Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity Among Registered

Nurses in A District Specialist Hospital

Members

Teh Pei Nee1

Chiew Shoen Chuen2

Sheila Gopal Krishnan3

Yap Ee Lee4

Fauziah Yusof5

Rasidah Abdul Manan5

Mathavi Santhrasegaran1

Roszimah bt Ismail6

Hazira Abdul Kadir7

1Staff Nurse Special Care Nursery Hospital Seri Manjung

2Pharmacist Clinical Research Centre Hospital Seri Manjung

3Head of Paediatric Department Hospital Seri Manjung

4Nursing Sister Paediatric Ward Hospital Seri Manjung

5Staff Nurse Paediatric Ward Hospital Seri Manjung

6Staff Nurse Intensive Care Unit Hospital Seri Manjung

7Staff Nurse Psychiatric Clinic Hospital Seri Manjung

NMRR-16-766-28807

1

2

AREA LAND 1168kmsup2POPULATION 247603 ( 2015 )

3

The Manjung District is a district in the southwestern part of Perakstate Malaysia

The district is well known for Pangkor Island a major attraction in Perak and the home of the Royal Malaysian Navy (TLDM) Lumut Naval Base and dockyard

MANJUNG

Bandar Seri Manjung is the districts principal

urban center

while smaller towns include

Lumut Sitiawan Ayer Tawar Pantai

Remis and Beruas

2

AREA LAND 1168kmsup2POPULATION 247603 ( 2015 )

3

The Manjung District is a district in the southwestern part of Perakstate Malaysia

The district is well known for Pangkor Island a major attraction in Perak and the home of the Royal Malaysian Navy (TLDM) Lumut Naval Base and dockyard

MANJUNG

Bandar Seri Manjung is the districts principal

urban center

while smaller towns include

Lumut Sitiawan Ayer Tawar Pantai

Remis and Beruas

3

The Manjung District is a district in the southwestern part of Perakstate Malaysia

The district is well known for Pangkor Island a major attraction in Perak and the home of the Royal Malaysian Navy (TLDM) Lumut Naval Base and dockyard

MANJUNG

Bandar Seri Manjung is the districts principal

urban center

while smaller towns include

Lumut Sitiawan Ayer Tawar Pantai

Remis and Beruas

HOSPITAL SERI MANJUNG 305 beds

NAVI HOSPITAL 1

HOSPITAL DESA PANGKOR 1

PRIVATE HOSPITAL 2

GOVERMENT HEALTH CLINIC 31

PRIVATE HEALTH CLINIC 72

5

6

Departments Units

bull Medical bull Surgicalbull Orthopaedicbull Ophthalmology bull Emergency amp Traumatology bull Paediatrics bull Obstetrics amp Gynaecologybull Psychiatry amp Mental Health bull Diagnostic amp Imaging bull Pharmacy amp Supply bull Pathology Departmentbull Dietetics amp Catering

bull Haemodialysis Unitbull ICU CCUbull Physiotherapy Unitbull Occupational

Rehabilitation bull Sterile Equipment Supply

Unitbull Health Education Unitbull Medical Social Work Unitbull Counselling Psychology

Unitbull Quality Unit Innovation amp

CRC(Clinical Research Centre)

7

8

Health burden

BMI = weight (kg) height (m2)

9

Overweight and obesity classificationCategory IBMI (kgm2) ABMI (kgm2 )

Underweight lt1850 lt1850

Normal 1850-2499 1850-2299

Overweight 2500-2999 2300-2749

Obese ge 3000 ge 2750

Source WHO 2004sup1 CPG on Management of Obesity 2004sup2

10

3) There has been some contention whether thegeneralisation of the IBMI (International Body Mass Index) tothe Asian population will underestimate theprevalence of overweight and obesity

4) In year 2004 WHO was recommended additionalBMI cut-off points for Asian populations for publichealth (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)

5) BMI cut-off points have been revised to suit Asianpopulation due to

(i) high prevalence of Type 2 Diabetes Mellitus among Asian individuals with BMI lt 250kgm2

(ii) higher cardiovascular risk factors among Asian individuals at any BMI level and

(iii) population based association between BMI body fat percentage and distribution

11

Prevalence of overweight and obesity is highest in developing countries and is associated with increase in incidence of cardiovascular disease

12

Lamon-Fava S et al 1996Hossain 2007 Bhurosy et al 2014

Deuremberg-Yap M et al 2001 (Singapore)

The BMI recommendation for public health was less than IBMI classification (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)

Feng R N et al 2012(China)

The optimal BMI for men and women to predict co-morbidities was less than IBMI classification ( 24 kgm2 )

Ren Q et al 2016(China)

The optimal BMI for men and women to predict Hypertension was less than IBMI classification(2353kgm2 and 2425kgm2)

Tanu et al 2014(India)

The optimal BMI to predict Hypertension was ge245kgm2 (men) and ge249kgm2( women)

13

Bogossian FE et al 2012

The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK

Miller SK et al 2008

The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively

Ogunjimi LO et al 2010

The prevalence of obesity among Nigerian nurses 626

Coomarasamy JD et al 2014

The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively

14

Malaysian National Health and Morbidity Survey(MNHMS)2006 2011

Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years

Malaysian National Health and Morbidity Survey 2015

IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306

bull Among obese population female Malaysians were more affected than the male counterparts

WHO- Non Communicable Disease Profile in Malaysia 2012

This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar

15

Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria

General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses

Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-

morbidities among those who were overweight and obese according to both definitions

2) To determine the factors associated with overweight and obesity in the study population

16

Sample size 384 (minimum)

- Stratified random sampling (working schedule)

- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5

(456- 556)

17

MREC approved

Cross-sectional Study

Hospital Seri Manjung

Nurses in all departments

September - October 2016

Inclusion criteria

All female registered nurses in HSM

Exclusion criteria

Pregnant on confinement paid unpaid leave refuse to consent

18

Data collection

Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire

Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005

Data analysis

Prevalence of outcome was presented as

Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated

Associating factors were analysed using multiple logistic regression

19

MREC approved

20

Consent taking process

Interviewing the respondent by using

questionnaire

Measuring of height and weight as well as BMI

calculation

Nurses who fulfilled the inclusion criteria

were given Respondent Information Sheet

Researchers explained to respondents about the study

Respondents were given sufficient time to understand ask

questions and consider before deciding on their participation

All respondents were asked to sign

2 sets of informed consent form

21

Figure 2 Information sheet amp Consent taking process

22

23

Result

Characteristics n ()

Demographic Data

Age in years median (quartiles) 36 (32-41)

Ethnicity

Malay

Chinese

Indian

Others

361 (919)

