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REVIEW OF LITERATURE:
Review of related literature is an important aspect of any research. It
involves systematic synoptic understanding of the research works already
conducted in the same field over a period of time. It provides some insight
regarding strong points and limitations of the previous studies and enables
the researcher to improve his own investigation. All available literature
concerning the problem at hand must necessarily be surveyed and examined
before a definition of the research problem is given. This means that the
researcher must be well conversant with relevant theories in the field,
reports and records also all other relevant literature.
Review of literature is done to find out what data and other materials
are available for operational purposes knowing what data are available
often serves to narrow the problem itself as well as the technique that
might be lose. This would also help a researcher to know if there are certain
problems under study are inconsistent with each other and so on. Studies on
related problems are useful for indicating the type of difficulties that may
be encountered in the present study as also the possible analytical
shortcomings.
Health and nutrition are the most important contributing factors for
human resource development. Good nutrition is the fundamental basic
requirement for positive health, functional efficiency and productivity.
Nutrition science provides abundant evidence of the importance of nutrition
in not only promoting proper physical growth and development, but also in
ensuring adequate immuno-competence and cognitive development. Now a
days overweight and obesity as an important public health problem in
developing as well as in developed countries. So it is very important to know
about the factors responsible for the obesity and the consequence and also
the prevalence of obesity. So various surveys are being conducted by
different researchers. Some are given below.
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2.1 ANTHROPOMETRY AND OBESITY:
Valsamakis, et al. (2004) found in their study the association of
simple anthropometric measures of obesity with visceral fat and metabolic
syndrome in male Caucasian and indo Asian subjects. The aims of this study
were first; to investigate the relationship between simple anthropometric
measures of obesity with visceral fat as assessed by a single slice magnetic
resonance imaging (MRI) can in patients attending a hospital clinic. Second
is to determine which anthropometric measure best relates to the adverse
metabolic profile of the metabolic syndrome. 41 male subjects were studied
by MRI scan to measure visceral fat at L 4/ L5 level and to investigate its
relationship with simple anthropometric measures. 83 male subjects were
studied to determine which anthropometric measures best predicts the
metabolic complications of obesity in the setting of a hospital clinic. It was
found that waist circumference was the best anthropometric measurement
that correlated with MRI visceral fat mass assessed at L 4/ L5 in 41 subjects
who had an MRI scan amongst the variables which also included age, BMI,
Sagittal diameter and ethnicity. Sagittal diameter better predicts the
adverse metabolic profile of the metabolic syndrome. Although there is
considerable variation in abdominal fat topography between ethnic groups
and also within populations, sagittal diameter assessment is a technique
that is simple and best predicts the metabolic syndrome.
Kim et al, (2004), conducted a study on BMI and metabolic disorders
in South Korean adults. The prevalence of overweight, obesity and
metabolic disorders and their relationship with body mass index (BMI) were
studied in South Korean adults. The appropriate BMI categories for overweight and obesity for Koreans were evaluated. The 1998 Korea national
Health and Nutrition examination survey provided data on body weight,
height, fasting serum glucose, triacylglycerol, total, low density lipoprotein
and high density lipoprotein cholesterol, and blood pressure, various other
questions that were incorporated into theirs study. A total of 39060 persons
over the age of one year from 12283 households participated in the Health
and Nutrition interview survey. Of these 10876 people over the age of 10
years old participated in the health examination, also 7692 adults over the
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age of 20 years. The overweight and obesity prevalence rates were low
among Korean adults. 23.4% and 1.7% in men and 24.9% and 3.2% in women,
respectively. But the prevalence of diabetes, hypertension, abnormal
concentration of serum triacylglycerols and total, low density lipoprotein
and high density lipoprotein cholesterol were high at 10.5%, 27.1%, 29.0%,
34.5%, 28.4%, and 37.4% respectively. These disorders were age dependent
and there was a strong linear relationship between BMI and the disorders.
Marild, et al, (2004) carried a study on prevalence trends of obesity
and overweight among 10 year old children in western Sweden and the
relationship with parental body mass index. A cross sectional study of 10 y
old children born in 1990, was performed during September 2000 to June
2001 at school health centers in three communities in the western part of
Sweden. Evaluation was performed in 6311 children or 81% of the target
population. Data from a cohort of children, born in 1974, who form the
national growth charts, were available for comparison. The mean body mass
index was 17.9 kg/m2 in 10 year old children born in 1990 and 17.0 kg/m 2
for 10 year old born in 1974. Of the 10 years old children in 2000-2001, born
in 1990, 18% were overweight and 2.9% obese, which corresponds to a two
fold increase in presence of overweight and a four fold increase in presence
of obesity among 10 year old children from 1984 to 2000. There was a
significant correlation between parental and children body mass index. The
prevalence of obesity and being overweight appeared to be higher in
children whose parents did not participate in the study. Parental
ponderosity or reluctance to participate in the study was related to a higher
prevalence of being overweight or obese in the children. There is a need for
the health care system to recognize the threats to the health of the
population of this new epidemic and initiate preventive measures and
treatment programmes.
Oliveira, et al., (2004) studied the relationships in women between
body mass index and the intravascular metabolism of chylomicrone like
emulsions. Four groups of 10 normolipidemic non-diabetic women at the
normal (BMI<25 kg/m2), preobese (BMI 25-30 Kg/m2), obese (BMI 30-40
kg/m2) and morbid obese (BMI >40 kg/m2). Chylomicron metabolism was
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studied using a method with triacylglycerols studied using a method with
triacylglycerol rich emulsions that mimic chylomicron. The chylomicron like
emulsion doubly labeled the chylomicron like emulsion doubly labeled with
3H –triolein (To) and 14c cholesterol – oleate (Co) was intravenously injected
to calculate the plasma fractional clearance rates (FCR, in mon -1) by a
compartmental analysis model. FCR- To mirror both the lipolysis from
lipoprotein lipase that the emulsion suffers while still in the circulation and
the triacylglycerols portion that is not broken down and is removed from the
plasma together with the remnant particles. FCR –To do not differ among
the 4 groups. The lipolysis index was positively correlated with BMI. On the
other hand FCR to progressively diminish from the normal to the morbid
obese groups and there was a negative correlation between FCR Co and BMI.
In obesity the capacity to break down chylomicron triacylglycerols by
lipoprotein lipase in vivo increases but the ability the organisms to remove
the resulting chylomicron remnants particles progressively diminishes as the
BMI rises.
Lara Esqueda, et al., (2004) observed from their study that the body
mass index is a less sensitive tool for detecting cases with obesity associated
co morbidities in short stature subjects. Information was obtained from
119975 subjects of a cardiovascular risk factors detection programme.
Standardized questionnaires were used. Capillary glucose and cholesterol
concentrations
were
measured.
Diabetes,
arterial
hypertension
and
hypercholesterolemia were measured diabetes; arterial hypertension and
hypercholesterolemia wee selected as end points. Sensitivity, specificity
and the likelihood ratio for several BMI thresholds were calculated. ROC
curves were constructed to identify the BMI cutoff points with best
diagnostic performance. The area under the curve (AUC) was used to assess
the proficiency of BMI. Short stature (heights<=150 cm for women or <=160
cm for men) was found in 24854 subjects (20.7%). These cases had a higher
prevalence of type 2 diabetes and arterial hypertension even after adjusting
for confounding variables. In addition, the frequency of abnormalities was
higher even at the lowest BMI values, the prevalence increased in direct
proportion with the BMI, but at a lower rate compared to cases with normal
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4stature. The prevalence of obesity associated co morbidities is higher in
subjects with short stature compared to those without it. The proficiency of
BMI as the diagnostic tool is poor in short stature subjects.
Halkjer, et al., (2004) observed in their study the food and drinking
patterns as predictors at 6 year BMI adjusted changes in waist
circumference. The subjects were 2300 middle aged men and women with
repeated measurements of dietary intake, BMI and WC from 1982 to 1993.
Intakes from ten food groups and from coffee, tea, wine, beer and spirits
were assessed. Gender specific food factors were identified by factor
analyses. Multiple linear regression analyses were done before and after
adjustment for concurrent changes in BMI. A high intake of potatoes seemed
to prevent again in WC for men, while a higher intake of refined bread was
associated with gain in WC for women. The association persisted for refined
bread, but not for potatoes, after adjustment for concurrent BMI changes.
Among women, high intakes of beer and spirits were associated with gain in
WC in both models. A higher intake of coffee for women and moderate to
high intake of tea for men, while associated with gain in WC, but the
associations were weakened, especially for men after adjustment for BMI
changes. None of the food factors was associated with WC changes.
Hengleng, et al., (2004) conducted a study on body mass index and
factors related to overweight among women workers in electronic factories
in peninsular Malaysia. Factors related to overweight were examined, in a
cross sectional survey that included 1612 women workers from 10 large
electronics assembly factories in peninsular Malaysia. Heights and weights
were taken to calculate the Body Mass Index (BMI). Weights and BMI
increased with increasing age. After adjusting for age, odds ratios for
overweight were significantly raised for married women in relation to not
married women, lower secondary education in relation to higher than upper
secondary educations, monthly income RM 800-999 and  RM 1000 in relation
to < RM 600, working in rotating shifts that included night shifts and not
staying in hostels. The overall prevalence of overweight was 37.4% and over
all mean BMI were 24.25.4 kg/m2. Prevalence of overweight and mean BMI
for younger age groups were similar to Malay women in the country wide
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representative National health and Morbidity survey II, but the older age
groups in this study had higher overweight prevalence and mean BMI than
the National sample-Electronics women workers face a higher risk of
overweight and is an important groups for nutrition intervention.
