Abstract
Objectives:
To investigate the association between body mass index (BMI) and physical and mental health-related quality of life (HRQoL) in a multiethnic Asian population in Singapore, and explore whether there were gender and ethnic differences in this association.
Methods:
We conducted cross-sectional analyses using data from 5027 Chinese, Malay and Indian participants (2403 men and 2624 women) aged 24–95 years. These subjects were from four previous cross-sectional surveys carried out in Singapore (from 1982 to 1998) who attended a follow-up examination (including both a questionnaire and a clinic examination) between 2004 and 2007, during which HRQoL was assessed. Participants were classified as underweight (<18.5 kg m−2), normal weight (18.5 to <23 kg m−2), overweight (23 to <25 kg m−2), moderate obese (25 to <30 kg m−2) and severe obese (⩾30 kg m−2). HRQoL was measured using the Short-Form 36-item questionnaire (SF-36) physical component summary score (PCS) and mental component summary score (MCS). Linear regressions with and without adjusting for other covariates were used to evaluate the association between BMI and SF-36 PCS and MCS.
Results:
Compared with participants with normal weight, moderate or severe obesity was associated with 0.8 points (95% confidence interval (CI): −1.5 to −0.1, P=0.03) and 2.1 points lower PCS (95% CI: −3.1 to −0.1, P<0.001), respectively, after adjustment for sociodemographic variables, family functioning measure scores and the presence of chronic diseases. These associations were greater in women than in men. In contrast, being underweight was associated with 1.3 points lower MCS (95% CI: −2.3 to −0.3, P=0.014).
Conclusions:
In this study (one of few studies in the Asia-Pacific region), obesity was associated with lower PCS and the effect was modified by gender but not ethnicity, such that the association was greater in women than in men. However, obesity was not associated with MCS. Underweight was associated with reduced MCS but not PCS.
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References
Kelly T, Yang W, Chen CS, Reynolds K, He J . Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond) 2008; 32: 1431–1437.
Epidemiology & Disease Control Division. In: (ed), National Health Survey 2004. Ministry of Health: Singapore, 2005.
Klenk J, Nagel G, Ulmer H, Strasak A, Concin H, Diem G et al. Body mass index and mortality: results of a cohort of 184 697 adults in Austria. Eur J Epidemiol 2009; 24: 83–91.
Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 2009; 373: 1083–1096.
Fontaine KR, Barofsky I . Obesity and health-related quality of life. Obes Rev 2001; 2: 173–182.
Wee HL, Cheung YB, Loke WC, Tan CB, Chow MH, Li SC et al. The association of body mass index with health-related quality of life: an exploratory study in a multiethnic Asian population. Value Health 2008; 11 (Suppl 1): S105–S114.
Tsai WL, Yang CY, Lin SF, Fang FM . Impact of obesity on medical problems and quality of life in Taiwan. Am J Epidemiol 2004; 160: 557–565.
Fine JT, Colditz GA, Coakley EH, Moseley G, Manson JE, Willett WC et al. A prospective study of weight change and health-related quality of life in women. JAMA 1999; 282: 2136–2142.
Katz DA, McHorney CA, Atkinson RL . Impact of obesity on health-related quality of life in patients with chronic illness. J Gen Intern Med 2000; 15: 789–796.
Han TS, Tijhuis MA, Lean ME, Seidell JC . Quality of life in relation to overweight and body fat distribution. Am J Public Health 1998; 88: 1814–1820.
Jia H, Lubetkin EI . The impact of obesity on health-related quality-of-life in the general adult US population. J Public Health (Oxf) 2005; 27: 156–164.
Ford ES, Moriarty DG, Zack MM, Mokdad AH, Chapman DP . Self-reported body mass index and health-related quality of life: findings from the Behavioral Risk Factor Surveillance System. Obes Res 2001; 9: 21–31.
Heo M, Allison DB, Faith MS, Zhu S, Fontaine KR . Obesity and quality of life: mediating effects of pain and comorbidities. Obes Res 2003; 11: 209–216.
Hopman WM, Berger C, Joseph L, Barr SI, Gao Y, Prior JC et al. The association between body mass index and health-related quality of life: data from CaMos, a stratified population study. Qual Life Res 2007; 16: 1595–1603.
Doll HA, Petersen SE, Stewart-Brown SL . Obesity and physical and emotional well-being: associations between body mass index, chronic illness, and the physical and mental components of the SF-36 questionnaire. Obes Res 2000; 8: 160–170.
