scholarly journals The silent epidemic of obesity in The Gambia: evidence from a nationwide, population-based, cross-sectional health examination survey

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e033882 ◽  
Author(s):  
Bai Cham ◽  
Shaun Scholes ◽  
Linda Ng Fat ◽  
Omar Badjie ◽  
Nora Ellen Groce ◽  
...  
Keyword(s):  
Higher Education ◽  
Abdominal Obesity ◽  
The Gambia ◽  
Older Age ◽  
Secondary Outcome ◽  
Outcome Variable ◽  
Health Examination ◽  
Obesity Prevalence ◽  
Urban Residence ◽  
Cross Sectional

ObjectivesNon-communicable diseases account for 70% of global deaths; 80% occur in low-income and middle-income countries. The rapid increase of obesity in sub-Saharan Africa is a concern. We assessed generalised and abdominal obesity and their associated risk factors among adults in The Gambia.DesignNationwide cross-sectional health examination survey using the WHO STEPwise survey methods.SettingThe Gambia.ParticipantsThis study uses secondary analysis of a 2010 nationally representative random sample of adults aged 25–64 years (78% response rate). The target sample size was 5280, and 4111 responded. Analysis was restricted to non-pregnant participants with valid weight and height measurements (n=3533).Primary and secondary outcome measuresThe primary outcome variable was generalised obesity, using WHO body mass index (BMI) thresholds. Analyses used non-response weighting and adjusted for the complex survey design. We conducted multinomial logistic regression analysis to identify factors associated with BMI categories. The secondary outcome variable was abdominal obesity, defined as high waist circumference (using the International Diabetes Federation thresholds for Europeans).ResultsTwo-fifths of adults were overweight/obese, with a higher obesity prevalence in women (17%, 95% CI 14.7 to 19.7; men 8%, 95% CI 6.0 to 11.0). 10% of men and 8% of women were underweight. Urban residence (adjusted relative risk ratio 5.8, 95% CI 2.4 to 14.5), higher education (2.3, 1.2 to 4.5), older age, ethnicity, and low fruit and vegetable intake (2.8, 1.1 to 6.8) were strongly associated with obesity among men. Urban residence (4.7, 2.7 to 8.2), higher education (2.6, 1.1 to 6.4), older age and ethnicity were associated with obesity in women.ConclusionThere is a high burden of overweight/obesity in The Gambia. While obesity rates in rural areas were lower than in urban areas, obesity prevalence was higher among rural residents in this study compared with previous findings. Preventive strategies should be directed at raising awareness, discouraging harmful beliefs on weight, and promoting healthy diets and physical activity.

scholarly journals Prevalence of Metabolically Obese, Normal-Weight Individuals and Its Dietary Patterns Characteristics: A Cross-Sectional Study in Thai Adults

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1464-1464
Author(s):  
Hung Nguyen Ngoc ◽  
Wantanee Kriengsinyos ◽  
Nipa Rojroongwasinkul ◽  
Wichai Aekplakorn
Keyword(s):  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Abdominal Obesity ◽  
Dietary Patterns ◽  
Lower Risk ◽  
Normal Weight ◽  
Normal Body Mass Index ◽  
Health Examination ◽  
Cross Sectional ◽  
Metabolically Obese Normal Weight

