5RF]3DQVWZ=DNO+LJ * Corresponding author:3LRWU6XSUDQRZLF]'HSDUWPHQWRI+HDOWK3URPRWLRQDQG3RVWJUDGXDWH(GXFDWLRQ1DWLRQDO,QVWLWXWHRI 3XEOLF+HDOWK±1DWLRQDO,QVWLWXWHRI+\JLHQH&KRFLPVNDVWUHHW :DUVDZ3RODQG SKRQH ID[ HPDLO SVXSUDQRZLF]#S]KJRYSO &RS\ULJKWE\WKH1DWLRQDO,QVWLWXWHRI3XEOLF+HDOWK1DWLRQDO,QVWLWXWHRI+\JLHQH
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Material and methods. 7KH VXUYH\ ZDV FRQGXFWHG DPRQJ :DUVDZ LQKDELWDQWV VHOHFWHG E\ QRQUDQGRP PHWKRG 2YHUZHLJKWDQGREHVLW\ZDVPHDVXUHGE\%RG\0DVV,QGH[ %0, RQWKHEDVLVRIWKHGDWDRIZHLJKWDQGKHLJKWUHSRUWHG E\UHVSRQGHQWV$FFRUGLQJWR:+2FULWHULDWKHQRUPDOZHLJKWLVGHILQHGDV%0,± NJPRYHUZHLJKWDV%0,
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Results. 2EHVLW\PHDVXUHGE\VHOIUHSRUWHGPHWKRGZDVUHFRJQLVHGDVVLJQLILFDQWULVNIDFWRUIRUGLDEHWHV 25 &, UHVSLUDWRU\GLVHDVHV 25 &, FDUGLRYDVFXODUGLVHDVHV 25 &, DUWKULWLV 25 &, GLJHVWLYHGLVHDVHV 25 &, DQGPHQWDOGLVRUGHUV 25 &, ZKLOHRYHUZHLJKW VLJQLILFDQWO\LQFUHDVHGWKHULVNRIGLDEHWHV 25 &, UHVSLUDWRU\GLVHDVHV 25 &, FDUGLRYDV-FXODUGLVHDVHV 25 &, DQGDUWKULWLV 25 &,
Conclusions. Our findings showed that data on weight and height collected by survey method provide some information DERXWWKHPDJQLWXGHRIWKHULVNUHJDUGLQJSDUWLFXODUJURXSVRIGLVHDVHVDWWULEXWDEOHWRRYHUZHLJKWDQGREHVLW\QHYHUWKHOHVV XQGHUHVWLPDWLRQRI%0,FDOFXODWHGLQWKLVZD\VKRXOGEHWDNHQLQWRDFFRXQW
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Obesity is one of the most dangerous risk factors of premature death and morbidity of the large number RIFKURQLFGLVHDVHVVLPXOWDQHRXVO\FUHDWLQJWKHKLJK FRVWVLQFRPPXQLW\DVZHOODVDWLQGLYLGXDOOHYHO,Q the high-income countries obesity are recognised as the third risk factor caused death (after tobacco use and high blood pressure) and annually have been responsible for GHDWKVLHRIDOOGHDWKV>@7KHSUHYD-lence of obesity in Europe and many other industrialised countries outside Europe has significantly increased RYHUWKHSDVWVHYHUDOGHFDGHV>@7KHGDWDDYDLODEOH IURP+HDOWK,QWHUYLHZ6XUYH\ +,6 ZKLFKKDVEHHQ FDUULHGRXWVLPXOWDQHRXVO\LQ (XURSHDQFRXQWULHV found the proportion of overweight and obese people LQDGXOWSRSXODWLRQYDULHGEHWZHHQDQG IRU PHQDQGDQGIRUZRPHQZKLOHSUHYDOHQFH RIREHVLW\UDQJHGIURPWRIRUPHQDQGIURP WRIRUZRPHQ> @
The prospective and methodologically reliable stu-dies conducted on the large cohorts provided evidences WKDWREHVLW\DQGLQWKHFHUWDLQFDVHVRYHUZHLJKWZHUH significant risk factors for mortality and morbidity. The wide range of chronic diseases was recognised as obesity-related. Increased risk of developing diabetes >@DQGRWKHUHQGRFULQHGLVHDVHV>@FDU-GLRYDVFXODUGLVHDVHV>@UHVSLUDWRU\ GLVHDVHV>@GLJHVWLYHGLVHDVHV>@ DUWKULWLV>@DQGVRPHFDQFHUV>@ by overweight and obesity was generally confirmed. 2EHVLW\LQFUHDVHVWKHULVNRIDOOFDXVHPRUWDOLW\> @DVZHOODVFDXVHVSHFLILFPRUWDOLW\>@$VRSSR-VHGWRREHVLW\WKHH[LVWLQJVWXGLHVGLGQRWFRQILUPWKDW RYHUZHLJKWLVDULVNIDFWRUIRUPRUWDOLW\)XUWKHUPRUH some investigations may suggest that overweight could SURWHFWDJDLQVWSUHPDWXUHGHDWK>@
