Abstract Background/problem definition: Mental illness, such as anxiety, is a health problem affecting about 10-20% of adolescents worldwide. Studies have found a person’s physical fitness to be associated with their mental health, but most studies have been done in the western world and few have investigated sub-Saharan African (SSA) countries. It has also been found that SSA countries’ guidelines regarding physical activity are few and incomplete, although the importance of it is well known.   Aim: To investigate to what extent physical fitness: grip strength (GS), 20 meter shuttle run test (20MSRT), body mass index (BMI) and waist circumference (WC) correlate to self-assessed anxiety in South African students at the UWC.   Methods: The study had a quantitative, cross-sectional and correlational research design with a non-randomized convenience sampling. The physical fitness data were collected through a hydraulic grip strength dynamometer, 20MSRT and by measuring anthropometric measurements in order to calculate BMI and WC. An electronic version of the GAD-7 form was used for self-assessed anxiety.   Results: The results showed a significant positive correlation between BMI and levels of anxiety in women, but not in men. The correlation of anxiety related to WC, GS and 20MSRT showed no significance for the whole sample or related to gender, respectively. Conclusion: No significant correlation could be determined between physical fitness and anxiety. Severe anxiety affected 25% of the population, supporting previous research indicating that students are a group prone to anxiety. / Sammanfattning Bakgrund: Mental ohälsa, till exempel ångest, är ett hälsorelaterat problem som drabbar cirka 10-20% av ungdomar i världen över. Studier har visat att en persons fysiska kondition (physical fitness) kan kopplas till mental hälsa och välmående, men de flesta studier har gjorts i västvärlden och det råder brist på forskning i länder söder om Sahara. Dessutom har afrikanska länder söder om Sahara få och inkompletta riktlinjer gällande fysisk aktivitet trots att betydelsen av fysisk aktivitet är väl etablerad. Syfte: Att undersöka om och till vilken utsträckning fysisk kondition (innefattande grepp styrka, beep-test, BMI och midjemått) korrelerar med självskattad ångest (GAD-7) hos Sydafrikanska studenter vid University of the Western Cape (UWC).   Metod: En kvantitativ tvärsnittsdesign användes och korrelationer studerades. Deltagarna rekryterades genom ett icke randomiserat bekvämlighetsurval. Datan för fysisk kondition och hälsa samlades in genom en greppstyrka-dynamometer, beep-test samt genom antropometriska mätningar för att mäta midjemått och räkna ut BMI. Självskattad ångest samlades in genom en elektronisk version av GAD-7 formuläret.   Resultat: Resultaten visade en statistiskt signifikant, positiv korrelation mellan BMI och ångest bland kvinnor. Inga signifikanta korrelationer kunde i övrigt ses i gruppen som helhet eller hos kvinnor respektive män. Konklusion: Ingen signifikant korrelation fastslogs mellan fysisk kondition och ångest. Svår ångest rapporterades av 25% av deltagarna, vilket stödjer tidigare forskning på området som indikerar att studenter är en grupp utsatt för ångest.

