were no disparities between urban and rural areas among older males (p > .05). These results provided practical implications for regional and geographical disparities in BMI among Chinese older adults.

Abstract C070: Racial disparities in body mass index and ovarian cancer risk in the OCWAA Consortium

Abstract Objective: Obesity disproportionately affects African American (AA) women, and there is some suggestion that its association with ovarian cancer risk may be stronger among AA compared to white women, but no study to date has been adequately powered to compare risk between the two populations. The Ovarian Cancer in Women of African Ancestry (OCWAA) Consortium provided a unique opportunity to evaluate the association between body mass index (BMI) and invasive epithelial ovarian cancer (EOC) risk in AA and white women and to estimate the contribution of obesity to ovarian cancer risk in both racial groups. Methods: The OCWAA Consortium is a collaboration of six of the largest epidemiologic studies of ovarian cancer in the United States that include AA women: four case-control and two case-control studies nested within cohort studies. The six studies are the Chicago Case-Control Study, the North Carolina Ovarian Cancer Study, the Los Angeles Ovarian Cancer Case-Control Studies, the African American Cancer Epidemiology Study, the Black Women’s Health Study, and the Multiethnic Cohort. BMI before diagnosis was available in all the studies and data on BMI and relevant confounders were harmonized for analyses. There were 1,144 AA cases, 2,910 AA controls, 3,174 white cases, and 9,160 white controls included. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were computed using random-effects multi-level logistic regression models separately by race and histotype with control for relevant covariates, which included study, age, education, parity, oral contraceptive use, age at menarche and family history of breast/ovarian cancer. Multinomial regression was used for histotype analyses. Population attributable risk (PAR) estimates were computed by race and histotype. Results: The prevalence of obesity (BMI≥30 kg/m2) was higher in AAs compared to white women for both cases (53.2% vs 21.4%) and controls (45.7% vs. 18.4%). For EOC, there was little evidence of an association with obesity for white women. For AAs, risk was elevated for BMI≥30 kg/m2 (ORBMI 30-34=1.37, 95% CI: 1.12, 1.69; ORBMI≥35 = 1.26, 95% CI: 0.74, 2.15) relative to BMI 18.5-&amp;lt;25 kg/m2. There was an elevated risk for non-high-grade serous EOC for both AA and white women (for AA women, ORBMI 30-34=1.67, 95% CI: 1.14, 2.44 and ORBMI≥35 = 1.76; 95% CI: 0.84, 3.69; for white women, ORBMI ≥35 = 1.39; 95% CI: 1.06, 1.82), but not for high-grade serous EOC. The PAR for BMI≥30 was 7.1% (95% CI: 2.4, 15.6) for AAs and 2.6% (95% CI: -0.3, 5.4) for whites for all EOC. For non-high-grade serous EOC, the PAR was 16.5% (95% CI: 3.4, 28.2) for AAs and 6.4% (95% CI: 2.2, 10.3) for whites. Conclusions: Obesity was a contributor to overall EOC risk among AA women but not among white women. Obesity did not contribute to the risk of high-grade serous EOC for AAs or whites, but it was associated with non-high-grade serous cases among both AA and white women. The association with non-high-grade serous EOC was greater among AAs than whites. Citation Format: Elisa V Bandera, Fabian Camacho, Deanna Chyn, Emily K Cloyd, Traci N Bethea, Alicia Beeghly-Fadiel, Charlotte E Joslin, Evan Myers, Patricia G Moorman, Heather M Ochs-Balcom, Holly R Harris, Lauren C Peres, Veronica Wendy Setiawan, Anna H Wu, Lynn Rosenberg, Joellen M Schildkraut. Racial disparities in body mass index and ovarian cancer risk in the OCWAA Consortium [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C070.

