1 1,2, Siti Nur’Asyura Adznam3,4, Shamsul Azahari Zainal Badari5 · 2020. 11. 20. · Nurulhudha...
1
access is high to a wide range of processed and traditional high-sugar, high-fat snack foods and beverages. ❖ Obesity has become the most critical menace to human health and a severe global public health problem. ❖ Obesity is associated with an elevated risk of several major non-communicable diseases, including type 2 diabetes, coronary heart disease, stroke, asthma, and several cancers (1) . ❖ Studies among university students in developing countries show high prevalence of overweight and obesity that range from 10%- 59.4% (2) . 1 Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor; 2 Research Centre of Excellence for Nutrition and Non-Communicable Disease, 3 Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor 4 Malaysian Research Institute on Aging (MyAging), Universiti Putra Malaysia; 5 Department of Resource Management and Consumer Studies, Faculty of Human Ecology, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor ❖ To determine the prevalence and factors associated with overweight and obesity among university students attending public universities in Peninsular Malaysia. ❖ One over three university students were overweight and obese. ❖ The prevalence of overweight and obesity is higher among university students. ❖ Thus, there is a need for a coordinated approach that improves financial and physical access to healthy foods among rural communities, shunning excessive consumption of low-quality calories. . ❖ The study was funded by the Malaysian Consumer and Family Economics (MACFEA) mini grant 2016/2017. ❖ We would wish to thank the universities (UUM, UKM, UMP and UTM) staffs and students who took part in the survey. • Cross-sectional • Public university in Peninsular Malaysia • 4 zones in Peninsular Malaysia • Universiti Utara Malaysia (UUM)- Northern • Universiti Malaysia Pahang (UMP)- Eastern • Universiti Kebangsaan Malaysia (UKM)- Central • Universiti Teknologi Malaysia (UTM)- Southern • Randomly selected 427 students Socioeconomic and demographic status, physical activity level, financial literacy, financial problem, food security status, and anthropometric measurement (height, weight). • Descriptive statistics- all variables (frequency and percentage), chi- square, and logistic regression Study Respondents Questionnaire Statistics *indicate significant at p-value <0.05; **indicate significant at p-value <0.001 • The mean age of the respondents was 21.6 years, with an average BMI of 23.4 ± 5.03 kg/m2, and 31.6% were overweight and obese. • This study found that students originated from rural area (X 2 =8.061) was significantly associated with overweight and obesity (p<0.05). • Students originated from rural areas (AOR=1.918, 95% CI: 1.201-3.062) were 1.9 times more likely to be overweight and obese. • Levels of overweight and obesity are increasing faster in rural areas since rural areas have begun to resemble urban areas as the modern food supply is now available due to the urbanization (4) . • The prevalence of overweight and obesity increase in rural areas due to the ease of accessibility to a wide range of processed and also the traditional high-sugar, high-fat snack foods and beverages (4) . • People, particularly those originating from rural areas with limited purchasing power, are more likely to confront the problem of food insecurity, most likely stems from poverty or a low-income family (5,6) . • Food insecure individuals reported tend to consume high calorie intake since it cost less than healthy food despite of having low diet quality (7) . • In the developing countries, the burden has doubled as obesity prevalence has risen alongside a persistent burden of undernutrition (8) . • The co-existence of under-and-overnutrition in rural areas is an emerging public health concern, it is a complex situation where under-nutrition, over-nutrition and their consequences such as micronutrient deficiencies, infectious diseases and non-communicable diseases coexist (9) . • A cohort study stated that