It is well established in the literature that children with developmental coordination disorder (DCD) are more likely to be physically inactive, have unhealthy weight, and report lower perceptions of self-worth than typically developing (TD) children. Physical inactivity, overweight/obesity and low self-worth are important risk factors for many physical and psychological health conditions. The interrelationships among these factors, however, have yet to be explored in children with DCD. There is limited information on change in body composition measures and self-worth over time in children with DCD, the effect of physical activity (PA) on body composition, and whether the combined negative influence of having both DCD and obesity result in poorer conceptions of self-worth. In this dissertation, I present a series of studies that explore the connections among these factors using longitudinal, population-based data on a large cohort of children with and without poor motor coordination. The first study, presented in Chapter 2, describes the results of change in BMI and waist circumference (WC) in children with probable DCD (pDCD) and TD children over a five-year time period, and the effects of sex and PA on this relationship. Chapter 3 describes the results of the relationship between body fat, pDCD, and PA after addressing the measurement- related limitations of the study reported in Chapter 2. Chapter 4 describes the results of self-worth in children with pDCD and overweight/obesity, only pDCD, only overweight/obesity, and the control group at baseline as well as change over time. Collectively, the results show that children with pDCD have a consistently higher BMI, WC, and body fat than TD children. BMI and WC increases over time in children with pDCD; specifically boys with pDCD show a much accelerated increase in these measures. Scores of body composition measures increase with decrease in self-reported and objectively measured PA, but participation in PA does not explain why children with pDCD are more likely to have excess weight gain. Finally, children with both pDCD and overweight/obesity and children with either of these conditions alone report lower self- worth than the control group, and the change in self-worth between groups remains constant over time. / Dissertation / Doctor of Philosophy (PhD)

Obesity is considered to be one of the diseases related to the change in the lifestyle, leading to increased incidence of myocardial infarction, type 2 diabetes mellitus, hypertension and other diseases. Due to the progressively increasing prevalence of obesity in adulthood, prevention of obesity has to start in childhood and adolescent, in which also increase in prevalence of obesity was found. Actual prevalence of overweight and obesity was tested in this thesis by different standards (5. NAS, WHO, IOTF, CDC) in Czech children population in age of 6.5 - 7.5 years in 2013. Its trend since 1951 was evaluated. Since 2008 maintaining of the values in all categories at the constant level was found. The role of risk factors assessed by personal, family and school questionnaires in overweight prevalence was tested. The most important factors were diet, exercise and family factors. Increased weight/height ratio (WHtR) marker of adipose tissue was found in the category of normal weight children also and it shows the link with above-mentioned risk factors of diet, exercise and family prediction. Key words Obesity, Overweight, Prevalence, Childhood, BMI, 5. NAS, WHO, IOTF, CDC, COSI, WHtR, Waist circumference, Risk factors

Introdução - A partir dos estudos de Barker observou-se que o baixo peso ao nascer está associado ao desenvolvimento de doenças crônicas no adulto. Estudos sobre a composição corporal na infância também podem contribuir para a compreensão de seu papel no risco de desenvolvimento de doenças crônicas em etapas posteriores da vida. Objetivo - Analisar as relações entre o peso ao nascer, a composição corporal e o estado nutricional em crianças de 2 a 6 anos de idade. Métodos - Estudo de coorte histórica a partir de uma amostra aleatória probabilística, por conglomerados, das creches públicas de Taubaté - SP (2008 e 2009) compondo uma amostra de 950 crianças. As medidas antropométricas das crianças utilizadas ao nascimento foram peso e comprimento e as na idade pré-escolar foram peso, estatura, circunferência do braço (CB), circunferência da cintura (CC), dobra cutânea tricipital (DCT) e dobra cutânea subescapular (DCSE). Para avaliação do estado nutricional, utilizou-se o Índice de Massa Corpórea (IMC) em escore z e pontos de corte internacionalmente aceitos. Para a avaliação da composição corporal utilizouse a área muscular do braço (AMB) e a área gorda do braço (AGB) em escores z e a razão CC para estatura (CC/E). As análises foram realizadas a partir dos parâmetros de tendência central, dispersão e proporções, adotando-se um nível de significância de 5 por cento . Resultados - A média de peso ao nascer (PN) dos pré-escolares foi de 3150,1g com um desvio padrão (dp) de 487,7g e uma mediana de 3142,5g. As médias e os dp do escore z de estatura, peso e IMC