Abdominal vs. overall obesity among women in a nutrition transition context: geographic and socio-economic patterns of abdominal-only obesity in Tunisia.
BACKGROUND
Most assessments of the burden of obesity in nutrition transition contexts rely on body mass index (BMI) only, even though abdominal adiposity might be specifically predictive of adverse health outcomes. In Tunisia, a typical country of the Middle East and North Africa (MENA) region, where the burden of obesity is especially high among women, we compared female abdominal vs. overall obesity and its geographic and socio-economic cofactors, both at population and within-subject levels.


METHODS
The cross-sectional study used a stratified, three-level, clustered sample of 35- to 70-year-old women (n = 2,964). Overall obesity was BMI = weight/height(2) ≥ 30 kg/m(2) and abdominal obesity waist circumference ≥ 88 cm. We quantified the burden of obesity for overall and abdominal obesity separately and their association with place of residence (urban/rural, the seven regions that compose Tunisia), plus physiological and socio-economic cofactors by logistic regression. We studied the within-subject concordance of the two obesities and estimated the prevalence of subject-level "abdominal-only" obesity (AO) and "overall-only" obesity (OO) and assessed relationships with the cofactors by multinomial logistic regression.


RESULTS
Abdominal obesity was much more prevalent (60.4% [57.7-63.0]) than overall obesity (37.0% [34.5-39.6]), due to a high proportion of AO status (25.0% [22.8-27.1]), while the proportion of OO was small (1.6% [1.1-2.2]). We found mostly similar associations between abdominal and overall obesity and all the cofactors except that the regional variability of abdominal obesity was much larger than that of overall obesity. There were no adjusted associations of AO status with urban/rural area of residence (P = 0.21), education (P = 0.97) or household welfare level (P = 0.94) and only non-menopausal women (P = 0.093), lower parity women (P = 0.061) or worker/employees (P = 0.038) were somewhat less likely to be AO. However, there was a large residual adjusted regional variability of AO status (from 16.6% to 34.1%, adjusted P < 0.0001), possibly of genetic, epigenetic, or developmental origins.


CONCLUSIONS
Measures of abdominal adiposity need to be included in population-level appraisals of the burden of obesity, especially among women in the MENA region. The causes of the highly prevalent abdominal-only obesity status among women require further investigation.
IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, 911 av. Agropolis, 34394 Montpellier, France.
Pierre
P
Traissac
IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, 911 av. Agropolis, 34394 Montpellier, France.
Rebecca
R
Pradeilles
INNTA (National Institute of Nutrition and Food Technology), 11 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia ; SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia.
Jalila
J
El Ati
SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia ; INSP (National Institute of Public Health), 5-7 rue de Khartoum, 1002 Tunis, Tunisia ; Faculty of Medicine, Tunis El Manar University, 15 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia.
Hajer
H
Aounallah-Skhiri
IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, 911 av. Agropolis, 34394 Montpellier, France.
Sabrina
S
Eymard-Duvernay
IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, 911 av. Agropolis, 34394 Montpellier, France.
Agnès
A
Gartner
INNTA (National Institute of Nutrition and Food Technology), 11 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia.
Chiraz
C
Béji
INSP (National Institute of Public Health), 5-7 rue de Khartoum, 1002 Tunis, Tunisia.
Souha
S
Bougatef
IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, 911 av. Agropolis, 34394 Montpellier, France.
Yves
Y
Martin-Prével
ITM (Institute of Tropical Medicine), 155 Nationalestraat, 2000 Antwerp, Belgium.
Patrick
P
Kolsteren
SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia.
Francis
F
Delpeuch
Epidemiology and Prevention of Cardiovascular Diseases Research Laboratory, Faculty of Medicine, 15 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia.
Habiba
H
Ben Romdhane
IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, 911 av. Agropolis, 34394 Montpellier, France.
Bernard
B
Maire
Abdominal obesity; Body mass index; Geographic disparities; Nutrition transition; Obesity; Socio-economic factors; Tunisia; Waist circumference; Women