Urban-Rural Comparison of Obesity and Related Metabolic Disorders in Southern Turkey

Abstract

Introduction: Once considered a high-income country problem, obesity is now on the rise in low and middle-income countries, particularly in urban settings. The aim of this study is to estimate the distribution of obesity and related metabolic morbidities between rural and urban regions of Adana. Materials and Methods: 545 consecutive patients, applied to Pozantı State Hospital Internal Medicine outpatient clinic between June-September 2017 were enrolled. Diabetes mellitus and/or hypertension and/or hyperlipidemia are defined as metabolic comorbid condition (MCC). Participants living at Pozantı were named locals, and those living in Adana city center were named springers. Results: 351 (64.4%) participants were from Pozantı and 194 (35.6%) were from Adana city center. The median Body-mass index (BMI) of the study population was 29.1 (17.5-48.8) kg/m2. Springers had slightly higher, but statistically insignificant BMI compared to locals (28.7 kg/m2 vs. 29.6 kg/m2 respectively, p=0.078). MCC was more frequent in springers (64.4% vs 54.1%, p= 0.02). Univariate analysis revealed that; springers (p=0.02), age>65 (p=0.00), patients with BMI>25 kg/m2 (p=0.001) and uric acid>7 mg/dl (p=0.001) is associated with MCC. Multivariate analysis displayed the association of BMI>25 kg/m2, age between 65-79 and uric acid >7 mg/dl with MCC independently. Conclusion: Obesity exists approximately one in every three cases and metabolic morbidities are observed in nearly half of the patients who applied to internal medicine outpatient clinic. The growing burden of obesity and related metabolic disorders in our region points to urgent preventive strategies on a national scale. Giriş: Bir zamanlar yüksek gelirli ülkelerin sorunu olarak görülen obezitenin, özellikle kent yaşamının yoğun olduğu düşük ve orta gelirli ülkelerde sıklığı giderek artmaktadır. Bu çalışmanın amacı, Adana’nın kırsal ve kentsel bölgeleri arasında obezite ve buna bağlı metabolik hastalıkların dağılımını belirlemektir. Materyal ve Metod: Haziran-Eylül 2017 tarihleri arasında Pozantı Devlet Hastanesi İç Hastalıkları polikliniğine başvuran 545 ardışık hasta dahil edildi. Diyabet, hipertansiyon ve/veya hiperlipidemi tanılarının varlığı metabolik komorbid durum (MKD) olarak tanımlandı. Pozantı ilçesinde yaşayan bireyler yerli, Adana şehir merkezinde yaşayan bireyler ise yaylacı olarak tanımlandı. Bulgular: Katılımcıların 351 (%64,4)’i Pozantı, 194 (%35,6)’ü Adana kent merkezinden idi. Çalışma popülasyonunun ortanca vücut-kitle indeksi (VKİ) 29,1 (17,5-48,8) kg/m2 saptandı. Yaylacılarda, yerlilere göre istatistiksel olarak anlamlı olmayan VKİ yüksekliği saptandı (sırasıyla 28,7 kg/m2 vs. 29,6 kg/m2, p=0,078). MKD, yaylacılarda daha sık görülmüştür (%64,4 vs. %54,1, p=0,02). Tek değişkenli analizler sonucunda; yaylacılarda (p=0,02), yaş>65 (p=0,00), VKİ>25 kg/m2 (p=0,001), ürik asit > 7 mg/dl (p=0,001) olanlarda MKD daha sık görülmüştür. Çok değişkenli analizler sonucunda ise; VKİ>25 kg/m2, 65-79 yaş arasında olmak ve ürik asit düzeyi > 7 mg/dl bağımsız olarak MKD varlığı ile ilişkili saptandı. Sonuç: İç Hastalıkları polikliniğine başvuran hastalardan her üç kişiden birinde obezite, ve her iki kişiden birinde de metabolik komorbiditeler bulunmaktadır. Bölgemizdeki artan obezite ve ilişkili metabolik problemler, ulusal ölçekte acil önleyici müdahale gerekliliğini ortaya koymuştur.

Keywords

• Obesity,Diabetes mellitus,Urban health,Rural health

References

1. 1. WHO. Obesity and overweight factsheet. Retrieved from: http://www.who.int/mediacentre/factsheets/fs311/en/. Access date: 05.07.2019
2. 2. Björntorp P. The association between obesity, adipose tissue distribution and disease. Acta Med Scand 1988;723 (Suppl):121–134.
3. 3. Jia WP, Xiang KS, Chen L, Lu JX, Wu TM. Epidemiological study on obesity and its comorbidities in urban Chinese older than 20 years of age in Shanghai, China. Obes Rev 2002;3:157–165.
4. 4. Bjorntorp P. Do stress reactions cause abdominal obesity and comorbidities? Obes Rev 2001; 2: 73–86.
5. 5. Rosmond R, Dallman MF, Bjorntorp P. Stress-related cortisol secretion in men: relationships with abdominal obesity and endocrine, metabolic and hemodynamic abnormalities. J Clin Endocrinol Metab 1998; 83: 1853–1859.
6. 6. Cossman JS, James WL, Cosby AG, Cossman RE. Underlying causes of the emerging non-metropolitan mortality penalty. Am J Public Health. 2010;100(8):1417-1419.
7. 7. Ebrahim S, Kinra S, Bowen L, Andersen E, Ben-Shlomo Y, Lyngdoh T, et al. The Effect of Rural-to-Urban Migration on Obesity and Diabetes in India: A Cross-Sectional Study. PLoS Med. 2010;7(4): e1000268.
8. 8. Neovius M, Rasmussen F. Place of residence and obesity in 1,578,694 young Swedish men between 1969 and 2005. Obesity (Silver Spring). 2008 Mar;16(3):671-676. 9. WHO. Ageing and Health factsheet. Retrieved from: http://www.who.int/mediacentre/factsheets/fs404/en/. Access date: 05.07.2019

