Zoltán Jancsó

Elhízó Magyarország. A túlsúly és az elhízás trendje és prevalenciája Magyarországon, 2015

INTRODUCTION The prevalence of obesity is growing continuously worldwide, even in Hungary. Since 1988, when the first professional wide-range evaluation was performed, only limited data are available. AIM Authors present the results of the ever largest Hungarian obesity-prevalence surveys, performed by family and occupational physicians. METHOD Data from 0.55% of the population above 18 year were registered in all geographical regions of Hungary (43,287 persons; 17,901 males and 25,386 females), close to the proper national representativeness. Age, body mass index, waist circumference, educational level, presence of hypertension and/or diabetes were analyzed statistically and compared with previous data. RESULTS The overall prevalence rate of overweight and obesity among men was 40% and 32%, respectively, while overweight and obesity occurred in 32% of women. In the different age groups of men, the prevalence of overweight and obesity was: 32.7% and 18.2% in 18-34 years; 40.1% and 34.4% in 35-59 years; 43.5% and 38.8% in over 60 years, respectively. In the same age groups of women, overweight and obesity occurred in 19.6% and 15.7%, 36.8% and 38.7%, and 36.5% and 39.7%, respectively. Body mass index and waist-circumference were presented according to age, by decades and by type of residency as well. The highest ratio of overweight was registered among men with the highest educational level, while highest ratio of obesity among women having the lowest education. Obesity according to Body mass index and abdominal obesity was the highest in the villages, especially among females. Registered metabolic morbidities were strongly correlated with body mass index and both were inversely related to the level of urbanization. CONCLUSIONS Over the previous decades, the ratio of the overweight and even the number of obese persons increased significantly, and it was most prominent among males, mainly in younger generation. Obesity means a serious medical, public health and economic problem, and it requires higher public awareness and political support. Orv. Hetil., 2016, 157(31), 1248-1255.Absztrakt Bevezetes: A vilagszerte novekvő aranyu elhizas Magyarorszagon is eszlelhető, populacios előfordulasarol az első nagyszabasu felmeres 1988-ban tortent. Celkitűzes: A szerzők az eddigi legnagyobb esetszamu hazai elhizasprevalencia-vizsgalataik eredmenyeit mutatjak be, amelyet haziorvosok es foglalkozas-egeszsegugyi orvosok reszvetelevel bonyolitottak le. Modszer: A 18 ev folotti magyar lakossag 0,55%-anak, 43 287 fő (17 901 ferfi es 25 386 nő) regisztralt adatait elemeztek, orszagosan reprezentativ megoszlasban. Osszehasonlitottak a korabbi hazai vizsgalatokkal, elemeztek a testtomegindex, haskorfogat, iskolazottsag, hypertonia es/vagy diabetes jelenlete es az eletkor kozotti kapcsolatot. Eredmenyek: Osszessegeben ferfiaknal a tulsuly 40%, az elhizas 32%-ban van jelen, mig nőknel mindket kategoria kozel 32%-ban. A 18–34 ev kozotti eletkori csoportban a ferfiak 32,7%-a tulsulyos, mig 18,2%-uk elhizott, 35–59 ev kozott 40,1% es 34,4%, 60 ev folott 43,5%, illetve 38,8%. Ugyanezen korosztalyi adatok ...

A public health threat in Hungary: obesity, 2013.

