title: Psychosocial factors and obesity in 17 high-, middle- and low-income countries: the Prospective Urban Rural Epidemiologic study.
abstract: OBJECTIVE
  Psychosocial stress has been proposed to contribute to obesity, particularly abdominal, or central obesity, through chronic activation of the neuroendocrine systems. However, these putative relationships are complex and dependent on country and cultural context. We investigated the association between psychosocial factors and general and abdominal obesity in the Prospective Urban Rural Epidemiologic study.
  
  
  METHODS
  This observational, cross-sectional study enrolled 151 966 individuals aged 35-70 years from 628 urban and rural communities in 17 high-, middle- and low-income countries. Data were collected for 125 290 individuals regarding education, anthropometrics, hypertension/diabetes, tobacco/alcohol use, diet and psychosocial factors (self-perceived stress and depression).
  
  
  RESULTS
  After standardization for age, sex, country income and urban/rural location, the proportion with obesity (body mass index ≥30 kg m(-)(2)) increased from 15.7% in 40 831 individuals with no stress to 20.5% in 7720 individuals with permanent stress, with corresponding proportions for ethnicity- and sex-specific central obesity of 48.6% and 53.5%, respectively (P<0.0001 for both). Associations between stress and hypertension/diabetes tended to be inverse. Estimating the total effect of permanent stress with age, sex, physical activity, education and region as confounders, no relationship between stress and obesity persisted (adjusted prevalence ratio (PR) for obesity 1.04 (95% confidence interval: 0.99-1.10)). There was no relationship between ethnicity- and sex-specific central obesity (adjusted PR 1.00 (0.97-1.02)). Stratification by region yielded inconsistent associations. Depression was weakly but independently linked to obesity (PR 1.08 (1.04-1.12)), and very marginally to abdominal obesity (PR 1.01 (1.00-1.03)).
  
  
  CONCLUSIONS
  Although individuals with permanent stress tended to be slightly more obese, there was no overall independent effect and no evidence that abdominal obesity or its consequences (hypertension, diabetes) increased with higher levels of stress or depression. This study does not support a causal link between psychosocial factors and abdominal obesity.
authors: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
authors: A
authors: A
authors: Rosengren
authors: Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
authors: K
authors: K
authors: Teo
authors: Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
authors: S
authors: S
authors: Rangarajan
authors: Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
authors: C
authors: C
authors: Kabali
authors: North-West University, Optentia Research Programme, Faculty of Humanities, Vanderbilpark, South Africa.
authors: I
authors: I
authors: Khumalo
authors: Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
authors: V R
authors: VR
authors: Kutty
authors: Fortis Escorts Hospital, JLN Marg, Jaipur, Rajasthan, India.
authors: R
authors: R
authors: Gupta
authors: Independent University Bangladesh, Dhaka, Bangladesh.
authors: R
authors: R
authors: Yusuf
authors: Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan.
authors: R
authors: R
authors: Iqbal
authors: Department of Community Health, Universiti Kebangsaan, Kuala Lumpur, Malaysia.
authors: N
authors: N
authors: Ismail
authors: SB Pediatric Endocrinology and Metabolism, Training and Research Hospital, Istanbul, Turkey.
authors: Y
authors: Y
authors: Altuntas
authors: Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: R
authors: R
authors: Kelishadi
authors: Estudios Clinicos Latinoamerica ECLA, Rosario, Santa Fe, Argentina.
authors: R
authors: R
authors: Diaz
authors: Dante Pazzanese Institute of cardiology, Sao Paulo, Brazil.
authors: A
authors: A
authors: Avezum
authors: Physiology Department, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe.
authors: J
authors: J
authors: Chifamba
authors: Department of Social Medicine, Medical University of Wrocław, Wrocław, Poland.
authors: K
authors: K
authors: Zatonska
authors: State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors: L
authors: L
authors: Wei
authors: Sichuan University West China Hospital, Chengdu, Sichuan Province, China.
authors: X
authors: X
authors: Liao
authors: Fundacion Oftalmologica de Santander (FOSCAL) and Medical School, Universidad de Santander (UDES), Santander, Colombia.
authors: P
authors: P
authors: Lopez-Jaramillo
authors: Dubai Health Authority, Dubai, UAE.
authors: A
authors: A
authors: Yusufali
authors: Universidad de La Frontera, Temuco, Chile.
authors: P
authors: P
authors: Seron
authors: Faculty of Health Sciences, Simon Fraser University and Division of Cardiology, Providence Health Care, Vancouver, BC, Canada.
authors: S A
authors: SA
authors: Lear
authors: Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
authors: S
authors: S
authors: Yusuf
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D019049:Developed Countries; D003906:Developing Countries; D004032:Diet; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data