Compar parison ison of Two Clinical ical Case Defini initio - - PowerPoint PPT Presentation

Compar parison ison of Two Clinical ical Case Defini initio tions ns in Detecting cting Ov Overwe rweight ight and Ob Obesity ity Among ng Registere tered d Nurse ses s in A D District rict Speci cialist list Hospita pital

Members:

Teh Pei Nee1

Chiew Shoen Chuen2 Sheila Gopal Krishnan3 Yap Ee Lee4 Fauziah Yusof5 Rasidah Abdul Manan5 Mathavi Santhrasegaran1 Roszimah bt Ismail6 Hazira Abdul Kadir7

AREA LAND : 1,168km² POPULATION : 247,603 ( 2015 )

 The Manjung District is a district in

the southwestern part of Perak state, Malaysia.

 The district is well known for

Pangkor Island, a major attraction in Perak and the home of the Royal Malaysian Navy (TLDM) Lumut Naval Base and dockyard.

MANJUNG

Bandar Seri Manjung is the district's principal urban center while smaller towns include Lumut , Sitiawan, Ayer Tawar, Pantai Remis and Beruas.

HOS OSPITAL PITAL SERI MANJUNG UNG 305 305 beds NAVI HOSPITAL 1 HOSPITAL DESA PANGKOR 1 PRIVATE HOSPITAL 2 GOVERMENT HEALTH CLINIC 31 PRIVATE HEALTH CLINIC 72

Departm rtmen ents ts Units ts

• Medical
• Surgical
• Orthopaedic
• Ophthalmology
• Emergency & Traumatology
• Paediatrics
• Obstetrics & Gynaecology
• Psychiatry & Mental Health
• Diagnostic & Imaging
• Pharmacy & Supply
• Pathology Department
• Dietetics & Catering
• Haemodialysis Unit
• ICU / CCU
• Physiotherapy Unit
• Occupational

Rehabilitation

• Sterile Equipment Supply

Unit

• Health Education Unit
• Medical Social Work Unit
• Counselling Psychology

Unit

• Quality Unit / Innovation &

CRC(Clinical Research Centre)

Health burden

 BMI = weight (kg)

height (m2)

Overweight and obesity classification

Catego gory ry IBMI (kg/ g/m2) ABMI (kg/m /m2 ) Underweight <18.50 <18.50 Normal 18.50-24.99 18.50-22.99 Overweight erweight 25.00 00-29. 9.99 99 23.00 00-27. 7.49 49 Obese ≥ 30.00 ≥ 27.50

3) There has been some contention whether the generalisation of the IBMI (International Body Mass Index) to the Asian population will underestimate the prevalence of overweight and obesity. 4) In year 2004, WHO was recommended additional BMI cut-off points for Asian populations for public

• health. (≥23 kg/m2 as increased risk and ≥27.5 kg/m2 as high risk).

5) BMI cut-off points have been revised to suit Asian population due to: (i) high prevalence of Type 2 Diabetes Mellitus among Asian individuals with BMI < 25.0kg/m2, (ii) higher cardiovascular risk factors among Asian individuals at any BMI level, and (iii) population based association between BMI, body fat percentage and distribution.

highest in developing countries and is associated with increase in incidence of cardiovascular disease.

Lamon-Fava va S et al, 1996 96 Hossain in, 2007 07 Bhuro rosy et al , 2 2014 Deure remberg erg-Ya Yap M et al, 2001 01 (Singapore) The BMI recommendation for public health was less than IBMI classification. (≥23 kg/m2 as increased risk and ≥27.5 kg/m2 as high risk) Feng ng R N N, et al 2 2012 (China) The optimal BMI for men and women to predict co-morbidities was less than IBMI classification.

( 24 kg/m2 )

Ren n Q, et al 2 2016 16 (China) The optimal BMI for men and women to predict Hypertension was less than IBMI classification

(23.53kg/m2 and 24.25kg/m2).

Tanu, et al 2 2014 14 (India) The optimal BMI to predict Hypertension was ≥24.5kg/m2 (men) n) and ≥24.9kg/m2( women) n).

Bogossian ian FE e et al, 2012 12 The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia, New Zealand and UK. Miller r SK et al, 2008 08 The prevalence of overweight, obesity and morbidly obesity among American nurses were 30%, 18.7% and 5.2% respectively. Ogunjim unjimi LO et al, 2010 10 The prevalence of obesity among Nigerian nurses 62.6%.

Coomarasa asamy my JD e et al, 2014 14 The prevalence of overweight and obesity among female nurses in Malaysia were 33.5% % and 17.1% 1% respectively.

Malaysia ian n National nal Healt lth h and Morbidity ty Surve vey (MNHMS) HMS) 2006, 06, 2011 11 Increa rease of o

• besit

ity y preva valence lence from 14 % (2006) 06) to 15.1% % (2011 011) in local populati tion

• n aged above 18 years

rs Malaysia ian n National nal Healt lth h and Morbidity ty Surve vey, y, 2015 15 IBMI IBMI classification

• overweight: 30.0% and obesity : 17.7%

7% ABMI classification – overweight: 33.4% 4% and obesity: 30.6%. %.

• Among obese population, female

le Malays ysians ans were re more affecte cted than n the male counterparts WHO- Non Communicable Disease Profile in Malaysia, 2012

 This study endeavours to answer whether

by using IBMI classification among Asian population would lead to a significant proportion

• f

the

• verweight

individuals going below the radar.