Haeffner, et al., (2004) assessed the association between maternal
smoking in pregnancy and BMI in young adults after adjusting for possible
confounders. A longitudinal study was carried out based on a birth cohort
born in 1978/79 in Ribeirao Preto; Brazil. Weight and length at birth were
measured and mothers were asked to answer a standardized questionnaire
shortly after delivery BMI was obtained at the time of compulsory military
draft at the age of 18 years from a sub-sample of 1191 males corresponding
to 36% of the original sample. The variation in BMI according to maternal
smoking adjusting for weight and length at birth, maternal age, gestational
age, maternal schooling, marital status, birth order and conscripts
education level in a multiple linear regression model were assessed. The
prevalence of maternal smoking was 25%. Conscript’s BMI in mothers who
smoked during pregnancy was 0.71 kg/m2 higher than among those whose
mothers did not smoke, after adjustment. Birth weight and maternal
schooling were slightly associated with BMI in adult’s life. BMI was strongly
associated with maternal smoking in pregnancy and remained so after
adjustment for a series of variables.
Hulanicka, et al., (2004) conducted a study on adiposity at the age of
50 in relation to BMI and WHR in childhood and adolescence. This study
concerned groups of people all born in 1953, who as randomly selected
sample of 7 years old children from city of Wroclaw, were examined once a
year till their physical maturity. Longitudinally collected anthropometric
data are available for 243 males and 269 females. Presently where the
members of the groups are fifty an extensive medical examination and
anthropometric measurements have been completed. Also the subjects had
filled up questionnaire. This pertains to many information concerning their
family situation, private and professional activities and SES. The material
comprises 120 women and 116 men. For males correlation of BMI at the age
of 50 with BMI at every age bracket between ages 8-18 is significant and
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steadily increases. But in females this is only till the beginning of puberty.
Correlation between BMI at the age of 50 and BMI at each age’s bracket
between 11 and 17 is almost same. In men adult adiposity level (BMI and
central body fat distribution (WHR) seem to be decided already at
adolescence. In females the significant correlation of the tempo of
maturation with the level of adiposity in children hood and adolescence
disappears in adulthood.
Taeymans, et al., (2004) conduct a study to detect anthropometric
variables as predictors of body composition at ages 17/18 and 30 from age 6
onwards and to investigate their predictive value based on longitudinal
data. The sample (n=67) was a part of a larger longitudinal growth study
called LEGS. The original sample consisted of five cohorts and totaled 525
children. They were followed anthropometrically from kindergarten age to
age 18. At the age 30 a sample of 37 male and 30 females’ subjects was
measured again. Multiple step wise linear regression was used with
anthropometric characteristics at each age separately from age 6 on as
predictors for obesity or overweight characteristics measured at age 30,
such as BMI, body weight and sum of skin folds. In men, moderate
correlations were found between skin fold thickness measurements at ages 6
to 13 and BMI at age 30. Body weight in men can only be used as prediction
for BMI 30 during the growth spurt period, while in women body weight has
predictive value for BMI 30 at all ages. In men there is no skeletal growth
related variables as possible predictor of BMI 30 while skin fold thicknesses
have predictive value only in children hood and puberty. Mesomorphy is
possible predictor from age 10 on. Ectomorphy is negatively related to BMI
30, as expected.
Deriemaeker, et al., (2004) conducted a study on anthropometric
measures of central obesity and cardiovascular risk factors in overweight
youth. The subjects (94 girls and 87 boys) were between 2.2 and 17 years of
age with a BMI>P 97. Plasma levels of glucose, cholesterol, triglycerides,
HDL cholesterol, uric acid, fibrinogen, homocysteine, serum insulin by
standards methods. LDL cholesterol, Homo insulin resistance index (HI) and
triglycerides/ HDL cholesterol ratio (TH) was calculated. ST (using
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Harpender Caliper) and waist C and upper arm C (using a adopted tape)
were evaluated by two trained observers. In overweight girls and boys most
measures of insulin resistance are related to increased central body fat, as
assessed, by waist circumference. No additional information could be
retrieved from skin fold or other anthropometric measurements in the
metabolic evaluation of cardiovascular risks.
Tufano et al., (2004) observed the anthropometric, hormonal and
biochemical differences in lean and obese women before and after
menopause. The menopausal status is associated with an increased risk of
metabolic and cardiovascular diseases. 24 normal weight premenopausal, 24
normal weight postmenopausal, 24 obese premenopausal and 20 obese post
menopausal women were taken for the study. All subjects were non smokers
and free from hypertension, diabetes or impaired glucose tolerance.
Anthropometric parameters, body composition, 17-a- Estradiol, LH, FSH,
androstenedione, SHBG, testosterone and leptin were determined. Free
androgen index (FAI) and insulin resistance index (HOMA) calculated. In
comparison with pre- OB, post – OB had higher values of waist
circumferences (P<0.02), while post NW showed no difference. Total and
LDL cholesterol were higher in post-NW women, where in obese subjects
they were already elevated in the premenopausal periods. Serum leptin
levels were higher in post OB than in pre OB, where as they were similar in
normal weight women. The risk of leptin levels may be related to the
greater abdominal fat deposition. In addition, menopausal status of
uncomplicated obese women is associated with a greater abdominal fat
deposition and with higher values of free androgen index, which may be
considered as factors of cardiovascular risk.
Wildman, et al, (2004) conducted a study on appropriate body mass
index and waist circumference cutoffs for categorization of overweight and
central adiposity among Chinese adults. A nationally representative, cross
sectional sample of 15239 Chinese adults aged 35-74 year was studied. Mean
blood pressure, total cholesterol, LDL cholesterol, triacylglycerols, and
glucose values were incrementally higher and mean HDL cholesterol values
were incrementally lower with each unit increase in BMI and waist
38
circumference in both men and women. Lower cutoffs for BMI and waist
circumference are needed in the identification of Chinese patients at high
risk of cardiovascular disease.
Bandini, et al, (2004) observed the relation of body mass index and
body
fatness
to
energy
expenditure,
longitudinal
changes
from
preadolescence through adolescence. A study was conducted to test the
hypothesis that reduced EE in the premenarcheal period in girls constitutes
a risk factor for an increase in relative weight and percentage of body fat
during adolescence. EE was measured at study entry in 196 premenarcheal
nonobese girls from Massachusetts, USA Resting metabolic rate (RMR) was
measured by indirect calorimeters. Total energy expenditure (TEE) was
measured by the doubly labeled water method. Activity energy expenditure
(AEE) was calculated from RMR and TEE. After the baseline study girls were
followed annually until 4 years after menarche. At each visit height, weight
and % BF by bioelectrical impedance were measured. Girls also completed
annual food frequency and activity questionnaires. No significant relation in
change in % BF with RMR, AEE, or TEE was found. A small positive relation
between BMI and score and AEE and TEE, but no significant relation with
RMR was found. It is suggested that EE in the premenarcheal period is not a
risk factor for increases in % BF or BMI Z score in girls during adolescence.
Ardern, et al., (2004) carried out a study on the development of
health related waist circumference thresholds within BMI categories. The
sample included adults classified as normal weight (BMI= 18.5-24.9),
overweight (BMI= 25-29.9), obese I (BMI = 30-34.9) and Obese II (BMI  35)
from the third U.S. national health and nutrition examination survey
(n=6286). The optimal WC thresholds increased across BMI categories from
87 to 124 cm in men and from 79 to 115 cm in women. The validation study
indicated improved sensitivity and specificity with the BMI specific WC
thresholds compared with the single thresholds. Compared with the
recommended WC thresholds, the BMI specific values improved the
identification of health risk. In normal weight, overweight, obese I, and
Obese II patients, WC cut offs of 90, 100, 110 and 125 cm in men and 80, 90,
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105 and 115 cm in women respectively, can be used to identify those at
increased risk.
Nandurker, et al, (2004), observed the relationship between body
mass index, diet, exercise and grastro–oesphageal reflux symptoms in a
community. Community subjects (n= 211, mean age = 36 years, 43% males)
completed validated questionnaires on gastro-esophageal reflux, energy
expenditure, dietary intake and measures of personality and life event
stress. Diet, exercise, BMI and other potential risk factors for reflux were
analyzed using logistic regression analyses. The overall mean BMI was
26.6,79(37%) reported infrequent reflux and 16 (8%) reported frequent
reflux. The median calorie intake was 2097 cal/ day. Among those with BMI
>25, 10% reported frequent reflux compared to 4% of those with BMI<25. In
models which included diet and exercise variables, BMI but not diet or
exercise was associated with reflux. BMI may be associated with
symptomatic gastro- esophageal reflux independent of diet and exercise.
Cole, et al, (2005) conducted a study to know what is the best
measure of adiposity change in growing children: BMI, BMI% BMI Z-score or
BMI Centile. A study was conducted to identify the optimal BMI measure for
change, whose short term variability was most consistent for children across
the spectrum of adiposity. A total of 135 children from a kindergarten in
Italy, aged 29-68 months at baseline, with BMI measured 3 times over a 9
month period. Each child’s short term variability in adiposity was
summarized by the standard deviation (S.D.) of BMI and BMI % adjusted for
age and BMI Z- Score. The within child S.D.S. of BMIZ-score and BMI Centile
were significantly smaller in obese than non obese children, while the S.D.S.
of BMI and BMI % were similar in the 2 groups. Also, the within Childs S.D.S.
of Z score and centimes’ and to a lesser extent BMI % were significantly
inversely correlated with baseline Z-score where as the S.D. of BMI was not.
The changes in adiposity over time, as assessed by the 4 measures, were
very highly correlated with each other, particularly for BMI with BMI %.
Better alternatives are BMI itself or BMI %. The results underscore the
importance of using a relatively stable method to assess adiposity change
when following children at risk of obesity.
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Hynkyung and Deurenberg, (2005) conducted a study on Body mass
index ad body fat percent of Koreans in Seoul and Pusan compared to those
of Caucasians. The relationships between percent body fat (% BF) and body
mass index (BMI) in Koreans was determined. In addition, % BF and BMI were
compared with those of Caucasians. Complete data were collected from
3297 subjects (2441 females and 856 males aged 18-79 years) between
September and November 2001 in Seoul and Pusan, Korean Republic. For
statistical analysis, only data from subjects aged 18-65 years (n=3200) were
used. Body weight and height were measured, BMI (Kg/m 2) was computed
and % BF was calculated using age and sex specific prediction formulas. % BF
was assessed using an INBODY 2.0 body fat analyzer. Data analysis showed
that females were significantly younger, smaller, and lighter and had a
lower BMI than male’s % BF was higher in females than males. The
differences between actual and predicted % BF were correlated with body
fat level and age. There was a significant age related decrease in body fat
in Koreans for any given BMI and sex, which was remarkably different,
compared to age related increases in body fat in Caucasians.