foram: -0,05 (1,06), 0,27 (1,21), 0,43 (1,22), respectivamente. Nos préescolares nascidos com 3000g ou mais, a estatura atual correlacionou-se positivamente com o PN (r =0,16 e p<0,0001). Nos pré-escolares como um todo, quanto maior o PN, maior o IMC (r P =0,19 e p<0,0001). A mediana do escore z de IMC nos pré-escolares nascidos com mais de 3500g foi superior à observada nas demais faixas de PN. Pela regressão linear múltipla, cada aumento de 1kg no peso ao nascer corresponde um aumento de 0,45 escores z no IMC na idade pré-escolar. Observou-se uma correlação direta entre o PN e a AMB (r P =0,13 e p<0,0001) e a AGB (r =0,10 e p=0,003). Os pré-escolares com excesso de peso e que nasceram abaixo da mediana de PN apresentaram uma menor AMB em comparação com os nascidos acima da mediana. Não houve diferença para as medianas de AGB ou de CC entre esses grupos de peso ao nascer. A razão CC/E mostrou correlação direta com o IMC (r P =0,78), a AMB (r P =0,52), a AGB (r P =0,66) e com a proporção da AGB (r =0,54), p<0,0001. Já entre a razão CC/E e a proporção de AMB corrigida observou-se uma correlação inversa (r = -0,38), p<0,0001. Conclusões - Quanto maior o peso ao nascer das crianças, maior o seu IMC na idade pré-escolar. A massa magra e a massa gorda corporal também são maiores na idade pré-escolar nas crianças com maior peso de nascimento. O importante é que nos pré-escolares com excesso de peso a massa magra é menor nos que nasceram com menor peso, sem que se observe diferença para a massa gorda corporal em função do peso ao nascer. Quanto maior a razão CC/E também será maior a quantidade de massa magra e de massa gorda corporal, contudo o aumento da razão CC/E é acompanhado por um aumento desproporcionalmente maior da massa gorda em comparação com o da magra / Introduction - Barker studies evinced that low birth weight is a risk factor to develop chronic diseases in adults. Research about children body composition can also contribute to understand its role in the development of chronic diseases in later stages in life. Objective - To analyze the relationship among birth weight, body composition and nutritional status of 2 to 6 years old children. Methods - Historical cohort study of a probabilistic randomized sample by conglomerates, of public day care centers in Taubaté, SP (2008-2009) that resulted in a final sample of 950 children. The childrens anthropometric measures collected at preschool age were weight, height, upper arm circumference (AC), waist circumference (WC), triceps skinfold (TS), and subscapular skinfold (SS). Birth weight and length were retrospectively corrected. Body Mass Index (BMI) Z score was used to evaluate the children nutritional status based on cut-off points internationally accepted. Upper arm muscle area (UMA) and upper arm fat area (UFA) in Z-scores, and the waist-toheight ratio (WHtR) were used to evaluate the body composition. The analysis was carried out from measures of central tendency, dispersion and proportions, adopting a level of significance of 5%. Results - The mean birth weight (BW) of the preschool children was 3150.5g with a standard deviation (SD) of 487.7g and the median of BW was 3142.5g. The means and the SD of the Z-score of height, weight and BMI at pre-school age were respectively: -0.05(1.06), 0.27(1.21), 0.43(1.22). Height of preschool children born with 3000g or more showed a direct correlation with BW (r =0.16; p<0.0001). In the preschool sample as a whole, the higher the BW the higher the BMI (r P =0.19; p<0.0001). The median preschool children Z-score of BMI of the group born with more than 3500g was superior to the one observed in the group born with lower weight. By a multiple linear regression each increase of 1kg in the birth weight corresponds to an increase of 0,45 z scores in the BMI at preschool age. It was also observed a direct correlation between BW and the UMA (r P P =0.13; p<0.0001) and the UFA (r =0.10; p=0.003). The preschool children with excess of weight and that were born below the median of BW showed a lower UMA in comparison to those born with a weight above the median. There was no difference to the medians of UFA or WC according to birth weight. The WHtR showed a direct correlation with the BMI (r P P =0.78), the UMA (r =0.52), the UFA (r P =0.66) and the arm fat index (% fat area), r P P =0.54, p<0.0001. On the other hand it was observed an inverse correlation between the WHtR and the proportion of the UMA corrected (% muscle area), r = -0.38 and p<0.0001. Conclusions - The higher the childrens birth weight, the higher their BMI in preschool age. The lean and the fat body masses are also higher in the preschool age in children with a higher birth weight. The most relevant things observed is that in preschool children with excess of weight the lean mass is lower in the ones who were born with a lower weight, and that there were no correlation between UFA and birth weight. The higher the WHtR it will also be higher the amount of lean and fat mass; however the increase of the WHtR is followed by a disproportionately higher increase of the fat body mass when compared to that of the lean body mass.

