Bernadette Kumar

Socio-demographic differences in food habits and preferences of school adolescents in Jiangsu Province, China

Objective:To identify the differences in food habits and preferences among the adolescents according to socio-demographic characteristics.Design:Cross-sectional, cluster design survey in 2002.Setting:Eight middle schools in two distinct socio-economic areas of the Jiangsu province, China.Subjects:Some 824 young adolescents (12–14 y) attending public schools with a response rate of 99%.Methods:A self-administered questionnaire containing questions on food and meal frequencies, food preferences and socio-demographic characteristics was used.Results:High socio-economic status (SES) and urban residence was positively associated with intake of high-energy foods, such as foods of animal origin, Western style foods and dairy products. In all, 76% of the students had three meals a day regularly , but 8.1% urban students vs 3.4% rural students had breakfast only 1–3 times per week or less often. Daily fruit consumption was fairly common, but with clear differences by SES. Only about 42% of the boys and 55% of the girls from low SES families ate fruit daily, compared with 66% and 72%, respectively in the high SES families. Urban boys had the lowest proportion of daily consumers of vegetables (67.0%). More urban students drank milk daily than the rural students (68.7 vs 38.5%). The frequency of milk drinking also showed a strong positive association with SES. About 10% of the high SES boys consumed hamburgers daily compared with 2.8% of the low SES boys. More than half of the students reported a liking for Western style fast foods including hamburgers, soft drinks and chocolate. Among high SES boys, 21.5% consumed soft drinks on a daily basis; however, as many as 72.3% wanted to drink soft drinks more often if they could afford it.Conclusions:SES and urban location were positively associated with frequency of intake of high-energy foods. Reported food preferences may enforce this trend. Nutrition education for adolescents and parents is needed to promote healthy eating. Health Authorities should strengthen the monitoring of food intake and its association with overweight/obesity.Sponsorship:This study was funded by the Norwegian Directorate of Health and Social affairs under the auspices of the Norway—China Health Agreement.

Ethnic differences in obesity among immigrants from developing countries, in Oslo, Norway

Objectives:To compare ethnic and gender differences in generalized and central obesity and to investigate whether these differences persisted after adjusting for socio-demographic and lifestyle factors.Design:In 2002, the population-based cross-sectional, Oslo Immigrant Health study was conducted.Subjects:A total of 7890 Oslo residents, born between 1942 and 1971 in Turkey, Iran, Pakistan, Sri Lanka and Vietnam, were invited and 3019 attended.Measurements:Participants completed a health questionnaire and attended a clinical screening that included height, weight, waist and hip measurements.Results:Generalized obesity (BMI⩾30 kg/m2) was greatest among women from Turkey (51.0%) and least among men from Vietnam (2.7%). The highest proportions of central obesity (waist hip ratio (WHR)⩾0.85) were observed among women from Sri Lanka (54.3%) and Pakistan (52.4%). For any given value of BMI, Sri Lankans and Pakistanis had higher WHR compared to the other groups. Despite a high mean BMI, Turkish men (27.9 kg/m2) and women (30.7 kg/m2) did not have a corresponding high WHR. Ethnic differences in BMI, waist circumference and WHR persisted despite adjusting for socio-demographic and lifestyle factors.Conclusion:We found large differences in generalized and central obesity between immigrant groups from developing countries. Our data find high proportions of overweight and obese subjects from Pakistan and Turkey, but low proportions among those from Vietnam. Subjects from Sri Lanka and Pakistan had the highest WHR for any given value of BMI. Our findings, in light of the burgeoning obesity epidemic, warrant close monitoring of these groups.

Changes in food habits after migration among South Asians settled in Oslo: the effect of demographic, socio-economic and integration factors.

The aim is to explore changes in food habits after migration, and the resultant present food consumption patterns, as well as the effect of demographic, socio-economic and integration factors on these changes. Analyses were based on data collected through the Oslo Immigrant Health study, from 629 persons 30-60 years of age, born in Sri Lanka and Pakistan, and living in Oslo, Norway. A majority of the Sri Lankans reported increase in the consumption of meat, milk, butter, margarine and potatoes. Around half of those from Pakistan reported increased consumption of oil, meat, fish and potatoes. Both groups reported a decrease in bean and lentil consumption. Multivariate regression showed that age was negatively related to increases in butter and margarine consumption, and a good command of the Norwegian language reduced the likelihood of increased consumption of oil and butter. The likelihood of having present fat and sugar rich food patterns were reduced with age and years of education, whereas scoring high on an index of integration increased the likelihood of a fat rich food pattern. In conclusion, a number of demographic and socio-cultural factors may modify the changes in food habits after migration. Some of these may have substantial health implications.