Obesity is seen as a serious threat to health also in 3RODQG>@+RZHYHUWRRXUNQRZOHGJHWKHUHZHUH no studies in Poland that estimated the risk of chronic diseases related to obesity. The aim of presented paper was to define the risk of wide range of chronic diseases DWWULEXWDEOHWRRYHUZHLJKWDQGREHVLW\ZLWK%0,PH-asured by self-reported weight and height.
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The presented analysis is a part of the wider scien-tific project concerning social participation in health UHIRUP> @2QHRIWKHPDLQSXUSRVHVRIWKHSURMHFW was to assess the usefulness of information collected by self-administrated questionnaire for developing more effective health policy. Data were collected during $SULO±-XQH7KHSDUWLFLSDQWVZHUHVHOHFWHGE\ non-random method. The questionnaires (with return HQYHORSHV ZHUHGHOLYHUHGWRKRXVHKROGVORFDWHG in the buildings inhabited at different time in order to obtain the sample varied by age and the level of afflu-HQFH7KHKRXVHZHUHVHOHFWHGE\DOODXWKRUVDFFRUGLQJ to their knowledge of inhabitants. All districts were included in proportion to the number of residents. Par-WLFLSDWLRQLQWKHVWXG\ZDVYROXQWDU\DQGDQRQ\PRXV WKHUHIRUHWKHGDWDZHUHFRPSOHWHGE\QRQDGGUHVVHG TXHVWLRQQDLUHV,QKDELWDQWVUHWXUQHGTXHVWLRQQDLUHV RIZKLFKFRUUHFWO\FRPSOHWHGZHUHDQDO\VHG7KH low response rate was discussed in our previous article > @&RPSDUHGWRWKHVWUXFWXUHRI:DUVDZSRSXODWLRQ LQRXUVDPSOHZRPHQROGHUSHUVRQV RYHU\HDUV WKHKLJKHGXFDWHGSHQVLRQHUVDQGFKURQLFDOO\LOOZHUH over-represented. A more detailed description of the sample and content of questionnaire was presented in RXUSUHYLRXVVWXGLHV> @
7KH%RG\0DVV,QGH[ %0, UHFRPPHQGHGE\WKH :+2IRUKHDOWKVXUYH\ZDVXVHGWRGHILQHRYHUZHLJKW DQGREHVLW\%0,ZDVFDOFXODWHGE\WKHZHLJKWLQNLOR-grams divided by squared height in metres. According WR WKH :+2 UHFRPPHQGDWLRQV %0, LV FODVVL-ILHGDVXQGHUZHLJKW %0, QRUPDOZHLJKW %0, RYHUZHLJKW %0,! REHVH >@ ,Q our study only the five respondents were underweight WKHUHIRUHWKLVJURXSKDVEHHQH[FOXGHGIURP further analyses. In order to collect information on the FKURQLFGLVHDVHVWKHUHVSRQGHQWVZHUHDVNHGZKHWKHU they are under continuous medical supervision due WRWKHLULOOQHVV7KHQWKH\SRLQWHGWRZKLFKJURXSRI diseases includes the disease they suffer from. When SUHSDULQJWKHOLVWRIFKURQLFGLVHDVHVLWZDVDVVXPHG that the list should include the basic groups of diseases FRYHUHG E\ ,&'7KHUHIRUH WKH IROORZLQJ JURXSV RIGLVHDVHVZHUHLQFOXGHG FDQFHUGLDEHWHVDQGRWKHU
HQGRFULQHGLVHDVHVPHQWDOGLVRUGHUVFDUGLRYDVFXODUGL-The risk of overweight and obesity in chronic diseases 199
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VHDVHVUHVSLUDWRU\GLVHDVHVGLJHVWLYHGLVHDVHVDUWKULWLV and allergic disorders.