Abstract Objectives Metabolically obese normal weight (MONW) individuals are subjects who have a normal body mass index (BMI), but manifest obesity-related metabolic syndrome (MetS). Nevertheless, the prevalence and correlation between MONW and dietary patterns have not been fully explored in Thais. This study aimed to investigate the national prevalence of MONW, determine which dietary patterns are consumed in Thai normal-weight adults and to identify whether those patterns were associated with the risk of MetS and its features. Methods Total 6899 Thais ≥18 years with normal BMI (18.5–22.9 kg/m2) were obtained from the Thai National Health Examination Survey IV. Sociodemographic, eating-habits, anthropometric, blood pressure and biochemical parameters were measured. MONW was diagnosed by the National Cholesterol Education Program/Adult Treatment Panel III within normal BMI. Dietary patterns were determined by means of factor analysis, and were evaluated by multiple logistic regressions for its association with MONW. Results Overall, the weighted prevalence of MONW was 9.9% (95% CI: 9.1–10.6%), particularly, the MONW prevalence was 7.2% (95% CI: 6.5–8.0%) and 13.1% (95% CI: 11.6–14.7%) in male and female respectively. Three major dietary patterns were distinguished: “westernized”, “healthy” and “carbohydrate” patterns. After controlling for potential confounders, compared with the lowest quartile, individuals in the highest quartile of the westernized and carbohydrate pattern were connected with the greater risk of MONW (adjusted odds ratio [OR]: 1.64, 95% CI: 1.25–2.17, P < 0.001) and (OR: 1.57, 95% CI: 1.19–2.08, P < 0.05) respectively, whereas subjects in the fourth quartile of healthy pattern reduce the risk of MONW and its components, except for elevated blood pressure and hyperglycemia (OR: 0.68, 95% CI: 0.50–0.92 for MONW, P < 0.05; OR: 0.43, 95% CI: 0.28–0.68 for abdominal obesity, P < 0.001; OR: 0.63, 95% CI: 0.49–0.81 for hypertriglyceridemia, P < 0.001; OR: 0.67, 95% CI: 0.54–0.82 for low high-density lipoprotein cholesterol [HDL-C], P < 0.01). Conclusions In Thai normal-weight adults, high consumption of whole grains, fruits, beans, juices, and dairy products is connected with a lower risk of metabolic syndrome and its features, i.e., lower risk of abdominal obesity, hypertriglyceridemia, and low HDL-C. Funding Sources This research received no funding.

scholarly journals Multilevel analysis of unhealthy bodyweight among women in Malawi: Does urbanisation matter?

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0249289
Author(s):  
Rotimi Felix Afolabi ◽  
Martin Enock Palamuleni
Keyword(s):  
Higher Education ◽  
Weight Status ◽  
Community Education ◽  
Community Level ◽  
Sub Saharan Africa ◽  
Health Concern ◽  
Outcome Variable ◽  
Education Attainment ◽  
Poverty Level ◽  
Urban Residence

Background Underweight and overweight constitute unhealthy bodyweight and their coexistence is symptomatic of the dual burden of malnutrition (DBM) of high public health concern in many sub-Saharan Africa countries. Little is known about DBM and its correlates in Malawi, a country undergoing urbanisation. The study examined net effects of urban residence on unhealthy weights amidst individual- and community-level factors among women in Malawi. Methods Data on 7231 women aged 15–49 years nested within 850 communities extracted from 2015–16 Malawi Demographic and Health Survey were analysed. Women’s weight status measured by body mass index, operationally categorised as underweight, normal and overweight, was the outcome variable while urban-rural residence was the main explanatory variable. Multilevel multinomial logistic regression analysis was employed at 5% significant level; the relative-risk ratio (RR) and its 95% confidence interval (CI) were presented. Results Urban residents had a significantly higher prevalence of overweight than rural (36.4% vs. 17.2%; p< 0.001) but a -non-significant lower prevalence of underweight (6.2% vs. 7.4%; p = 0.423). Having adjusted for both individual- and community-level covariates, compared to rural, living in urban (aRR = 1.25; CI: 1.02–1.53) accounted for about 25% higher risk of being overweight relative to normal weight. Higher education attainment, being married and belonging to Chewa, Lomwe or Mang’anja ethnic group significantly reduced the risk of being underweight but heightened the risk of being overweight. Being older and living in wealthier households respectively accounted for about 3- and 2-times higher likelihood of being overweight, while breastfeeding (aRR = 0.65; CI: 0.55–0.76) was protective against overweight. Living in communities with higher poverty and higher education levels reduced and increased the risk of being overweight, respectively. Evidence of community’s variability in unhealthy weights was observed in that 11.1% and 3.0% respectively of the variance in the likelihood of being overweight and underweight occurred across communities. Conclusions The study demonstrated association between urban residence and women overweight. Other important associated factors of overweight included breastfeeding, community education- and poverty-level, while education attainment, marital status and ethnicity were associated with the dual unhealthy weight. Thus, both individual- and community-level characteristics are important considerations for policy makers in designing interventions to address DBM in Malawi.

