The effects of socioeconomic indicators on dietary habits, physical activity and nutritional status in Macedonian youth

Prof. D-r Simovska Vera, MD., PhD.

CBM Summer School 2010, Pesonalized Medicine “Nutrition and Health”

IntroductionIntroduction Strong evidence shows that physical inactivity physical inactivity increases the risk of health problems, including major noncommunicable diseases (NCDs) such as coronary heart disease, type 2 diabetes (T2DM), and breast and colon cancers, and shortens life expectancy. Unbalanced diets: Unbalanced diets: high in sugars, saturated and trans fats, low fiber foods, sweetens food and soft drinks contribute to NCDs and other health problems. High intake of “fast food” and processed foods increases these health risks.

Numerous studies were confirmed that a low socioeconomic socioeconomic status status (income, education)income, education) is related to less healthy dietary habits and lower participating in sport, but certain reasons for this remain unclear.

It’s known that families with low levels of incomeincome, price is important drivers for food selection, whereas a higher income is related to a higher relative importance of individual health status.


Smoking

Unhealthy nutritionUnhealthy nutrition

Physical inactivityPhysical inactivity

Alcohol

CVD

Diabetes

Cancer

Pulmonary disease

Musculoskeletal

Oral health

An integrated approach to prevention of NCDAn integrated approach to prevention of NCD

The highest priority in prevention and reduction of NCD is addressing to common common behavioural risk factors behavioural risk factors associated with the lifestyle the lifestyle of the population: unbalanced nutritional, physical inactivity, tobacco use, higher level of alcohol consumption and a chronically stressful life and anxiety.


“Major” NCD’s known as nutrition-related diseases represents a huge public health problem, 75% of total mortality in Macedonia (2012).

Integrated approach, targeting main behavioural factors: diet, physical activity and tobacco is a key of success health promotion policy.


Objectives

- To describe socioeconomic differences in dietary habits, physical activity including sport and BMI distribution in youth of Republic of Macedonia, in 2012.

- To analyse and evaluate the results obtained from the new “cross-section” study for common behavioural risk factors of youth in 2014.

- To propose a new prevention measures related to health inequalities and behavioural risk factors of Macedonian youth (2014).

Non-modifiableNon-modifiableRisk FactorsRisk Factors

AgeSex

Genes

Behavioural Behavioural risk factorsrisk factors

Diet Diet Physical ActivityPhysical Activity

TobaccoTobaccoAlcohol

Chronically stressful life and anxiety

Socioeconomic, Socioeconomic, Cultural & EnvironmentalCultural & Environmental

ConditionsConditions


.

Methods I

The survey was comprised of a self – administered questionnaire: 1 - Dietary habits Dietary habits were monitored by using the standardized, non-quantitative Food Frequency Questionnaire to examine the frequency of consumption of various foods groups during the week. According to the FFQ survey, regular consumption of certain foods meant 5 and/or several times a week. Occasional consumption of certain foods mean 2-4 times a week. The third group included respondents who were once a week or do not consume certain foods. 2 - Leisure time physical activity (LTPA) Leisure time physical activity (LTPA) including sportsport was a priority measure in the study, because data collected is expressed in certain intensity categories of physical activity (PA) includes a comprehensive list of examples of brisk walking, and easy bicycling known as PA with moderate intensity, as well as walking, household activities, gardening and other activities known as light activities with low intensity. Organized sports known as strenuous activity are the form of LTPA for improving physical fitness. Physical inactivity was noted using term “no activity”


3 - 3 - Nutritional status Nutritional status was estimated using body weight, height and BMI kg/mBMI kg/m22 presented in presented in percentilepercentile using the WHO Child Growth Standards.

4 - Indicators of socioeconomic inequalities socioeconomic inequalities in health behaviour by gender and age : → income income per family member per family member : : Individual income was calculated by the household budget divided with the number of family members. It was measured as monthly income and grouped in three classes: up to 75 Eurosto 75 Euros, from 75 to 150 75 to 150 Euros Euros and over 150 Eurosover 150 Euros per family member. → Education of parentsEducation of parents: : primary (elementary), secondary and higher education (university degree).