Huang IC, Frangakis C, Wu AW . The relationship of excess body weight and health-related quality of life: evidence from a population study in Taiwan. Int J Obes (Lond) 2006; 30: 1250–1259.
Katsura H, Yamada K, Kida K . Both generic and disease specific health-related quality of life are deteriorated in patients with underweight COPD. Respir Med 2005; 99: 624–630.
Shoup R, Dalsky G, Warner S, Davies M, Connors M, Khan M et al. Body composition and health-related quality of life in patients with obstructive airways disease. Eur Respir J 1997; 10: 1576–1580.
Forli L, Moum T, Bjortuft O, Vatn M, Boe J . The influence of underweight and dietary support on well-being in lung transplant candidates. Respir Med 2006; 100: 1239–1246.
Larsson U, Karlsson J, Sullivan M . Impact of overweight and obesity on health-related quality of life--a Swedish population study. Int J Obes Relat Metab Disord 2002; 26: 417–424.
Hughes K, Yeo PP, Lun KC, Thai AC, Sothy SP, Wang KW et al. Cardiovascular diseases in Chinese, Malays, and Indians in Singapore. II. Differences in risk factor levels. J Epidemiol Community Health 1990; 44: 29–35.
Tan CE, Emmanuel SC, Tan BY, Jacob E . Prevalence of diabetes and ethnic differences in cardiovascular risk factors. The 1992 Singapore National Health Survey. Diabetes Care 1999; 22: 241–247.
Hughes K, Aw TC, Kuperan P, Choo M . Central obesity, insulin resistance, syndrome X, lipoprotein(a), and cardiovascular risk in Indians, Malays, and Chinese in Singapore. J Epidemiol Community Health 1997; 51: 394–399.
Cutter J, Tan BY, Chew SK . Levels of cardiovascular disease risk factors in Singapore following a national intervention programme. Bull World Health Organ 2001; 79: 908–915.
Third Report of the National Cholesterol Education Program (NCEP). Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143–3421.
WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004; 363: 157–163.
Thumboo J, Fong KY, Chan SP, Leong KH, Feng PH, Thio ST et al. Validation of the medical outcomes study family and marital functioning measures in SLE patients in Singapore. Lupus 1999; 8: 514–520.
Ware J, Kosinki M, Bjorner J, Turner-Bowker D, Gandek B, Maruish M . User's Manual for the SF-36v2 Health Survey 2nd edn. QualityMetric Incorporated: Lincoln, RI, 2007.
Thumboo J, Fong KY, Machin D, Chan SP, Leon KH, Feng PH et al. A community-based study of scaling assumptions and construct validity of the English (UK) and Chinese (HK) SF-36 in Singapore. Qual Life Res 2001; 10: 175–188.
Lloyd A . Assessment of the SF-36 version 2 in the United Kingdom. J Epidemiol Community Health 1999; 53: 651–652.
Ali SM, Lindstrom M . Socioeconomic, psychosocial, behavioural, and psychological determinants of BMI among young women: differing patterns for underweight and overweight/obesity. Eur J Public Health 2006; 16: 325–331.
Sach TH, Barton GR, Doherty M, Muir KR, Jenkinson C, Avery AJ . The relationship between body mass index and health-related quality of life: comparing the EQ-5D, EuroQol VAS and SF-6D. Int J Obes (Lond) 2007; 31: 189–196.
Faulkner G, Cohn T, Remington G, Irving H . Body mass index, waist circumference and quality of life in individuals with schizophrenia. Schizophr Res 2007; 90: 174–178.
Kuskowska-Wolk A, Bergstrom R, Bostrom G . Relationship between questionnaire data and medical records of height, weight and body mass index. Int J Obes Relat Metab Disord 1992; 16: 1–9.
Wyrwich KW, Bullinger M, Aaronson N, Hays RD, Patrick DL, Symonds T . Estimating clinically significant differences in quality of life outcomes. Qual Life Res 2005; 14: 285–295.
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Wee, HL., Wu, Y., Thumboo, J. et al. Association of body mass index with Short-Form 36 physical and mental component summary scores in a multiethnic Asian population. Int J Obes 34, 1034–1043 (2010). https://doi.org/10.1038/ijo.2010.24
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DOI: https://doi.org/10.1038/ijo.2010.24
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