7KH(SL,QIRSURFHVVLQJGDWDEDVHDQGVWDWLVWLFDOV\V-tem for epidemiology for microcomputer was applied for establishing database and statistical analyses. The .UXVNDO:DOOLV non-parametric test for differences be-tween medians was used for the analyses of differences LQ%0,LQGLFDWRUVZKLOH&KLVTXDUHWHVWZDVXVHGWR determine the prevalence of obesity and overweight The risk value of overweight or obesity for chronic diseases ZDVHVWLPDWHGE\RGGVUDWLRV 25 %RWKWKHXQDGMXVWHG 25DQGDGMXVWHGIRUJHQGHUDJHDQGHGXFDWLRQ 0DQWHO +DHQV]HO summarised stratified OR) were presented. 7KHVLJQLILFDQFHZDVDFFHSWHGDWWKHOHYHORIS
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2XW RI WKH UHVSRQGHQWV ZKR UHSRUWHG WKHLU KHLJKWDQGZHLJKWOHVVWKDQKDOIKDGERG\PDVVZLWKLQ WKHQRUPHYHU\WKLUGZDVRYHUZHLJKWDQGRQHLQVHYHQ was obese (Table 1). The prevalence of overweight ZDVFRQVLGHUDEO\KLJKHULQPHQZKLOHWKHGLIIHUHQFH between genders in obesity was slight. The percentage RIRYHUZHLJKWSHRSOHLQFUHDVHGZLWKDJHZKLOHLQWKH obese the noticeable difference was found between the \RXQJHVWJURXSDQGWKRVHRYHU\HDUV$OWKRXJKWKH DYHUDJH %0, VFRUHV VLJQLILFDQWO\ GLIIHUHQWLDWHG WKH respondents varied by the level of education (the lower OHYHO RI HGXFDWLRQ WKH KLJKHU %0, QHYHUWKHOHVV WKH differences in distribution of overweight and obese in relation to education were too small to reach statistical significance.
3HRSOHVXIIHULQJIURPGLDEHWHVUHVSLUDWRU\GLVHDVHV cardiovascular diseases and arthritis were characterised E\WKHKLJKHVW%0,VFRUHV 7DEOH 2EHVLW\DQGDOVR overweight were found to be significant risk factors for
the most chronic diseases. Obesity increased the risk RIRFFXUUHQFHRIGLDEHWHVDQGUHVSLUDWRU\GLVHDVHV WLPHVZKLOHFDUGLRYDVFXODUGLVHDVHVDUWKULWLVGLJHVWLYH GLVHDVHVDQGPHQWDOGLVRUGHUVIURPDOPRVWWRWLPHV 2YHUZHLJKWLQFUHDVHGWLPHVWKHULVNRIRFFXUUHQFHRI GLDEHWHVDQGWLPHVWKHULVNRIUHVSLUDWRU\GLVHDVHV arthritis and cardiovascular diseases. The risk of obesity LQFDQFHUVDQDO\VHGWRJHWKHUDVZHOODVIRUHQGRFULQH disorders (without diabetes) and allergic disorders was not found.