3 (08)

23 (59)

6 (15 )

Marital Status

Single

Married

Divorced

Widow

9 (23)378 (962)

2 (05)4 (10)

Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)

Weight satisfaction

Satisfied

Not satisfied

118 (300)275 (700)

24

Table 1 Characteristics of Respondents total respondents = 393

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

6

Departments Units

bull Medical bull Surgicalbull Orthopaedicbull Ophthalmology bull Emergency amp Traumatology bull Paediatrics bull Obstetrics amp Gynaecologybull Psychiatry amp Mental Health bull Diagnostic amp Imaging bull Pharmacy amp Supply bull Pathology Departmentbull Dietetics amp Catering

bull Haemodialysis Unitbull ICU CCUbull Physiotherapy Unitbull Occupational

Rehabilitation bull Sterile Equipment Supply

Unitbull Health Education Unitbull Medical Social Work Unitbull Counselling Psychology

Unitbull Quality Unit Innovation amp

CRC(Clinical Research Centre)

7

8

Health burden

BMI = weight (kg) height (m2)

9

Overweight and obesity classificationCategory IBMI (kgm2) ABMI (kgm2 )

Underweight lt1850 lt1850

Normal 1850-2499 1850-2299

Overweight 2500-2999 2300-2749

Obese ge 3000 ge 2750

Source WHO 2004sup1 CPG on Management of Obesity 2004sup2

10

3) There has been some contention whether thegeneralisation of the IBMI (International Body Mass Index) tothe Asian population will underestimate theprevalence of overweight and obesity

4) In year 2004 WHO was recommended additionalBMI cut-off points for Asian populations for publichealth (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)

5) BMI cut-off points have been revised to suit Asianpopulation due to

(i) high prevalence of Type 2 Diabetes Mellitus among Asian individuals with BMI lt 250kgm2

(ii) higher cardiovascular risk factors among Asian individuals at any BMI level and

(iii) population based association between BMI body fat percentage and distribution

11

Prevalence of overweight and obesity is highest in developing countries and is associated with increase in incidence of cardiovascular disease

12

Lamon-Fava S et al 1996Hossain 2007 Bhurosy et al 2014

Deuremberg-Yap M et al 2001 (Singapore)

The BMI recommendation for public health was less than IBMI classification (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)

Feng R N et al 2012(China)

The optimal BMI for men and women to predict co-morbidities was less than IBMI classification ( 24 kgm2 )

Ren Q et al 2016(China)

The optimal BMI for men and women to predict Hypertension was less than IBMI classification(2353kgm2 and 2425kgm2)

Tanu et al 2014(India)

The optimal BMI to predict Hypertension was ge245kgm2 (men) and ge249kgm2( women)

13

Bogossian FE et al 2012

The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK

Miller SK et al 2008

The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively

Ogunjimi LO et al 2010

The prevalence of obesity among Nigerian nurses 626

Coomarasamy JD et al 2014

The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively

14

Malaysian National Health and Morbidity Survey(MNHMS)2006 2011

Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years

Malaysian National Health and Morbidity Survey 2015

IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306

bull Among obese population female Malaysians were more affected than the male counterparts

WHO- Non Communicable Disease Profile in Malaysia 2012

This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar

15

Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria

General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses

Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-

morbidities among those who were overweight and obese according to both definitions

2) To determine the factors associated with overweight and obesity in the study population

16

Sample size 384 (minimum)

- Stratified random sampling (working schedule)

- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5

(456- 556)

17

MREC approved

Cross-sectional Study

Hospital Seri Manjung

Nurses in all departments

September - October 2016

Inclusion criteria

All female registered nurses in HSM

Exclusion criteria

Pregnant on confinement paid unpaid leave refuse to consent

18

Data collection

Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire

Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005

Data analysis

Prevalence of outcome was presented as

Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated

Associating factors were analysed using multiple logistic regression

19

MREC approved

20

Consent taking process

Interviewing the respondent by using

questionnaire

Measuring of height and weight as well as BMI

calculation

Nurses who fulfilled the inclusion criteria

were given Respondent Information Sheet

Researchers explained to respondents about the study

Respondents were given sufficient time to understand ask

questions and consider before deciding on their participation

All respondents were asked to sign

2 sets of informed consent form

21

Figure 2 Information sheet amp Consent taking process

22

23

Result

Characteristics n ()

Demographic Data

Age in years median (quartiles) 36 (32-41)

Ethnicity

Malay

Chinese

Indian

Others

361 (919)

3 (08)

23 (59)

6 (15 )

Marital Status

Single

Married

Divorced

Widow

9 (23)378 (962)

2 (05)4 (10)

Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)

Weight satisfaction

Satisfied

Not satisfied

118 (300)275 (700)

24

Table 1 Characteristics of Respondents total respondents = 393

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

7

8

Health burden

BMI = weight (kg) height (m2)

9

Overweight and obesity classificationCategory IBMI (kgm2) ABMI (kgm2 )

Underweight lt1850 lt1850

Normal 1850-2499 1850-2299

Overweight 2500-2999 2300-2749

Obese ge 3000 ge 2750

Source WHO 2004sup1 CPG on Management of Obesity 2004sup2

10

3) There has been some contention whether thegeneralisation of the IBMI (International Body Mass Index) tothe Asian population will underestimate theprevalence of overweight and obesity

4) In year 2004 WHO was recommended additionalBMI cut-off points for Asian populations for publichealth (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)

5) BMI cut-off points have been revised to suit Asianpopulation due to

(i) high prevalence of Type 2 Diabetes Mellitus among Asian individuals with BMI lt 250kgm2

(ii) higher cardiovascular risk factors among Asian individuals at any BMI level and

(iii) population based association between BMI body fat percentage and distribution

11

Prevalence of overweight and obesity is highest in developing countries and is associated with increase in incidence of cardiovascular disease

12

Lamon-Fava S et al 1996Hossain 2007 Bhurosy et al 2014

Deuremberg-Yap M et al 2001 (Singapore)

The BMI recommendation for public health was less than IBMI classification (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)

Feng R N et al 2012(China)

The optimal BMI for men and women to predict co-morbidities was less than IBMI classification ( 24 kgm2 )

Ren Q et al 2016(China)

The optimal BMI for men and women to predict Hypertension was less than IBMI classification(2353kgm2 and 2425kgm2)

Tanu et al 2014(India)

The optimal BMI to predict Hypertension was ge245kgm2 (men) and ge249kgm2( women)

