title: The association between obesity and severe disability among adults aged 50 or over in nine high-income, middle-income and low-income countries: a cross-sectional study.
abstract: OBJECTIVE
  The association between obesity and disability may differ between high-income and low-income/middle-income countries but there are no studies comparing this association between these settings. The aim of the study was to assess this association in nine countries using nationally-representative data from the Collaborative Research on Ageing in Europe (COURAGE) study and the WHO's Study on global AGEing and Adult Health (SAGE).
  
  
  METHODS
  Population-based cross-sectional study
  
  
  METHODS
  The survey was conducted in China, Finland, Ghana, India, Mexico, Poland, Russia, South Africa and Spain between 2007 and 2012.
  
  
  METHODS
  42 116 individuals 50 years and older. The institutionalised and those with limited cognition were excluded.
  
  
  METHODS
  Disability was defined as severe or extreme difficulty in conducting at least one of six types of basic activities of daily living (ADL).
  
  
  RESULTS
  The mean body mass index (BMI) ranged from 20.4 kg/m(2) in India to 30.7 kg/m(2) in South Africa. Compared to normal BMI (18.5-24.9 kg/m(2)), BMI≥35 kg/m(2) was associated with significantly higher odds for ADL disability in Finland (OR 4.64), Poland (OR 2.77), South Africa (OR 2.19) and Spain (OR 2.42). Interaction analysis showed that obese individuals in high-income countries were more likely to have ADL limitations than those in low-income or middle-income countries.
  
  
  CONCLUSIONS
  The higher odds for disability among obese individuals in high-income countries may imply longer life lived with disability due to factors such as the decline in cardiovascular disease mortality. In South Africa, this may have been due to the exceptionally high prevalence of class III obesity. These findings underscore the importance of obesity prevention to reduce the disability burden among older adults.
authors.affiliation: Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
authors.forename: Ai
authors.identifier: http://orcid.org/0000-0002-9565-5004
authors.initials: A
authors.lastname: Koyanagi
authors.affiliation: Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
authors.forename: Maria Victoria
authors.initials: MV
authors.lastname: Moneta
authors.affiliation: Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Institut d'Investigacions Biomédiques Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret 167, 08025 Barcelona, Universitat Autónoma de Barcelona, Bellaterra 08193 (Cerdanyola del Vallés), Spain.
authors.forename: Noe
authors.initials: N
authors.lastname: Garin
authors.affiliation: Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Olaya
authors.affiliation: Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Ayuso-Mateos
authors.affiliation: Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland.
authors.forename: Somnath
authors.initials: S
authors.lastname: Chatterji
authors.affiliation: Department of Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation, Milan, Italy.
authors.forename: Matilde
authors.initials: M
authors.lastname: Leonardi
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Päivi
authors.initials: P
authors.lastname: Sainio
authors.affiliation: Department of Epidemiology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Galas
authors.affiliation: Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Haro
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000375:Aging; D003430:Cross-Sectional Studies; D019049:Developed Countries / Q000706:statistics & numerical data*; D003906:Developing Countries / Q000706:statistics & numerical data*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D014943:Global Health; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors
keywords: EPIDEMIOLOGY; NUTRITION & DIETETICS; PUBLIC HEALTH
references.citation: Obesity (Silver Spring). 2013 Dec;21(12):E798-804
references.pmid: 23804319
references.citation: J Am Geriatr Soc. 2012 Dec;60(12):2364-5
references.pmid: 23231555
references.citation: Int J Epidemiol. 2012 Dec;41(6):1639-49
references.pmid: 23283715
references.citation: Int J Integr Care. 2010 Jan 29;10 Suppl:e025
references.pmid: 20228922
references.citation: Popul Dev Rev. 2011;37(3):435-51
references.pmid: 22110257
references.citation: Circulation. 2006 May 16;113(19):2285-92
references.pmid: 16682616
references.citation: Curr Aging Sci. 2011 Dec;4(3):184-91
references.pmid: 21529321
references.citation: JAMA. 1963 Sep 21;185:914-9
references.pmid: 14044222
references.citation: Obes Rev. 2012 May;13(5):456-68
references.pmid: 22212629
references.citation: J Clin Epidemiol. 1996 Dec;49(12):1407-17
references.pmid: 8970491
references.citation: Lancet. 2011 Aug 27;378(9793):804-14
references.pmid: 21872749
references.citation: World Health Organ Tech Rep Ser. 2000;894:i-xii, 1-253
references.pmid: 11234459
references.citation: Clin Psychol Psychother. 2014 May-Jun;21(3):193-8
references.pmid: 23881690
references.citation: JAMA. 2007 Nov 7;298(17):2020-7
references.pmid: 17986695
references.citation: JAMA. 2005 Apr 20;293(15):1868-74
references.pmid: 15840861
references.citation: Int J Obes (Lond). 2008 Sep;32(9):1431-7
references.pmid: 18607383
references.citation: Lancet. 2004 Jan 10;363(9403):157-63
references.pmid: 14726171
references.citation: Obesity (Silver Spring). 2009 Apr;17(4):783-9
references.pmid: 19165165
references.citation: LDI Issue Brief. 2008 Jan;13(3):1-4
references.pmid: 18354852
references.citation: Am J Epidemiol. 2010 Jun 15;171(12):1282-8
references.pmid: 20472569
references.citation: J Am Geriatr Soc. 2014 Feb;62(2):329-35
references.pmid: 24438515