Objetivo. Ao mesmo tempo em que a obesidade aumenta no mundo todo e se torna cada vez mais um problema de Saúde Pública, o stress aumenta no cotidiano das pessoas e na busca pela sobrevivência. Verificar a possível associação entre prevalências de obesidade centralizada e indicadores de stress é o objetivo desse trabalho. Métodos. Utilizam-se dados de um estudo transversal, com informações de 298 mulheres de 20 a 59 anos, moradoras de um município da Grande São Paulo, as quais responderam questionários especialmente elaborados para avaliar o stress psicológico. O diagnóstico de obesidade centralizada foi feito através da medida da circunferência da cintura (CC) e da razão cinturaquadril (RCQ). O stress psicológico foi medido em escores atribuídos às respostas dos questionários e classificado em 3 categorias: isento, resistência e exaustão. A análise estatística foi realizada mediante dois modelos de regressão linear generalizada múltipla entre a variável resposta obesidade centralizada em duas categorias (sim, não) e o stress psicológico em três fases (isento, resistência e exaustão), controlando-se as variáveis demográficas: idade e escolaridade. Resultados. As prevalências de obesidade centralizada foram semelhantes nos dois modelos, respectivamente 40,6 % e 42% para CC e RCQ. As prevalências de stress psicológico foram 61,7% e 8,4% para as fases resistência e exaustão. As associações entre a categoria sim foram positivas e significantes, respectivamente para CC e RCQ (RP 1,51, P 0,028 e RP 1,52, P 0,022) com o stress na fase de exaustão, com o aumento da idade (RP 1,02, P 0,001 e RP 1,01, P 0,002) e com baixa escolaridade (RP 0,67, P 0,030 e RP 0,59, P 0,005). O teste de tendência foi positivo (P 0,029) para a categoria sim do RCQ e aumento das categorias de stress. Conclusões. A fase de exaustão do stress mostrou associação positiva e significante com a obesidade centralizada nos dois modelos estudados, CC e RCQ. O teste significante de tendência com a RCQ sugere efeito gradativo das fases do stress sobre a obesidade centralizada. São necessários, no entanto, outros estudos que comprovem a associação da obesidade centralizada com o stress subdividido em categorias. / Objective. When observing modern life nowadays we find out that, at the same time that obesity increases all around the world and becomes a real concern to public health authorities, we also see stress proliferating in peoples everyday life, specially in the fight for survival. The purpose of this work is to verify the association between prevalence of abdominal obesity and stress indicators. Methods. This work uses given data of a transversal study, containing information of 298 women aged between 20 and 59, inhabitants of the Great São Paulo, who had been submitted to questionnaires especially formulated to evaluate psychological stress. The diagnosis of abdominal obesity was made using two models: measuring Waist Circumference (WC) and Waist - Hip ratio (WHR). Psychological stress was measured in scores attributed to answers of the questionnaires and classified in 3 categories: Exempt, Resistance and Exhaustion. The statistics analysis were carried through two models of multiple generalized linear regression between the variable which is the answer- abdominal obesity focused in two categories (Yes, No) and psychological stress focused in three categories (Exempt, Resistance, Exhaustion) maintaining under control the demographic variables such as age and scholarship. Results. The results referring to the prevalence of abdominal obesity were similar in the two models showing respectively 40.6% and 42% for WC and WHR. The results on the prevalence of psychological stress were 61.7% and 8.4% respectively for the phase of Resistance and the phase of Exhaustion. The associations in the Yes category were classified as being positive and significant, for WC and WHR respectively, Prevalence Ratio PR 1,51, significancy P 0,028 and PR 1,52, P 0,022 for the stress in the phase of Exhaustion, when considered also an increase in age (PR 1,02, P 0,001 and PR 1,01, P 0,002) and a decrease in the level of education (PR 0,67, P 0,030 and PR 0,59, P 0,005) The trend analysis was positive (P 0,029) for the increase of the WHR and the categories of stress. Conclusions. The phase of Exhaustion of Stress showed positive and significant association with the Abdominal Obesity in the two models, WC and WHR. The positive results in the trend tests with the WHR suggest that abdominal obesity may be gradually affected by the phases of stress. Nevertheless, there is the need of further investigation to confirm the association between abdominal obesity and the various categories of stress.