13

Bogossian FE et al 2012

The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK

Miller SK et al 2008

The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively

Ogunjimi LO et al 2010

The prevalence of obesity among Nigerian nurses 626

Coomarasamy JD et al 2014

The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively

14

Malaysian National Health and Morbidity Survey(MNHMS)2006 2011

Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years

Malaysian National Health and Morbidity Survey 2015

IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306

bull Among obese population female Malaysians were more affected than the male counterparts

WHO- Non Communicable Disease Profile in Malaysia 2012

This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar

15

Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria

General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses

Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-

morbidities among those who were overweight and obese according to both definitions

2) To determine the factors associated with overweight and obesity in the study population

16

Sample size 384 (minimum)

- Stratified random sampling (working schedule)

- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5

(456- 556)

17

MREC approved

Cross-sectional Study

Hospital Seri Manjung

Nurses in all departments

September - October 2016

Inclusion criteria

All female registered nurses in HSM

Exclusion criteria

Pregnant on confinement paid unpaid leave refuse to consent

18

Data collection

Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire

Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005

Data analysis

Prevalence of outcome was presented as

Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated

Associating factors were analysed using multiple logistic regression

19

MREC approved

20

Consent taking process

Interviewing the respondent by using

questionnaire

Measuring of height and weight as well as BMI

calculation

Nurses who fulfilled the inclusion criteria

were given Respondent Information Sheet

Researchers explained to respondents about the study

Respondents were given sufficient time to understand ask

questions and consider before deciding on their participation

All respondents were asked to sign

2 sets of informed consent form

21

Figure 2 Information sheet amp Consent taking process

22

23

Result

Characteristics n ()

Demographic Data

Age in years median (quartiles) 36 (32-41)

Ethnicity

Malay

Chinese

Indian

Others

361 (919)

3 (08)

23 (59)

6 (15 )

Marital Status

Single

Married

Divorced

Widow

9 (23)378 (962)

2 (05)4 (10)

Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)

Weight satisfaction

Satisfied

Not satisfied

118 (300)275 (700)

24

Table 1 Characteristics of Respondents total respondents = 393

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

8

Health burden

BMI = weight (kg) height (m2)

9

Overweight and obesity classificationCategory IBMI (kgm2) ABMI (kgm2 )

Underweight lt1850 lt1850

Normal 1850-2499 1850-2299

Overweight 2500-2999 2300-2749

Obese ge 3000 ge 2750

Source WHO 2004sup1 CPG on Management of Obesity 2004sup2

10

3) There has been some contention whether thegeneralisation of the IBMI (International Body Mass Index) tothe Asian population will underestimate theprevalence of overweight and obesity

4) In year 2004 WHO was recommended additionalBMI cut-off points for Asian populations for publichealth (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)

5) BMI cut-off points have been revised to suit Asianpopulation due to

(i) high prevalence of Type 2 Diabetes Mellitus among Asian individuals with BMI lt 250kgm2

(ii) higher cardiovascular risk factors among Asian individuals at any BMI level and

(iii) population based association between BMI body fat percentage and distribution

11

Prevalence of overweight and obesity is highest in developing countries and is associated with increase in incidence of cardiovascular disease

12

Lamon-Fava S et al 1996Hossain 2007 Bhurosy et al 2014

Deuremberg-Yap M et al 2001 (Singapore)

The BMI recommendation for public health was less than IBMI classification (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)

Feng R N et al 2012(China)

The optimal BMI for men and women to predict co-morbidities was less than IBMI classification ( 24 kgm2 )

Ren Q et al 2016(China)

The optimal BMI for men and women to predict Hypertension was less than IBMI classification(2353kgm2 and 2425kgm2)

Tanu et al 2014(India)

The optimal BMI to predict Hypertension was ge245kgm2 (men) and ge249kgm2( women)

13

Bogossian FE et al 2012

The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK

Miller SK et al 2008

The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively

Ogunjimi LO et al 2010

The prevalence of obesity among Nigerian nurses 626

Coomarasamy JD et al 2014

The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively

14

Malaysian National Health and Morbidity Survey(MNHMS)2006 2011

Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years

Malaysian National Health and Morbidity Survey 2015

IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306

bull Among obese population female Malaysians were more affected than the male counterparts

WHO- Non Communicable Disease Profile in Malaysia 2012

This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar

15

Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria

General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses

Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-

morbidities among those who were overweight and obese according to both definitions

2) To determine the factors associated with overweight and obesity in the study population

16

Sample size 384 (minimum)

- Stratified random sampling (working schedule)

- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5

(456- 556)

17

MREC approved

Cross-sectional Study

Hospital Seri Manjung

Nurses in all departments

September - October 2016

Inclusion criteria

All female registered nurses in HSM

Exclusion criteria

Pregnant on confinement paid unpaid leave refuse to consent

18

Data collection

Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire

Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005

Data analysis

Prevalence of outcome was presented as

Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated

Associating factors were analysed using multiple logistic regression

19

MREC approved

20

Consent taking process

Interviewing the respondent by using

questionnaire

Measuring of height and weight as well as BMI

calculation

Nurses who fulfilled the inclusion criteria

were given Respondent Information Sheet

Researchers explained to respondents about the study

Respondents were given sufficient time to understand ask

questions and consider before deciding on their participation

All respondents were asked to sign

2 sets of informed consent form

21

Figure 2 Information sheet amp Consent taking process

22

23

Result

Characteristics n ()

Demographic Data

Age in years median (quartiles) 36 (32-41)

Ethnicity

Malay

Chinese

Indian

Others

361 (919)

3 (08)

23 (59)

6 (15 )

Marital Status

Single

Married

Divorced

Widow

9 (23)378 (962)

2 (05)4 (10)

Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)

Weight satisfaction

Satisfied

Not satisfied

118 (300)275 (700)

24

Table 1 Characteristics of Respondents total respondents = 393

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

BMI = weight (kg) height (m2)

9

Overweight and obesity classificationCategory IBMI (kgm2) ABMI (kgm2 )

Underweight lt1850 lt1850

Normal 1850-2499 1850-2299

Overweight 2500-2999 2300-2749

Obese ge 3000 ge 2750

Source WHO 2004sup1 CPG on Management of Obesity 2004sup2

10

3) There has been some contention whether thegeneralisation of the IBMI (International Body Mass Index) tothe Asian population will underestimate theprevalence of overweight and obesity

4) In year 2004 WHO was recommended additionalBMI cut-off points for Asian populations for publichealth (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)

5) BMI cut-off points have been revised to suit Asianpopulation due to

(i) high prevalence of Type 2 Diabetes Mellitus among Asian individuals with BMI lt 250kgm2

(ii) higher cardiovascular risk factors among Asian individuals at any BMI level and