Body mass index across the life course: emergence of race-by-sex disparities in early childhood

PurposeThe purpose of this study was to assess when in the life-course race-by-sex disparities in body mass index (BMI) emerge. MethodsChild Health and Development Studies participants, from whom height and weight data were collected at ages 5, 9–11, and 15–17 years, were followed up at the age of 50 years for anthropometric outcomes. Follow-up was completed for 605 subjects, 460 of whom were assessed for height and weight at the age of 50 years, had at least one available childhood BMI measure, and self-identified as either non-Hispanic black or non-Hispanic white. Linear regression analyses were conducted to determine whether interactions existed between race (black vs. white) and sex for predicting BMI at ages 5, 9–11, 15–17, and 50 years. ResultsAt age 5 years, BMI was independent of sex for both blacks and whites, but by the age of 9–11 years, BMI was sex-dependent in blacks, with higher BMI observed among black females. This sex dependence for BMI among blacks persisted at ages 15–17 years and age 50 years. The race-by-sex interaction was significant at ages 9–11, 15–17, and 50 years (P for interaction = 0.001, 0.002, and 0.01, respectively). ConclusionsRace-by-sex disparities in body size were observed by the age of 9–11 years and persisted until the age of 50 years.

The BRIGHT Study Shows Geographical Disparities in Body Mass Index among Heart Transplant Recipients

Purpose Overweight and obesity are not unexpected following heart transplantation (HTx). The variability in body mass index (BMI) of populations has been observed, yet no study has addressed BMI disparities after HTx in different countries. We thus examined the variability in BMI of HTx recipients among countries who participated in the multi-continental BRIGHT study. Methods We conducted a secondary data analysis of the BRIGHT self-reported data for 1,373 HTx recipients in four continents, 11 countries, and 36 heart transplant centers. The BMI (kg/m 2 ) was categorized into underweight (BMI linear regression . Results The median age was 56 years (IQR= 45, 63), 27.3% were female, and 34.1% had at least some university education. The mean BMI was 27.1 ± 5.7, and 59% were overweight or obese (see Figure). The highest mean BMI was in North America, followed by Australia, Europe, and South America. The regression analysis showed that higher age (B= 0.029, p=.013), male gender (B= 1.65, p post-hoc analysis for the dummy-coded country showed that only the United States (B= 4.27, p Conclusion Our data show that overweight and obesity are highly prevalent in HTx with variation among geographical regions, which calls for population-specific weight control interventions. Despite the small variance in BMI explained by the predictors, our results about geographical disparities in BMI are comparable to the ISHLT registry data for the same period. More research is warranted to elucidate the etiologies and outcomes of these geographical differences.

Socioeconomic differences in body mass index in Spain: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy.

Many studies have demonstrated the existence of simple, unidimensional socioeconomic gradients in body mass index (BMI). However, in the present paper we move beyond such traditional analyses by simultaneously considering multiple demographic and socioeconomic dimensions. Using the Spanish National Health Survey 2011–2012, we apply intersectionality theory and multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to analyze 14,190 adults nested within 108 intersectional strata defined by combining categories of gender, age, income, educational achievement and living situation. We develop two multilevel models to obtain information on stratum-specific BMI averages and the degree of clustering of BMI within strata expressed by the intra-class correlation coefficient (ICC). The first model is a simple variance components analysis that provides a detailed mapping of the BMI disparities in the population and measures the accuracy of stratum membership to predict individual BMI. The second model includes the variables used to define the intersectional strata as a way to identify stratum-specific interactions. The first model suggests moderate but meaningful clustering of individual BMI within the intersectional strata (ICC = 12.4%). Compared with the population average (BMI = 26.07 Kg/m2), the stratum of cohabiting 18-35-year-old females with medium income and high education presents the lowest BMI (-3.7 Kg/m2), while cohabiting 36-64-year-old females with low income and low education show the highest BMI (+2.6 Kg/m2). In the second model, the ICC falls to 1.9%, suggesting the existence of only very small stratum specific interaction effects. We confirm the existence of a socioeconomic gradient in BMI. Compared with traditional analyses, the intersectional MAIHDA approach provides a better mapping of socioeconomic and demographic inequalities in BMI. Because of the moderate clustering, public health policies aiming to reduce BMI in Spain should not solely focus on the intersectional strata with the highest BMI, but should also consider whole population polices.