there is long-term impact of childhood experience on weight into adulthood (10) . Thus, targeted interventions and policies involving dietary intake should focus in solving this co-existence issues mainly in rural areas. • Meanwhile further studies need to be done among university students to address the obesogenic environment in the campus. Simultaneously, health promotion should be promoted in the universities campus to encourage healthy life styles as proposed by the WHO Global Strategy on Diet, Physical Activity and Health. B40 T20 1) WHO, (2018). Retreive from https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases 2) Peltzer, K., Pengpid, S., Samuels, T.A., Ozcan, N.K., Mantilla, C., Rahamefy, O.H., Wong, M.L. & Gasparishvili, A. (2014). Prevalence of Overweight/Obesity and Its Associated Factors among University Students from 22 Countries. Int J Environ Res Public Health 11(7): 7425–7441. 3) Department of Statistics Malaysia. (2017). Household Income and Basic Amenities Survey Report, 2016. 4) Nurwanti, E., Hadi, H., Chang, J.S., Choa, J.C.J., Paramashanti, B.A., Gittelsohn, J., & Bai, C.H. (2019). Rural–Urban Differences in Dietary Behavior and Obesity: Results of the Riskesdas Study in 10–18-Year-Old Indonesian Children and Adolescents. Nutrients. 11(11): 2813. 5) Thanthida, W. (2010). Food security in thailand: hunger in the midst of plenty. Georgetown University, Washington, D.C. 6) Smith, L, El Obeid, A. & Jensen, H. (2000). The geography and causes of food insecurity in developing countries. Agricultural Economics 22: 199-215. 7) Morales, M.E. & Berkowitz, S.A. (2016). The Relationship between Food Insecurity, Dietary Patterns, and Obesity. Curr. Nutr. Rep. 5(1): 54–60 8) Ford, N.D., Patel, S.A. & Narayan, K.M. (2017). Obesity in Low- and Middle-Income Countries: Burden, Drivers, and Emerging Challenges. Annu. Rev Public Health. 38:145-164. 9) Senbanjo, I.O., Senbanjo, C.O., Afolabi, W.A. & Olayiwola, O. (2019). Co-existence of maternal overweight and obesity with childhood undernutrition in rural and urban communities of Lagos State, Nigeria. Acta Biomed; 90 (3): 266-274 10) Bentley, T. & Widom, C.S. (2009). A 30-year follow-up of the effects of child abuse and neglect on obesity in adulthood. Obesity. 17(10):1900-5. Nurulhudha Mohd Jamil 1 , Norhasmah Sulaiman 1,2 , Siti Nur’Asyura Adznam 3,4 , Shamsul Azahari Zainal Badari 5 Socio-demographic status 39.8% 60.2% In Campus 96% Out Campus 4% Accommodation T20 7% M40 18% B40 75% Family Income (3) <RM4360 (USD 1061.47) RM 9619-4360 (USD 2341.81- 1061.47) ≥ RM 9620 (USD 2342.06) Mean age: 21.6 years *p-value < 0.05;** Origin referred to the hometown of the respondents; ***Household Income and Basic Amenities (HIS/BA) survey of 2016 Characteristics Non-obese n (%) Overweight and obesity n (%) χ 2 p- value* University UUM 66 (22.60) 41 (30.37) 4.515 0.211 UMP 79 (27.05) 29 (21.48) UKM 77 (26.37) 29 (21.48) UTM 70 (23.97) 36 (26.67) Gender Male 116 (39.73) 54 (40.00) 0.003 0.957 Female 176 (60.27) 81 (60.00) Age 19-21 168 (57.53) 64 (47.41) 3.816 0.051 22-25 124 (42.47) 71 (52.59) Years of Study 1st 124 (42.47) 46 (34.07) 3.946 0.267 2nd 76 (26.03) 34 (25.19) 3rd 65 (22.26) 39 (28.89) 4th 27 (9.25) 16 (11.85) Residence In Campus 284 (97.26) 128 (94.81) 1.629 0.202 Out Campus 8 (2.74) 7 (5.19) Origin** Rural 161 (55.14) 94 (69.63) 8.061 0.005* Urban 131 (44.86) 41 (30.37) Number of siblings 1-3 97 (33.22) 41 (30.33) 1.629 0.202 ≥4 195 (66.78) 7 (5.19) Household Income*** B40 241 (82.53) 115 (85.19) 0.509 0.775 M40 37 (12.67) 15 (11.11) T20 14 (4.78) 5 (3.70) Financial Literacy Low 147 (50.34) 69 (51.11) 0.022 0.883 High 145 (49.66) 66 (48.89) Financial Problem Low 158 (54.11) 65 (48.15) 1.315 0.251 High 134 (45.89) 70 (51.85) Father education Level Higher 99 (35.23) 35 (26.92) 2.862 0.239 Secondary 155 (55.16) 82 (63.08) Primary 27 (9.61) 13 (10.00) Mother education Level Higher 78 (27.08) 41 (30.37) 0.701 0.704 Secondary 179 (62.15) 82 (60.74) Primary 31 (10.76) 12 (8.89) Physical Activity Level Low 73 (25.00) 26 (19.26) 1.864 0.394 Moderate 146 (50.00) 