(iii) population based association between BMI body fat percentage and distribution

11

Prevalence of overweight and obesity is highest in developing countries and is associated with increase in incidence of cardiovascular disease

12

Lamon-Fava S et al 1996Hossain 2007 Bhurosy et al 2014

Deuremberg-Yap M et al 2001 (Singapore)

The BMI recommendation for public health was less than IBMI classification (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)

Feng R N et al 2012(China)

The optimal BMI for men and women to predict co-morbidities was less than IBMI classification ( 24 kgm2 )

Ren Q et al 2016(China)

The optimal BMI for men and women to predict Hypertension was less than IBMI classification(2353kgm2 and 2425kgm2)

Tanu et al 2014(India)

The optimal BMI to predict Hypertension was ge245kgm2 (men) and ge249kgm2( women)

13

Bogossian FE et al 2012

The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK

Miller SK et al 2008

The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively

Ogunjimi LO et al 2010

The prevalence of obesity among Nigerian nurses 626

Coomarasamy JD et al 2014

The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively

14

Malaysian National Health and Morbidity Survey(MNHMS)2006 2011

Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years

Malaysian National Health and Morbidity Survey 2015

IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306

bull Among obese population female Malaysians were more affected than the male counterparts

WHO- Non Communicable Disease Profile in Malaysia 2012

This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar

15

Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria

General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses

Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-

morbidities among those who were overweight and obese according to both definitions

2) To determine the factors associated with overweight and obesity in the study population

16

Sample size 384 (minimum)

- Stratified random sampling (working schedule)

- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5

(456- 556)

17

MREC approved

Cross-sectional Study

Hospital Seri Manjung

Nurses in all departments

September - October 2016

Inclusion criteria

All female registered nurses in HSM

Exclusion criteria

Pregnant on confinement paid unpaid leave refuse to consent

18

Data collection

Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire

Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005

Data analysis

Prevalence of outcome was presented as

Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated

Associating factors were analysed using multiple logistic regression

19

MREC approved

20

Consent taking process

Interviewing the respondent by using

questionnaire

Measuring of height and weight as well as BMI

calculation

Nurses who fulfilled the inclusion criteria

were given Respondent Information Sheet

Researchers explained to respondents about the study

Respondents were given sufficient time to understand ask

questions and consider before deciding on their participation

All respondents were asked to sign

2 sets of informed consent form

21

Figure 2 Information sheet amp Consent taking process

22

23

Result

Characteristics n ()

Demographic Data

Age in years median (quartiles) 36 (32-41)

Ethnicity

Malay

Chinese

Indian

Others

361 (919)

3 (08)

23 (59)

6 (15 )

Marital Status

Single

Married

Divorced

Widow

9 (23)378 (962)

2 (05)4 (10)

Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)

Weight satisfaction

Satisfied

Not satisfied

118 (300)275 (700)

24

Table 1 Characteristics of Respondents total respondents = 393

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

10

3) There has been some contention whether thegeneralisation of the IBMI (International Body Mass Index) tothe Asian population will underestimate theprevalence of overweight and obesity

4) In year 2004 WHO was recommended additionalBMI cut-off points for Asian populations for publichealth (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)

5) BMI cut-off points have been revised to suit Asianpopulation due to

(i) high prevalence of Type 2 Diabetes Mellitus among Asian individuals with BMI lt 250kgm2

(ii) higher cardiovascular risk factors among Asian individuals at any BMI level and

(iii) population based association between BMI body fat percentage and distribution

11

Prevalence of overweight and obesity is highest in developing countries and is associated with increase in incidence of cardiovascular disease

12

Lamon-Fava S et al 1996Hossain 2007 Bhurosy et al 2014

Deuremberg-Yap M et al 2001 (Singapore)

The BMI recommendation for public health was less than IBMI classification (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)

Feng R N et al 2012(China)

The optimal BMI for men and women to predict co-morbidities was less than IBMI classification ( 24 kgm2 )

Ren Q et al 2016(China)

The optimal BMI for men and women to predict Hypertension was less than IBMI classification(2353kgm2 and 2425kgm2)

Tanu et al 2014(India)

The optimal BMI to predict Hypertension was ge245kgm2 (men) and ge249kgm2( women)

13

Bogossian FE et al 2012

The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK

Miller SK et al 2008

The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively

Ogunjimi LO et al 2010

The prevalence of obesity among Nigerian nurses 626

Coomarasamy JD et al 2014

The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively

14

Malaysian National Health and Morbidity Survey(MNHMS)2006 2011

Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years

Malaysian National Health and Morbidity Survey 2015

IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306

bull Among obese population female Malaysians were more affected than the male counterparts

WHO- Non Communicable Disease Profile in Malaysia 2012

This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar

15

Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria

General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses

Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-

morbidities among those who were overweight and obese according to both definitions

2) To determine the factors associated with overweight and obesity in the study population

16

Sample size 384 (minimum)

- Stratified random sampling (working schedule)

- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5

(456- 556)

17

MREC approved

Cross-sectional Study

Hospital Seri Manjung

Nurses in all departments

September - October 2016

Inclusion criteria

All female registered nurses in HSM

Exclusion criteria

Pregnant on confinement paid unpaid leave refuse to consent

18

Data collection

Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire

Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005

Data analysis

Prevalence of outcome was presented as

Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated

Associating factors were analysed using multiple logistic regression

19

MREC approved

20

Consent taking process

Interviewing the respondent by using

questionnaire

Measuring of height and weight as well as BMI

calculation

Nurses who fulfilled the inclusion criteria

were given Respondent Information Sheet

Researchers explained to respondents about the study

Respondents were given sufficient time to understand ask

questions and consider before deciding on their participation

All respondents were asked to sign

2 sets of informed consent form

21

Figure 2 Information sheet amp Consent taking process

22

23

Result

Characteristics n ()

Demographic Data

Age in years median (quartiles) 36 (32-41)

Ethnicity

Malay

Chinese

Indian

Others

361 (919)

3 (08)

23 (59)

6 (15 )

Marital Status

Single

Married

Divorced

Widow

9 (23)378 (962)

2 (05)4 (10)

Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)

Weight satisfaction

Satisfied

Not satisfied

118 (300)275 (700)

24

Table 1 Characteristics of Respondents total respondents = 393

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

5) BMI cut-off points have been revised to suit Asianpopulation due to

(i) high prevalence of Type 2 Diabetes Mellitus among Asian individuals with BMI lt 250kgm2

(ii) higher cardiovascular risk factors among Asian individuals at any BMI level and

(iii) population based association between BMI body fat percentage and distribution