2.2 PHYSICAL ACTIVITY AND OBESITY:
Hills and Byrne, (2004) carried out study on physical activity in the
management of obesity physical activity is any movement of skeletal
muscles that results in energy expenditure. Long term success in weight
management depends on both physical activity and dietary modification.
Exercise has a pivotal role in weight management, optimizing body
composition by minimizing fat free mass losses and maximizing fat mass loss
and enhancing metabolic fitness. The amount and the type of exercise
needed to obtain health related benefits may differ from that recommended
for fitness benefits. Public health messages about exercise have focused on
improvements in general health and fitness rather than on weight loss,
prevention of weight gain or weight regain. About 2.5 times more exercise
than the US surgeon general’s recommendation is needed to maintain
energy balance and thus maintain a certain weight. The challenge is to get
the exercise prescription right at an individual level.
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Janssen, et al, (2004) conducted a study on overweight and obesity in
Canadian adolescents and their associations with dietary habits and physical
activity patterns. Nationally representatives sample of 11-16 year old
adolescents (n=5890) from the Canadian components of the 2001/2002 world
health organization. Health behaviors in school aged children survey were
used. Height, weight, dietary habits, and leisure time activities were
determined from self report. Age and gender specific prevalence rate of
overweight and obesity were calculated based on international body mass
index cut points. Logistic regression was employed to examine the
association among measures of overweight, obesity and lifestyle habits.
Fifteen percent of 11-16 year old Canadian youth were overweight (preobese) and 4.6% were obese in 2002. These prevalence rates were greater in
boys than girls, but did not vary according to age. There were no clear
associations observed between dietary habits and measures of overweight
and obesity. However, physical activity levels were lower and television
viewing times were higher in overweight and obese boys and girls than
normal weight youth.
Dansou, et al, (2004) studied the effects of physical activity on
adipose tissue cellularity in pre-menopausal obese women in Benin. This
study investigated the effect of exercise on the adipocyte level of 6 obese
women from Benia, who underwent physical training 3 times a week for 6
months. Another 6 obese women who didn’t undergo physical training were
included as controls. Biopsy samples of adipose tissue were taken from the
gluteal iliac region at baseline and after 6 months and analyzed by histochemistry and electron microscopy. All subjects had severe central obesity.
Lipid content and adipocyte level were higher among the sedentary groups
than the exercise groups intense exercise used more lipids than
carbohydrates it is concluded that a regular, supervised exercise programme
reduces lipid levels, thus inducing weight loss.
Treuth, et al, (2004) carried a longitudinal study of fitness and
activity in girls predisposed to obesity. Normal weight girls (N=91) were
recruited at 8 year of age according to parental body mass index. LN = girls
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with two lean parents. LNOB= girls with the obese and one lean parents and
OB = girls with two obese parents.
A longitudinal study was undertaken with annuals assessment at 8,9
and 10 year at age. The primary outcomes were fitness measured by
treadmill testing and physical activity measured by heart rate monitoring
and by questionnaire. The percent of the day spent active on the weekday
and weekend didn’t change over time or between groups. Time spent on
watching TV during the school year and summer was similar over the study
period and between groups. The fitness and physical activity remain fairly
constant in girls from 8 to 10 years of age, but girls of obese parents tend to
be less fit.
Fulkerson, et al, (2004) assessed weight bearing physical activity
barriers, benefits, self efficiency, social influence and behaviors among girls
and their mothers according to girls weight status, participants were 9 to 11
years old girls and their mothers who participated in the baseline
assessment of a nutrition and PA intervention trial. Girls and mothers WBPA
attitudes and mothers WBPA behaviors were self reported on questionnaire.
Overweight status was based on BMI, compared with non-overweight girls.
Overweight girls were significantly more likely to report barriers to WBPA
participation and perceive social influence from family and friends to do
more WBPA. They were also significantly less likely to report self efficacy
regarding WBPA and to believe that they did enough WBPA compared with
mothers of non overweight girls. Mothers of overweight girls were
significantly more likely to report that it is difficult to persuade their
daughters to do more WBPA and significantly less likely to report that WBPA
was fun for their daughters.
Kazaks and Stern, (2004) examined how diet, exercise and behavior
contribute to obesity, as well as interventions that might be effective to
control the epidemic. The genetic determinants and environmental factors
associated with overweight and obesity were studied. Distorted food
portions, food availability, dietary fat, energy dense foods, and calories in
drinks encourage overeating. Reduced energy intake, reduced dietary fat
intake, and increased physical activity are key elements in long term weight
43
management. Behavioral therapy and strategies to control obesity such as
self monitoring, stimulus control, cognitive restructuring and social support
are also studied. Several approaches to weight management are suggested.
Kemper, (2004) determined the longitudinal relationship of two
lifestyle factors (EE and EI) with body composition. Body composition was
measured with height, weight and four skin folds (biceps, triceps subscapularis and supra iliaca). Overweight -ness was estimated from body mass
index (BMI) and the sum of four skin folds (S4S). EE and EI were measured by
cross check interview from structured questionnaires. The median value of
EI/ EE in both sexes varies from 6/1 between age 13 to age 32. BI and S4S
increase exponentially. The percentage of subjects that have BMI>25
increases from 2% at age 13 to 25% in females and 45% in males at age 36. A
high EE is in males significantly related worth lower S4S and BMI. A high EI
was not related to a lower BMI and S4S in both genders. A low physical
activity pattern is the key factor in the increasing trends of youngsters of
overweightness and obesity. Therefore, promotion of physical activity in
adolescence and young adulthood seems to be effective in early prevention
of obesity.
Das, et al, (2004) observed the energy expenditure in extremely
obese women. A cross sectional study was conducted in 30 extremely obese
women. TEE was measured over 14d using the doubly labeled water method.
Resting energy expenditure and the thermic effect of feeding (TEF) were
measured using indirect calorimetry and activity energy expenditure (AEE)
was calculated as TEE (REE- TEF). Body composition was determined using a
3-compartment model. Subsets were divided into turtle, of BMI for data
analysis. TEE and REE increased with increasing BMI tertile TEE. No
significant differences were observed among BMI tertile for AEE, TEF or
physical activity level. Extremely obese individuals have higher absolute
values for TEE and REE, indicating that excess energy intake contributes to
the maintenance of excess weight. Standard equation developed for nonobese populations provided the most accurate estimates of REE for the
obese individuals studied here. REE was not accurately predicted by
equations developed in obese populations.
44
2.3 OBESITY AND SOCIOECONOMIC STATUS:
Zhang and Wang, (2004) together studied the secular trends in the
disparity of obesity across socioeconomic status (SES) groups among U.S.
adults. National representative data collected in the national health and
nutrition examination surveys conducted in 1971 to 1974, 1976 to 1980,
1988 to 1994, and 1999 to 2000 from 28,543 adults of 20 to 60 years old,
was used in the study. Obesity was defined based on BMI calculated using
measured weight and height. Trends in the relationship between obesity and
education levels were analyzed controlling for age, gender and ethnicity.
The disparity in obesity across SES has decreased over the past 3 decades. In
national health and nutrition examination surveys I (1971 to 1974), there
was as much as a 50% relative difference in the obesity prevalence across
the three groups, but by 1999 to 2000, it decreased to 14%. This trend was
more pronounced in women. This trend of diminishing disparities in obesity
was also revealed by logistic and linear regression analysis. In most sociodemographic groups, the relationship between BMI and SES has been
weakened
over
time,
when
the
prevalence
of
obesity
increased
dramatically. Individual characteristics are not likely the main cause of the
current obesity epidemic in the U.S., where as social environmental plays an
important role.
Monteiro, et al, (2004) examined the impact of different social,
familiar and behavior factors on the risk of developing obesity in
adolescents Brazil. A case control study nested in a population based cohort
that was followed from birth in 1982. The cases were adolescents with
obesity as defined by the world health organization. The control came from
randomly chosen samples of members of the cohort examined in 1997 and
1998. Information concerning risk factors was obtained from cohort records
that were collected at different ages. Multivariate analysis was carried out
using logistic regression. The risk factor varies according to sex. Among
boys, a family income at birth above one minimum wage and anxiety were
associated with 6 and 4 fold increase in risk of obesity, respectively. In both
sexes, a one unit increase in pre-pregnancy maternal body mass index was
associated with a 10% increase in risk of obesity. Smoking, fat consumption
45
time spent in watching television or performing physical activity and
concurrent maternal weight were not associated with obesity.
Klumbiene, et al, (2004) analyzed the pattern of socio-demographic
variations in the prevalence of obesity in Estonia, Finland and Lithuania. In
addition the association between obesity and selected health behaviors was
examined. Cross sectional surveys were conducted among representative
national samples of adult population in 1994, 1996 and 1998. The number of
participants aged 20-64 was 8759 in Estonia, 9488 in Finland and 5635 in
Lithuania. The data were obtained from mailed questionnaire covering socio
demographic characteristics, health behavior indicators and self reported
height and weight. Obesity was defined as BMI>= 30 kg/m 2. The prevalence
of obesity among men and women was 10% and 15% in Estonia, 11% and 10%
in Finland and 10% and 18% in Lithuania, respectively. Obesity was more
prevalent among those aged over 50 in all three countries. It was also more
prevalent among the less educated women in all countries and among the
less educated men and Finland. Obesity was less prevalent among daily
smokers among Estonian men and women and Lithuanian men. Physically
inactive Estonian women and Finnish men and women were more likely to
be obese. A significant association is found between low educational levels
and obesity in women in all the countries, but this association is found in
Finnish men only. Thus, even through the social gradient of obesity is
broadly similar in all the countries studied; differences emerge with regard
to the behavioral correlates of obesity.