Retropalatal Cross-Sectional Area Is Predictive of Obstructive Sleep Apnea in Patients With Syndromic Craniosynostosis

2019 ◽  
Vol 57 (5) ◽  
pp. 560-565 ◽  
Author(s):  
Cory M. Resnick ◽  
Jason K. Middleton ◽  
Carly E. Calabrese ◽  
Karan Ganjawalla ◽  
Bonnie L. Padwa
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Cross Sectional Area ◽  
Secondary Outcome ◽  
Outcome Variable ◽  
Sectional Area ◽  
Cross Sectional ◽  
Syndromic Craniosynostosis ◽  
Obstructive Sleep

Objective: There is a high rate of obstructive sleep apnea (OSA) in patients with syndromic craniosynostosis (SCS). Little is known about the airway anatomy in this population. The purpose of this study is to characterize the 3 dimensional (3D) upper airway in patients with SCS with and without OSA. Design: This is a retrospective study of patients with SCS treated at Boston Children’s Hospital from 2000 to 2015. Patients were divided into OSA and no-OSA groups based on polysomnography. Predictor variables included age, sex, body mass index (BMI), and 3D upper airway measurements. The primary outcome variable was the presence or absence of OSA. Secondary outcome variables were apnea–hypopnea index and oxygen saturation nadir. Descriptive and bivariate statistics were computed, and significance was set as P < .05. Results: There were 24 patients: 16 in the OSA group and 8 in the no-OSA group. The 2 groups did not differ significantly by age, BMI, or syndromic diagnosis. The presence of OSA was associated with a smaller minimum retropalatal cross-sectional area (minRPCSA; P < .001). In a logistic regression model controlling for age, sex, and upper airway length, minRPCSA was the primary predictor of OSA ( P ≤ .002). Receiver operating characteristic analysis determined minRPCSA = 55.3 mm2 to be the optimal diagnostic threshold for OSA, with sensitivity = 100% and specificity = 87.5% ( P < .001). Conclusion: A minRPCSA ≤55.3 mm2 is predictive of the presence of OSA in patients with SCS.

scholarly journals Prevalence and associated factors of diabetic retinopathy in Beijing, China: a cross-sectional study

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e015473 ◽  
Author(s):  
Jing Cui ◽  
Ji-Ping Ren ◽  
Dong-Ning Chen ◽  
Zhong Xin ◽  
Ming-Xia Yuan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diabetic Retinopathy ◽  
Disease Duration ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Health Examination ◽  
Sectional Study ◽  
Cross Sectional ◽  
Patients With Diabetes ◽  
Beijing China

ObjectivesThe study aimed to determine the exact risk factors for diabetic retinopathy (DR) in the Chinese population using a cohort of 17  985 individuals from Beijing, China.DesignCross-sectional study.SettingA hospital.Participants17  985 individuals from Beijing, China.Primary and secondary outcome measuresThis was a cross-sectional study of permanent residents from the Changping area (Beijing, China) recruited from July 2010 to March 2011 and from March 2014 to February 2015 during a routine health examination at the Tongren Hospital of Beijing. Eye examinations were conducted by experienced ophthalmologists. Medical history, height, weight, body mass index (BMI) and blood pressure were recorded. Routine laboratory examinations were performed.ResultsThe prevalence of DR was 1.5% in the general study population and 8.1% among individuals with diabetes. Compared with the non-DR group, individuals in the DR group in the diabetes population had longer disease duration, higher systolic blood pressure (SBP), fasting plasma glucose (FPG) and uric acid (UA) (in men) and lower UA (in women) (all p<0.05). The multivariate analysis showed that disease duration (p<0.001), BMI (p=0.046), SBP (p=0.012), creatinine clearance rate (CCR) (p=0.014), UA (p=0.018) and FPG (p<0.001) were independently associated with DR in patients with diabetes.ConclusionThe prevalence of DR was 8.1% among patients with diabetes. Disease duration, BMI, SBP, CCR, UA and FPG were independently associated with DR.