11

Prevalence of overweight and obesity is highest in developing countries and is associated with increase in incidence of cardiovascular disease

12

Lamon-Fava S et al 1996Hossain 2007 Bhurosy et al 2014

Deuremberg-Yap M et al 2001 (Singapore)

The BMI recommendation for public health was less than IBMI classification (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)

Feng R N et al 2012(China)

The optimal BMI for men and women to predict co-morbidities was less than IBMI classification ( 24 kgm2 )

Ren Q et al 2016(China)

The optimal BMI for men and women to predict Hypertension was less than IBMI classification(2353kgm2 and 2425kgm2)

Tanu et al 2014(India)

The optimal BMI to predict Hypertension was ge245kgm2 (men) and ge249kgm2( women)

13

Bogossian FE et al 2012

The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK

Miller SK et al 2008

The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively

Ogunjimi LO et al 2010

The prevalence of obesity among Nigerian nurses 626

Coomarasamy JD et al 2014

The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively

14

Malaysian National Health and Morbidity Survey(MNHMS)2006 2011

Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years

Malaysian National Health and Morbidity Survey 2015

IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306

bull Among obese population female Malaysians were more affected than the male counterparts

WHO- Non Communicable Disease Profile in Malaysia 2012

This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar

15

Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria

General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses

Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-

morbidities among those who were overweight and obese according to both definitions

2) To determine the factors associated with overweight and obesity in the study population

16

Sample size 384 (minimum)

- Stratified random sampling (working schedule)

- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5

(456- 556)

17

MREC approved

Cross-sectional Study

Hospital Seri Manjung

Nurses in all departments

September - October 2016

Inclusion criteria

All female registered nurses in HSM

Exclusion criteria

Pregnant on confinement paid unpaid leave refuse to consent

18

Data collection

Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire

Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005

Data analysis

Prevalence of outcome was presented as

Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated

Associating factors were analysed using multiple logistic regression

19

MREC approved

20

Consent taking process

Interviewing the respondent by using

questionnaire

Measuring of height and weight as well as BMI

calculation

Nurses who fulfilled the inclusion criteria

were given Respondent Information Sheet

Researchers explained to respondents about the study

Respondents were given sufficient time to understand ask

questions and consider before deciding on their participation

All respondents were asked to sign

2 sets of informed consent form

21

Figure 2 Information sheet amp Consent taking process

22

23

Result

Characteristics n ()

Demographic Data

Age in years median (quartiles) 36 (32-41)

Ethnicity

Malay

Chinese

Indian

Others

361 (919)

3 (08)

23 (59)

6 (15 )

Marital Status

Single

Married

Divorced

Widow

9 (23)378 (962)

2 (05)4 (10)

Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)

Weight satisfaction

Satisfied

Not satisfied

118 (300)275 (700)

24

Table 1 Characteristics of Respondents total respondents = 393

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

Prevalence of overweight and obesity is highest in developing countries and is associated with increase in incidence of cardiovascular disease

12

Lamon-Fava S et al 1996Hossain 2007 Bhurosy et al 2014

Deuremberg-Yap M et al 2001 (Singapore)

The BMI recommendation for public health was less than IBMI classification (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)

Feng R N et al 2012(China)

The optimal BMI for men and women to predict co-morbidities was less than IBMI classification ( 24 kgm2 )

Ren Q et al 2016(China)

The optimal BMI for men and women to predict Hypertension was less than IBMI classification(2353kgm2 and 2425kgm2)

Tanu et al 2014(India)

The optimal BMI to predict Hypertension was ge245kgm2 (men) and ge249kgm2( women)

13

Bogossian FE et al 2012

The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK

Miller SK et al 2008

The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively

Ogunjimi LO et al 2010

The prevalence of obesity among Nigerian nurses 626

Coomarasamy JD et al 2014

The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively

14

Malaysian National Health and Morbidity Survey(MNHMS)2006 2011

Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years

Malaysian National Health and Morbidity Survey 2015

IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306

bull Among obese population female Malaysians were more affected than the male counterparts

WHO- Non Communicable Disease Profile in Malaysia 2012

This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar

15

Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria

General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses

Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-

morbidities among those who were overweight and obese according to both definitions

2) To determine the factors associated with overweight and obesity in the study population

16

Sample size 384 (minimum)

- Stratified random sampling (working schedule)

- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5

(456- 556)

17

MREC approved

Cross-sectional Study

Hospital Seri Manjung

Nurses in all departments

September - October 2016

Inclusion criteria

All female registered nurses in HSM

Exclusion criteria

Pregnant on confinement paid unpaid leave refuse to consent

18

Data collection

Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire

Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005

Data analysis

Prevalence of outcome was presented as

Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated

Associating factors were analysed using multiple logistic regression

19

MREC approved

20

Consent taking process

Interviewing the respondent by using

questionnaire

Measuring of height and weight as well as BMI

calculation

Nurses who fulfilled the inclusion criteria

were given Respondent Information Sheet

Researchers explained to respondents about the study

Respondents were given sufficient time to understand ask

questions and consider before deciding on their participation

All respondents were asked to sign

2 sets of informed consent form

21

Figure 2 Information sheet amp Consent taking process

22

23

Result

Characteristics n ()

Demographic Data

Age in years median (quartiles) 36 (32-41)

Ethnicity

Malay

Chinese

Indian

Others

361 (919)

3 (08)

23 (59)

6 (15 )

Marital Status

Single

Married

Divorced

Widow

9 (23)378 (962)

2 (05)4 (10)

Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)

Weight satisfaction

Satisfied

Not satisfied

118 (300)275 (700)

24

Table 1 Characteristics of Respondents total respondents = 393

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

13

Bogossian FE et al 2012

The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK

Miller SK et al 2008

The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively

Ogunjimi LO et al 2010

The prevalence of obesity among Nigerian nurses 626

Coomarasamy JD et al 2014

The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively

14

Malaysian National Health and Morbidity Survey(MNHMS)2006 2011

Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years

Malaysian National Health and Morbidity Survey 2015

IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306

bull Among obese population female Malaysians were more affected than the male counterparts

WHO- Non Communicable Disease Profile in Malaysia 2012

This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar

15

Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria

General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses

Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-

morbidities among those who were overweight and obese according to both definitions

2) To determine the factors associated with overweight and obesity in the study population

16

Sample size 384 (minimum)

- Stratified random sampling (working schedule)

- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5

(456- 556)