Musaiger, et al, (2004) investigated the social factors associated with
body shape preferences for females and males as perceived by Arab women
living in Qatar and correlated the current weight status of women studied
with these preferences. The subjects were 535 non pregnant. Arab Women
aged 20-67 years who attend health centers in Doha city, the capital of the
state of Qatar. Illustrations of males and female body shapes ranging from
very thin to very obese using the 9 figure silhouettes scale were shown to
women and they were asked to select their preferred figure. Body mass
index (BMI) was used to determine the weight status of women studied. Age,
educational level and employment status were found to be significantly
46
associated with ideal body shape preference for both males and females,
where as marital status and current weight status had no significant
association. In general, the Arab women studied selected a more mid range
of body fitness for males than for females. It is concluded that attention
should be given to socio-cultural factors, such as body shape preferences, in
any programme to promote ideal weight for the public.
Sutjahjo, et al, (2004) carried out a study on perceived personal,
social and environmental barriers to weight maintenance among young
women. In Oct- Dec 2001 a total of 445 women aged 18-32 years, selected
randomly from the Australian electoral roll, completed a mailed self report
survey that included questions on 11 barriers to physical activity and 11
barriers to healthy eating relating to personal, social and environmental
factors. Height, weight and socio demographic details were also obtained.
Statistical analyses were conducted mid 2003. The most common perceived
barriers to physical activity and healthy eating encountered by young
women were related to motivation, time and cost. Women with children
were particularly likely to report a lack of social support as an important
barrier to healthy eating. Perceived barriers didn’t differ by SES or
overweight status. Health promotion strategies aimed at preventing weight
gain should take into account the specific perceived barriers to physical
activity and healthy eating faced by women in this age groups, particularly
lack of motivation, lack of time and cost. Strategies targeting perceived
lack of time and lack of social support are particularly required for young
women with children.
Veiga, et al, (2004) assessed the changes in body mass index (BMI)
among Brazilian adolescent. In 1975, 1989 and 1997, a household survey of
the weight and statures of a probabilistic sample of about 50,000 Brazilian
adolescents aged 10-19 years were taken. Weighted prevalence was
calculated and an analysis was performed with the sample design taken into
account. Adolescents of rich (South-east) and poor (north-east) regions
showed a substantial increase in BMI. In the southeast, prevalence of
overweight defined by international age and gender specific BMI cutoffs for
both genders reached 17% in 1997, where as in the northeast the prevalence
47
tripled, reaching 5% among boy’s and 12% among girls. Older girls living in
urban areas in the southeast showed a decrease in the prevalence from 16%
to 13% in the latter 2 surveys. For all boys and for young girls, the BMI
values for the 85th percentile in 1997 were much higher than the 95th
percentile values in 1975. BMI increased dramatically in Brazilian
adolescents, mainly among boys, among older girls from the richest region,
the prevalence of overweight is decreasing.
Danielzik, et al, (2004) identified the major risk factors of overweight
and obesity like parental overweight, socio economic status and higher birth
weight in pre-pubertal children. A total of 2631, 5-7 years old children and
their parents are taken for the study. Main outcome measures are weight
status, socio economic status, parental overweight, dietary intake, activity,
inactivity and further determinants of the children. The prevalence of
overweight was 9.2% in boys and 11.2% in girls, respectively. Family,
environment and development related determinants showed some relation
to overweight and obesity. In multivariate analysis parental overweight, a
low SES as well as a high birth weight were the strongest independent risk
factors of overweight and obesity in children. Additionally, there were sex
specific risk factors. Parental smoking and single households were risk
factors in boys; where as a low activity was associated with obesity in girls.
Overweight families of low SES have the highest risk of overweight and
obese children. Further prevention programme must also take into account
sex specific risk factors.
2.4 OBESITY AND DISEASES:
Douketis & Sharma, (2004) conducted a study on the management of
hypertension in the overweight and obese patient. The management of
hypertension in the overweight and obese patient is a frequently
encountered but under investigated clinical problem. The conventional
management of such patients involves weight reduction with dietary therapy
or a combined approach with dietary and anti-obesity drug therapy.
However, long term weight reduction, which is necessary to sustain blood
48
pressure (BP) control, is not feasible in over 80% of patients. Anti-obesity
therapy with sibutramine may be associated with a modest worsening of BP
control. Consequently, antihypertensive drug therapy is often required to
supplement a weight reduction programme and also in patience with severe
hypertension or hypertension associated end-organ damage. Concurrent
disease is an important determinant of first line and supplementary antihypertensive drug therapy. Additional studies are needed to determine the
long term efficacy and safety of anti-hypertensive and anti obesity
management strategies in the overweight and obese hypertensive patients.
Pischon, et al, (2004) reviews studies on the effects of weight loss on
hypertension, dyslipidaemia, diabetes and impaired glucose tolerance.
Dietary interventions as well as pharmacological treatment with orlistat and
sibutramine are considered. It is concluded that slight reduction with non
pharmacological methods and treatment with orlistat and sibutramine
confer
improvements
in
biochemical
and
physiological
markers
of
cardiovascular risk.
Hamilton,
et
al,
(2004)
studied
on
obesity
and
associated
complications. The relationship between obesity and mortality is affected
by several factors including age, ethnicity, body composition, body fat
distribution, stature and fitness. The morbidities related to obesity are
cardiovascular complications, congestive heart failure, ventricular ectopic,
venous stasis, ulcers, venous thrombosis, pulmonary embolism, sleep apnea,
gastrointestinal disorders, osteoarthritis, neurological consequences, and
dermatological disorders. Some disorders unrelated to physical effects of
adiposity include gall bladder disease, neoplasm, menstrual irregularity,
infertility, polycystic ovary syndrome and skin problems. Additional obesity
related complications affecting quality of life, emotional well being and self
image as well as the economic casts of obesity are also discussed.
Ogawa, et al, (2004) studied the prevalence of obesity and its
association with the development of diabetes, macro-angioplasty and microangioplasty. The clinical records of 634 patients in a hospital with type 2
diabetes were surveyed. The relationship between obesity and diabetic
retinopathy and nephropathy and macro-angioplasty was examined using
49
univariate and multivariate analysis. A body mass index (BMI)  25 kg/m2
was used as the diagnostic criterion for obesity. The prevalence of obesity
at the time of survey was 35% and a history of obesity was reported in 70%
of the survey population. The prevalence of nephropathy in previously obese
patients was significantly higher than in non obese patients. The maximum
BMI was significantly associated with the development of retinopathy and
nephropathy, as shown by logistic regression analysis. This suggests that a
history of obesity may be an important risk factor for the development of
micro and macro angioplasty in Japanese with type 2 diabetes.
Bramlage, et al, (2004) assessed the prevalence of hypertension and
the diagnosis, treatment status and control rates of hypertension, in obese
patients as compared to patient with normal weight. A cross sectional point
prevalence study of 45125 unselected consecutive primary care attences
was conducted in a representative nation wide sample of 1912 primary care
physicians in Germany. Blood pressure levels were consistently higher in
obese patients. Over-all prevalence of hypertension in normal weight
patients was 34.3%, in overweight participants 60.6%, in grade I obesity
72.9%, in grade II obesity 77.1% and in grade III obesity 74.1%. The odds ratio
(OR) for good BP control in diagnosed and treated patients was 0.8, in
overweight patients, 0.6 in grade I 0.5 in grade II and 0.7 in grade III obese
patients. The increasing prevalence of hypertension in obese patients and
the low control rates in overweight and obese patients document the
challenge that hypertension control in obese patients imposes on the
primary care physician.
Spruch, et al., (2004) analyzed the additional atherosclerosis risk
factors in children and adolescents with simple obesity. The study included
106 children with simple obesity. The age of the studied children was 8-16
years. The evaluation of nutrition and diagnosis of obesity were performed
on the basis of anthropometrical measurements. In all of the children, body
weight, height, thickness of skin folds, circumference of the hips and waist
were taken. Also BMI as well as WHR were evaluated with relation to age
standards included in the tables and Centile grids. The concentration of
triglycerides, total cholesterol and HDL cholesterol were assayed in the
50
blood serum. The level of LDL cholesterol and VLDL cholesterol was
determined with an indirect method. The increased total cholesterol level
in blood serum was noticed in 68% children with simple obesity. The
increased level of atherogenic fraction (LDL cholesterol) was observed in
74.5% obese children and reduced level of protective fraction in 63.2%
children. Obesity in both parents was confirmed in 9.5% families of the
examined children. In 46% of the family obesity was confirmed in one of the
parents. The results indicate that atherosclerosis prophylactics should be
realized from the very early childhood.
Erem, et al, (2004) estimated the prevalence of overweight and
obesity in the Trabzon region and its associations with demographic factors,
socioeconomic factors, family history of selected medical conditions,
lifestyle factors and hypertension in the adult population. A total of 5016
subjects were included in the study. Individuals more than 20 years were
selected from their family health cards. Systolic and diastolic pressure
levels were measured for all subjects. Study procedures were carried out in
the local health care centers in each town over an 8 month period. The
prevalence of obesity was 23.5%; 29.4% in women and 16.5% in men. The
combined prevalence of both overweight and obesity was 60.3%. The
prevalence of abdominal obesity was 29.4%, 38.9% among women and 18.1%
among men. The prevalence of obesity increased with age, being highest in
the 60-69 year old age groups, but lower again in the 70+ age groups.
Obesity was associated positively with marital status, parity, cessation of
cigarette smoking, alcohol consumption and household’s income and
inversely with level of education, cigarette use and physical activity.