Introdução: Segundo a literatura, a incidência de hipertensão arterial sistêmica (HAS) tem aumentado, particularmente em idosos, e as evidências epidemiológicas mostram que o estado nutricional e gordura abdominal estão associados, positivamente, com o desenvolvimento dessa doença. Objetivo: Verificar a associação entre incidência de HAS referida e estado nutricional e gordura abdominal, em idosos do município de São Paulo/Brasil - 2000 e 2006. Casuística e métodos: Trata-se de estudo de coorte, epidemiológico, de base domiciliar, realizado no município de São Paulo, utilizando dados do Estudo SABE . Saúde, Bem-estar e Envelhecimento, em 2000 (2.143 idosos), e em 2006 (1.115 idosos). A população de estudo foi constituída por idosos (&#8805;66 anos), de ambos os sexos, selecionados por amostra probabilística, e que não referiram HAS, em 2000, e que apresentaram todos os dados necessários a este estudo. As variáveis analisadas foram: HAS referida, com alternativa de resposta dicotômica (sim ou não), estado nutricional, pelo índice de massa corporal - baixo peso (IMC< 23 kg/m2) e excesso de peso (IMC &#8805;30 kg/m2), gordura abdominal (circunferência da cintura - CC &#8805; 88 cm, para mulheres, e &#8805; 102 cm, para homens; e razão cintura/quadril - RCQ &#8805; 1, para homens, e &#8805; 0,85, para mulheres) e características sociodemográficas: sexo, grupos etários (60 a 74 anos; &#8805; 75 anos), escolaridade e tabagismo. Para verificar a associação entre as variáveis, utilizou-se teste Rao & Scott, para amostra complexa, regressão logística múltipla (p<0,05) e o programa Stata/SE 10.0 for Windows. Resultados: Dos 1.115 idosos, foram reavaliados 522, sendo 164 novos casos de HAS referida (33,61/ 1.000 pessoa/ano). A maior proporção de idosos que referiram HAS era composta por mulheres (55%), do grupo de 60 a 74 anos (86%). Excesso de peso e gordura abdominal foram associadas, positivamente, com referência de HAS em homens e mulheres, com diferença estatística para CC (OR= 3,18; IC95% 1,02-9,93; p=0,04), em mulheres. Conclusão: Constatou-se que a gordura abdominal esteve associada positiva e significativamente com incidência de HAS referida, em mulheres, após 6 anos de acompanhamento. / Introduction: According to scientific literature, the incidence of hypertension (HBP- high blood pressure) has increased, particularly in the elderly, and epidemiological evidence shows that both the nutritional status and abdominal fat are positively associated with the development of this disease. Objective: To verify the association between incidence of hypertension and both the nutritional status and abdominal fat of elderly people in São Paulo / Brazil - 2000 and 2006. Casuistic and methods: This is a cohort study, epidemiological and household based study, carried out in the city of São Paulo, using data from the SABE Survey - Health, Wellbeing and Aging in 2000 (2.143 individuals), and 2006 (1115 individuals). The study population consisted of elderly people (&#8805; 66 years) of both genders, selected by probabilistic sample, who did not reported HBP in 2000 and with all the necessary data for this study. The analyzed variables were: reported HBP (yes or no), nutritional status, by body mass index - underweight (BMI <23 kg / m2) and overweight (BMI &#8805; 30 kg / m2) , abdominal fat (waist circumference - WC &#8805; 88 cm for women and &#8805; 102 cm for men, waistto- hip ratio (WHR &#8805; 1, for men and &#8805; 0.85, for women) and socio-demographic characteristics: gender, age groups (60 to 74 years, &#8805; 75 years), educational status and smoking. To verify the association among the variables, we used the Rao Scott test, for complex samples, multiple logistic regression (p<0.05) and the Stata software (Stata/SE 10.0 for Windows). Results: Out of the 1,115 elderly individuals in 2006, 522 were reassessed, resulting in 164 elderly persons who referred being new cases of hypertension (33.61 / 1,000 person/years). The majority of individuals who reported HBP were women (55%), belonging to the group among 60 to 74 years of age (86%). Overweight and abdominal fat were positively associated to hypertension in men and women, with statistical significance, according to the waist-to-hip ratio WHR of women (OR = 3.18; 95% CI=1.02 - 9.93, p = 0.04). Conclusion: abdominal fat was positively associated with the incidence of hypertension in women, after 6 years of follow-up.