17

MREC approved

Cross-sectional Study

Hospital Seri Manjung

Nurses in all departments

September - October 2016

Inclusion criteria

All female registered nurses in HSM

Exclusion criteria

Pregnant on confinement paid unpaid leave refuse to consent

18

Data collection

Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire

Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005

Data analysis

Prevalence of outcome was presented as

Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated

Associating factors were analysed using multiple logistic regression

19

MREC approved

20

Consent taking process

Interviewing the respondent by using

questionnaire

Measuring of height and weight as well as BMI

calculation

Nurses who fulfilled the inclusion criteria

were given Respondent Information Sheet

Researchers explained to respondents about the study

Respondents were given sufficient time to understand ask

questions and consider before deciding on their participation

All respondents were asked to sign

2 sets of informed consent form

21

Figure 2 Information sheet amp Consent taking process

22

23

Result

Characteristics n ()

Demographic Data

Age in years median (quartiles) 36 (32-41)

Ethnicity

Malay

Chinese

Indian

Others

361 (919)

3 (08)

23 (59)

6 (15 )

Marital Status

Single

Married

Divorced

Widow

9 (23)378 (962)

2 (05)4 (10)

Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)

Weight satisfaction

Satisfied

Not satisfied

118 (300)275 (700)

24

Table 1 Characteristics of Respondents total respondents = 393

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

Coomarasamy JD et al 2014

The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively

14

Malaysian National Health and Morbidity Survey(MNHMS)2006 2011

Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years

Malaysian National Health and Morbidity Survey 2015

IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306

bull Among obese population female Malaysians were more affected than the male counterparts

WHO- Non Communicable Disease Profile in Malaysia 2012

This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar

15

Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria

General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses

Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-

morbidities among those who were overweight and obese according to both definitions

2) To determine the factors associated with overweight and obesity in the study population

16

Sample size 384 (minimum)

- Stratified random sampling (working schedule)

- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5

(456- 556)

17

MREC approved

Cross-sectional Study

Hospital Seri Manjung

Nurses in all departments

September - October 2016

Inclusion criteria

All female registered nurses in HSM

Exclusion criteria

Pregnant on confinement paid unpaid leave refuse to consent

18

Data collection

Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire

Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005

Data analysis

Prevalence of outcome was presented as

Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated

Associating factors were analysed using multiple logistic regression

19

MREC approved

20

Consent taking process

Interviewing the respondent by using

questionnaire

Measuring of height and weight as well as BMI

calculation

Nurses who fulfilled the inclusion criteria

were given Respondent Information Sheet

Researchers explained to respondents about the study

Respondents were given sufficient time to understand ask

questions and consider before deciding on their participation

All respondents were asked to sign

2 sets of informed consent form

21

Figure 2 Information sheet amp Consent taking process

22

23

Result

Characteristics n ()

Demographic Data

Age in years median (quartiles) 36 (32-41)

Ethnicity

Malay

Chinese

Indian

Others

361 (919)

3 (08)

23 (59)

6 (15 )

Marital Status

Single

Married

Divorced

Widow

9 (23)378 (962)

2 (05)4 (10)

Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)

Weight satisfaction

Satisfied

Not satisfied

118 (300)275 (700)

24

Table 1 Characteristics of Respondents total respondents = 393

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar

15

Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria

General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses

Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-

morbidities among those who were overweight and obese according to both definitions

2) To determine the factors associated with overweight and obesity in the study population

16

Sample size 384 (minimum)

- Stratified random sampling (working schedule)

- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5

(456- 556)

17

MREC approved

Cross-sectional Study

Hospital Seri Manjung

Nurses in all departments

September - October 2016

Inclusion criteria

All female registered nurses in HSM

Exclusion criteria

Pregnant on confinement paid unpaid leave refuse to consent

18

Data collection

Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire

Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005

Data analysis

Prevalence of outcome was presented as

Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated

Associating factors were analysed using multiple logistic regression

19

MREC approved

20

Consent taking process

Interviewing the respondent by using

questionnaire

Measuring of height and weight as well as BMI

calculation

Nurses who fulfilled the inclusion criteria

were given Respondent Information Sheet

Researchers explained to respondents about the study

Respondents were given sufficient time to understand ask

questions and consider before deciding on their participation

All respondents were asked to sign

2 sets of informed consent form

21

Figure 2 Information sheet amp Consent taking process

22

23

Result

Characteristics n ()

Demographic Data

Age in years median (quartiles) 36 (32-41)

Ethnicity

Malay

Chinese

Indian

Others

361 (919)

3 (08)

23 (59)

6 (15 )

Marital Status

Single

Married

Divorced

Widow

9 (23)378 (962)

2 (05)4 (10)

Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)

Weight satisfaction

Satisfied

Not satisfied

118 (300)275 (700)

24

Table 1 Characteristics of Respondents total respondents = 393

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses

Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-

morbidities among those who were overweight and obese according to both definitions

2) To determine the factors associated with overweight and obesity in the study population

16

Sample size 384 (minimum)

- Stratified random sampling (working schedule)

- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5

(456- 556)

17

MREC approved

Cross-sectional Study

Hospital Seri Manjung

Nurses in all departments

September - October 2016

Inclusion criteria

All female registered nurses in HSM

Exclusion criteria

Pregnant on confinement paid unpaid leave refuse to consent

18

Data collection

Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire

Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005

Data analysis

Prevalence of outcome was presented as

Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated

Associating factors were analysed using multiple logistic regression

19

MREC approved

20

Consent taking process

Interviewing the respondent by using

questionnaire

Measuring of height and weight as well as BMI

calculation

Nurses who fulfilled the inclusion criteria

were given Respondent Information Sheet

Researchers explained to respondents about the study

Respondents were given sufficient time to understand ask

questions and consider before deciding on their participation

All respondents were asked to sign

2 sets of informed consent form

21

Figure 2 Information sheet amp Consent taking process

22

23

Result

Characteristics n ()

Demographic Data

Age in years median (quartiles) 36 (32-41)

Ethnicity

Malay

Chinese

Indian

Others

361 (919)

3 (08)

23 (59)

6 (15 )

Marital Status

Single

Married

Divorced

Widow

9 (23)378 (962)

2 (05)4 (10)

Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)

Weight satisfaction

Satisfied

Not satisfied

118 (300)275 (700)

24

Table 1 Characteristics of Respondents total respondents = 393

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

Sample size 384 (minimum)

- Stratified random sampling (working schedule)

- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5

(456- 556)

