Preventabilni čimbenici rizika za abdominalnu pretilost u žena fertilne dobi [Modifiable risk factors for abdominal obesity in women of childbearing age]

Fišter, Kristina (2011) Preventabilni čimbenici rizika za abdominalnu pretilost u žena fertilne dobi [Modifiable risk factors for abdominal obesity in women of childbearing age]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Visceral adiposity is considered a causal factor in the development of cardiovascular diseases and type 2 diabetes. Of anthropometrical indices, waist circumference has been shown to best correlate with the amount of visceral fat. It has been proposed that obesity campaigns should focus on women of childbearing age. In 2003, 1,999 women of childbearing age participated in the Croatian Adult Health Survey, of whom 598 (29.9%) participated in the second wave in 2008. Trained visiting nurses measured waist circumference in both waves of the survey. This thesis showed that waist circumference cut-offs used in the literature to define abdominal obesity seem suitable for identifying Croatian women of childbearing age who are in need of weight management, with sensitivity and specificity of 98.8% and 94.8%, respectively, for the IDF cut-off (80 cm), as well as 99.9% and 99.8%, respectively, for the NCEP ATP III cut-off (88 cm). The prevalence of abdominal obesity among Croatian women of childbearing age for 2008 was estimated at 70.3% (95% CI 61.8% to 75.7%) and 48.6% (42.6% to 54.7%) using the IDF and NCEP ATP III cut-offs, respectively. The preceding five year cumulative incidence was estimated at 54.3% (44.5% to 64.2%) and 35.2% (28.0% to 42.4%) for the two cut-offs, respectively. In 2008, almost half of the women followed an unhealthy dietary pattern and 62.3% (56.8% to 67.7%) had a sedentary lifestyle. These and other behavioural, psychosocial, and socioeconomic factors showed cross sectional as well as longitudinal bivariate associations with abdominal obesity. In the multivariate logistic model—which included age, socioeconomic position, waist circumference at baseline, dietary pattern, sedentary lifestyle, consumption of alcoholic beverages, smoking, and chronically high perceived stress—low socioeconomic position and chronically high perceived stress were the major predictors of abdominal obesity after five years. Psychological stress preceded abdominal obesity and increased the odds of abdominal obesity up to three-fold in fully adjusted analyses.

Abstract in Croatian

Količina visceralnog masnog tkiva, s kojom od antropometrijskih pokazatelja debljine najbolje korelira opseg struka, uzročno-posljedično je povezana s nastankom kardiovaskularnih bolesti i dijabetesa tipa 2. Preporučeno je da se kampanje za prevenciju pretilosti fokusiraju na žene fertilne dobi. U Hrvatskoj zdravstvenoj anketi 2003. godine anketirano je 1.999 žena fertilne dobi a 2008. godine ponovo njih 598 (29,9%). U oba su kruga ankete patronažne sestre mjerile opseg struka ispitanica. Ova je disertacija pokazala da granične vrijednosti opsega struka koje se u literaturi koriste za definiranje abdominalne pretilosti identificiraju među ženama fertilne dobi u Hrvatskoj one s rizičnom debljinom s osjetljivošću od 98,8% i specifičnošću od 94,8% (IDF kriterij, granična vrijednost 80 cm) te osjetljivošću od 99,9% i specifičnošću 99,8% (NCEP ATP III kriterij, granična vrijednost 88 cm). Prevalencija abdominalne pretilosti u istraživanoj populaciji bila je 2008. godine 70,3% (95% CI 61,8% do 75,7%) po IDF kriteriju odnosno 48,6% (42,6% do 54,7%) po NCEP ATP III kriteriju. U prethodnom petogodišnjem razdoblju 54,3% (44,5% do 64,2%) promatranih žena prešlo je iz zdrave abdominalne debljine u abdominalnu pretilost po IDF kriteriju a 35,2% (28,0% do 42,4%) je postalo abdominalno pretilo po NCEP ATP III kriteriju. Gotovo polovica se žena nezdravo hranilo a 62,3% (56,8% do 67,7%) je bilo sedentarno 2008. godine. Ovi ali i drugi ponašajni, psihosocijalni i socioekonomski čimbenici pokazali su bivarijatne povezanosti s abdominalnom pretilošću kako presječno tako i longitudinalno. U multivarijatnom modelu—koji je uključivao dob, socioekonomski položaj, opseg struka na početku istraživanja, prehranu, sedentarnost, konzumaciju alkoholnih pića, pušenje i kronično visoki percipirani stres—najsnažnijim prediktorima abdominalne pretilosti nakon pet godina pokazali su se nizak socioekonomski položaj i kronično visoki percipirani stres, koji je prethodio abdominalnoj pretilosti i do tri puta povećavao izglede za abdominalnu pretilost u konačnom modelu.

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