Objetivo. Ao mesmo tempo em que a obesidade aumenta no mundo todo e se torna cada vez mais um problema de Saúde Pública, o stress aumenta no cotidiano das pessoas e na busca pela sobrevivência. Verificar a possível associação entre prevalências de obesidade centralizada e indicadores de stress é o objetivo desse trabalho. Métodos. Utilizam-se dados de um estudo transversal, com informações de 298 mulheres de 20 a 59 anos, moradoras de um município da Grande São Paulo, as quais responderam questionários especialmente elaborados para avaliar o stress psicológico. O diagnóstico de obesidade centralizada foi feito através da medida da circunferência da cintura (CC) e da razão cinturaquadril (RCQ). O stress psicológico foi medido em escores atribuídos às respostas dos questionários e classificado em 3 categorias: isento, resistência e exaustão. A análise estatística foi realizada mediante dois modelos de regressão linear generalizada múltipla entre a variável resposta obesidade centralizada em duas categorias (sim, não) e o stress psicológico em três fases (isento, resistência e exaustão), controlando-se as variáveis demográficas: idade e escolaridade. Resultados. As prevalências de obesidade centralizada foram semelhantes nos dois modelos, respectivamente 40,6 % e 42% para CC e RCQ. As prevalências de stress psicológico foram 61,7% e 8,4% para as fases resistência e exaustão. As associações entre a categoria sim foram positivas e significantes, respectivamente para CC e RCQ (RP 1,51, P 0,028 e RP 1,52, P 0,022) com o stress na fase de exaustão, com o aumento da idade (RP 1,02, P 0,001 e RP 1,01, P 0,002) e com baixa escolaridade (RP 0,67, P 0,030 e RP 0,59, P 0,005). O teste de tendência foi positivo (P 0,029) para a categoria sim do RCQ e aumento das categorias de stress. Conclusões. A fase de exaustão do stress mostrou associação positiva e significante com a obesidade centralizada nos dois modelos estudados, CC e RCQ. O teste significante de tendência com a RCQ sugere efeito gradativo das fases do stress sobre a obesidade centralizada. São necessários, no entanto, outros estudos que comprovem a associação da obesidade centralizada com o stress subdividido em categorias. / Objective. When observing modern life nowadays we find out that, at the same time that obesity increases all around the world and becomes a real concern to public health authorities, we also see stress proliferating in peoples everyday life, specially in the fight for survival. The purpose of this work is to verify the association between prevalence of abdominal obesity and stress indicators. Methods. This work uses given data of a transversal study, containing information of 298 women aged between 20 and 59, inhabitants of the Great São Paulo, who had been submitted to questionnaires especially formulated to evaluate psychological stress. The diagnosis of abdominal obesity was made using two models: measuring Waist Circumference (WC) and Waist - Hip ratio (WHR). Psychological stress was measured in scores attributed to answers of the questionnaires and classified in 3 categories: Exempt, Resistance and Exhaustion. The statistics analysis were carried through two models of multiple generalized linear regression between the variable which is the answer- abdominal obesity focused in two categories (Yes, No) and psychological stress focused in three categories (Exempt, Resistance, Exhaustion) maintaining under control the demographic variables such as age and scholarship. Results. The results referring to the prevalence of abdominal obesity were similar in the two models showing respectively 40.6% and 42% for WC and WHR. The results on the prevalence of psychological stress were 61.7% and 8.4% respectively for the phase of Resistance and the phase of Exhaustion. The associations in the Yes category were classified as being positive and significant, for WC and WHR respectively, Prevalence Ratio PR 1,51, significancy P 0,028 and PR 1,52, P 0,022 for the stress in the phase of Exhaustion, when considered also an increase in age (PR 1,02, P 0,001 and PR 1,01, P 0,002) and a decrease in the level of education (PR 0,67, P 0,030 and PR 0,59, P 0,005) The trend analysis was positive (P 0,029) for the increase of the WHR and the categories of stress. Conclusions. The phase of Exhaustion of Stress showed positive and significant association with the Abdominal Obesity in the two models, WC and WHR. The positive results in the trend tests with the WHR suggest that abdominal obesity may be gradually affected by the phases of stress. Nevertheless, there is the need of further investigation to confirm the association between abdominal obesity and the various categories of stress.

