Transcript Introduction

Are Chinese Women
Maximizing their
Lifelong Health Potential?
Georgia S. Guldan
Asian University for Women
Chittagong, Bangladesh
[email protected]
Rapid transition
in women’s diets, behaviors, health
• What are the health
consequences of these rapid diet
and lifestyle changes?
• Are women aware of the effects
on their health?
• Is public health helping them
maximize their health potential?
20-45-year-old Chinese women’s BMI
distributions in 1989 and 2000
Mean BMI +SD
1989
2000
1989
Proportion
21.8+2.7 22.4+3.2
 2000
BMI
Wang et al. IJO 2005
Risk factors for overweight and obesity
in Chinese women in Shanghai
• A study followed 3,032 Shanghai males and females
aged 25 to 95 for 3.6 years, from about 2000 to 2004.
• The women’s overweight rate was 29.9% and obesity
10.0% at baseline using Chinese references.
• For the 1,768 women, the BMIs increased significantly
only in the 35-44-year-old age group.
• The risk factors for the women’s obesity:
– Age and family history (shared for both genders)
– Education in women only, inversely
– Income was only associated at univariate level
Hou et al., BMC Pub Hlth 2008
Hong Kong 20- to 84-year-old women’s
BMI category * distribution 2005-2007
OW
100%
N
80%
UW
60%
40%
20%
0%
20-20
30-39
40-49
50-59
60-69
Age group in years
70-84
*OW = BMI>23
N = BMI >18.5; <23
UW = BMI <18.5
Women’s Food Intakes from 2002 China
National Nutrition and Health Survey
Foods Need, g 7-
11- 14- 18- 30- 45- 60-
Grains
Veg
250-400
300-500
345 393 415 432 456 446 406
199 228 238 271 284 290 264
Fruits
Beans
Pork,
Poultry
Eggs
Dairy
200-400
30-50
50-75
47
11
54
46
13
56
58
13
64
53
14
74
45
16
69
37
15
65
35
15
60
25-50
300
18
21
18
19
21
27
23
21
22
17
21
23
21
28
Oil, fat
25-30%
28
33
35
40
41
42
38
Li & Huang, Curr Wom Hlth Rev 2009
The Shanghai Women’s Health Study
(SWHS)
• Population-based prospective cohort
study among 64,191 middle-aged women
aged 40-70 years from 7 urban Shanghai
communities recruited from 1996 to 2000
• 92.3% response rate
• Detailed dietary intake survey,
anthropometric measurements and other
lifestyle factor inquiries in 2000 at
baseline and 2y later
Villegas et al. 2010
SWHS Dietary Intake Measurement
• Follow-up interviews conducted in 2002
with response rate 99.2%
• Dietary intake assessed using an
interviewer-administered validated food
frequency questionnaire with 77 items
• For women with diagnosed diabetes,
cancer or CVD, only baseline dietary
data used.
• For others, average of baseline and
follow-up used.
Villegas et al. 2010
SWHS Dietary intake analysis
• Cluster analysis grouped the women into
groups with similar dietary patterns
• A cluster solution with four clusters, one very
small (N=241) emerged for further analysis:
Cluster
N women
High staple and soy foods intakes
36,159
High dairy intake
25,948
High protein, fruit, vegetable, energy
1,843
Villegas et al. 2010
Clusters’ nutrient and other characteristics
Cluster
Other characteristics
Lowest vitamin, mineral, fiber, protein
and fat and highest carbohydrate
Staple and intakes; less education, less
soy
employment, more retired or not
working (303.6g/d staples)
Lowest prevalence of general or central
obesity or hypertension; highest
Dairy
income and professionals, least likely
to have ever smoked. (266.4g/d staples)
Protein, fruit, Highest proportion of alcohol drinkers,
veg, energy, fried and processed meat eaters and
processed nutrients except carbohydrates
foods
(286.2g/d staples)
Villegas et al. 2010
Results
1,514 cases of incident T2D were observed
over the 6.9-y follow-up period.
Cluster
Relationship with T2D
Staple
(Used as reference group)
Dairy
Less T2D: RR 0.78 (0.71-0.86)
Protein, fruit,
No relationship with T2D
veg, energy,
processed foods
Villegas et al. 2010
Discussion (1)
• Might the lower intake of staples in the
dairy group have been responsible for
the lower risk of T2D?