9. 10. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eight Joint National Committee (JNC 8) JAMA. 2014;311:507–20.
10. 11. Jellinger PS, Handelsman Y, Rosenblit PD, Bloomgarden ZT, Fonseca VA, Garber AJ, et al. American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of Dyslipidemia and Prevention of Cardiovascular Disease. Endocr Pract. 2017 Apr; 23(2):1-87.
11. 12. Expert Committee on the diagnosis and Classification of diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of diabetes mellitus. Diabetes Care 1997;20:1183-1197.
12. 13. Erem C. Prevalence of Overweight and Obesity in Turkey. IJC Metabolic & Endocrine 2015;8:38-41
13. 14. Onat A, Yıldırım B, Çetinkaya A, Aksu H, Keleş İ, Uslu N, et al. Erişkinlerimizde obezite ve santral obezite göstergeleri ve ilişkileri: 1990-98'de Düşündürücü Obezite Artışı erkeklerde daha belirgin. Türk Kardiyoloji Arşivi 1999;27:209-217.
14. 15. Ozgul N, Tuncer M, Abacioglu M, Gultekin M. Prevalence of Obesity among Women in Turkey: Analysis of KETEM data. Asian Pacific J Cancer Prev. 2011;12(9):2401-2404.
15. 16. Erem C, Arslan C, Hacihasanoglu A, Deger O, Topbas M, Ukinc K, et al. Prevalence of Obesity and Associated Risk Factors in a Turkish Population (Trabzon city, Turkey). Obes Res. 2004 July;12(7):1117-1127.
16. 17. Akman M, Budak S, Kendir M. Genel Dahiliye Polikliniğine Basvuran Hastalarda Obezite Sıklığı ve İlişkili Saglık Problemleri. Marmara Medical Journal 2004;17(3);113-120.
17. 18. Low S, Chin MC, Deurenberg-Yap M. Review on Epidemic of Obesity. Ann Acad Med Singapore 2009;38:57-65.
18. 19. Nazlican E, Demirhindi H, Akbaba M. Adana Ili Solakli ve Karatas Merkez Sağlık Ocagı Bolgesinde Yasayan 20-64 Yas Arası Kadınlarda Obezite ve Ilişkili Risk Faktorlerinin Incelenmesi. Duzce Universitesi Sağlık Bilimleri Enstitusu Dergisi 2011;1(2):5-12
19. 20. Gundogan K, Bayram F, Gedik V, Kaya A, Karaman A, Demir O, et al. Metabolic syndrome prevalence according to ATP III and IDF criteria and related factors in Turkish adults. Arch Med Sci 2013; 9(2):243-253.
20. 21. Ciarla S, Struglia M, Giorgini P, et al. Serum uric acid levels and metabolic syndrome. Arch Physiol Biochem 2014;120:119-122.
21. 22. Li Y, Chen S, Shao X, et al. Association of uric acid with metabolic syndrome in men, premenopausal women and postmenopausal women. Int J Environ Res Public Health 2014;11:2899-2910.
22. 23. Ndrepepa G, Braun S, King L, et al. Uric acid and prognosis in angiography-proven coronary artery disease. Eur J Clin Invest 2013;43:256-266.
23. 24. Akbas EM, Ozcicek A, Ozcicek F, Demirtas L, Timuroğlu A, Gungor A, et al. Metabolik olarak sağlıklı ve sağlıksız obez hastalarda ürik asit seviyeleri. Dicle Medical Journal. 2014; 41(4):676-680.
24. 25. Weng X, Liu Y, Ma J, Wang W, Yang G, Caballero B. Use of body mass index to identify obesity-related metabolic disorders in the Chinese population. European Journal of Clinical Nutrition. 2006; 60:931-937.
25. 26. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002 Jan 16;287(3):356-9.
26. 27. Metintas S, Arikan I, Kalyoncu C. Awareness of hypertension and other cardiovascular risk factors in rural and urban areas in Turkey. Trans R Soc Trop Med Hyg. 2009 Aug;103(8):812-818.
27. 28. Erem C, Hacihasanoglu A, Deger O, Kocak M, Topbas M. Prevalence of dyslipidemia and associated risk factors among Turkish adults: Trabzon lipid study. Endocrine. 2008 Aug-Dec;34(1-3):36-51.
28. 29. Joshi SR, Anjana RM, Deepa M, Pradeepa R, Bhansali A, Dhandania VK, et al. Prevalence of dyslipidemia in urban and rural India: the ICMR-INDIAB study. PLoS One. 2014 May 9;9(5):e96808.
29. 30. Sanisoglu SY, Oktenli C, Hasimi A, Yokusoglu M, Ugurlu M. Prevalence of metabolic syndrome-related disorders in a large adult population in Turkey. BMC Public Health. 2006; 6:92.
30. 31. Satman I, Yilmaz T, Sengul A, Salman S, Salman F, Uygur S, et al. The TURDEP Group Population-based study of diabetes and risk characteristics in Turkey: results of the Turkish Diabetes Epidemiology Study. Diabetes Care. 2002;25:1551–1556.
31. 32. Gokcel A, Ozsahin AK, Sezgin N, Karakose H, Ertorer ME, Akbaba M, et al. High prevalence of diabetes in Adana, a southern province of Turkey. Diabetes Care. 2003;26:3031–3034.
32. 33. Ramachandran A, Mary S, Yamuna A, Murugesan N, Snehalatha C. High prevalence of diabetes and cardiovascular risk factors associated with urbanization in India. Diabetes Care. 2008 May;31(5):893-898.