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Abstract The aim of the present study was to analyze the association of socioeconomic (SES) and lifestyle factors, with the conditions of overweight (OW), general (OB) and abdominal obesity (AO) in Spanish adults. A representative sample of 1655 Spanish adults (18 to 65 years) from the ANIBES Study was investigated. Collected data included measured anthropometry (weight, height and waist circumference), demographic and SES data (region and habitant population size, educational level, family income, unemployment rate), physical activity (PA) and other lifestyle factors (sleeping time and frequency of viewing television). OW, OB and AO were determined in each participant. Being male, older than 40 years, and watching television more frequently were associated with higher risk of OB and AO, whereas those with a higher level of education, smokers, and more time in sleeping and in vigorous PA, but not in moderate-vigorous PA, were associated with a lower risk. Living in the Atlantic region and stating no answer to the question regarding family income were also associated with lower risk of AO. Strategies for preventing and reducing OB and AO should consider improving sleeping habits and PA.
They should also pay more attention to the most vulnerable groups such as those less educated. Introduction Obesity is a public health problem that is increasing worldwide []. Recently published data from the ANIBES (Anthropometry, Intake, and Energy Balance in Spain) Study show that the prevalence of overweight (OW) and obesity (OB) in the Spanish population is 35.8 and 19.9%, respectively []. The figures regarding abdominal obesity (AO) are even more disturbing, affecting 58.4% of the population when waist to height ratio (WHtR) ≥0.5 is considered []. Obesity is the result of an imbalance between energy intake and expenditure where genetic, physiological and environmental factors are also involved [], Apart from sex and age, which has shown to be related to obesity [], other potential confounders of this association in adults include the socioeconomic status (SES) [,], physical inactivity [], sleeping time [,] and smoking habits []. Because of the economic downturn that has affected Spain since 2008, unemployment has increased and household economic resources declined. It has been suggested that economic problems can affect not only the diet but also physical activity (PA), smoking habits [] and sleep [].
There is also some evidence of a relationship between the economic crisis in Spain and the health and lifestyle of the Spanish population [], and this probably also had an impact on the factors associated with overweight and obesity. The ANIBES Study (Anthropometry, Intake, and Energy Balance in Spain) was conducted from mid-September to mid-November 2013 in a representative sample of the Spanish population. The aim of this paper was to analyze the relationships between different socioeconomic and lifestyle factors, including PA, with the conditions of OW, OB and AO. Anthropometric data Weight, height, and waist circumference were measured using standardized procedures by well-trained interviewers to minimize the inter-observer coefficients of variation []. Weight was measured once with a Seca model 804 weighing scale (Medizinische Messsysteme und Waagen seit 1840, Hamburg, Germany; range 0.1–150 kg, precision 100 g).
Height was assessed in triplicate using a Seca model 206 Stadiometer (range 70–205 cm, precision 1 mm). Waist circumference was measured in triplicate using a Seca 201 tape measure (Seca, Hamburg, Germany; range 0–150 cm, precision 1 mm).
General adiposity was assessed using body mass index (BMI) and AO by waist to height ratio (WHtR). BMI was calculated as weight to height squared (kg/m 2).
Overweight and obesity were defined as BMI 25.0–29.9 kg/m 2 and ≥30 kg/m 2, respectively []. WHtR was calculated as waist (cm)/height (cm). Abdominal obesity was defined as a WHtR ≥0.5 []. Lifestyle factors Physical activity was estimated based on the International Physical Activity questionnaire (IPAQ) []. Time spent in vigorous-intensity PA (VPA) was calculated and grouped into (a) 300 min /week. Also, moderate vigorous-intensity PA (MVPA) was calculated and grouped into (a) 300 min/week based on public health guidelines [].
Smoking habits were grouped as smoker or non-smoker. Participants also described their frequency of viewing television as (a) never or almost never, (b) low frequency, (c) frequently, (d) quite often, or (e) very often, and reported their daily hours of sleeping as (a). Statistical analyses Analyses were performed using SPSS version 22.0 (SPSS, Inc, Chicago, IL, USA).
Data are presented as means, standard deviation, and percentages. The Kolmogorov-Smirnoff test was used to test if the variables followed a normal distribution and to decide between parametric or non-parametric analysis. Differences between sexes were performed using Student’s-t or Mann–Whitney test. When comparing proportions, the z-test was used.
The associations of sex, age and socioeconomic and lifestyle factors (independent variables) and OW, OB or AO (dependent variables) were analyzed by logistic regression analysis to calculate odds ratios (OR). The 95% confidence intervals (CI) were calculated, and Wald’s test was used for comparison of the OR.
Multivariate analyses were also used to examine the simultaneous effect of the different socioeconomic and lifestyle variables on the prevalence of OW, OB and AO. The level of significance was set at p. Results shows personal, anthropometric, sociodemographic and lifestyle factors of the total sample and by sex. Some of these results have been described in previous publications [,] and are presented again for simple characterization. The final sample consisted of 1655 individuals (48.2% men). Over a third (35.8%) were OW and 19.9% were OB, with higher percentages in males.
