title: Early life urban exposure as a risk factor for developing obesity and impaired fasting glucose in later adulthood: results from two cohorts in Thailand.
abstract: BACKGROUND
  Obesity and obesity related conditions, driven by processes such as urbanization and globalization, are contributing to pronounced cardiovascular morbidity and mortality in developing countries. There is limited evidence on the influence of living in an urban environment in early life on obesity and obesity related conditions later in life in developing countries such as Thailand.
  
  
  METHODS
  We used data from two cohort studies conducted in Thailand, the Thai Cohort Study (TCS) and the Chiang Mai University (CMU) Health Worker Study, to investigate the association between early life urban (vs rural) exposure and the later development of obesity. We additionally explored the association between early life urban exposure and impaired fasting glucose in adulthood using data from the CMU Health Worker Study.
  
  
  RESULTS
  Among 48,490 adults from the TCS, 9.1 % developed obesity within 4 years of follow-up. Among 1,804 initially non-obese adults from CMU Health worker study, 13.6 % developed obesity within 5 years of follow-up. Early life urban exposure was associated with increased risk of developing obesity in adulthood in both cohorts. Adjusting for age and sex, those who spent their early lives in urban areas were 1.21 times more likely to develop obesity in the TCS (OR 1.21, 95 % CI 1.12 to 1.31) and 1.65 times more likely in the CMU Health Worker study (OR 1.65, 95 % CI 1.23 to 2.20). These associations remained significant despite adjustment for later life urban exposure and current household income. No evidence for an association was found for impaired fasting glucose.
  
  
  CONCLUSIONS
  Early life urban exposure was associated with increased risk of developing obesity in adulthood. These findings support public health intervention programs to prevent obesity starting from early ages.
authors.affiliation: Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK. Chaisiri.angkurawaranon@lshtm.ac.uk.|Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. Chaisiri.angkurawaranon@lshtm.ac.uk.
authors.forename: Chaisiri
authors.initials: C
authors.lastname: Angkurawaranon
authors.affiliation: Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. anawat@med.cmu.ac.th.
authors.forename: Anawat
authors.initials: A
authors.lastname: Wisetborisut
authors.affiliation: Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. rerkase@gmail.com.
authors.forename: Kittipan
authors.initials: K
authors.lastname: Rerkasem
authors.affiliation: Faculty of Human Ecology, Sukhothai Thammathirat Open University, Nonthaburi, Thailand. sam-ang.seubsman@anu.edu.au.|National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia. sam-ang.seubsman@anu.edu.au.
authors.forename: Sam-Ang
authors.initials: SA
authors.lastname: Seubsman
authors.affiliation: National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia. Adrian.sleigh@anu.edu.au.
authors.forename: Adrian
authors.initials: A
authors.lastname: Sleigh
authors.affiliation: Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK. pat.doyle@lshtm.ac.uk.
authors.forename: Pat
authors.initials: P
authors.lastname: Doyle
authors.affiliation: Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK. dorothea.nitsch@lshtm.ac.uk.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Nitsch
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D018149:Glucose Intolerance / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*