Busetto, et al, (2004)conducted by a study on the short term effects
of weight loss on the cardiovascular risk factors such as blood pressure blood
glucose, total cholesterol ,high density Lipo-protein, (HDL) cholesterol and
triglycerides
were
determined
before
and
15.32.1
months
after
laparoscopic gastric banding in 650 morbidly obese patients. Global
cardiovascular
risk
was
calculated
according
to
the
prospective
cardiovascular Munster (PROCAM) scoring system. Mean weight loss was
22.720.4 Kg. Normalization of the metallic alteration was observed in
51
67.3% of patients with diabetes, 38.3% of patients with hypercholesterolemia, 72.5% of patients with low HDL-cholesterol, 72.3% patients with
hypertriglyceridemia and 46.7% of patients with hypertension. Percentage of
weight loss was significantly related to the reductions of fasting blood
glucose, triglyceride level and the PROCARM score and to the increase of
HDL cholesterol concentrations observed after surgery. However the
strength of these four relationships was generally low. Weight loss observed
in the first 12 to 18 months after gastric banding was associated with a
significant improvement of single cardiovascular risk factors and global risk.
On the other hand, the extent of weight loss was poorly related to the
magnitude of improvement in cardiovascular risk.
Ribeiro et al, (2004) analyzed the body fatness and clustering of
cardiovascular disease risk factors in Portuguese children and adolescent.
The cluster of CVD risk factor was determined in 1533 children, 731 males
and 802 females. Sex and age specific high risk quartiles were formed for
each of the biological risk factors and the life style factor. Thus for blood
pressure, cholesterol, and obesity, the sex and age adjusted 4 th quartile was
defined as the ‘high risk’ quartile, while for physical activity the 1 st quartile
(1) was defined as the high risk quartile. The majority of the children at risk
of obesity are at risk of other risk factors. 8-15 years old children in the
highest quartile of body fitness are an increased risk of having a cluster of
other risk factors, namely HBP, HTC and LPAI. These data provide further
evidence that juvenile obesity warrants early intervention because of the
patterns of unhealthy behavior are formed in adolescence and young
adulthood.
Vorona, et al, (2005) examined the association between restricted
sleep and obesity in a heterogeneous adult primary care population. A total
of 1001 patients from 4 primary care practices in Virginia, USA participated
in this prospective study. The relationship between body mass index (BMI)
and reported total sleep time per 24 hours was analyzed after categorizing
patients according to their BMI as being of normal weight (<25), overweight
(25-29.9), obese (30-39.9) or extremely obese (40). Analyzable forms from
924 patients aged 18-19 years indicated that the mean BMI was 30, women
52
slept more than men, overweight and obese patients slept less than patients
with a normal BMI and this trend of decreasing sleep time was reversed in
the extremely obese patients. This study found that reduced amounts of
sleep
are
associated
with
overweight
and
obesity.
Interventions
manipulating total sleep time could elucidate a cause and effect
relationship between insufficient sleep and obesity.
Parsi (2004) conducted a study on obesity and cardiovascular
diseases. 5459, patients were examined, in 2002, 37.3% of whom were overweight or obese. The ratio of male: female was 44:56%. The main symptoms
for their consultation at the cardiologists were dyspnoea during exercise,
thoracic pain, and decrease in physical exercise capacity, day time fatigue,
and peripheral edema. These patients had arterial hypertension (31.42%),
cardiac failure (47.30%) angina pectoris (12.10%) and other complaints
(10.18%). There is a clear relationship between obesity and cardiovascular
diseases. Because of high costs for morbidity due to obesity in hospital and
outpatients care, attention should be focused on the reduction of obesity.
Zepter, et al, (2004) studied on the mechanism of obesity- related
hypertension. Obesity has become an epidemic problem in western
societies,
contributing
to
metabolic
disease,
hypertension
and
cardiovascular diseases. Although the importance of obesity as a cause of
hypertension is well established, the molecular basis of the relationship
between obesity and increased blood pressure remains poorly understood.
This
brief
review
examines
the
association
between
obesity
and
hypertension along with the mechanisms and proposed to explain this
association, while presenting evidence of a direct causal effect of adipose
tissue in the development of hypertension through the involvement of the
adrenal cortex.
Tingfan, et al, (2004) assessed the relation between obesity and
asthmatic airway inflammation. Asthmatic patients aged 7-18 year old were
recruited. Weight-for-height Z score was calculated from anthropometry.
Exhaled nitric oxide (ENO) was measured by online single breath method
using a chemiluminescence analyzer; where as leukotriene B4 (LTB4)
concentration in exhaled breath condensate (EBC) were quantified using
53
competitive enzyme immunoassay. Ninety two asthmatics and 23 controls
were recruited. The mean ENO and LTB4 concentrations in EBC were higher
in asthmatic patients than controls. Obesity as defined by weight >120%
median weight for height was not associated with any alteration in ENO or
LTB4 concentrations in patients with Asthma. ENO and LTB4 concentrations
in EBC are increased in childhood asthma. However, these inflammatory
markers didn’t differ between obese and non obese children with asthma.
Loon, et al (2004) conducted a study on intromycellular lipid content
in type 2 diabetes patients compared with overweight sedentary men and
highly endurance athletes. Immunofluorescence microscopy was performed
on muscle biopsies obtained from eight high trained endurance athletes,
eight type 2 diabetes patients and eight overweight sedentary men after an
overnight fast. Mixed muscle lipid content was substantially greater in the
endurance athletes. More than 40% of the greater mixed muscle lipid
content was attributed to a higher proportion type I muscle fibers. The
remaining difference was explained by a significantly greater IMCL content
in the type I muscle fibers of the trained athletes. Differences in the IMCL
content between groups or fiber types were accounted for by differences in
lipid droplet density, not lipid droplet size. In conclusion, IMCL contents can
be substantially greater in trained endurance athletes compared with
overweight or type 2 diabetes patients. Because structural characteristics
and intramyocellular distribution of lipids aggregates seems to be similar
between groups, we conclude that elevated IMCL deposits are unlikely to be
directly responsible for inducing insulin resistance.
Wannamethee, et al, (2004) conducted study to examine the
prevalence of disease burden and disability associated with overweight and
obesity in men aged 60-79 years and assessed whether the current WHO
weight guidelines are appropriate in the elderly. In total 4232 men aged 6079 year with measured weight and height were taken for the study.
Cardiovascular risk factors, prevalence of diabetes, cardiovascular disease,
cancer, disability, were observed in the subjects. In total 17% of the men
were obese and a further 52% were overweight. Prevalence of hypertension,
low HDL cholesterol, higher triacylglycerols, and insulin resistance and the
54
prevalence of most disease outcomes increased with increasing degrees of
overweight and obesity. Men in the normal weight range (18.5-24.5 kg/m2)
had the lowest prevalence of ill health. Compared with normal weight men,
obese men showed a 2 fold risk of major CVD and locomotors disability and
were nearly 3 times as likely to have diabetes, CV interventions or to be on
CV medication. In elderly men, overweight and obesity are associated with a
significantly increased burden of disease, in particular CV related disorders
and disability.
Consedine, et al, (2004) studied on obesity and awareness of obesity
as risk factors for breast cancer in six ethnic groups. A stratified cluster
sampling plan was used to recruit 1364 older women from Brooklyn, NY,
during 2000-2002. Two groups were born in the United States, where as
others were from the English-speaking Caribbean, Haiti the Dominican
republic and Eastern Europe. Participants provided demographics, height
and weight measures, and estimates of the risk obesity posed for breast
cancer. Women from all groups were significantly overweight (BMI>25
kg/m2), although European Americans were lowest, followed by Dominicans
and Haitians. Knowledge of obesity as a breast cancer risk factor was also
poor across groups, but Dominicans and Haitians, had the loosest scores on
knowledge. Importantly, knowledge was not associated with BMI in the
overall sample, even when controlling for demographic and ethnicity,
although logistic regressions comparing normal weight women with
overweight and obese grouping suggested some knowledge of breast cancer
risk in the overweight, but not in the obese groups.
Cikim, et al, (2004) evaluated the relationship between different
types of obesity and cardiovascular risk indictors. A total of 623 overweight
and 2559 obese women were divided into four groups according to their BMI
and waist to hip ratio. In simple overweight BMI 25-30 kg/ m2 and WHR <0.8,
was observed, in abdominal adiposity BMI >30 kg/m2 and WHR >0.8, was
recorded, in peripheral obesity BMI >30 kg / m2 and WHR <0.8 and central
obesity BMI>30kg m and WHR >0.8 was recorded. The levels of the risk
indicators measured were significantly higher in the central obesity groups.
Total body fat and abdominal accumulation seems to result in more serious
55
hyper insulinaemia and insulin resistance in central obesity. Measuring BMI
and WHR in obese patients may reveal their risk for coronary heart disease.
Groot, et al, (2005) investigated the relationship between body mass
index (BMI) and nitric oxide in exhaled air (eNo) in Netherlands. Twenty four
(10 males and 14 females) healthy non smoking subjects of mean age 27-39
years, mean BMI 23.0 kg/m2, mean eNo level 18.1 ppb were enrolled in this
study. The results showed that these lung function parameters of all
subjects were normal none of the subjects had airflow obstruction and the
mean forced vital capacity was 85.0 %. BMI was positively associated with
mean eNo (p=0.007). The findings show a significant increase in eNo level in
subjects with higher BMI. The data suggest that direct or indirect up
regulation of inflammatory processes outside the adipose tissue and a
contribution of obesity related inflammatory activity tot eh pathophysiology
of asthma.
Rode, et al, (2005) studied the relationship between pre-pregnancy
and obstetric body mass index BMI as well as fetal complications in large,
unselected cohort of Danish women with single cephalic pregnancies. A
cohort of 8092 women from the Copenhagen first trimester study with a
registered pre-pregnancy BMI and a single cephalic term delivery were
stratified into 3 BMI groups, normal weight (BMI > 25 kg/m2), overweight
(BMI 25-29.9 kg/m2) and obese (BMI30 kg/m2). The effects of BMI and
parity on the outcome were analyzed using multivariate logistic regression
analyses. Overweight women had an odds ratio (OR) of 3.4 for diabetes, 1.9
for hypertension, 1.7 for preeclampsia and 1.5 for cesarean delivery. The
corresponding figures for obese women were 15.3 4.8, 2.7 and 1.7
respectively. No relationship was found between BMI and vacuum
extraction. Obese women had an increased risk of delivering macroscopic
but also low birth weight children. The rate of complications during
pregnancy and delivery increases with an increasing pre-pregnancy BMI in
women with single cephalic term pregnancies, particularly in nulliparous
women.
