Newly Diagnosed Type 2 Diabetics Have The Lowest Body Mass Index Change Among Rural Populations Of Sweden And The United States

摘要

Objective: To evaluate demographic and cardiovascular risk factors associated with ten-year BMI development in rural populations using observational panel studies. Methods: 1145 Swedish (547 men, 598 women) and 8122 U.S. (3837 men, 4285 women) adults aged 25-64 yr were recruited. Body mass index (kg/m2) was obtained in 1989 and 1999. Demographics, smoking status, type 2 diabetes, physical inactivity and use of antihypertensive medications were obtained at each survey.Results: Both populations had mean increases in BMI over 10 years. Age, baseline BMI, smoking, diabetes, use of antihypertensive medication and physical inactivity were strongly associated with BMI development. Newly diagnosed type 2 diabetics had the lowest mean BMI increases. Conclusion: BMI development in these rural populations is associated with age and cardiovascular risk factors. Obesity prevention strategies may be most effective in specific high risk subgroups (e.g. newly diagnosed diabetics). Funding: The New York State Department of Health provided funding for Health Census '89 and Health Census '99. Introduction Obesity is quickly increasing in the U.S. and Sweden.[1, 2] Much remains to be understood about the reasons for the obesity epidemic, although behavioural factors are potentially the most amenable to change. Many studies have shown that the risk associated with increasing obesity occurs along a continuum, and the adverse effects are clearly seen with body mass indices (BMI) above 25 kg/m2.[3, 4] Approximately a fourth of Swedish and U.S. populations live in rural areas,[5, 6] and in Northern Sweden this number is even higher.[7] Rural populations are less studied than urban and suburban groups. Understanding what factors are important for obesity development or progression in rural populations is important since these populations differ from those in urban areas.[8]Using panel data from two populations with both similarities and differences,[9, 10] and data collected during a similar time period, we have a unique opportunity to understand what factors are most influential in BMI development in rural populations.The primary aim of this paper is to evaluate demographic and established cardiovascular risk factors that are predictive of ten-year BMI development (maintenance or change) in the rural, adult populations of Sweden and the U.S. A secondary aim is to evaluate whether there are differences in predictive risk factors between the two countries. Material and Methods The Swedish data are from the WHO Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) in Northern Sweden. The U.S. data are from Health Census '89 and Health Census '99 conducted in Otsego County, New York. The Northern Sweden MONICA study was approved by the Research Ethics Committee of Ume? University, Ume?, Sweden and computer data handling procedures were approved by the Swedish National Computer Data Inspection Board. Collection of the Health Census '89 and '99 data were approved by the Institutional Review Board of The Mary Imogene Bassett Hospital in Cooperstown, NY and approval for data use for this analysis was granted by the Health Census '99 Data Monitoring Committee.MONICA was initiated in the early 1980s as repeated, representative, random sample, cross-sectional studies.[11] The cross-sectional surveys were supplemented in Northern Sweden with a panel cohort composed of adults aged 25-64 years seen in 1990 and 1999. Data were collected between January and April. Self-reported information included age, sex, civil status, years of education, daily tobacco use, intake of antihypertensive medications, type 2 diabetes and leisure activity. Height and weight were measured in a standardized fashion.[12] Demographics and cardiovascular risk factors for this population are published elsewhere.[10, 13] The Health Censuses were conducted on the entire adult ( 18 years) population of Otsego County between June and December in 1989 and 1999 [14]