scholarly journals Timing of first antenatal care contact, its associated factors and state-level analysis in Nigeria: a cross-sectional assessment of compliance with the WHO guidelines

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e047835
Author(s):  
Adeniyi Francis Fagbamigbe ◽  
Olugbenga Olaseinde ◽  
Omon Stellamaris Fagbamigbe
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Associated Factors ◽  
Healthcare Utilisation ◽  
First Trimester ◽  
Household Wealth ◽  
Secondary Outcome ◽  
Outcome Variable ◽  
Who Guidelines ◽  
Cross Sectional

ObjectivesTo assess the compliance of WHO guidelines on the timeliness of antenatal care (ANC) initiation in Nigeria and its associated factors and to provide subcountry analysis of disparities in the timing of the first ANC in Nigeria.DesignCross-sectional.SettingNationally representative data of most recent pregnancies between 2013 and 2018 in Nigeria.ParticipantsWomen with pregnancies within 5 years before the study.Primary and secondary outcome measuresThe outcome variable was the trimesters of the first ANC contact. Data were analysed using descriptive statistics, bivariable and multivariable multinomial logistic regression at 5% significance level.ResultsOf all the 21 785 respondents, 75% had at least one ANC contact during their most recent pregnancies within the five years preceding the data collection. Among which 24% and 63% started in the first and second trimester, respectively. The proportion who started ANC in the first trimester was highest in Benue (44.5%), Lagos (41.4%) and Nasarawa (39.3%) and lowest in Zamfara (7.6%), Kano (7.4%) and Sokoto (4.8%). Respondents aged 40–49 years were 65% (adjusted relative risk ratio (aRRR: 1.65, 95 % CI: 1.10 to 2.45) more likely to initiate ANC during the first trimester of pregnancy relative to those aged 15–19 years. Although insignificant, women who participate in their healthcare utilisation were 4% (aRRR: 1.04, 95 % CI: 0.90 to 1.20) times more likely to have early initiation of ANC. Other significant factors were respondents’ and spousal educational attainment, household wealth quintiles, region of residence, ethnicity, religion and birth order.ConclusionsOnly a quarter of pregnant women, initiated ANC contact during the first trimester with wider disparities across the states in Nigeria and across the background characteristics of the pregnant women. There are needs to enhance women’s autonomy in healthcare utilisation. Concerted efforts on awareness creation and empowerment for women by all stakeholders in maternal and child healthcare are antidotes for early ANC contact initiation.

scholarly journals Prehipertensi pada Obesitas Abdominal

2015 ◽  
Vol 9 (4) ◽  
pp. 293
Author(s):  
Lia Churniawati ◽  
Santi Martini ◽  
Catharina Umbul Wahyuni
Keyword(s):  
Sex Education ◽  
Abdominal Obesity ◽  
Eating Habits ◽  
Fasting Blood Glucose ◽  
P Value ◽  
Obesity Prevalence ◽  
Chi Square ◽  
Cross Sectional ◽  
Dietary Compliance ◽  
Outpatient Unit