75 (55.56) High 73 (25.00) 34 (25.19) Food Security Status Food Secure 122 (41.78) 45 (33.33) 2.766 0.096 Food Insecure 170 (58.22) 90 (66.67) Variable B Adjusted Odds Ratio (OR) OR (95% CI) p value* University UUM 0.004 1.004 (0.553-1.823) 0.990 UMP -0.285 0.7521 (0.389-1.455) 0.398 UTM -0.477 0.621 (0.331-1.164) 0.137 UKM 1.000 (ref) Age 19-21 1.000 (ref) 22-25 0.176 1.193 (0.743-1.913) 0.465 Residence In Campus 1.000 (ref) Out Campus -0.885 0.413 (0.133-1.280) 0.125 Origin** Rural 0.651 1.918 (1.201-3.062) 0.006* Urban 1.000 (ref) Number of siblings 1-3 1.000 (ref) ≥4 -0.095 0.909 (0.566-1.459) 0.693 Food Security Status Food Secure 1.000 (ref) Food Insecure 0.220 1.247 (0.797-1.949) 0.334 Father education level Primary -0.186 0.830 (0.379-0.561) 0.642 Secondary 0.155 1.168 (0.561-2.433) 0.679 Higher 1.000 (ref) *p-value < 0.05;** Origin referred to the hometown of the respondents; adjusted covariates based on university, age, residence, origin, number of siblings, food security status and father education level Table 1: Association between factors and body weight status Table 2: Factors associated with body weight status Underweight 13% Normal 56% Overweight 21% Obese 10% Body Weight Status (%) 1st 40% 2nd 26% 3rd 24% 4th 10% Years of Study (%) 6.3 20.6 73.1 5.4 20.8 73.8 Primary Secondary Higher Father Education Level Mother Education Level Low 51% High 49% Financial Literacy Scores (%) 52% 48% Financial Problems scores (%) Low High Rural 60% Urban 40% Origin/ Hometown (%)
Transcript of 1 1,2, Siti Nur’Asyura Adznam3,4, Shamsul Azahari Zainal Badari5 · 2020. 11. 20. · Nurulhudha...
access is high to a wide range of processed and traditional high-sugar, high-fat snack
foods and beverages.
❖ Obesity has become the most critical menace tohuman health and a severe global public healthproblem.
❖ Obesity is associated with an elevated risk ofseveral major non-communicable diseases,including type 2 diabetes, coronary heart disease,stroke, asthma, and several cancers(1).
❖ Studies among university students in developingcountries show high prevalence of overweightand obesity that range from 10%- 59.4%(2).
1Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor; 2Research Centre of Excellence for Nutrition
and Non-Communicable Disease, 3Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor 4Malaysian
Research Institute on Aging (MyAging), Universiti Putra Malaysia; 5Department of Resource Management and Consumer Studies, Faculty of Human Ecology, Universiti
Putra Malaysia, 43400 UPM Serdang, Selangor
❖ To determine the prevalence and factorsassociated with overweight and obesityamong university students attending publicuniversities in Peninsular Malaysia.
❖ One over three university students were overweight and obese.
❖ The prevalence of overweight and obesity is higher among universitystudents.
❖ Thus, there is a need for a coordinated approach that improvesfinancial and physical access to healthy foods among ruralcommunities, shunning excessive consumption of low-quality calories..
❖ The study was funded by the Malaysian Consumer and Family Economics (MACFEA) minigrant 2016/2017.
❖ We would wish to thank the universities (UUM, UKM, UMP and UTM) staffs and studentswho took part in the survey.
• Cross-sectional
• Public university in Peninsular Malaysia
• 4 zones in Peninsular Malaysia
• Universiti Utara Malaysia (UUM)-Northern
• Universiti Malaysia Pahang (UMP)- Eastern
• Universiti Kebangsaan Malaysia (UKM)- Central
• Universiti Teknologi Malaysia (UTM)- Southern
• Randomly selected 427 students
Socioeconomic and demographic status, physical activity level,
financial literacy, financial problem, food security status, and
anthropometric measurement (height, weight).
• Descriptive statistics- all variables (frequency and percentage), chi-square, and logistic regression
Study
Respondents
Questionnaire
Statistics
*indicate significant at p-value <0.05; **indicate significant at p-value <0.001
• The mean age of the respondents was 21.6 years, with an average BMI of 23.4 ± 5.03 kg/m2, and 31.6% were overweightand obese.