56
Auer, et al, (2005) studied about obesity, body fat and coronary
atherosclerosis, in six hundred and seventy three men and four hundred and
twenty eight women who underwent coronary angiography for suspected or
known coronary heart disease were analyzed. The body mass index BMI and
the BF were used as main exposure variables, and either the presence of
significant coronary diameter stenosis or a coronary artery disease severity
score were defined as outcome variables, in a sex specific logistic regression
analysis. Among male patients, BF was slightly higher with increasing
number of vessels involved. In contrast, BMI slowed no association with
presence and severity of coronary artery disease (CAD). These results did
not differ between younger and older men and females, associated with an
increasing number of vessels involved. These results suggested that BF may
be predictive of an increasing number of coronary vessels involved among
male patients, but not among female patients. This study failed to detect a
positive association of presence and severity of CAD with BMI.
Rana, et al, (2004) studied obesity and the risk of death after acute
myocardial infarction. A prospective cohort study of 1898 patients
hospitalized with confirmed acute myocardial infraction was done. The
patients were categorized according to WHO criteria for body mass index
(BMI). Of the 1898 eligible patients, 607 were normal weight, 832 were
overweight, 331 were class I obese and 128 were Class II or more obese. The
relative risk of death in all obese patients was 1.46 compared with those
with normal weight. BMI appeared to have a positive, graded relation with
post myocardial information death.
Shah (2009) conducted a study on obesity and sexuality in women as
sexual health is an important part of an individual’s overall health. This
article presents the definitions and classification of female sexual
dysfunction (FSD), emphasizes the importance of obtaining a sexual health
assessment, and describes the tools that can be used for this assessment.
The impact of obesity on reproductive health over a women’s entire life
span is described. The treatment of obesity will have a positive effect on a
woman’s sexual health, with a likely improvement in FSD and a decrease in
risk factors related to contraception, pregnancy, infertility and menopause.
57
Zavorsky (2009) reviewed the cardiopulmonary aspects of obesity in
non-pregnant women. The effects of obesity on pulmonary diffusing
capacity and pulmonary gas exchange are related to the waist-to-hip ratio.
Obese women have an increased risk for heart failure compared with normal
weight women, a risk that progressively worsens with increasing body mass
index. They also have poor cardiac accommodation and possess a lower
oxygen pulse at peak exercise. Cardiac output, heart rate and total blood
volume are higher in obese women whereas ejection fraction is lower
compared with normal weight women; substantial weight loss normalizes
these parameters.
Lash and Armstrong (2003) reviewed the impact of obesity on
women’s reproductive health and fertility. Obesity is associated with early
puberty, aberrant menstrual patterns, decreases contraceptive efficacy,
ovulatory disorders, and an increased miscarriage rate and worse assisted
reproductive technology outcomes. Losing weight can ameliorate many of
these problems.
Dennis (2007) reviewed the effects of obesity that have particular
relevance for postmenopausal women. The health consequences of obesity
include increased risk of heart disease, hypertension, diabetes, sleep apnea,
cancer, osteoarthritis and mental health problems. Post-menopausal women
have reached an age when the incidence of chronic health conditions
becomes more prevalent. In addition to physical disease risks a lifetime of
ridicule and disrespect may seriously and adversely affect general and
health related quality of life. Thus, obese post-menopausal women stand at
a crossroads between living the remainder of their lives in essentially good
health and facing the likely on set of chronic diseases that might have been
prevented.
2.5 DIET AND OBESITY:
Kiefer and Kunze, (2005), studied on changes in dietary behaviour and
body weight within the framework of the weight reduction program. Ten
600 minute sessions of professional counseling were performed in 150 clients
formed in small groups. Food intake and dietary behavior were determined
58
using a weighing protocol and questionnaire. To determine long term
success, a follow up control check was conducted after a minimum of 6
months and a maximum of 24 months, after counseling was stopped. The
results showed that body weight was reduced by an average of 3.96 kg over
9 weeks. At one year follow up., 73.2% of clients had a body weight below
their initial weight, 37% had a body weight below their end weight and
14.8% had a body weight similar with end weight. During the counseling
period, energy intake from foods and drinks was significantly reduced,
primarily through reduction in food intake, from 37.8% of total energy
intake in week 1 to 34.7% in week 9. There were reductions in cholesterol,
sucrose, salt and alcohol intakes. It is concluded that due to the long term
success in terms of weight loss and modification of dietary behaviors, the
programme is well suited for weight reduction.
Layman, (2004), assessed that protein quantity and quality at levels
above the RDA improves adult weight loss. Evidence is accumulating that
diets with reduced carbohydrates and increased levels of high quality
protein are effective for weight loss. These diets appear to provide a
metabolic advantage during restricted energy intake that targets increased
loss of body fat while reducing loss of lean tissue and stabilizing regulations
of blood glucose. It is proposed that the branched chain amino acid leaking
is a key to the metabolic advantage of a higher protein diet because of its
unequal roles in the regulation of muscle protein synthesis, insulin signaling
and glucose recycling via alanine. These metabolic actions of leucine
require plasma and intracellular concentration to increase above minimum
levels maintained by current dietary guide liens and dietary practices in the
USA. The research suggests that increased use of high quality protein at
breakfast may be important for the metabolic advantage of a higher protein
diet.
Schmidhuber and Shetty, (2004), studied on nutrition transition,
obesity and non communicable diseases. The last few decades have seen
fundamental changes in food intake patterns around the world. The changes
are characterized by an increase in the amounts of food consumed and a
shift in the composition of the diet towards more meat, eggs, dairy
59
products, and fats and oils. The main drivers for this transition are rapidly
falling food prices, urbanization with the development of new marketing
changes and freer trade and globalization are also discussed. Policy options
on possible remedies to stop the obesity epidemic are examined.
Pandher and Jasvinder, (2004), studied on energy and nutrient intake
in obese children. The energy and nutrient intake and energy intake to basal
metabolic rate (EI: BMR) ratio of 60 students (30 males and 30 females)
were determined. The students were from 3 public schools in Ludhiana and
were chosen on the basis of their weight for age data, being 20% above
normal. The average daily intake of energy for both sexes was higher than
the recommended dietary allowance (RDA) with values of 2161.40±351.24
and 2139.38  298.71 Kcal, respectively for males and females. The higher
energy intake was due to higher intake of fats, oils, milk and milk products,
roots and tubers. Protein, carbohydrate and fat contributions to total
energy intake in males and females were 12.6, 52.99 and 34.41% and 12.35,
54.46 and 33.19% respectively. EI: BMR ratio was 1.64 and 1.95 for males
and females, respectively. The overall intake for both sexes of ascorbic
acid, retinol, thiamine, and folate exceeded the RDA, including calcium,
vitamin B12 where as pyridoxine and iron intakes were lower than the RDA.
The intake of niacin, riboflavin and vitamin B12 were higher where as
pyridoxine and iron intakes were lower than the RDA. The intake of niacin,
riboflavin and vitamin B12 were close to the RDA. The high levels of Vit C
were due to increased intake of citrus fruits among subjects. Daily iron
intake was below the RDA due to the inadequate consumption of green leafy
vegetables, whole cereals and pulses.
Tentolouris, et al, (2004) studied the effect of two different is
energetic meals, one rich in carbohydrates and one rich in fat, on plasma
active ghrelin levels in lean or obese subjects. Eight obese and eight lean
women, strictly matched for age, were fed two isoenergetic meals of
different composition, one rich in fat and one rich in carbohydrates on
separate days. Plasma active ghrelin level was measured just before and at
1.2 and 3 hours after meal consumption. Overall plasma active ghrelin level
was significantly lower in the obese compared to the lean women.
60
Furthermore, ghrelin levels decreased significantly by 30% from baseline
values in the lean subjects in the first hour after the carbohydrate rich meal
returning to near baseline levels by 2 hours, while no significant change was
observed in obese subjects. After the fat rich meal, active ghrelin levels did
not change significantly in either group. A fat rich meal does not suppress
plasma active ghrelin levels in either lean or obese women. More-over in
obese, unlike lean women, a higher carbohydrate meal also fails to suppress
plasma ghrelin levels, which are already quite low. This suggests that
ghrelin induced satiety mechanisms may be compromised in these subjects.
Hauner, (2004), conducted a study to know whether a low
carbohydrate or low fat diet is better for weight low. Several recent clinical
studies show that a low carbohydrate diet produces greater initial weight
loess than conventional low fat diets, and is associated with a greater
reduction of elevated serum triacylglycerols. After one year, however,
weight loss is similar with both diets. Since the intake of saturated fat is
higher on a low carbohydrate diet, there may be an increased risk of
elevated levels of LDL cholesterol, thus furthering atherosclerosis, over the
long term. Before, low carbohydrate diets can be considered an equivalent
alternative to low fat diets for the treatment of obesity, long term clinical
trials are urgently required. The greater weight loss under low carbohydrate
diets would appear to be due to a lower calorie intake. Successful weight
loss largely depends on restricting the intake of calories, but the supply of
essential nutrients should be guaranteed.
Hill, (2004), studied to know does dieting make you fat. Dieting
makes you fat, the title of a 1980s book on weight control is a popularized
paradox, conveying conclusion that is consistent with personal experience
and the reported failure of most dietary approaches in the treatment of
obesity. Few studies have been designed specifically to test this association.
Yet there are prospective data showing that baseline dieting or dietary
restraint increased the risk of weight gain, especially in women. Metabolic
adaptations and the disinhibited eating of restrained eaters have been the
most commonly cited explanations in the development and persistence of
binge eating.
