Association between nutrition, physical activity and socioeconomic status and intermediate risk factors of non-communicable diseases

Abstract

Background: NCDs are causing a large number of death, globally, but also living with any chronic condition is also very expensive for the individual as well as for the health care systems. First indicators for NCDs are intermediate risk factors like hypertension or overweight and obesity. These factors are themselves influenced by modifiable behavioural risk factors like nutrition and physical activity. But also the influence of SES needs to be considered. An unhealthy diet, lack of physical activity and low SES are linked to a higher prevalence of overweight and hypertension. Methods: The project ‘Health promotion and prevention in urban neighbourhoods’ in Hamburg aims to measure health status and behaviours in six statistical areas of different SES and improve it by participatory interventions. The data of primary data collection are used to test the influence of nutrition, physical activity and SES on BMI and hypertension. SES is measured by the social index of the neighbourhood as well as by the individual’s education and income. Influences on BMI are tested by linear regression, those on hypertension by binary logistic regression. Results: BMI in women is influenced by individual SES (b=-0.34; CI: -0.66 - -0.01; p=0.041), very low social index of the living environment (b=4.70; CI: 1.33 – 8.08; p=0.007), and age (b=0.09; CI: 0.03 – 0.14; p=0.002). The effect of medium and low social index is mediated by individual SES. In men, individual SES has only an effect on BMI in areas with high social index (b=- 0.88 kg/m2; CI: -1.70 - -0.06; p=0.038), other influences could not be identified. Hypertension in women can be predicted by R2=30.7% by age (OR=1.074; CI: 1.049 – 1.100; p<0.001) and physical activity (OR=0.410; CI: 0.191 – 0.879; p=0.022). Also very low SES in the living environment compared to the other statuses has an effect (OR=2.212; CI: 1.181 – 4.145; p=0.013). In men, only age had the same effect on occurrence of hypertension. Discussion: The findings support the evidence that SES has an influence on BMI and hypertension whereas nutrition could not be identified as a risk factor and physical activity only had an influence on hypertension in women. Selection and information bias could not be excluded. Further research needs to address which indicators differ between socioeconomic groups so that public health actions can directly work on these specific results.