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Results of our study showed that obesity genera-WHGKLJKHVWULVNIRUGLDEHWHVDQGUHVSLUDWRU\GLVHDVHV IROORZHGIRUDUWKULWLVPHQWDOGLVRUGHUVFDUGLRYDVFXODU diseases and digestive diseases. The previous studies KDYHJHQHUDOO\FRQILUPHGWKLVVHTXHQFHUHJDUGOHVVRI how the risk was defined. If the population-attributa-EOHIUDFWLRQ 3$) ZDVXVHG RIGLDEHWHV RIFDUGLRYDVFXODUGLVHDVHVRI DUWKULWLVDQGRIGLJHVWLYHGLVHDVHVIRXQGWR EHDWWULEXWHGWRREHVLW\>@
In the previous studies using the risk assessment FDOFXODWLQJDVRGGVUDWLR±25RUULVNUDWLR±55 WKH dispersion of the risk of diabetes caused by obesity was KLJKDQGWKHHVWLPDWHGULVNUDQJHGIURPWR KRZHYHULQPRVWRIWKHVWXGLHVWKHULVNZDVKLJKHUWKDQ >@,QWKHUHVHDUFKLQZKLFKWKHREHVLW\ FODVV,,DQG,,,ZHUHVHSDUDWHO\DQDO\VHGWKHULVNRIGLD-EHWHVIRUWKHVHJURXSVUDQJHGIURPWR>@7KH estimated risk of all respiratory diseases ranged from 1.3 WR>@$PRQJWKHVHGLVHDVHVWKHREHVLW\K\SRYHQWL-ODWLRQV\QGURPHRFFXUVRQO\LQWKHREHVHEHFDXVHRQH RIWKHFULWHULDRIGLDJQRVLVLV%0,!DQGIURPWR RIVXEMHFWVKDGPRUELGREHVLW\ %0,! > @$V Table 1. Differences in body mass in relation to demographic characteristics
Demographic characteristics
%0, Category of body mass
Mean p1 Norm Q Overweight Q Obesity Q p 7RWDO Q Gender 0DOH Q )HPDOH Q Age Q Q RUPRUH Education 6HFRQGDU\RUORZHU Q +LJK Q 37.9 35.9 37.8 38.3 15.3 13.3 11.3 16.3 16.9 1 .UXVNDO:DOOLV test &KL2 test
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be-WZHHQDQGDQGEHWZHHQDQG> @ %HVLGHVGLDEHWHVWKHULVNRIFHUWDLQRWKHUQRQQHRSODVWLF HQGRFULQH GLVHDVHV DUH ZHOO GRFXPHQWHG HVSHFLDOO\ IRUWK\URLGGLVHDVHV K\SRWK\URLGLVPQRGXODUJRLWHU IRUZKLFKWKHULVNYDULHGIURPWR>@ $VUHJDUGVPHQWDOGLVRUGHUVVRPHVWXGLHVFRQILUPHG obesity as a risk factor. The estimated risk of obesity IRUGHSUHVVLRQUDQJHGIURPWR>@IRU DQ[LHW\IURPWR>@IRUELSRODUDIIHFWLYH GLVRUGHUIURPWR >@DQGIRUSRVWWUDXPDWLF VWUHVVGLVRUGHU±>@2QWKHRWKHUKDQG6FRWW et al. in the international comparative study observed that value of the risk was largely country-specific. The risk differentiation of depression due to obesity ranged from LQ,WDO\DQGWKH1HWKHUODQGVWRLQ-DSDQDQGIRU DQ[LHW\IURPLQ,WDO\WRLQWKH1HWKHUODQGV>@ 7KH ULVN IRU FKURQLF GLVHDVHV FDXVHG E\ REHVLW\ UHSRUWHGLQRXUVWXG\ZDVFRPSDUDEOHWRUHVXOWVIURP WKHRWKHUVWXGLHVZLWKWKHH[FHSWLRQRIUHVSLUDWRU\GL-VHDVHVDQGPHQWDOGLVRUGHUVZKHUHWKHULVNLGHQWLILHG in our study was much higher. As regards respiratory GLVHDVHVWKHSUHYLRXVVWXGLHVLQFRQWUDU\WRRXUVWXG\ usually excluded sufferers from obesity hypoventilation V\QGURPHDPRQJZKRVHDOODUHREHVH7KHUHIRUHLQ RXUVWXG\LQFRPSDULVRQWRRWKHUFKURQLFGLVHDVHVWKH percents of obese patients with respiratory diseases was the highest.