BackgroundIn Hungary, the last wide-range evaluation about nutritional status of the population was completed in 1988. Since then, only limited data were available. Our aim was to collect, analyze and present updated prevalence data.MethodsAnthropometric, educational and morbidity data of persons above 18 y were registered in all geographical regions of Hungary, at primary care encounters and within community settings.ResultsData (BMI, waist circumference, educational level) of 40,331 individuals (16,544 men, 23,787 women) were analyzed. Overall prevalence for overweight was 40.4% among men, 31.3% among women, while for obesity 32.0% and 31.5%, respectively. Abdominal obesity was 37.1% in males, 60.9% in females. Among men, the prevalence of overweight-obesity was: under 35 y = 32.5%-16.2%, between 35-60 y = 40.6%-34.7%, over 60 y = 44.3%-36.7%. Among women, in the same age categories were: 17.8%-13.8%, 29.7%-29.0%, and 36.9%-39.0%. Data were presented according to age by decades as well. The highest odds ratio of overweight (OR: 1.079; 95% CI [1.026-1.135]) was registered by middle educational level, the lowest odds ratio of obesity (OR: 0.500; 95% CI [0.463-0.539]) by the highest educational level. The highest proportion of obese people lived in villages (35.4%) and in Budapest (28.9%). Distribution of overweighed persons were: Budapest (37.1%), other cities (35.8%), villages (33.8%). Registered metabolic morbidities were strongly correlated with BMIs and both were inversely related to the level of urbanization. Over the previous decades, there has been a shift in the distribution of population toward being overweight and moreover obese, it was most prominent among males, mainly in younger generation.ConclusionsEvaluation covered 0.53% of the total population over 18 y and could be very close to the proper national representativeness. The threat of obesity and related morbidities require higher public awareness and interventions.

Life-long weight change can predict metabolic diseases

BACKGROUND Patients with diabetes and hypertension represent a large proportion of primary care patients. Evaluation of their parameters usually requires medical setting, body weight and height can be measured by the patients themselves and this is often the case. The aim of this retrospective study is to analyse and to compare the life-long data on weight and BMI of patients with diabetes and hypertension and those without these pathologic conditions. PATIENTS Eventually selected 759 patients (337 men, 422 women) between 60 and 70 years of age in different primary care settings were involved. METHODS Retrospective and recent self-recorded data on weight and height in every decade since the age of 20 years in both genders were collected. These were compared to the control group of persons free from diabetes and hypertension. RESULTS The current body weight and BMI were significantly higher in all groups than at 20 years and less than their maximal values. Patients with diabetes started at higher weights and their greatest gain was observed between 20-30 years in men and between 30-40 years in women, and in the last decade prior to diagnosis in both genders. Weight gain in the control group was steady at a lower rate. CONCLUSIONS Higher increases in body weight in the early youth decades were related to elevated hazard ratios for diabetes in men and for hypertension in women. More research with standardized methodology is needed to explore this relationship better: meanwhile more contribution is expected from primary care physicians in the weight management of their younger patients.

Differences in weight gain in hypertensive and diabetic elderly patients primary care study

BackgroundTreatment and care of elderly patients with diabetes and hypertension means a hard task in primary care. Patients with these two components of metabolic syndrome are often overweight or obese. Although some parameters of metabolic syndrome are usually measured in a medical setting, checking body weight is usually done by the patients.AimThe aim of this study is to analyse the patients’ self-recorded data on weight and compare them according to hypertension and diabetes.Patients and MethodsFive hundred and forty people (225 men and 315 women) between 60 and 75 years of age were eventually selected in primary care settings. Retrospective self-recorded data on recent weights and every decade since the age of 20, as well as the decade prior to diagnosis were collected. The data of patients with and without diabetes and/or hypertension were compared.ResultsThe current mean body weight was significantly higher in all groups than at the age of 20. Compared with the control group, hypertensive men and women were approximately of the same weight in their twenties and, also, recently, but they gained more weight in the 4th and 5th decades of their life. Diabetics started at higher weights. The greatest weight gain was observed as follows: between 20–30 years and 30–40 years in men and women, respectively, as well as between 50–60 years of age and in the last decade prior to diagnosis in both genders. Weight gain in the control group was steady at a lower rate.ConclusionsWeight gain between 20–40 years of age could be an important factor in the aetiology of diabetes. Stable or at least limited weight gain may be a preventive factor. Considering the limitations of the study, further and decades long epidemiological evaluations are suggested in a larger study population.