AbstrakPrehipertensi banyak terjadi pada penderita obesitas abdominal. Prevalensi obesitas abdominal di Kabupaten Gresik sebesar 21,5%. Kepatuhan diet penderita prehipertensi dengan obesitas abdominal diperlukan untuk mengurangi risiko terjadinya hipertensi. Prehipertensi dan hipertensi berhubungan dengan pelbagai komplikasi pada hampir seluruh organ. Penelitian ini bertujuan untuk menganalisis determinan prehipertensi pada obesitas abdominal di Kabupaten Gresik. Penelitian ini dilaksanakan di Kabupaten Gresik pada November 2013 - November 2014 dengan rancangan penelitian potong lintang. Responden adalah pasien yang datang ke unit rawat jalan puskesmas yang diambil secara konsekutif sejumlah 74 orang. Responden berusia antara 25 - 64 tahun, mengalami obesitas abdominal, tidak hamil, tidak hipertensi, dan tidak syok. Responden diwawancarai usia, jenis kelamin, pendidikan, aktivitas fisik, kebiasaan merokok, riwayat keluarga, dan kebiasaan makan serta diperiksa tekanan darah, kadar kolesterol total, LDL, HDL, trigliserida, dan gula darah puasa. Analisis data dilakukan secara univariat dan bivariat dengan uji kai kuadrat serta multivariat dengan regresi logistik ganda. Prevalensi prehipertensi pada obesitas abdominal sebesar 62,2%. Jika dibandingkan menurut jenis kelamin, laki-laki banyak mengalami prehipertensi. Kadar trigliserida berhubungan secara signifikan dengan prehipertensi (PR = 4,620; 95% CI = 1,439 - 14,831; nilai p = 0,010). Intervensi untuk mencegah prehipertensi perlu dilakukan sejak dini dengan memodifikasi gaya hidup orang dengan obesitas abdominal.AbstractPrehypertension commonly happened to people suffering abdominal obesity. The abdominal obesity prevalence in Gresik District was 21.5%. Dietary compliance of patients with prehypertension and abdominal obesity was needed to decrease hypertension risk. Prehypertension and hypertension correlate with various complications in almost organs. This study aimed to analyze prehypertension determinants among abdominal obesity as conducted on November 2013 - November 2014 using cross sectional design. Respondents were patients coming to primary health care’s outpatient unit as 74 people taken consecutively. They were 25 - 64 years old, suffering abdominal obesity, not getting pregnant, non-hypertensive and not in a shock. Respondents were interviewed regarding age, sex, education, physical activities, smoking habits, family records and eating habits as blood pressure and levels of total cholesterol, LDL, HDL, triglyceride and fasting blood glucose measured. Data analysis applied univariate, bivariate with chi square test and multivariate with multiple logistic regressions. The prehypertension prevalence among abdominal obesity was 62.2%. If compared based on sex, males have more prehypertension experience. Triglyceride levels significantly related to prehypertension (PR = 4.620; 95% CI = 1.439 - 14.831; p value = 0.010). Intervention to prevent prehypertension should be implementedsince early by modifying lifestyle of people suffering abdominal obesity.

scholarly journals Using a system dynamics model to study the obesity transition by socioeconomic status in Colombia at the country, regional and department levels

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e036534
Author(s):  
Jose D Meisel ◽  
Angie M Ramirez ◽  
Valentina Esguerra ◽  
Felipe Montes ◽  
Ivana Stankov ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
System Dynamics ◽  
Prevalence Ratio ◽  
Overweight And Obesity ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Obesity Prevalence ◽  
System Dynamics Model ◽  
Dynamics Model ◽  
Cross Sectional

ObjectiveWe study the obesity transition by socioeconomic status (SES), gender and age within the Colombian urban population at the country, regional and department levels.DesignThe study is informed by cross-sectional data from the 2005 and 2010 ENSIN survey. We used these data to develop a system dynamics model that simulates the dynamics of obesity by body mass index (BMI) categories, gender and SES at the country, regional and department levels from 2005 to 2030.ParticipantsThe sample size of the 2005 ENSIN comprised 8515 children younger than 5 years, 32 009 children and adolescents aged 5–17 years and 48 056 adults aged 18–64 years. In 2010, the corresponding numbers were 11 368, 32 524 and 64 425, respectively.Primary and secondary outcome measureThe obesity prevalence ratio and prevalence rates for each BMI category.ResultsThe results show, at the country level, transitions from overweight to obesity were projected to increase sharply among lower SES adults, particularly among women, suggesting that these groups will undergo an obesity transition by 2030. The model projections also indicate that the regions of Colombia are in different stages of the obesity transition. In the case of women, five out of the six regions were expected to undergo an obesity transition by SES over time. For men, only one region was expected to undergo an obesity transition. However, at the department level, trends in the burden of obesity varied.ConclusionsWe evidence that the Colombian population could be experiencing an obesity transition where the increase in the GDP could be related to shifts in the burden of obesity from higher to lower SES, especially in women. These patterns support the need for policy planning that considers SES and gender, at the national and subnational levels, as important determinants of overweight and obesity among adults in Colombia.