Inequality in body mass indices across countries: Evidence from convergence tests

This study examines the long-term inequality in body mass index (BMI) based on convergence tests applied to a database of 172 countries recently published by the NCD Risk Factor Collaboration. First, we find that countries converge in clubs, which indicates that country disparities in BMIs will persist over time. Second, there are three and six convergence clubs in BMIs for female and male individuals, respectively. That is, we would not observe a single convergence pattern in body weights as the nutrition transition theory and the dietary convergence hypothesis seem to suggest. Females have only one healthy club (18.5 ≤ BMI < 25) and two overweight clubs (BMI ≥ 25). Males have three healthy clubs and three overweight clubs. Third, the analysis of club convergence indicates that BMI inequality has increased due to the BMI growth observed in club 1 (the one with the highest average BMI and led by the US) in each gender group. Finally, potential determinants of BMI such as globalization, human capital, income, and urbanization are relevant to understand differences across clubs. We interpret the club convergence as the result of a heterogeneous integration of countries into the global economy, which is probably related to strong domestic preferences, policies designed to manage the impacts of globalization, and shifts in productive structures.

Social disparities in body mass index (BMI) trajectories among Chinese adults in 1991\u20132011

BackgroundObesity is a serious public health problem in China. The relationship between obesity and socio-economic status (SES) is changing and affected by uncertainty, particularly, in developing countries. The sex-related differences in body mass index (BMI) trajectories are controversial and require substantial empirical data for updating and enriching.MethodsThis study examined the relationship between SES and BMI in Chinese adults from a dynamic perspective using longitudinal data (1991–2011) from the China Health and Nutrition Survey (CHNS). Then, sex-related differences were determined. A hierarchical linear model was used.ResultsSES positively affected the male BMI changes, with faster BMI growth rates in the high-SES males over the past 20 years. By contrast, female BMI was only affected by BMI baseline and residential area. Specifically, greater BMI baseline led to greater BMI growth rate and earlier BMI decline. In the past 20 years, the BMI growth rate has been greater in the urban females than in the rural females.ConclusionsThe relationship between SES and obesity is complex in China, and a substantial sex-related difference exists. We argue that this large sex-related difference is due to the rapid economic and social changes that have affected national health and increased the gender inequality and social role restrictions in females. We provide insights for further research and policy recommendations.

Disentangling overlapping influences of neighborhoods and schools on adolescent body mass index.

To compare the simultaneous influence of schools and neighborhoods on adolescent body mass index (BMI). Analyzing data from a nationally representative sample of adolescents in grades 7 to 12 (n = 18,200), cross-classified multilevel modeling was used to examine the fixed and random effects of individuals, schools, and neighborhoods on adolescent BMI. Additionally, the ability of school and neighborhood demographics to explain racial/ethnic disparities in BMI was assessed. There were 18,200 students nested in 128 schools and 2,259 neighborhoods, with 2,757 unique combinations of schools and neighborhoods. In girls, schools (vojk = 0.18, CI: 0.06-0.33) contributed twice that of neighborhoods (uojk = 0.08, CI: 0.01-0.20) to the variance in BMI, while in males, schools (uojk = 0.15, CI: 0.05-0.30) and neighborhoods (vojk = 0.16, CI: 0.05-0.31) had similar contributions. The interaction of the neighborhood and school random effects contributed significantly to the variance of male and female BMI. Characteristics of neighborhoods and schools explained a large portion of the racial/ethnic disparity in female BMI. In an analysis of a nationally representative sample including multiple racial and ethnic groups, the BMI variance of adolescent females was associated with schools more than neighborhoods. In males, there was no difference in school or neighborhood association with BMI.