61
Lowe and Timko, (2004), studied to know Dieting: really harmful,
merely ineffective or actually helpful? Dieting has developed a negative
reputation among many researchers and health care professionals. However,
“dieting” can refer to a variety of behavioral patterns that are associated
with different effects on eating and body weight. The wisdom of dieting
depends on what kind of dieting is involved, who is doing it and why. Thus,
depending on what one means by the term, dieting can be quite, harmful,
merely ineffective or actually beneficial. In particular, we argue that
judgments about the desirability of dieting should consider the likely
consequences to particular individuals of engaging in or not engaging in
dieting behavior.
Waller, et al, (2004) tested the hypothesis that providing a structured
snack in the form of a ready to eat breakfast cereal would help regulate
excess energy intake and contribute to weight loss in night snackers. Adult
of age range 18-65 years of age, BMI  25 kg/m2, with self reported night
snacking behaviors, were randomized into a cereal groups (CR) and a no
cereal groups (MC). During a period of 4 weeks, the cereal groups was
instructed to consume a serving of ready to eat cereals with low fat milk 90
minutes after their evening meal. Concurrently, the non cereal groups
continued their regular diet. At baseline, there were no significant
differences between groups for age, body weight, body mass index, daily
calorie intake or evening calorie intake. There was correlation between
number of days of compliance with past dinner cereal consumption and
weight loss. Compared to baseline, the complaint CR groups reduced their
total daily calorie intake by- 396.50641.6 Kcal where as the NC groups
experienced a reduction of-23.22889.60 kcal/ day during the same period.
Reduction in post dinner calorie intake for the compliant CR groups was
significantly greater compared to the NC groups. Eating ready to eat cereal
after the evening meal may attenuate calorie intake in night snackers and
promote weight loss in compliant individuals.
Mori, et al, (2004) examined whether dietary fish enhanced the
effects of weight loss in serum leptin levels, in 69 overweight, treated
hypertensive men and women. Participants were randomized to a daily fish
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meal, a weight reduction regimen, the two regimens combined or a control
groups for 16 weeks. A total of 63 individuals completed the study. Weight
fell 5.6+/ -0.8 kg with energy restriction. Blood pressure (BP) reductions in
the combined fish weight loss groups were twice that seen with either
intervention alone. At baseline, in all groups combined, serum leptin levels
correlated with serum insulin, but not with body weight. The greatest
change in serum leptin occurred in the fish weight loss groups. In the fish
weight loss groups, the change in serum leptin was predicted by changes in
serum insulin, and 24 hours heart rate. Using general linear models, there
was a significant fish and weight loss interaction on post intervention serum
leptin after adjustment for baseline levels, independent of post intervention
insulin. A daily fish meal as part of a weight reducing regimen was more
effective than either measure alone at reducing leptin levels. Reduction in
leptin may be related to the substantial fall in BP seen with fish weight loss
programme.
Hensrud, (2004) studied on diet and obesity. The main aim was to
reviews the factors that influence energy intake and dietary treatments
used to promote weight loss. Increasing portion size, eating away from
home and consuming a variety of higher energy dense foods appear to
increase energy intake. Hormonal influence on diet continues to be
explored. Very low calorie diets and low carbohydrate diets lead to greater
initial weight loss, but long term results are no better than more moderate
calories restricted diets. A programme using meal replacements appears to
lead to weight loss slightly greater than calories restricted diets and offers
one option to treat obesity. Dietary patterns low in energy density and
glycemic index have potential in treating obesity and should be studied
further. Further studies should explore dietary strategies and combination
therapies that contribute to weight loss, long term weight maintenance and
improved health.
Anderson and Moore, (2004) studied on dietary proteins in the
regulation of food intake and body weight in humans. This review presents 4
lines of evidence supporting the role of proteins in the regulation of food
intake and maintenance of healthy body weight. It is concluded that the
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protein content of food and perhaps its source, is a strong determinants of
short term satiety and of how much food is eaten. Although the role of
protein in the regulation of long term food intake and body weight is less
clear, the evidence reviewed suggest that further research to define its role
is merited. Such research has the potential to lead to new functional foods,
food formulations and dietary recommendation for achieving healthy body
weight.
Blanck, et al, (2004) studied on diet and physical activity behavior
among users of prescription weight loss medications. The sample consisted
of 135435 non institutionalized adults aged 18 years old and older. The
prevalence and odds of prescription weight loss medication use, odds of 10%
weight loss, and among current weight loss medication users, the
prevalence and odds for diets and physical activity behaviors were
determined. 10.2% of obese women and 3.1% of obese men reported using
prescription weight loss medications in the past 2 years of users, 28.2% had
lost at least 10% of their pretreatment body weight. The odds of losing at
least this much weight were higher among women, those who usually
consumed  5 fruits and vegetables daily and those who met physical
activity
recommendations.
Among
current
prescription
weight
loss
medication users, 26.7% reported both eating fewer calories and meeting
recommended leisure time physical activity levels. Of those meeting both
recommendation, almost half had lost 10% of their pretreatment body
weight. Of current users, 9% reported using the medications for weight
maintenance. Only 26.7% of prescription weight loss mediation users
reported following recommended diet and physical activity behaviors.
Further research is needed to assess whether behavioral changes are
associated with greater weight loss and maintenance among prescription
weight loss medication users.
Hauner, (2004) assessed to know whether a low carbohydrate or low
fat diet is better for weight loss? Several recent clinical studies show that a
low carbohydrate diet produces a greater initial weight loss than
conventional low fat diets, and is associated with a greater reduction of
elevated serum triacylglycerols. After one year, however, weight loss is
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similar with both diets. Since the intake of saturated fat is higher on a low
carbohydrate diet, there may be an increased risk of elevated levels of LDL
cholesterol, thus furthering atherosclerosis, over the long term. Before a
low carbohydrate diets can be considered an equivalent alternative to low
fat diets for the treatment of obesity, long term clinical trials are urgently
required. The greater weight loss under low carbohydrate diets would
appear to be due to a lower calorie intake. Successful weight loss largely
depends on restricting the intake of calories, but the supply of essential
nutrients should be guaranteed.
Seshadri, et al, (2004) conducted a study to compare the effects of
low carbohydrate diet and a conventional diet on lipoprotein sub-fractions
and inflammation in severely obese subjects. The changes in lipoprotein
sub-fractions and C- reactive protein levels in 78 severely obese subjects,
including 86% with either diabetes or metabolic syndrome, who were
randomly to either a low carbohydrate or conventional diet for 6 months,
were compared. Subjects on a low carbohydrate diet experienced a greater
decrease in large very low density lipoprotein (VLDL) levels but more
frequently developed detectable chylomicron. Both diet groups experienced
similar decreases in the number of low density lipoprotein particles and
increases in large high density lipoprotein concentrations. Over all, Creactive protein levels decreased modestly in both diet groups. However,
patients with a high risk baseline level experienced a greater decrease in C –
Reactive protein levels on a low carbohydrate diet, independent of weight
loss. In this study, there is an overall favourable effect of a low
carbohydrate diet on lipoprotein sub-fractions, and on inflammation in high
risk subjects. Both diets had similar effects on LDL and HDL sub-fractions.
Miyashita, et al, (2004) investigated the effects of low carbohydrate
diet
on
glucose
and
lipid
metabolism,
especially on
visceral fat
accumulation, and comparing that of a high carbohydrate diet. Obese
subjects with type 2 diabetes mellitus were randomly assigned to take a low
calorie and low carbohydrate diet or a low calorie and high carbohydrate
diet, for 4 weeks. Similar decreases in body weight and serum glucose level
were observed in both groups. Fasting serum insulin levels were reduced in
65
the low carbohydrate diet groups, compared to high carbohydrate diet
groups. Total serum cholesterol and triglyceride levels decreased in both
groups, but were not significantly different from each other. High density
lipoprotein cholesterol increased in the low carbohydrate diet group, but
not in the higher carbohydrate diet groups. There was a large decrease in
visceral fat area measured by computed tomography in the low
carbohydrate diet groups compared to the high carbohydrate diet groups.
The ratio of visceral fat area to subcutaneous fat area did not change in the
high carbohydrate diet groups, but it decreased significantly in the low
carbohydrate diet groups.
Manco, et al, (2004) studied the effects of dietary fatty acids on
insulin sensitivity and secretion. Globalization and global market have
contributed to increased consumption of high fat, energy-dense diets
particularly rich in saturated fatty acids (SFAs). Poly unsaturated fatty acids
(PUFAs) regulate fuel partitioning within the cells by inducing their own
oxidation through the reduction of lipogenic gene expression and the
enhancement of the expression of those genes controlling lipid oxidation
and thermogensis. Moreover, PUFAs prevent insulin resistance by increasing
membrane fluidity and GLUT4 transport. In contrast, SFAS are stored in non
adipocyte cells as triglycerides leading to cellular damage as a sequence of
their lipotoxicity. Triglyceride accumulation in skeletal muscle cells derives
from increased FA uptake coupled with deficient FA oxidation. The
biochemical mechanisms responsible for lower fatty acid oxidation involve
reduced Carnitrine Polmitoyl Transferase (CPT) activity, as a likely
consequence of increased intracellular concentration of malonyl COA;
reduced glycogen syntheses activity and impairment of insulin signaling and
glucose transport.
Bharati et al, (2007) studied the prevalence and causes of chronic
energy deficiency and obesity in Indian women. The study was based on
81,712 women from 26 states and 6 zones, which were grouped according to
geographic proximity of the states of India. A multiple linear regression
analysis was done to see the relation between nutritional status of women
and different socioeconomic factors. The data revealed that the prevalence
66
of CED, overweight, and obesity in India are 31.2%, 9.4% and 2.6%
respectively. The incidences of CED and obesity are negatively related. The
prevalence of CED is the lowest in Arunachal Pradesh and highest in Orissa.
Punjab has the highest prevalence of obesity and Bihar has the lowest. For
the zone wise distribution the Northeast Zone has the lowest degree of
prevalence of CED and the East zone is at the bottom of the list with the
highest degree of malnutrition.
