Urban rural differences in diet, physical activity and obesity in India: are we witnessing the great Indian equalisation? Results from a cross-sectional STEPS survey Jaya Prasad Tripathy, J.S. Thakur, Gursimer Jeet, Sohan Chawla, Sanjay Jain and Rajendra Prasad ripathy et al. BMC Public Health (2016) 16:816 OI 10.1186/s12889-016-3489-8
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Urban rural differences in diet, physical activity and obesity in India: are we witnessing the great Indian equalisation? Results from a cross-sectional STEPS
Sources of data and detailsComparability of assessment methods
Yes
Recommendation ReportBias Potential sources of bias No
Study size Sample size calculation YesQuantitative variables
How quantitative variables were handled in the analyses
Yes
Statistical methods
1. Describe all statistical methods, including those used to control for confounding
2. Describe any methods used to examine subgroups and interactions
3. Explain how missing data were addressed
Yes
STROBE check list…
PARAMETERS STUDIED1. Socio-demographic profile and
Behavioural information (Tobacco and alcohol use, diet, physical activity, H/O chronic diseases, family H/O chronic conditions, health screening and health care costs)
2. Physical measurementsa) Weight: SECA electronic weighing scale to nearest 100gb) Height: SECA adult portable stadiometer to the nearest 0.1cmc) Waist circumference: SECA constant tension tape to the nearest
0.1cm Midway between the lowest rib margin and the iliac crest
d) BMI: Categorised as normal, overweight and obese
PARAMETERS STUDIED..3. Dietary practices • 1 serving of vegetable – 1 cup of raw green leafy vegetables / ½
cup of other vegetables (cooked/chopped raw) • 1 serving of fruit – 1 medium size piece of apple, banana or
orange, ½ cup of chopped, canned fruit / ½ cup of fruit juice
PARAMETERS STUDIED..4. Levels of physical activity • GPAQ (Global Physical Activity Questionnaire) developed by WHO • 3 domains – work, transport & during leisure time in a normal
active week • Activities – vigorous, moderate & light • Minimum duration of physical activity/week recommended by
WHO → 150 min of moderate intensity physical activity / 75 min of vigorous intensity physical activity
(OR) Equivalent combination of moderate + vigorous
intensity physical activity at least 600 MET with each activity performed in bouts of at least 10 min duration
PARAMETERS STUDIED..4. Obesity • Asian cut off < 18.5 → Underweight 18.5 – 23 → Normal weight 23 – 27.5 → Pre-obese > 27.5 → Obese • WHO cut off < 18.5 → Underweight 18.5 – 24.9 → Normal weight 25 – 29.9 → Pre-obese / Overweight 30 – 34.9 → Class 1 obesity 35 – 39.9 → Class 2 obesity > 40 → Class 3 obesity
Table 1: Socio-demographic profile of study participants in STEPS Survey, Punjab, India
Table 2: Urban rural differences in dietary practices, STEPS Survey, Punjab, India 2014-2015
Table 3: Urban rural differences in levels of physical activity, STEPS Survey, Punjab, India 2014-2015
Table 3: Urban rural differences in body mass index and abdominal obesity, STEPS Survey, Punjab, India 2014-2015
Table 4: Socio-demographic characteristics associated with obesity and lack of physical activity, STEPS Survey, Punjab, India 2014-2015
Recommendation Report
Results
Participants 1. Report numbers of individuals at each stage of study
2. Give reasons for non-participation at each stage
3. Consider use of a flow diagram
Yes
Descriptive data
1. Characteristics of study participants, number of participants with missing data (Give information separately if applicable, for exposed and unexposed groups in cohort studies)
2. Indicate number of participants with missing data for each variable of interest
3. Summarise follow-up time (eg, average and total amount)
Yes
Outcome data Numbers of outcome events or summary measures over time
Yes
STROBE check list…
Recommendation Report
Results 1. Unadjusted estimates and, if applicable, confounder-adjusted estimates and their precision (eg, 95% confidence interval)
2. Report category boundaries when continuous variables were categorized
3. If relevant, consider translating estimates of relative risk into absolute risk for a meaningful time period
Yes
Other results Report other analyses done—eg analyses of subgroups and interactions, and sensitivity analyses
STROBE check list…
DISCUSSIONDiet and physical activity:• Present study - Minimal urban rural differences in dietary habits
and levels of physical activity• Other studies- Higher physical inactivity in urban areas and poor
intake of fruits and vegetables in the rural areas• Similar survey conducted in 2005 in India reported 6.8% of overall
inactivity levels• Recent studies reports 38 to 70% of higher levels of physical
inactivity in India – indicating declining physical activity levels in recent times
DISCUSSION...
Obesity:• Present study – Urban females had higher proportion of
obesity compared to rural counterparts• Previous study have highlighted significant urban rural
differences in prevalence of overweight and obesity with urban dwellers being more overweight and obese
DISCUSSION...
Recreational physical activity:• Current study – 90% of individuals in both urban and rural
areas reports no physical activity during leisure time• Other studies in India and Vietnam – inactivity in the
recreational domain to be as high as 90%
RECOMMENDATIONS
Multi-pronged strategic approach :• For promoting healthy diet• Restricting the use of unhealthy diet
Regulations to control the content of salt, sugar, saturated fats and trans fats in dietary products
STRENGHTS
• Multi-stage stratified sampling approach• Involved whole state of Punjab• Followed standard methodology of STEPS survey