Nutritional Counseling for Diabetic Patients: A Pilot Study in Hungarian Primary Care

Although nutritional advice and counseling are an important part of diabetes care, current Hungarian health care regulations make it available only in the secondary (specialist) care. Authors planned and implemented a self-financed nutritional counseling in primary care setting. For 67 of 108 diagnosed diabetic patients of a primary care practice in Budapest, a free of charge educational service was offered. The 47 patients (45 type 2 and 2 type 1) who accepted the invitation were educated in two consecutive group sessions. Only 24 of them were ready to take part in three further individual consultations. Fasting blood glucose and glycated hemoglobin were measured before and after the sessions and 1 year later. Comparison was made between genders (31 men, 16 women) and patients who took part in the group and the individual nutritional counseling, respectively. Patients with a higher educational level, males and persons with shorter duration of diabetes were more likely to participate in the consultation. All glycemic parameters improved after counseling in both groups, but this was significant only in men and for the group consultation. After 1 year, a further improvement was seen in women and in patients of the individually counseled group. In turn, fasting blood glucose and glycated hemoglobin concentrations of men and group-consulted patients increased again, reaching almost the baseline level before consultations. Nutritional counseling in the primary care offers more comfort and help for diabetics but requires changes in insurance regulation, and reimbursement system together with increase in resources.

An appraisal: how notifiable infectious diseases are reported by Hungarian family physicians

BackgroundWithin the frame of National Epidemiological Surveillance System, family physicians have an obligation to report infections and suspicions cases.The aim of this study was to evaluate the knowledge, attitudes, daily practice and the reporting activities of Hungarian family physicians regarding to infectious diseases.MethodsA self-administered survey was developed, validated and used. The survey was completed by family physicians who had taken part in continuous medical educational programmes of all Hungarian medical faculties. The questionnaire, consisting demographic questions and 10 statements about their reporting habits were completed by 347 doctors, 8% of the total number of family physicians. The data were processed in a cross-sectional design with general linear model.ResultsAccording to the majority of responders, the current reporting system works efficiently. Rural physicians were mainly agreed, that reporting is not a simply obligation, it is a professional task as well. They were less hindered in daily work by reporting activities, waited less for laboratory confirmation before reporting, reported suspicious cases more frequently.Practitioner’s based in urban settlements preferred to await laboratory tests before reporting and were hindered less by failures of the electronic reporting system.Older physicians trusted more in the recent system and they wished to increase the number of reports.Female physicians have higher consciousness in epidemiology. They were mostly in agreement that even severe infectious diseases can be diagnosed at primary care level and their daily practices were less burdened by reporting duties.ConclusionsBoth the epidemiological knowledge of general practitioners’ and the electronic surveillance systems should be improved. There is a need to develope the electronic infrastructure of primary care. More and regular control is also expected by the health care authorities, beside the synthesis of professional and governmental expectations and regulations.

Trends and current questions of cardiovascular prevention in primary health care

Although an impressive progress has been achieved in the treatment of cardiovascular diseases, they are at the top of the mortality statistics in Hungary. Prevention of these diseases is an essential task of the primary health care. Cardiovascular prevention is carried out at primary, secondary and tertiary levels using risk group and population preventive strategies. The two main tasks of primary cardiovascular prevention are health promotion and cardiovascular disease prevention, and its main programs are ensuring healthy nutrition, improving physical training and accomplishing an anti-smoking program. The essential form of secondary prevention is the screening activity of the primary health care. The majority of cardiovascular risk factors can be discovered during the doctor-patient consultation, but laboratory screening is needed for assessing metabolic risks. The official screening rules of the cardiovascular risk factors and diseases are based on diagnostic criteria of the metabolic syndrome; however, nowadays revealing of global cardiometabolic risks is also necessary. In patients without cardiovascular diseases but with risk factors, a cardiovascular risk estimation has to be performed. In primary care, there is a possibility for long term follow-up and continuous care of patients with chronic diseases, which is the main form of the tertiary prevention. In patients with cardiovascular diseases, ranking to cardiovascular risk groups is a very important task since target values of continuous care depend on which risk group they belong to. The methods used during continuous care are lifestyle therapy, specific pharmacotherapy and organ protection with drugs. Combined health education and counselling is the next element of the primary health care prevention; it is a tool that helps primary, secondary and tertiary prevention. Changes needed for improving cardiovascular prevention in primary care are the following: appropriate evaluation of primary prevention, health education and counselling, renewal of the cardiovascular screening system based on the notion of global cardiometabolic risk, creating a unified cardiovascular prevention guideline, and operating primary care cardiovascular prevention within the framework of an integrated prevention system.