title: Educational inequalities in obesity, abdominal obesity, and metabolic syndrome in seven Latin American cities: the CARMELA Study.
abstract: OBJECTIVE
  Earlier reviews have found that the proportion of inverse associations between socioeconomic status and obesity increased according to the level of development of the studied country. Based on this finding, it has been hypothesized that in low- to middle- income countries the burden of obesity shifts to disadvantaged groups as a country develops.
  
  
  RESULTS
  CARMELA is a cross-sectional, population-based observational study that sampled 11,550 women and men age 25-64 from seven major Latin American cities. We analyzed by gender the association of educational attainments (as proxy of socioeconomic status) with body mass index, waist circumference and metabolic syndrome. Participating cities were divided by country Human Development Index (HDI). An inverse gradient between socioeconomic status and body mass index in women was uniformly present in High HDI cities (Buenos Aires, Santiago, Mexico) but not in Medium HDI group (Barquisimeto, Bogota, Lima, Quito), where two cities showed an inverse gradient and two cities did not. In men, no clear socioeconomic gradients were found. Findings regarding waist circumference and metabolic syndrome closely mirrored those about body mass index.
  
  
  CONCLUSIONS
  In women but not men, these results give support to the hypothesis of obesity shifting to the poor and extend it to the related concepts of abdominal obesity and metabolic syndrome. Obesity should be considered as a socially-generated disease and an indicator of socioeconomic disadvantage, to be approached by comprehensive strategies that bear in mind this perspective.
authors: Coronary Care Unit, Centro de Educación Médica e Investigaciones Clínicas 'Norberto Quirno', Ciudad Autónoma de Buenos Aires, Argentina. pboisson@intramed.net
authors: Carlos
authors: C
authors: Boissonnet
authors: Herman
authors: H
authors: Schargrodsky
authors: Fabio
authors: F
authors: Pellegrini
authors: Alejandro
authors: A
authors: Macchia
authors: Beatriz
authors: B
authors: Marcet Champagne
authors: Elinor
authors: E
authors: Wilson
authors: Gianni
authors: G
authors: Tognoni
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology*; D056128:Obesity, Abdominal / Q000175:diagnosis / Q000453:epidemiology*; D011203:Poverty; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D014504:Urban Health / Q000706:statistics & numerical data*; D055105:Waist Circumference