Explaining the Heterogeneity in Overweight and Underweight among Adult Indonesians, 1993-2007: The Influence of Compositional and Contextual Factors

Helda Khusun (2011). Explaining the Heterogeneity in Overweight and Underweight among Adult Indonesians, 1993-2007: The Influence of Compositional and Contextual Factors PhD Thesis, School of Population Health, The University of Queensland.

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Author Helda Khusun
Thesis Title Explaining the Heterogeneity in Overweight and Underweight among Adult Indonesians, 1993-2007: The Influence of Compositional and Contextual Factors
School, Centre or Institute School of Population Health
Institution The University of Queensland
Publication date 2011-03
Thesis type PhD Thesis
Supervisor A/Prof. Geoffrey C. Marks
A/Prof. Abdullah Al Mamun
DR. Kurt Long
DR. Atmarita
Total pages 277
Total colour pages 2
Total black and white pages 275
Language eng
Subjects 111199 Nutrition and Dietetics not elsewhere classified
111706 Epidemiology
160404 Urban and Regional Studies (excl. Planning)
Abstract/Summary Abstract Background: In the last two decades there has been a significant shift in nutritional problems amongst adults in many countries, sometimes called the nutrition transition, with important increases in levels of overweight, while underweight has tended to decrease, but frequently persists. The overall pattern of change is well described, but the underlying factors are less understood. Most studies in developing countries have been cross-sectional and focused mainly on the effect of individual and household level (compositional) factors with little examination of changes at the community level (contextual factors). Moreover, heterogeneity in the pattern of change across population groups is often noted, but the extent of this heterogeneity and the contribution of compositional and contextual factors are not well understood. Objectives: (1) To examine the pattern and heterogeneity of change in nutritional problems amongst adults in Indonesia for the period 1993-2007; and (2) to examine the compositional and contextual factors leading to the change and the extent to which the heterogeneity across locations can be explained by those factors. Method: The study utilized data from the Indonesian Family Life Survey (IFLS), a large scale longitudinal study that used robust and standardized methods across several surveys from 1993 to 2007. The research was carried out in two parts. The first part addressed objective 1, using cross-sectional data for adults aged 18 years and older, from IFLS surveys in 1993, 2000 and 2007 covering 12,765, 21,868 and 26,630 adults, respectively. The second part addressed objective 2, using data from a panel of 8319 individuals that had complete follow-up for these survey years. The outcomes were overweight and underweight, defined using WHO BMI classifications. Factors influencing underweight and overweight were examined using binary logistics GEE modelling, conducted in a step by step manner. Factors that could explain heterogeneity between areas were determined by assessing the percentage of excess risk explained (%ERE) by each factor, which was derived from the area differential in odds ratio for underweight and overweight before and after adjustment for the factor(s). Results: Cross-sectional comparison of weight status showed that overweight prevalence increased significantly from 1993 to 2007 in both men and women. Underweight persisted, although a significant reduction was noted from 2000 to 2007 surveys. In 2007 the prevalence of overweight was 16.2% (CI: 15.5-17.0) and 30% (CI: 29.2-30.9) for men and women respectively, and underweight was 15.8% (CI: 15.1-16.6) and 13.5% (CI: 12.8-14.2). While increasing overweight occurred in all the study population, underweight prevalence increased among young men, despite the general reduction shown. Significant heterogeneity in levels of overweight and underweight was noted, not only between different areas, but also among different sub-population by gender and SES within the same area. Urban areas had higher overweight and lower underweight prevalence than rural areas. Across different provinces, heterogeneity in overweight and underweight prevalence and individual risk was associated with socioeconomic development indicators at the province level. Increasing overweight and decreasing underweight was influenced significantly by both compositional and contextual factors: level of education, smoking habit, household PCE and certain household and community characteristics representing modernity for overweight and related to hygiene and sanitation for underweight. The importance of specific compositional and contextual factors was different for underweight and overweight as well as by gender. More than 90% of the excess risk of overweight in urban areas and 72-100% of the excess risk of underweight in rural areas was explained by the compositional and contextual variables used in this study. The province group differential in risk for overweight was partially explained by differences in urban/rural composition of the area. After adjusting for rural-urban areas and the compositional and contextual factors, less than 50% of the risk difference in underweight and overweight between provinces was explained. The findings imply that differences in risk of overweight between provinces may be related to other factors not investigated in this study, such as differences in living environment and cultural factors. Conclusions: The findings highlight the increasing risk of overweight accompanied by persistent underweight amongst adults in Indonesia. In contrast to most countries, levels of underweight increased amongst young men. However, the findings showed significant heterogeneity across areas in the patterns of change. Most of the difference between urban and rural areas was explained by the composition of the population and differences in the context. But these factors only partially explained differences between provinces, suggesting other important differences not assessed, particularly in living environment and cultural factors. The findings demonstrate differences in pathways for the nutrition transition across population sub-groups and areas in Indonesia that may well explain differences seen across other populations as well. Moreover, the study identified compositional and contextual factors that influence the levels of overweight and underweight, providing a basis for identifying risk markers, and highlighting the need to tailor the focus of public health interventions to the specific population sub-group or area.
Keyword Nutrition Transition
Compositional Factor
Contextual Factor
Developing countries
Additional Notes Page number to be printed in colour: 102, 107 Page number to be printed lanscape: 34-35,57, 59, 90, 104, 109, 124, 146-149, 152-153, 161-162, 171-174, 181-182, 264, 273, 276-277

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Created: Mon, 30 Apr 2012, 19:24:21 EST by Mrs Helda Khusun on behalf of Library - Information Access Service