• Previous studies in
– Japan showed a higher rice consumption
associated with higher levels of glycated
hemoglobin
– Beijing showed higher refined staples
associated with higher homocysteine
levels
Villegas et al. 2010
Discussion (2)
• Might the higher intakes of calcium,
magnesium from more dairy and fiber,
antioxidants and magnesium from
more vegetables have contributed to
the lower T2D incidence in the dairy
group?
• Other studies have showed magnesium
and calcium intakes to be associated
with lower risk of T2D.
Villegas et al. 2010
Conclusions
• A dietary pattern low in staples and
high in dairy milk in middle aged
Chinese women
– was associated with a lower risk of T2D.
– when combined with low BMI, low WHR,
this pattern was associated with an 86%
reduction in T2D.
• Might point to some ‘protective’ factors
for a public health focus for prevention
in this population.
Villegas et al. 2010
SWHS II: Dietary carbohydrates,
glycemic load, glycemic index and T2DM
• Same study group (N=64,227)
• 4.6y follow-up
• Examined relationships between
glycemic index and load and
T2DM incidence (N=1,608 cases)
Villegas et al. 2007
Dietary carbohydrates, glycemic load
glycemic index and T2DM from SWHS
• GL associated with dietary carbohydrate,
overall and central obesity, and inversely
associated with protein, fat and fiber intakes.
• Higher carbohydrate intake, percent energy
from carbohydrate, high intake of staples, rice
consumption and dietary GI and GL were all
associated with increased risk of T2D.
• Tuber and potato intakes were inversely
associate with increased risk of T2D.
• Lowest quartile of physical activity
participation had a modestly higher risk of T2D.
Villegas et al. 2007
Relative Risk of Diabetes
Glycemic Load, Cereal Fiber Intake,
Diabetes Risk
2.50
2.30
2.05
2.17
2.5
1.80
2
1.5
1
2.5
2.17
1.51
0.5
1.62
2.3
2.05
1.8
1.62
1.28
1
Cereal Fiber
Intake
Low (<2.5 g/d)
Medium (2.5-5.8g/d)
High (>5.8g/d)
0
High (>165)
Medium
(165-143)
Low (<143)
Glycemic Load
Nurses’ Health Study
Minimal Whole Grain Consumption
in Hong Kong in 2005-2007
• The mean daily consumption for the cereals and
grains products was 489 g.
• The rice subgroup, was by far the most common
type of grain consumed, made up 61% of the
total.
• Rice and wheat together made up 94%.
• However, whole grain items made up less than
2%, or only about 9 grams of the total amount of
cereals and grains consumed. The whole grains
include oatmeal, pearl barley, brown rice, red
rice, brown rice congee, red rice congee, rye
bread and wheat bran breakfast cereal.
FEHD 2010
SWHS III:Resting heart rate and T2DM (1)
• Resting heart rate (RHR) predicts
cardiovascular mortality in the general
population—could it be a risk factor for
T2DM in Chinese women?
• Heart rates were measured after 5 min
rest by pulse palpation over 30 sec
• 47,571 women with mean baseline age
53.5(+8.7) y were followed for 4.9 y
Zhang et al. Int J Epi 2010
SWHS III:Resting heart rate and T2DM (2)
Results
• 849 incident cases of T2DM occurred
Resting heart rate categories
<68
69-72 73-76 77-80
>80
N subjects 12,613 13,060 8,110
N cases
180
212
147
Ageadjusted
HR
Multivariate
HRa
aAdjusted
P for trend
8,620
176
5,168
134
1.00
1.19
1.32
(0.98- (1.061.46) -1.65)
1.48
(1.211.83)
1.83
(1.472.29)
<0.0001
1.00
1.21
1.30
(0.99- (1.051.47) 1.62)
1.29
(0.991.69)
1.60
(1.282.00)
<0.0001
for age, education, occupation, family income, cigarette
smoking, alcohol consumption, BMI
Zhang et al. Int J Epi 2010
SWHS III:Resting heart rate and T2DM (3)
• A high RHRwas associated with moderate
increase in the risk of T2D after accounting for
BMI, WHR, BP, physical activity and other
confounders.