Sedentary lifestyles and energy-rich diets are driving an increasing prevalence of abdominal obesity, which is associated with cardiovascular risk. Reliable estimates of the worldwide prevalence of abdominal obesity are needed to quantify the associated health risk. The International Day for the Evaluation of Abdominal obesity (IDEA) study is a large, international epidemiological cross-sectional study designed to provide reliable data on the distribution of waist circumference according to region, gender, age, and socio-economic level in 177 345 primary care patients from 63 countries across five continents. Any non-pregnant patient aged 18–80 consulting one of the randomly selected primary care physicians on two pre-defined half days was eligible to participate in the study. The primary objective was to estimate the prevalence of abdominal obesity in primary care, in each participating country. Secondary objectives were to estimate the prevalence of hypertension, type 2 diabetes, dyslipidaemia, and smoking, and to evaluate their associations with abdominal obesity, according to age, gender, and socio-economic level and region. The IDEA study will provide the first global map of the prevalence of abdominal obesity and associated comorbidities in primary care practice.

Metabolic syndrome is a cluster of disorders including central obesity, hypertension, dyslipidemia, and hyperglycemia. Today's metabolic syndrome definitions identify central obesity by waist circumference (WC) measurements. A recent pilot study suggests that cut-points derived from a waist-to-height ratio (WHtR), or Index of Central Obesity (ICO), is a more accurate measurement of central obesity. This study compared the association between the metabolic syndrome components and central obese parameters (ICO and WC) among the white, black, and Hispanic adults in the United States. The subjects' data was obtained from the 2005-2006 National Health and Nutrition Examination Survey. ICO was highly correlated with metabolic syndrome components among white subjects and the least correlated in Hispanic subjects. Multivariate logistic regression analysis did not indicate that ICO was a better parameter for metabolic syndrome than WC. Other WHtR cut-points may be more sensitive in predicting metabolic syndrome components than the values used in this study.

Background: Obesity and the accompanying increased morbidity and mortality risk is highly prevalent among older adults. As obese elderly might benefit from intentional weight reduction, it is necessary to determine associated and potentially modifiable factors on senior obesity. This cross-sectional study focuses on multi-morbid patients which make up the majority in primary care. It reports on the prevalence of senior obesity and its associations with lifestyle behaviors. Methods: A total of 3,189 non-demented, multi-morbid participants aged 65–85 years were recruited in primary care within the German MultiCare-study. Physical activity, smoking, alcohol consumption and quantity and quality of nutritional intake were classified as relevant lifestyle factors. Body Mass Index (BMI, general obesity) and waist circumference (WC, abdominal obesity) were used as outcome measures and regression analyses were conducted. Results: About one third of all patients were classified as obese according to BMI. The prevalence of abdominal obesity was 73.5%. Adjusted for socio-demographic variables and objective and subjective disease burden, participants with low physical activity had a 1.6 kg/m2 higher BMI as well as a higher WC (4.9 cm, p<0.001). Current smoking and high alcohol consumption were associated with a lower BMI and WC. In multivariate logistic regression, using elevated WC and BMI as categorical outcomes, the same pattern in lifestyle factors was observed. Only for WC, not current but former smoking was associated with a higher probability for elevated WC. Dietary intake in quantity and quality was not associated with BMI or WC in either model. Conclusions: Further research is needed to clarify if the huge prevalence discrepancy between BMI and WC also reflects a difference in obesity-related morbidity and mortality. Yet, age-specific thresholds for the BMI are needed likewise. Encouraging and promoting physical activity in older adults might a starting point for weight reduction efforts.