• This study found that students originated from rural area (X2=8.061) was significantly associated with overweight andobesity (p<0.05).
• Students originated from rural areas (AOR=1.918, 95% CI: 1.201-3.062) were 1.9 times more likely to be overweight andobese.
• Levels of overweight and obesity are increasing faster in rural areas since rural areas have begun to resemble urban areasas the modern food supply is now available due to the urbanization(4).
• The prevalence of overweight and obesity increase in rural areas due to the ease of accessibility to a wide range ofprocessed and also the traditional high-sugar, high-fat snack foods and beverages (4).
• People, particularly those originating from rural areas with limited purchasing power, are more likely to confront theproblem of food insecurity, most likely stems from poverty or a low-income family (5,6).
• Food insecure individuals reported tend to consume high calorie intake since it cost less than healthy food despite ofhaving low diet quality (7).
• In the developing countries, the burden has doubled as obesity prevalence has risen alongside a persistent burden ofundernutrition(8).
• The co-existence of under-and-overnutrition in rural areas is an emerging public health concern, it is a complex situationwhere under-nutrition, over-nutrition and their consequences such as micronutrient deficiencies, infectious diseases andnon-communicable diseases coexist(9).
• A cohort study stated that there is long-term impact of childhood experience on weight into adulthood(10). Thus, targetedinterventions and policies involving dietary intake should focus in solving this co-existence issues mainly in rural areas.
• Meanwhile further studies need to be done among university students to address the obesogenic environment in thecampus. Simultaneously, health promotion should be promoted in the universities campus to encourage healthy life stylesas proposed by the WHO Global Strategy on Diet, Physical Activity and Health.
B40
M40
T20
1) WHO, (2018). Retreive from https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
2) Peltzer, K., Pengpid, S., Samuels, T.A., Ozcan, N.K., Mantilla, C., Rahamefy, O.H., Wong, M.L. & Gasparishvili, A. (2014). Prevalence of Overweight/Obesity and Its Associated Factors among University Students from 22
Countries. Int J Environ Res Public Health 11(7): 7425–7441.
3) Department of Statistics Malaysia. (2017). Household Income and Basic Amenities Survey Report, 2016.
4) Nurwanti, E., Hadi, H., Chang, J.S., Choa, J.C.J., Paramashanti, B.A., Gittelsohn, J., & Bai, C.H. (2019). Rural–Urban Differences in Dietary Behavior and Obesity: Results of the Riskesdas Study in 10–18-Year-Old Indonesian
Children and Adolescents. Nutrients. 11(11): 2813.
5) Thanthida, W. (2010). Food security in thailand: hunger in the midst of plenty. Georgetown University, Washington, D.C.
6) Smith, L, El Obeid, A. & Jensen, H. (2000). The geography and causes of food insecurity in developing countries. Agricultural Economics 22: 199-215.
7) Morales, M.E. & Berkowitz, S.A. (2016). The Relationship between Food Insecurity, Dietary Patterns, and Obesity. Curr. Nutr. Rep. 5(1): 54–60
8) Ford, N.D., Patel, S.A. & Narayan, K.M. (2017). Obesity in Low- and Middle-Income Countries: Burden, Drivers, and Emerging Challenges. Annu. Rev Public Health. 38:145-164.
9) Senbanjo, I.O., Senbanjo, C.O., Afolabi, W.A. & Olayiwola, O. (2019). Co-existence of maternal overweight and obesity with childhood undernutrition in rural and urban communities of Lagos State, Nigeria. Acta Biomed; 90 (3):
266-274
10) Bentley, T. & Widom, C.S. (2009). A 30-year follow-up of the effects of child abuse and neglect on obesity in adulthood. Obesity. 17(10):1900-5.