17

MREC approved

Cross-sectional Study

Hospital Seri Manjung

Nurses in all departments

September - October 2016

Inclusion criteria

All female registered nurses in HSM

Exclusion criteria

Pregnant on confinement paid unpaid leave refuse to consent

18

Data collection

Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire

Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005

Data analysis

Prevalence of outcome was presented as

Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated

Associating factors were analysed using multiple logistic regression

19

MREC approved

20

Consent taking process

Interviewing the respondent by using

questionnaire

Measuring of height and weight as well as BMI

calculation

Nurses who fulfilled the inclusion criteria

were given Respondent Information Sheet

Researchers explained to respondents about the study

Respondents were given sufficient time to understand ask

questions and consider before deciding on their participation

All respondents were asked to sign

2 sets of informed consent form

21

Figure 2 Information sheet amp Consent taking process

22

23

Result

Characteristics n ()

Demographic Data

Age in years median (quartiles) 36 (32-41)

Ethnicity

Malay

Chinese

Indian

Others

361 (919)

3 (08)

23 (59)

6 (15 )

Marital Status

Single

Married

Divorced

Widow

9 (23)378 (962)

2 (05)4 (10)

Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)

Weight satisfaction

Satisfied

Not satisfied

118 (300)275 (700)

24

Table 1 Characteristics of Respondents total respondents = 393

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

Inclusion criteria

All female registered nurses in HSM

Exclusion criteria

Pregnant on confinement paid unpaid leave refuse to consent

18

Data collection

Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire

Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005

Data analysis

Prevalence of outcome was presented as

Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated

Associating factors were analysed using multiple logistic regression

19

MREC approved

20

Consent taking process

Interviewing the respondent by using

questionnaire

Measuring of height and weight as well as BMI

calculation

Nurses who fulfilled the inclusion criteria

were given Respondent Information Sheet

Researchers explained to respondents about the study

Respondents were given sufficient time to understand ask

questions and consider before deciding on their participation

All respondents were asked to sign

2 sets of informed consent form

21

Figure 2 Information sheet amp Consent taking process

22

23

Result

Characteristics n ()

Demographic Data

Age in years median (quartiles) 36 (32-41)

Ethnicity

Malay

Chinese

Indian

Others

361 (919)

3 (08)

23 (59)

6 (15 )

Marital Status

Single

Married

Divorced

Widow

9 (23)378 (962)

2 (05)4 (10)

Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)

Weight satisfaction

Satisfied

Not satisfied

118 (300)275 (700)

24

Table 1 Characteristics of Respondents total respondents = 393

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

Data collection

Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire

Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005

Data analysis

Prevalence of outcome was presented as

Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated

Associating factors were analysed using multiple logistic regression

19

MREC approved

20

Consent taking process

Interviewing the respondent by using

questionnaire

Measuring of height and weight as well as BMI

calculation

Nurses who fulfilled the inclusion criteria

were given Respondent Information Sheet

Researchers explained to respondents about the study

Respondents were given sufficient time to understand ask

questions and consider before deciding on their participation

All respondents were asked to sign

2 sets of informed consent form

21

Figure 2 Information sheet amp Consent taking process

22

23

Result

Characteristics n ()

Demographic Data

Age in years median (quartiles) 36 (32-41)

Ethnicity

Malay

Chinese

Indian

Others

361 (919)

3 (08)

23 (59)

6 (15 )

Marital Status

Single

Married

Divorced

Widow

9 (23)378 (962)

2 (05)4 (10)

Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)

Weight satisfaction

Satisfied

Not satisfied

118 (300)275 (700)

24

Table 1 Characteristics of Respondents total respondents = 393

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

20

Consent taking process

Interviewing the respondent by using

questionnaire

Measuring of height and weight as well as BMI

calculation

Nurses who fulfilled the inclusion criteria

were given Respondent Information Sheet

Researchers explained to respondents about the study

Respondents were given sufficient time to understand ask

questions and consider before deciding on their participation

All respondents were asked to sign

2 sets of informed consent form

21

Figure 2 Information sheet amp Consent taking process

22

23

Result

Characteristics n ()

Demographic Data

Age in years median (quartiles) 36 (32-41)

Ethnicity

Malay

Chinese

Indian

Others

361 (919)

3 (08)

23 (59)

6 (15 )

Marital Status

Single

Married

Divorced

Widow

9 (23)378 (962)

2 (05)4 (10)

Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)

Weight satisfaction

Satisfied

Not satisfied

118 (300)275 (700)

24

Table 1 Characteristics of Respondents total respondents = 393

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

Nurses who fulfilled the inclusion criteria

were given Respondent Information Sheet

Researchers explained to respondents about the study

Respondents were given sufficient time to understand ask

questions and consider before deciding on their participation

All respondents were asked to sign

2 sets of informed consent form

21

Figure 2 Information sheet amp Consent taking process

22

23

Result

Characteristics n ()

Demographic Data

Age in years median (quartiles) 36 (32-41)

Ethnicity

Malay

Chinese

Indian

Others

361 (919)

3 (08)

23 (59)

6 (15 )

Marital Status

Single

Married

Divorced

Widow

9 (23)378 (962)

2 (05)4 (10)

Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)

Weight satisfaction

Satisfied

Not satisfied

118 (300)275 (700)

24

Table 1 Characteristics of Respondents total respondents = 393

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

22

23

Result

Characteristics n ()

Demographic Data

Age in years median (quartiles) 36 (32-41)

Ethnicity

Malay

Chinese

Indian

Others

361 (919)

3 (08)

23 (59)

6 (15 )

Marital Status

Single

Married

Divorced

Widow

9 (23)378 (962)

2 (05)4 (10)

Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)

Weight satisfaction

Satisfied

Not satisfied

118 (300)275 (700)

24

Table 1 Characteristics of Respondents total respondents = 393

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

23

Result

Characteristics n ()

Demographic Data

Age in years median (quartiles) 36 (32-41)

Ethnicity

Malay

Chinese

Indian

Others

361 (919)

3 (08)

23 (59)

6 (15 )

Marital Status

Single

Married

Divorced

Widow

9 (23)378 (962)

2 (05)4 (10)

Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)

Weight satisfaction

Satisfied

Not satisfied

118 (300)275 (700)

24

Table 1 Characteristics of Respondents total respondents = 393

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

Characteristics n ()

Demographic Data

Age in years median (quartiles) 36 (32-41)

Ethnicity

Malay

Chinese

Indian

Others

361 (919)

3 (08)

23 (59)

6 (15 )

Marital Status

Single

Married

Divorced

Widow

9 (23)378 (962)

2 (05)4 (10)

Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)

Weight satisfaction

Satisfied

Not satisfied

118 (300)275 (700)

24

Table 1 Characteristics of Respondents total respondents = 393

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

1 The denominator was total respondents (393)

2 The denominator was respondents in the particular BMI category

CVD = cardiovascular disease

25

Category

IBMI

Category

ABMI

No amp of

respondents in

each category1CVD

(n )2

No amp of

respondents in

each category1CVD

(n )2

Overweight

(25-299kgm2)146 (372) 21 (144)