Ethnic differences in body mass index and associated factors of adolescents from minorities in Oslo, Norway: a cross-sectional study

OBJECTIVES To examine ethnic differences in body mass index (BMI), food habits and physical activity, and determine the factors contributing to differences in BMI. DESIGN AND METHOD In 2000-2001, 7343 (response rate 88%) 15- and 16-year-old students, enrolled in lower secondary schools in Oslo, participated in the cross-sectional Oslo Health Study. Of these participants, 1719 were defined as ethnic minorities. RESULTS Significant gender and ethnic differences in mean BMI were observed. Of the ethnic minority adolescents, 5.8% were underweight (<5th percentile of the US Centers for Disease Control and Prevention (CDC)/National Center for Health Statistics (NCHS) reference distribution) and 9.1% were overweight (>85th percentile of the US CDC/NCHS reference distribution). BMI was not significantly associated with either socio-economic factors or physical activity. Food habits and physical activity differed with ethnicity but not with socio-economic factors. An ordinal regression showed that girls from East Asia (odds ratio (OR) 0.4) and boys from sub-Saharan Africa (OR 0.4) had lower BMI than the Western group. Among girls, higher BMI was associated with less frequent consumption of chocolates and sweets, full-fat milk and breakfast (OR 2.4, 1.7 and 1.7, respectively). Higher BMI, for both boys and girls, was associated with current and past dieting (OR 3.7 and 4.2, respectively). CONCLUSIONS Adolescent food habits and physical activity varied by gender and ethnicity but not with socio-economic factors. BMI was associated with ethnicity, gender and food habits, but no significant relationship was observed with socio-economic factors or physical activity. Ethnicity, in addition to gender, should be taken into consideration when studying BMI and associated factors among adolescents.

Cardiovascular disease risk factors among five major ethnic groups in Oslo, Norway: the Oslo Immigrant Health Study:

Background The levels of cardiovascular risk factors vary in different segments of a population. Our aim was to investigate ethnic differences in cardiovascular risk factors among five major immigrant groups in Oslo, Norway. Design A population-based, cross-sectional study. Methods The Oslo Immigrant Health study was conducted in 2002. All first-generation immigrants aged 31-60 years living in Oslo from Sri Lanka, Turkey, Iran, Vietnam, and a random sample of 30% of those from Pakistan, were invited. A total of 3019 individuals provided written consent and met the inclusion criteria. Participants had a clinical examination, blood test, and were asked to complete the study questionnaire. Results Immigrants from Vietnam had the highest high-density lipoprotein (HDL) cholesterol, whereas immigrants from Sri Lanka and Pakistan, and men from Turkey, had the lowest HDL-cholesterol and highest triglycerides. Immigrants from Sri Lanka, Pakistan and Turkey had the highest blood pressure. Smoking was least prevalent among Sri Lankan immigrants and most common among Turkish immigrants. Ethnic differences in blood pressure and HDL-cholesterol, and triglycerides among women, were attenuated after adjusting for obesity measures. A moderate and higher (> 10%) Framingham risk score was most common among Turkish and Pakistani immigrants. Conclusions We found ethnic differences in triglycerides, HDL-cholesterol and blood pressure; however, the differences in blood pressure were surprisingly small. Ethnic differences were partly explained by obesity. The prevalence of smoking also varied greatly between the different ethnic groups. Eur J Cardiovasc Prev Rehabil 13:348-355

Attitudes toward female circumcision among Somali immigrants in Oslo: a qualitative study.

Due to its negative impact on public health, female circumcision (FC) has gained increased attention from international communities and the Norwegian public in recent decades. In 1995, the Norwegian government outlawed the practice and simultaneously developed a package of measures aimed at preventing and ultimately eradicating FC in Norway. Like many other Western countries, immigrants of Somali descent constitute the largest immigrant group in Norway from countries with FC traditions. Although this immigrant group is often perceived as a cultural society that supports FC generally as a practice, there appears to be a lack of studies that explore the impact of acculturation and the Western social context on Somali immigrants’ attitudes toward the practice. Against this background, this paper explores the attitudes of Somalis living in Oslo, Norway to the practice of FC. Findings from this qualitative study indicate that Somalis in Oslo have, to a large extent, changed their attitude toward the practice. This was proven by the presence in Oslo of a large number of Somali parents who left their daughters uncut as well as Somali girls, boys, men, and women who attribute being uncircumcised a high status. This study adds to the knowledge of the process of abandonment of FC among immigrants in the Western countries. The study highlights the success that has been achieved in improving attitudes toward the practice of the Somali community in Oslo, Norway, as well as emerging challenges that need to be addressed further.