Also, 58.4% of the population had AO, and again the percentage of people with central obesity is significantly higher in men. Characteristics of the study population. Most participants had a high school diploma (48.9%), an average monthly income between 1000 and 2000 € (39.1%), and 16% were unemployed. Approximately a third were smokers. Women spent more time on MVPA, and 1 out of 4 people spent less than 150 min/week on physical activities. By contrast, men spent more time weekly on VPA, and 62.9% of the population spent less than 75 min/week on them. The average sleeping time was 7.46 ± 1.13 h/day, and 46.7% sleep more than 8 h/day.
Sixty five percent of the population indicated watching TV quite or very often. The univariate analyses with sociodemographic and lifestyle variables and the risk of OW, OB and AO are shown in. Association of sociodemographic and lifestyle factors with prevalence of overweight, general and abdominal obesity in Spanish adults.
Logistic regression analysis. Being male and aged more than 41 years was significantly associated with an increased risk of being OW, OB or AO, while having high school or university education was associated with a lower risk in all cases. It is noteworthy that not answering the question of income was associated with a lower risk of any excess body weight. Regarding OW, the only other variables associated with a lower risk were living in a city and sleeping more than 8 h/day. On the other hand, regarding both OB and AO, general and central obesity, a higher family income, more time on VPA or MVPA, and sleeping more than 7 h/day were associated with a lower risk, while being unemployed, and watching TV quite or very often were associated with increased risk. Multivariate analyses of all the variables studied are shown in.
Ford Repair Manuals 1999. Serial All here. Association of socio-demographic and lifestyle factors on prevalence of overweight, general and abdominal obesity in Spanish adults. Multivariate regression analysis.
Sex and age remained statistically significant in all models. After adjusting for other variables, the only variables that were associated with a lower risk of OW were a higher educational level and spending more than 150 min/week in VPA. Educational level, time spent in VPA, sleeping time, and frequency of viewing television remained significantly associated with both OB and AO, while the family income, employed status, and MVPA were no longer significant. It is noteworthy that the no answer to the question about income level only maintains its association with AO, and that in the adjusted model living in the Atlantic region becomes a protective factor of AO. In contrast to the findings in the unadjusted model, being a smoker is associated with a lower risk of both OB and AO. Discussion Our results show that a higher level of education, smoking, more time spent in VPA, and sleeping more than 7 h/day are associated with a lower risk of OB and AB.
While being male, older than 40 years, and watching TV quite or very often are associated with the risk factors. Aspects such as the municipal habitat size, family income, being an immigrant or unemployed, or time spent on MVPA are not associated with an increased risk of OW, OB and AO. The associations of sex and age with OW, OB and AO in the ANIBES study have been previously described []. It has been suggested that sex itself (sex hormones affect the amount and distribution of body fat) is a factor influencing body composition, its oxidation and mobilization []. In our study, the increased risk to males may also be due to the different pattern of PA [] or to different dietary habits of men and women. Other studies indicate that living in the Atlantic region is associated with a lower risk for AO, and have shown geographic differences in obesity prevalence in Spain [,].
Whenever possible, SES level is generally measured by occupation, educational level and income. Although they are not completely independent, analysis of these three SES dimensions together is of interest, but owing to limited availability of data, only a few surveys have included all of these together []. In our investigation, only educational level was inversely associated with both OB and AO. Our results agree with others and confirm that in developed countries the level of education is inversely associated with increased risk of OW and OB [], and also with AO as defined by WHtR [], waist circumference [,,], or waist to hip ratio []. Educational level can exert its influence on health and body weight since it is related to knowledge about health and healthy lifestyles [], including dietary habits and PA []. Furthermore, educational level is assumed to be stable throughout life and to partly reflect childhood socioeconomic conditions []. It is noteworthy that 23.6% did not answer the question of family income and this was associated with a lower risk of AO.
Bearing in mind that the questionnaire was administered face to face and some people may really have not known their income, it is also possible that those with higher incomes did not want to declare them. This group also included those with the highest purchasing power. Smoking was associated with lower prevalence of both OB and AO. This relationship has been confirmed in numerous studies that have shown that smokers have less weight or BMI than nonsmokers [], although there are also studies that observed an inverse association [].
However, the results of studies that have examined the relationship between smoking and AO are controversial, since some found no association [], while others found lower [] or higher risk in smokers [,]. Smoking could possibly be associated with lower weight and adiposity because nicotine acutely increases the levels of various neurotransmitters, suppresses appetite and consequently reduces food intake []. This process likely explains why smokers tend to decrease body weight, and why smoking cessation is frequently followed by weight gain. As a result, one of the barriers to quitting is the fear of gaining weight []. Physical activity is a key determinant of energy expenditure.
Adults over 18 years should perform at least 150 min/week of moderate-intensity aerobic PA or at least 75 min/week of vigorous-intensity aerobic PA, or an equivalent combination of MVPA []. Recently, it has been shown that in Spain, 27% of the adult population did not meet international recommendations regarding PA, and 20.1% of adults never performed MVPA [].
Our data suggest that VPA may have a greater effect on preventing obesity than PA of lower intensity, since MVPA was not associated with the prevalence of OB. In addition, more than 75 min/week of VPA was associated with a lower risk of OB, while more than 150 min/week (vs. Less than 75 min/week) was associated with lower risk of OW or AO. It is possible that some people in our study who performed between 75 and 150 min/week of VPA were classified as OW, although actually they did not have excess body fat.
Therefore, BMI alone is not an indicator of body composition and that 15.0% of our population who were OW had a WHtR.