Nurulhudha Mohd Jamil1, Norhasmah Sulaiman1,2, Siti Nur’Asyura Adznam3,4, Shamsul Azahari Zainal Badari5
Socio-demographic status
39.8%
60.2%
In Campus
96%
Out Campus
4%
Accommodation
T207%M40
18%
B4075%
Family Income (3)<RM4360 (USD 1061.47)
RM 9619-4360(USD 2341.81-
1061.47)
≥ RM 9620 (USD 2342.06)
Mean age:21.6 years
*p-value < 0.05;** Origin referred to the hometown of the respondents; ***Household Income and Basic Amenities (HIS/BA) survey of 2016
Characteristics Non-obese
n (%)
Overweight and
obesity n (%)
χ2 p-
value*
University
UUM 66 (22.60) 41 (30.37) 4.515 0.211
UMP 79 (27.05) 29 (21.48)
UKM 77 (26.37) 29 (21.48)
UTM 70 (23.97) 36 (26.67)
Gender
Male 116 (39.73) 54 (40.00) 0.003 0.957
Female 176 (60.27) 81 (60.00)
Age
19-21 168 (57.53) 64 (47.41) 3.816 0.051
22-25 124 (42.47) 71 (52.59)
Years of Study
1st 124 (42.47) 46 (34.07) 3.946 0.267
2nd 76 (26.03) 34 (25.19)
3rd 65 (22.26) 39 (28.89)
4th 27 (9.25) 16 (11.85)
Residence
In Campus 284 (97.26) 128 (94.81) 1.629 0.202
Out Campus 8 (2.74) 7 (5.19)
Origin**
Rural 161 (55.14) 94 (69.63) 8.061 0.005*
Urban 131 (44.86) 41 (30.37)
Number of siblings
1-3 97 (33.22) 41 (30.33) 1.629 0.202
≥4 195 (66.78) 7 (5.19)
Household Income***
B40 241 (82.53) 115 (85.19) 0.509 0.775
M40 37 (12.67) 15 (11.11)
T20 14 (4.78) 5 (3.70)
Financial Literacy
Low 147 (50.34) 69 (51.11) 0.022 0.883
High 145 (49.66) 66 (48.89)
Financial Problem
Low 158 (54.11) 65 (48.15) 1.315 0.251
High 134 (45.89) 70 (51.85)
Father education Level
Higher 99 (35.23) 35 (26.92) 2.862 0.239
Secondary 155 (55.16) 82 (63.08)
Primary 27 (9.61) 13 (10.00)
Mother education Level
Higher 78 (27.08) 41 (30.37) 0.701 0.704
Secondary 179 (62.15) 82 (60.74)
Primary 31 (10.76) 12 (8.89)
Physical Activity Level
Low 73 (25.00) 26 (19.26) 1.864 0.394
Moderate 146 (50.00) 75 (55.56)
High 73 (25.00) 34 (25.19)
Food Security Status
Food Secure 122 (41.78) 45 (33.33) 2.766 0.096
Food Insecure 170 (58.22) 90 (66.67)
Variable B Adjusted Odds Ratio (OR)
OR (95% CI) p value*
University
UUM 0.004 1.004 (0.553-1.823) 0.990
UMP -0.285 0.7521 (0.389-1.455) 0.398
UTM -0.477 0.621 (0.331-1.164) 0.137
UKM 1.000 (ref)
Age
19-21 1.000 (ref)
22-25 0.176 1.193 (0.743-1.913) 0.465
Residence
In Campus 1.000 (ref)
Out Campus -0.885 0.413 (0.133-1.280) 0.125
Origin**
Rural 0.651 1.918 (1.201-3.062) 0.006*
Urban 1.000 (ref)
Number of siblings
1-3 1.000 (ref)
≥4 -0.095 0.909 (0.566-1.459) 0.693
Food Security Status
Food Secure 1.000 (ref)
Food Insecure 0.220 1.247 (0.797-1.949) 0.334
Father education
level
Primary -0.186 0.830 (0.379-0.561) 0.642
Secondary 0.155 1.168 (0.561-2.433) 0.679
Higher 1.000 (ref)
*p-value < 0.05;** Origin referred to the hometown of the respondents; adjusted covariates based on university, age, residence, origin, number of siblings, food security status and father education level
Table 1: Association between factors and body weight status
Table 2: Factors associated with body weight status
Underweight13%
Normal56%
Overweight21%
Obese10%
Body Weight Status (%)
1st40%
2nd26%
3rd24%
4th10%
Years of Study (%)
6.320.6
73.1
5.420.8
73.8
Primary Secondary Higher
Father Education LevelMother Education Level
Low51%
High49%
Financial Literacy Scores (%)
52%48%
Financial Problems scores (%)
Low
High
Rural60%
Urban40%
Origin/ Hometown (%)