2.6 OBESITY AND PREGNANCY:
Andreasen, et al, (2004) reviewed on obesity and pregnancy. Their
paper reviews the potential complications associated with obesity and
pregnancy. The complications associated with obesity in pregnancy are
gestational
diabetes
mellitus,
hypertensive
disorders
(hypertension,
preeclampsia, and eclampsia) and thromboembolic complications. The
complications associated with obesity during labor are augmentation, early
amniotomy,
cephalopelvic
disproportion,
caesarean
section
and
preoperative morbidity. The complications associated with obesity in
neonates are fetal macrosomia, shoulder dystopia, small for gestational age,
late fetal death and congenital malformations, especially neural tube
defects. The data suggest that obesity is associated with a higher risk of all
reviewed complications except small for gestational age.
Waller and Dawson, (2004) conducted a study on the relationship
between maternal obesity and adverse pregnancy outcomes. This chapter
reviews the literature on maternal obesity with adverse pregnancy
outcomes. The methodological issues pertinent to the measurement of
obesity in epidemiological studies and the effect of obesity on reproductive
function. Pregnancy complications and adverse outcomes of pregnancy (late
fetal death, small for gestational age infants, preterm birth and birth
defects) are also discussed.
2.7 OBESITY AND PSYCHOSOCIAL ASPECTS:
Biedert and Margraf, (2004) studied on the psychosocial aspects of
obesity. Obesity is generally a lifelong problem with numerous weight
67
related medical complications. The relationship between body weight and
risk of developing a significant disease, as well as total mortality and
morbidity, has been examined in many epidemiological studies. Such studies
provide insight into biological relationship. In addition to negative physical
effects, obesity may also have deleterious psychological and social effects
on the individuals concerned. It is not obesity as a physical state that
creates a psychological burden for many obese individuals, but rather the
people or society who create this burden and suffering. Discrimination and
prejudice may have adverse effects on the psychological well being of
subgroup of obese persons.
Fabricatore and Wadden, (2004) studied on psychological aspects of
obesity. Obesity is a complex condition associated with a host of medical
disorders. A common assumption is that obesity must also be related to
psychological and emotional complications. Research on the psychosocial
aspects of obesity has grown more sophisticated over the years, from purely
theoretical papers to cross-sectional comparisons of people with and
without obesity to prospective investigations of the temporal sequence of
obesity and mood disturbance. These studies have shown that obesity, by
itself,
does
not
appear
to
be
systematically
associated
with
psychopathological outcomes.
Certain obese individuals however are at a greater risk of psychiatric
disorder, especially depression. The present paper reviews the research
findings and presents there clinical implications. Chiefly, treatment provides
should not assume that a depressed or other wise disturbed obese persons
needs only to loose weight in order to return to psychological health.
Significant mood disturbances should be treated equally aggressively,
regardless of a patient’s weight status.
Ryden, et al, (2004) conducted a study to examine the effects of
weight change on personality traits after 2 years in severely obese subjects
treated conventionally or surgically. Personality traits were assessed using 7
of 15 scales from the Karolinska scales of personality (KSP): Somatic anxiety,
muscular tension, psychasthenia, psychic anxiety, monotony avoidance,
impulsiveness and irritability. A total of 1380 surgical candidates, 1241
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conventionally treated patients and 1135 subjects form the SOS (Swedish
obese subjects) reference study representing the general populations of
Sweden completed the KSP. Data presented in this study were gathered
twice from the patients and once form the reference subjects. Significance
tests and effects sizes (ES) were calculated. At baseline, the obese were
characterized as more anxiety prone, impulsive, irritable and less monotony
avoiding than the reference groups. These were observed more in surgery
patients than in conventionally treated patients. At follow-up, it was found
that anxiety proneness decreased and monotony avoidance increased with
increasing weight loss. The conventionally treated were on average, weight
stable and hence only a small decreased was noted regarding somatic
anxiety. The surgery groups lost an average of 28 kg and the differences
between surgically treated and the reference groups decreased on all scales
except impulsiveness, which remained unchanged. The largest improvement
was in relation to psychasthenia.
2.8 OBESITY AND HEALTH CONSCIOUSNESS:
Vriendt, et al, (2009) investigated the role of socio-demographic and
life style determinants on the nutrition knowledge of Belgian women and
the association between their knowledge and dietary behavior. A total of
803 women, aged 18-39 years, were included in a cross – sectional study and
completed a general and nutrition knowledge questionnaire and a 2 – day
food record. Their height and weight were measured under standardized
conditions. Linear regression models showed independent significant
associations between the following determinants and the women’s nutrition
knowledge (in order of importance) educational level, age, kind of
occupation, smoking behavior and work status. Inconsistent or no
associations were found for body mass index, physical activity, living
situation, and whether or not they had children. The investigated
determinants accounted for 13-14.5% of variance in total nutrition
knowledge. A rise in nutrition knowledge was associated with a significant
rise in consumption of vegetable and fruit, but no differences were seen for
other dietary indicators. Most important determinants of the women’s
69
nutrition knowledge were educational level, age and their kind of
occupation. Women who had better knowledge of nutrition also exhibited
better dietary behaviors, thus underlying the importance of nutrition
education for improving dietary behavior.
Kristal, et al (2007) studied on nutrition knowledge, attitudes and
perceived norms as correlates of selecting low fat diets. Participants were
97 women, aged 45-59, with a broad range of dietary fat intakes. Usual
dietary patterns were assessed with a food frequency questionnaire, 8 days
of food diaries and an 18- item questionnaire on fat–related diet behavior.
Participants completed a questionnaire with 125 items. A Q-sort and item
and factor analyses were used to develop their knowledge, two attitude and
four norms scales. These scales had fair internal consistency reliabilities
(ranges were 0.53 – 0.73) and most were significantly associated with both
percent of energy from fat and fat- related diet behavior. Factors most
strongly associated with low-fat diets were related to perceived norms and
knowledge about fat in foods. In multiple regression models, norms and
knowledge contributed significantly and independently to both measures of
diet behavior, while the variance explained by attitudes was small. These
findings support the inclusion of components that enhance practical food
knowledge and change dietary behavior norms in nutrition education
programs. These scales may also be useful tools, both to evaluate nutrition
intervention programs and to develop hypotheses about dietary behavior
which can be tested empirically.
Charlton, et al (2004) identified the major sources and credibility of
nutrition information among black urban South African women, with a focus
on messages related to obesity. Three hundred and ninety-four black women
aged 17-49 years were conveniently sampled from the Western Cape and
Gauteng provinces in South Africa. The most frequently encountered source
of nutrition information was the media, particularly the radio and TV (73.4%
and 72.1% of subjects, respectively, obtained information from this source
in the past year) followed by family/friends (64.6%). Despite only 48.5% of
subjects having received nutrition information from a health professional,
this was the most highly credible information source. A lack of knowledge
70
on certain aspects of nutrition was identified as well as misconceptions
regarding diet and obesity. To improve the nutrition knowledge and the
effectiveness of nutrition education activities in South Africa, it is
recommended that health and nutrition educators become more actively
involved with the training of health professionals, particularly those
engaged in delivery of services at primary care level and in turn encourage
health professionals to engage more with media sources.
Kearney, et al, (2003) studied on attitudes toward and beliefs about
nutrition and health among a random sample of adults in the republic of
Ireland and Northern Ireland, by using a self administered questionnaire. A
randomly selected sample of 1256 adults from the republic of Ireland and
Northern Ireland completed the attitudinal questionnaire. A majority of
subjects (62%) perceived that they make conscious efforts to eat a healthy
diet either most of the time or quite often, while just over half (52%)
agreed that they do not need to make changes to their diet as it is healthy
enough. Subjects most likely to make conscious efforts to try to eat a
healthy diet were females, older subjects (51-64 yrs) and those with the
highest intakes of fruit and vegetable and lowest quartile of fat (% food
energy). The results suggest that people appear to be reasonably accurate
at evaluating their own diet in terms of how healthy it is. In terms of the
two food groups examined in this study, some optimistic bias was evident
for vegetables but not for fruit. It may be useful therefore to assess
attitudes and beliefs about healthy eating by way by examining attitudes to
such food groups individually.
Susan, et al, (2000) compared relative weight, weight loss efforts and
nutrient intakes among similarly health conscious vegetarian, post
vegetarian and non vegetarian premenopausal women. Demographic data,
life style practices and weight loss efforts (by questionnaire), body mass
index (BMI; Kg/m2) and dietary intake (via multiple-pass 24-hour diet recall)
were compared in a convenience sample of 90 current vegetarians, 35 post
vegetarians and 68 non-vegetarians. Age (31.9 + 18.8), educational
attainment, smoking status, alcohol use, physical activity and perceived
health status were similar among the three groups of women. BMI did not
71
differ by dietary pattern and averaged 23.7 + 4.7 for all women combined.
Participants had intentionally lost ≥ 10 pounds a mean of 2.1 times and 39%
of women perceived themselves to be overweight; again, no differences
were observed among dietary groups. Dietary intake of vegetarians and
current non-vegetarians were consistent with current recommendations for
macronutrient composition (<30% fat, <10% saturates). Compared to current
non vegetarians, current vegetarians had lower intakes of protein, saturated
fat, cholesterol, niacin, vitamin- B12 and D and higher fiber and magnesium
intakes. Vegetarians mean vitamin B12 and D intakes were well below
recommendations.
Hankey, et al, (2003) studied about the eating habits, beliefs,
attitudes and knowledge among health professionals regarding the links
between obesity, nutrition and health. A systematic stratified sample of
2290 subjects incorporated general practitioners (n= 1400), practice nurse
(n=613) and all practicing dieticians (n=360) who were all member of the
British Dietetic Association. The overall response rate was 65%. All
professionals showed a clear understanding of nutrition and health. But
understanding of obesity as a disease and of the effectiveness of weight
management using low energy diets was limited. Below 10% had carried out
audit to determine the incidence of obesity and overweight, and most were
uncertain about their own effectiveness in delivering weight management
advice. This study confirms that health professional have some knowledge of
nutrition and weight management but are unclear how to deliver effective
weight management advice. Further training is justified to ensure the
effective provision of nutritional advice to patients.
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