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%0, Mean Overweight Obesity Unadjusted OR &, Adjusted OR &, Unadjusted OR &, Adjusted OR &, +HDOWK\ Q 'LDEHWHV Q 5HVSLUDWRU\GLVHDVHV Q &DUGLRYDVFXODUGLVHDVHV Q $UWKULWLV Q 'LJHVWLYHGLVHDVHV Q 2WKHUHQGRFULQHGLVHDVHV Q 0HQWDOGLVRUGHUV Q &DQFHU Q $OOHUJLFGLVRUGHUV Q 3.1 (1.1-8.9) 1.8 1.1 (1.1-9.6) 1.6 1.3 11.8 6.5 5.7 1.7 9.6* 6.3** 3.8* (1.3-83.6) 3.3 5.8* 25±RGGVUDWLR DGMXVWHGIRUJHQGHUDJHDQGHGXFDWLRQ
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The issue of obesity risk for cancers requires se-parate discussion. The authors of several prospective and methodologically excellent studies confirmed that obesity existing at baseline of the research significantly increases the risk of occurrence of certain cancers in people healthy at baseline. The estimated risk of obe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risk of obesity for cancers analysed together reported in our study.
The association between overweight and chronic diseases seems to be more complicated. The previous studies confirmed in general that overweight significan-WO\LQFUHDVHGWKHULVNRIGLDEHWHVDQGWKHHVWLPDWHGULVN OD\LQWKHLQWHUYDO±>@$VUHJDUGVRWKHU FKURQLFGLVHDVHVWKHFXUUHQWUHVXOWVDUHLQFRQFOXVLYH DQGUHSRUWHGULVNUDQJHGIURP WRIRUUHVSLUDWRU\ GLVHDVHV>@IURPWRIRUFDUGLRYDVFXODUGL-VHDVHV>@IURP±IRURVWHRDUWKULWLV> @DQGIURP WRIRUGLJHVWLYHGLVHDVHV>@,Q WKHVWXGLHVOLNHRXUVLQZKLFKZHLJKWDQGKHLJKWZHUH VHOIUHSRUWHGE\UHVSRQGHQWVWKHULVNRIFKURQLFGLVHDVHV caused by overweight was usually higher than measured E\DQWKURSRPHWULFPHWKRGVEHFDXVHUHVSRQGHQWVZHUH likely to underestimate their weight or overestimate KHLJKW>@7KXVPDQ\RIWKHPZHUHUHDOO\REHVH
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Our studies that data on weight and height collected through survey method may provide some information about the magnitude of the risk of particular groups of diseases attributable to overweigh and obesity. In par-WLFXODUWKHVHOIUHSRUWHGZHLJKWDQGKHLJKWE\:DUVDZ inhabitants indicated that:
1. Obesity strongly increased the risk of several chronic GLVHDVHVWRWKHJUHDWHVWH[WHQWRIGLDEHWHVDQGUH-VSLUDWRU\GLVHDVHVDQGDOVRFDUGLRYDVFXODUGLVHDVHV DUWKULWLVGLJHVWLYHGLVHDVHVRWKHU H[FHSWGLDEHWHV endocrine diseases and mental disorders.
2YHUZHLJKW ZDV IRXQG WR EH WKH VLJQLILFDQW ULVN factor of diabetes. The higher than expected risk IRU UHVSLUDWRU\ GLVHDVHV FDUGLRYDVFXODU GLVHDVHV
arthritis and digestive diseases would indicate that reported weight may be underestimated or self- UHSRUWHGKHLJKWRYHUHVWLPDWHGDQGPDQ\RIRYHU-ZHLJKWSHRSOHZHUHUHDOO\REHVH1HYHUWKHOHVVWKH XQGHUHVWLPDWLRQRI%0,FDOFXODWHGE\VHOIUHSRUWHG weight and height should be taken into account.
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