Overweight and weight dissatisfaction related to socio- economic position, integration and dietary indicators among South Asian immigrants in Oslo

OBJECTIVE To investigate how socio-economic position, demographic factors, degree of integration and dietary indicators are related to BMI/waist:hip ratio (WHR) and to weight dissatisfaction and slimming among South Asians in Oslo, Norway. DESIGN Cross-sectional study consisting of a health check including anthropometric measures and two self-administered questionnaires. SETTING Oslo, Norway. SUBJECTS Pakistanis and Sri Lankans (n 629), aged 30-60 years, residing in Oslo. RESULTS BMI was positively associated with female gender (P = 0.004) and Pakistani origin (P < 0.001), and inversely associated with years of education (P = 0.011) and eating more hot meals (P = 0.016). WHR was positively associated with male gender (P < 0.001), age (P < 0.001) and a dietary pattern with high-fat foods (P = 0.005), and inversely associated with degree of integration (measured by a composite index, independent of duration of residence; P = 0.017). One-third of those with normal weight and most of those obese were dissatisfied with their weight. Among these, about 40 % had attempted to slim during the past year. Dissatisfaction with weight was positively associated with education in women (P = 0.006) and with integration in men (P = 0.026), and inversely associated with physical activity (P = 0.044) in men. Women who had made slimming attempts had breakfast and other meals less frequently than others (P < 0.05). CONCLUSIONS Weight dissatisfaction exists among South Asian immigrants. More research is needed regarding bodily dissatisfaction and the relationship between perception of weight and weight-change attempts among immigrants in Norway, in order to prevent and treat both obesity and eating disorders.

Differential utilization of primary health care services among older immigrants and Norwegians: a register-based comparative study in Norway

BackgroundAging in an unfamiliar landscape can pose health challenges for the growing numbers of immigrants and their health care providers. Therefore, better understanding of how different immigrant groups use Primary Health Care (PHC), and the underlying factors that explain utilization is needed to provide adequate and appropriate public health responses. Our aim is to describe and compare the use of PHC between elderly immigrants and Norwegians.MethodsRegistry-based study using merged data from the National Population Register and the Norwegian Health Economics Administration database. All 50 year old or older Norwegians with both parents from Norway (1,516,012) and immigrants with both parents from abroad (89,861) registered in Norway in 2008 were included. Descriptive analyses were carried out. Immigrants were categorised according to country of origin, reason for migration and length of stay in Norway. Binary logistic regression analyses were conducted to study the utilization of PHC comparing Norwegians and immigrants, and to assess associations between utilization and both length of stay and reason for immigration, adjusting for other socioeconomic variables.ResultsA higher proportion of Norwegians used PHC services compared to immigrants. While immigrants from high-income countries used PHC less than Norwegians disregarding age (OR from 0.65 to 0.92 depending on age group), they had similar number of diagnoses when in contact with PHC. Among immigrants from other countries, however, those 50 to 65 years old used PHC services more often (OR 1.22) than Norwegians and had higher comorbidity levels, but this pattern was reversed for older adults (OR 0.56 to 0.47 for 66-80 and 80+ years respectively). For all immigrants, utilization of PHC increased with longer stay in Norway and was higher for refugees (1.67 to 1.90) but lower for labour immigrants (0.33 to 0.45) compared to immigrants for family reunification. However, adjustment for education and income levels reduced most differences between groups.ConclusionsImmigrants’ lower utilization of PHC services might reflect better health among immigrants, but it could also be due to barriers to access that pose public health challenges. The heterogeneity of life courses and migration trajectories should be taken into account when developing public policies.

Multimorbidity among registered immigrants in Norway: the role of reason for migration and length of stay.

International migration is rapidly increasing worldwide. However, the health status of migrants differs across groups. Information regarding health at arrival and subsequent periodic follow‐up in the host country is necessary to develop equitable health care to immigrants. The objective of this study was to determine the impact of the length of stay in Norway and other sociodemographic variables on the prevalence of multimorbidity across immigrant groups (refugees, labour immigrants, family reunification immigrants and education immigrants).

High Levels of Cardiovascular Risk Factors among Pakistanis in Norway Compared to Pakistanis in Pakistan

Objectives. Previous studies have shown that the Norwegian-Pakistanis had considerably higher prevalence for diabetes and obesity compared to Norwegians. We studied the additional risk of obesity, dyslipidemia, and hypertension among Pakistanis in Norway compared to Pakistanis living in Pakistan. Method. 770 Norwegian-Pakistani adults (53.9% men and 46.1% women) born in Pakistan from two surveys conducted in Norway between 2000 and 2002 were compared with a sample of 1230 individuals (29.1% men and 70.9% women) that participated in a survey in Pakistan in 2006. Results. Both populations had similar height, but Norwegian-Pakistanis had considerably higher mean weight. Of the Norwegian-Pakistanis, 56% of the males and 40% of the females had a BMI above 25 kg/m2, as opposed to 30% and 56% in Pakistan, for males and females, respectively. Norwegian-Pakistanis had higher total cholesterol. Conclusion. Obesity and an unfavourable lipid profile were widely prevalent in both populations; the highest level was recorded amongst those living in Norway. The increased risk for obesity and dyslipidemia may be ascribed to change of lifestyle after migration.