• RHR elevation reflects autonomic tone and
imbalance in autonomic nervous system
favouring sympathetic activation
• RHR linked to insulin insensitivity, high BP,
obesity, sub-clinical inflammation and
metabolic syndrome, all associated with T2D
Zhang et al. Int J Epi 2010
SWHS III:Resting heart rate and T2DM (4)
• A high resting heart rate independently
predicted moderate increase in the risk
of T2D after accounting for BMI, WHR,
BP, physical activity and other
confounders in middle-aged and older
Chinese women.
• Resting heart rate may be a simple
measure of autonomic tone and T2DM
risk for use in public screenings, along
with other measurements.
Zhang et al., Int J Epi 2010
SWHS IV: Weight gain after age 20
and prehypertension (1)
• Effect of weight change
Weight
OR(95% CI)
on blood pressure in
change
normotensive individuals
<-10 0.47 (0.38-0.49)
was lacking.
-6-10 0.76 (0.67-0.87)
• SWHS examined 36,075
-5-5
1.0 (reference)
non-hypertensive women
6-10 1.36 (1.28-1.45)
for whom odds ratios
11-15 1.64 (1.54-1.75)
were calculated for
16-20 2.32 (2.14-2.51)
prehypertension in
21-25 2.91 (2.60-3.26)
association with recalled
weight change over time
>25
3.65 (3.13-4.26)
since age 20
Yang et al. IJO 2007
SWHS IV: Weight gain after age 20
and prehypertension (2)
Conclusions:
• A graded positive association was seen
between weight gain ad hypertension.
• Weight loss associated with reduction in
risk.
• Avoiding a 1-kg weight gain slowed down 1
year of ‘aging’ on a woman’s risk of
developing hypertension.
• Weight gain in early life and throughout
adulthood should be avoided.
Yang et al. IJO 2007
SWHS V: Abdominal adiposity
and mortality (1)
• Association between waist hip ratio
(WHR) and mortality among 72,773
women followed for 5.7 years
• Mean age of the women was 54 y, mean
BMI 24 at enrollment and mean WHR
0.81
• 1,456 deaths documented: cancer, 50%;
CVD, 25%; diabetes, 7%; and other
causes, 18%.
Zhang et al. Arch Int Med 2007
SWHS V: Abdominal adiposity
and mortality (2)
• Using WHR quintiles, WHR positively
and significantly associated with risk of
death from all causes as well as from
CVD, stroke and diabetes in a doseresponse fashion (P<0.01 for trend).
Findings more evident in women with
lower BMIs.
• A less significant positive association
was found for cancer.
Zhang et al. Arch Int Med 2007
SWHS V: Abdominal adiposity
and mortality (3)
• When waist circumference was examined
individually, positive associations appeared
for total mortality and death from CVD [RR
1.95 (1.46-2.60)], diabetes [RR 6.37 (2.0020.33)], cancer [RR 1.61 (1.07-2.42)] and other
causes [RR 2.22 (1.15-4.27)] .
• Waist circumference appeared to be more
predictive for women 50 y or younger than
for women over 50.
• Hip circumference showed no independent
association.
Zhang et al. Arch Int Med 2007
SWHS V: Abdominal adiposity
and mortality (4)
• Results underscore the significance of
fat distribution, and not simply BMI.
• Apparently lean but abdominally obese
patients should receive guidance from
their health care providers about their
enhanced risk.
• WHR findings consistent with findings
from both the Nurses’ and Iowa
Women’s Health Studies and a Swedish
Study.
Zhang et al. Arch Int Med 2007
Other consequences of Obesity
• A study of 1,532 HK women aged 30 to 60 y
found a 2.1% prevalence of sleep-disordered
breathing among women, in which
increasing age and BMI were significant
independent predictors.
–Ip et al. Chest 2008
• Increasing BMI associated with adverse
pregnancy outcomes such as caesarian
section, pre-eclampsia, gestational diabetes,
preterm delivery, LGA as well as SGA in a
study of 29,303 HK women.
--Leung et al BJOG 2008
Brown Rice Acceptable?
• Focus group with 32 Shanghai adults
• Prior to focus group, brown rice
considered to have
– Rough texture
– Unpalatable taste
• Only 8 had tried it before
• After learning of its nutritional value,
– All thought large-scale promotion needed
– 27/32 willing to participate in long-term
brown rice intervention
Zhang et al., JADA 2010
Public health initiatives for women?
• reducing edible oil intake
• increasing whole grains, fruit and
vegetable intakes
• increasing activity levels
• raising awareness about the dietand weight- related risk factors of
NCDs
• managing weight throughout
adulthood