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Psychosocial Factors and Obesity in 17 High-, Middle- and Low-Income Countries: The Prospective Urban Rural Epidemiologic Study Publisher Pubmed



Rosengren A1 ; Teo K2 ; Rangarajan S2 ; Kabali C2 ; Khumalo I3 ; Kutty VR4 ; Gupta R5 ; Yusuf R6 ; Iqbal R7 ; Ismail N8 ; Altuntas Y9 ; Kelishadi R10 ; Diaz R11 ; Avezum A12 Show All Authors
Authors
  1. Rosengren A1
  2. Teo K2
  3. Rangarajan S2
  4. Kabali C2
  5. Khumalo I3
  6. Kutty VR4
  7. Gupta R5
  8. Yusuf R6
  9. Iqbal R7
  10. Ismail N8
  11. Altuntas Y9
  12. Kelishadi R10
  13. Diaz R11
  14. Avezum A12
  15. Chifamba J13
  16. Zatonska K14
  17. Wei L15
  18. Liao X16
  19. Lopezjaramillo P17
  20. Yusufali A18
  21. Seron P19
  22. Lear SA20
  23. Yusuf S2
Show Affiliations
Authors Affiliations
  1. 1. Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, 416 85, Sweden
  2. 2. Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
  3. 3. North-West University, Optentia Research Programme, Faculty of Humanities, Vanderbilpark, South Africa
  4. 4. Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
  5. 5. Fortis Escorts Hospital, JLN Marg, Jaipur, Rajasthan, India
  6. 6. Independent University Bangladesh, Dhaka, Bangladesh
  7. 7. Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
  8. 8. Department of Community Health, Universiti Kebangsaan, Kuala Lumpur, Malaysia
  9. 9. SB Pediatric Endocrinology and Metabolism, Training and Research Hospital, Istanbul, Turkey
  10. 10. Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  11. 11. Estudios Clinicos Latinoamerica ECLA, Rosario, Santa Fe, Argentina
  12. 12. Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
  13. 13. Physiology Department, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
  14. 14. Department of Social Medicine, Medical University of Wroclaw, Wroclaw, Poland
  15. 15. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Natl. Ctr. for Cardiovasc. Dis., Chinese Acad. of Med. Sciences, Peking Union Medical College, Beijing, China
  16. 16. Sichuan University West China Hospital, Chengdu, Sichuan Province, China
  17. 17. Fundacion Oftalmologica de Santander (FOSCAL) and Medical School, Universidad de Santander (UDES), Santander, United Kingdom
  18. 18. Dubai Health Authority, Dubai, United Arab Emirates
  19. 19. Universidad de la Frontera, Temuco, Chile
  20. 20. Faculty of Health Sciences, Simon Fraser University, Division of Cardiology, Providence Health Care, Vancouver, BC, Canada

Source: International Journal of Obesity Published:2015


Abstract

Background/Objectives:Psychosocial stress has been proposed to contribute to obesity, particularly abdominal, or central obesity, through chronic activation of the neuroendocrine systems. However, these putative relationships are complex and dependent on country and cultural context. We investigated the association between psychosocial factors and general and abdominal obesity in the Prospective Urban Rural Epidemiologic study.Subjects/Methods:This observational, cross-sectional study enrolled 151 966 individuals aged 35-70 years from 628 urban and rural communities in 17 high-, middle- and low-income countries. Data were collected for 125 290 individuals regarding education, anthropometrics, hypertension/diabetes, tobacco/alcohol use, diet and psychosocial factors (self-perceived stress and depression).Results:After standardization for age, sex, country income and urban/rural location, the proportion with obesity (body mass index ≥30 kg m - 2) increased from 15.7% in 40 831 individuals with no stress to 20.5% in 7720 individuals with permanent stress, with corresponding proportions for ethnicity- and sex-specific central obesity of 48.6% and 53.5%, respectively (P<0.0001 for both). Associations between stress and hypertension/diabetes tended to be inverse. Estimating the total effect of permanent stress with age, sex, physical activity, education and region as confounders, no relationship between stress and obesity persisted (adjusted prevalence ratio (PR) for obesity 1.04 (95% confidence interval: 0.99-1.10)). There was no relationship between ethnicity- and sex-specific central obesity (adjusted PR 1.00 (0.97-1.02)). Stratification by region yielded inconsistent associations. Depression was weakly but independently linked to obesity (PR 1.08 (1.04-1.12)), and very marginally to abdominal obesity (PR 1.01 (1.00-1.03)).Conclusions:Although individuals with permanent stress tended to be slightly more obese, there was no overall independent effect and no evidence that abdominal obesity or its consequences (hypertension, diabetes) increased with higher levels of stress or depression. This study does not support a causal link between psychosocial factors and abdominal obesity. © 2015 Macmillan Publishers Limited. All rights reserved.
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