scholarly journals Prevalence and risk factors of atrioventricular block among 15 million Chinese health examination participants in 2018: a nation-wide cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ruiqi Shan ◽  
Yi Ning ◽  
Yuan Ma ◽  
Siliang Liu ◽  
Jing Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Density Lipoprotein ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Older Age ◽  
City Size ◽  
Health Examination ◽  
Av Block ◽  
Cross Sectional ◽  
Multivariable Adjustment

Abstract Background Nationwide data on the prevalence of atrioventricular (AV) block are currently unavailable in China. Thus, we aimed to assess the prevalence and risk factors of AV block among Chinese health examination adults. Methods A total of 15,181,402 participants aged ≥ 18 years (mean age 41.5 ± 13.4 years, 53.2% men) who underwent an electrocardiogram as a part of routine health examination in 2018 were analyzed. AV block was diagnosed by physicians using 12-lead electrocardiogram. Overall and stratified prevalence (by age, sex, and city size) of all, first-, second- and third-degree AV block were calculated. Multivariable logistic regression analyses were performed to explore risk factors associated with AV block. Results AV block was observed in 88,842 participants, including 86,153 with first-degree, 2249 with second-degree and 440 with third-degree AV block. The age- and sex-standardized prevalence rate [95% confidence interval (CI)] of all, first-, second- and third-degree AV block were 7.06‰ (7.01–7.11), 6.84‰ (6.79–6.89), 0.18‰ (0.17–0.18) and 0.04‰ (0.03–0.04) respectively. After multivariable adjustment, the risk of AV block was positively associated with older age, being male, lower heart rate, higher body mass index, hypertension, diabetes and low high-density lipoprotein cholesterol. High total cholesterol was associated with a lower risk of AV block. Conclusion First-degree AV block is relatively common while severe AV block is rare in health examination adults. Besides, AV block was highly prevalent among the elderly. The risk of AV block was associated with older age, being male and metabolic factors.

Differential educational patterning of cardiometabolic risks between women and men among community-dwelling Chinese adults in Hong Kong: the mediating role of obesity

2021 ◽  
pp. 1-33
Author(s):  
Gary K.K. Chung ◽  
Francisco T.T. Lai ◽  
Heidi Hung ◽  
Eng-Kiong Yeoh ◽  
Roger Y. Chung
Keyword(s):  
Hong Kong ◽  
Clinical Data ◽  
Abdominal Obesity ◽  
Education Level ◽  
Community Dwelling ◽  
Binary Logistic Regression Analysis ◽  
Health Examination ◽  
Educational Inequalities ◽  
Anthropometric Measures ◽  
Cross Sectional

Abstract Objectives: Educational inequalities in cardiometabolic diseases (CMD) are globally recognised; nonetheless, evidence on potential explanatory mechanisms and effective strategies for CMD prevention and inequality reduction is relatively scarce in Asia. Therefore, this study examined the extent and potential mediators of the association of education level with CMD conditions (i.e., hypertension and diabetes) in an advanced economy in Asia. Design: A cross-sectional study. Setting: This territory-wide cross-sectional Population Health Survey in 2014/15 was performed in Hong Kong. Demographic, socioeconomic, and lifestyle factors were collected via questionnaire, while clinical data on blood pressure and glucose levels, lipid profiles, and anthropometric measures were obtained during health examination. Hypertension and diabetes statuses were objectively defined by both clinical data and the use of relevant medications. Participants: 2297 community-dwelling adults aged between 15-84 years recruited via systematic replicated sampling of living quarters. Results: Multivariable binary logistic regression analysis showed that lower education level was significantly associated with hypertension among women but not men, whereas similar pattern was also observed for diabetes and other related clinical risk factors. Also, general and abdominal obesity were independently associated with hypertension and diabetes among both women and men, and substantially mediated the observed inequalities across education levels among women. Specifically, abdominal obesity was a particularly strong risk factor and mediator for diabetes. Conclusion: Educational patterning of CMD was more apparent among women in Hong Kong. Obesity control appears to be important for both overall CMD prevention and reduction of educational inequalities in CMD among women.

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