Regarding to PA, the first “cross-section” population-based study was conducted in 2012 including 580 participants aged 10-18 years using LTPA LTPA as priority measure in the study.

A “new” study was conducted in 2014 including 400 participants aged 12 – 18 years using IQPAIQPA (short version) including “sitting sitting time/daytime/day”.

The results were presented in percentages (%) of total numbers of the participants examined in separate studies, in 2012 and 2014.

Methods II


R E S U L T S – Physical Activity R E S U L T S – Physical Activity

In 20122012, Nearly 60% of Macedonian children and adolescent younger than

19 years had vigorous to moderate intensity of PA such as organized sports.

28% of young people had low intensity of PA, especially girls and 12%12% was

physically inactive.

In 20142014, 71.2% had vigorous to moderate intensity of PA and 28.7%28.7% of all

participants was sedentary or physically inactive.

Regarding PA, higher family income had higher impact on the engagement

in organized sports activities of youth (31.4%), and low effect on participating

in moderate intensity of PA (brisk walking, cycling) - 26.5%.

However, more research is needed in order to evaluate the effect of

socioeconomic indicators on PA including sport activities of youth, health and

inequalities.


Proportion (%) of youth between 10-18 years old related to Proportion (%) of youth between 10-18 years old related to income and PALs (2012) income and PALs (2012)


Education and family monthly income have low impact on the frequency of consumption of fruits and vegetables. The main reason is relatively low price, availability and relative good production of vegetables and fruits in the Republic of Macedonia.

CBM Summer School 2010, Pesonalized Medicine “Nutrition and Health” Education is associated negatively with the consumption of energy-dense foods.

11% 11% од испитаниците купуваат храна на база на здравствените ефекти. од испитаниците купуваат храна на база на здравствените ефекти. Главен фактор се најчесто вкусот и цената.Главен фактор се најчесто вкусот и цената.


16.1%16.1% од младите лица имаа прекумерна телесна тежина и дебелина прекумерна телесна тежина и дебелина (споредспоред BMIBMI) во 2012 (Симовска В.), Симовска В.), додека тој процент изнесуваше 16.75%16.75% според перцентилитеперцентилите во 2013 (ЈакимоваЈакимова--Јорданоска, РЈорданоска, Р), а во 2014, процентот порасна на 23.23.77%, %, подеднакво изразен во перцентили перцентили (Старова, В (Старова, В ..))


ConclusionConclusion

The first complex results of our study indicate that the action for health through

improving physical activity levels and dietary habits should be focused on should be focused on youngeryounger age

groups.

Concerning the changes in dietary habits, the most important is radical change in

the food market and changes in food production food production including availability of whole grain

bread, fresh fish and eliminating “fast food”eliminating “fast food”, sweetness food sweetness food (pasta, rise and

potatoes) and soft drinkssoft drinks..

On the practical level, reducing the price of healthy food reducing the price of healthy food could be an effective

strategy for improving the diets, guidelinesguidelines, , policy on food labelling policy on food labelling and health health

claimsclaims. . However, more research is needed in order to evaluate the exact effects of a range

of pricing strategies on food consumption as well as the effect of socioeconomic

indicators on PALs including sport activities of youth and health.

One of the important measure is city planning city planning that facilitates active

(environmental support).


Recommendations: Application of population-based preventionpopulation-based prevention, acting on changes in

dietary habits and other risk factors associated with the lifestyle of the

whole population is the most stable and effective way to reduce the NCD

morbidity and to promote health in combination with high risk strategy.

The next step is to develop an innovative “Skills for HealthSkills for Health” model

including nutrition and physical activity educationeducation program in Macedonia.

Also, it’s useful to implement the Standards for school’s daily mails to implement the Standards for school’s daily mails

prepared by Macedonian Ministry of Science and Education in 2014 (Expert

group).

“Sports club for HealthSports club for Health” is health-oriented sports activities in a club

setting . It’s an approach in which sports clubs are encouraged to invest

on health related sports activities and /or health promotion within it’s

activities.

Health & Medicine

The effects of socioeconomic indicators on dietary habits, physical activity and nutritional status in Macedonian youth