Overweight

(23-2749kgm2)136 (346) 14 (103)

Obese

(ge 30kgm2)102 (260) 25 (245)

Obese

(ge 275kgm2)172 (438) 35 (203)

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

Table 3 Sensitivity and specificity of IBMI and ABMI

(overweight + obesity) definitions in prediction

of CV-related co-morbidities

In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95

CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific

[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]

26

CVD ()

Sensitivity Specificity PPV NPV

IBMI definition 852 404 185 945

ABMI definition 907 236 159 941

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)

Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses

Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent

27

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

1a Prevalence of Overweight amp Obesity among Nurses

28

Country of overweight

of obesity

IBMI

1 Ogunjimi LO et al 2010 Nigeria - 626

2 Kim MJ et al 2013 Korea 186 74

3 Miller SK et al 2007 US 30 239

4 Coomarasamy JD et al2014

Malaysia 335 171

Current study 2016 Malaysia 372 260

ABMI

1 Aryee PA et al 2013 Ghana 182 155

Current study 2016 Malaysia 346 438

SLIM

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

1b Comparison with GENERAL POPULATION

NHMS National Health Morbidity Survey⁷ 2015

29

Subjects of overweight of obesity

IBMI

1 NHMS 2015 General Population

300 177

2 Current study 2016 Nurses 372 260

ABMI

1 NHMS 2015 General Population

334 306

2 Current study 2016 Nurses 346 438

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

Both ABMI amp IBMI definitions had good sensitivity

(907 vs 852) but IBMI had much higher

specificity (404) than ABMI (236)

However IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

of ABMI in Malaysian population

30

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

31

Studies Factors

van Drongelen A et alsup1⁴ 2011

(Systematic Review)shift work

Kim MJ et alsup1sup3 2013 shift work

Smith P et alsup1⁵ 2013 shift work

Bogossian FE et alsup1ordm 2012increasing age male pre-

menopause as well as menopause

Ogunjimi LO et al⁹ 2010 Eating habit and being married

Current study 2016Age being married amp compliance to

food pyramid

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

The co-morbidities food pyramid adherence andintensity of physical activities were self-reported

Less privacy during interview sessions

32

1 The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI

2 The prevalence of CV related co-morbidities among overweight and obese nurses were similar by using both definitions

3 Increasing age being married and the lack of adherence to food pyramid are associated with a higher risk of being overweight and obese

Conclusion

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

1 Further studies need to be done to evaluate ABMI as a screening tool in the local population

2 Although maintaining an ideal BMI is in our yearly SKT this study indicates that it is not being achieved among with increasing age and married Therefore we need to look at workplace-based intervention to overcome this

33

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

We would like to thank

- Hospital Director Chief Matron (KPJH) Matrons Sisters CRC unit staffs attendants and guards who support this research

- All the respondents (all categories of female nurses) in Hospital Seri Manjung

- Pathology amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test

- Administrative amp CRC unit staffs who involved during interviewer training session

34

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163

2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004

3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509

4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215

5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147

6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116

7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016

8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65

9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49

10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38

35

11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the

Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014

7(3)1202-1208

12 Canadian National Survey of the Work and Health of Nurses 2005

13 Kim MJ et al Association between shift work and obesity among female nurses Korean Nurses Survey

BMC Public Health 2013 131204

14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body

weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011

13263ndash275

15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among

Canadian Nurses Appl Nurs Res 20132624-31

16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120

(3)455-461

17WHO | Global recommendations on physical activity for health 2015

httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016

18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23

36

37

Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo

Introduction

We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months

You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study

While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible

I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital

I understand that

I understand that my participation is voluntary I can stop participating in this survey at any time

While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential

I may not directly benefit from taking part in this survey

I can ask the researcher at any time for any additional information

Participantrsquos name _______________

IC No __________________________

Date ___________________________

Participants signature

____________________________

Investigatorrsquos name _______________

IC No __________________________

Date ___________________________

Investigators signature

____________________________

Principal Investigator KUP Teh Pei Nee

SCN Hospital Seri Manjung

Tel 05 ndash 689 6833 Email peinee71gmailcom

38

Appendix A Respondent Information Sheet amp Consent Form

Appendix B Questionnaire

39

40

Appendix B Questionnaire

Appendix B Questionnaire

41

Source Tee ES 2011sup1⁶

Appendix B Questionnaire

42

Reference

WHO | Global recommendations on physical activity for health

httpwwwwhointdietphysicalactivityphysical_activity_intensityen

Appendix 1

Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo

Introduction

We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months

You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study

While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible

I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital

I understand that

I understand that my participation is voluntary I can stop participating in this survey at any time

While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential

I may not directly benefit from taking part in this survey

I can ask the researcher at any time for any additional information

Participantrsquos name _______________

IC No __________________________

Date ___________________________

Participants signature

____________________________

Investigatorrsquos name _______________

IC No __________________________

Date ___________________________

Investigators signature

____________________________

Principal Investigator KUP Teh Pei Nee

SCN Hospital Seri Manjung

Tel 05 ndash 689 6833 Email peinee71gmailcom

38

Appendix A Respondent Information Sheet amp Consent Form

Appendix B Questionnaire

39

40

Appendix B Questionnaire

Appendix B Questionnaire

41

Source Tee ES 2011sup1⁶

Appendix B Questionnaire

42

Reference

WHO | Global recommendations on physical activity for health

httpwwwwhointdietphysicalactivityphysical_activity_intensityen

Appendix 1

Appendix B Questionnaire

39

40

Appendix B Questionnaire

Appendix B Questionnaire

41

Source Tee ES 2011sup1⁶

Appendix B Questionnaire

42

Reference

WHO | Global recommendations on physical activity for health

httpwwwwhointdietphysicalactivityphysical_activity_intensityen

Appendix 1

40

Appendix B Questionnaire

Appendix B Questionnaire

41

Source Tee ES 2011sup1⁶

Appendix B Questionnaire

42

Reference

WHO | Global recommendations on physical activity for health

httpwwwwhointdietphysicalactivityphysical_activity_intensityen

Appendix 1

Appendix B Questionnaire

41

Source Tee ES 2011sup1⁶

Appendix B Questionnaire

42

Reference

WHO | Global recommendations on physical activity for health

httpwwwwhointdietphysicalactivityphysical_activity_intensityen

Appendix 1

Appendix B Questionnaire

42

Reference

WHO | Global recommendations on physical activity for health

httpwwwwhointdietphysicalactivityphysical_activity_intensityen

Appendix 1

43