Hypothesis : Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria?

General Objective

To compare the prevalence of overweight and

• besity based on IBMI and ABMI among female

registered nurses.

Specific Objectives

morbidities among those who were overweight and obese according to both definitions. 2) To determine the factors associated with overweight and

• besity in the study population.

 Sampl

mple e size ze : : 384 (minimum)

• Stratified random sampling (working schedule)
• A random number list was generated by using Epical

2000 software.

• Proportions were set at 50.6% and precision at 5%

(45.6- 55.6%).

MREC C approved

Cross-sectional Study

Hospital Seri Manjung Nurses in all departments

September - October 2016

 Inclu

clusion sion cri riteria teria : :

All female registered nurses in HSM

 Exclus

clusion ion criter teria ia :

Pregnant, on confinement / paid / unpaid leave, refuse to consent

 Data co

collectio ection :

activity were collected via interview by trained researchers by using questionnaire.

Health of Nurses¹², 2005

 Data analysi

ysis :

 Prevalence of outcome was presented as %

related co-morbidities were calculated

regression

MREC C approved

Consent taking process Interviewing the respondent by using questionnaire Measuring of height and weight as well as BMI calculation

Nurse ses who fulfill lled ed the inclus usion

• n criter

teria ia were re give ven n Respond

• ndent

nt Inform rmati ation

• n Sheet.

Researchers archers explained ained to respon

• nde

dents nts about t the study. . Respond

• ndents

nts were given n sufficient cient time to understand tand, , ask questi tions ns and consid ider before re deciding iding on their r partici icipatio ation. n. All responde

• ndents

nts were re asked d to sign n 2 sets of inform rmed consent nt form.

Figure 2: Information sheet & Consent taking process

Result

Characteri racteristic ics n n (%) Demographic Data Age in years, median (quartiles) 36 (32-41) Ethnicity Malay Chinese Indian Others 361 (91.9%) 3 (0.8%) 23 (5.9%) 6 (1.5 %) Marital Status Single Married Divorced Widow 9 (2.3%) 378 (96.2%) 2 (0.5%) 4 (1.0%) Body Mass Index (BMI) BMI in kg/m2, median (quartiles) 26.30 (23.63-30.13) Weight satisfaction Satisfied Not satisfied 118 (30.0%) 275 (70.0%)

Table 1: Characteristics of Respondents* total respondents = 393

CVD = cardiovascular disease

Categor tegory

IBMI

Categor tegory

ABMI MI

• No. & % of

CVD (n, %)2

• No. & % of

CVD (n, %)2

146 (37.2%) 7.2%) 21 (14.4%)

136 (34.6%) 4.6%) 14 (10.3%)

102 (26.0%) 6.0%) 25 (24.5%)

172 (43.8%) 3.8%) 35 (20.3%)

Table 3: Sensitiv itivity ity and speci cificity ficity of IBMI MI and ABMI I (overweight erweight + o

• besi

esity) ty) def efinitions nitions in predi ediction ction

• f CV

CV-rel elated ated co-morb morbiditi dities

CI : 72.34; 92.95)] than ABMI [90.7% (95% CI: 78.89; 96.52)] but more specific [40.4% (95% CI: 35.17; 45.85)] than ABMI [23.6% (95% CI: 19.26; 28.56)].

CVD (%) Sens nsiti tivi vity ty Speci cific ficity ty PPV NPV

IBMI definiti tion

• n

85.2 40.4 18.5 94.5

ABMI MI definiti tion

• n

90.7 23.6 15.9 94.1

• time. (OR=1.83; 95%CI: 1.24; 2.70, p=0.002).

• bese (OR=13.11; 95%CI 2.44; 70.63, p=0.003) than single

nurses.

time were 2 times more likely to be overweight or obese (OR=2.41, 95%CI: 1.33; 4.35, p=0.004) compared to nurses who were adherent.

• 1a. Prevalen

valence ce of

• f Overweigh

verweight & Obesity esity among mong Nurses

ses

Count ntry ry

% of

• verwei

rweigh ght % o

• f
• besi

sity ty

IBMI MI

• 1. Ogunjimi LO et al, 2010

Nigeria

• 62.6%
• 2. Kim MJ et al, 201

013 Korea ea 18. 8.6% 6% 7.4%

• 3. Miller SK et al , 2007

U.S. 30% 23.9%

• 4. Coomarasamy JD et al,

2014 Malaysia 33.5% 17.1 7.1% Current rrent study dy , 2016 016 Malaysia 37.2% 26. 6.0% 0% ABMI MI

• 1. Aryee PA et al , 2013

Ghana 18.2 15.5 Current rrent study dy , 2016 016 Malaysia

34.6% 6% 43.8% 8% SLIM

• 1b. Comparison

mparison with th GENERAL NERAL POPULA LATI TION ON

NHMS: National Health Morbidity Survey⁷ 2015

Subject cts % of overwe erweight ght % of obes esit ity

IBMI MI

• 1. NHMS 2015

General Population

30.0% 17.7%

• 2. Current study , 2016

Nurses

37.2% 26.0% ABMI MI

• 1. NHMS 2015

General Population

33.4% 30.6%

• 2. Current study , 2016

Nurses

34.6% 43.8%

 Both ABMI & IBMI definitions had good sensitivity

(90.7% vs 85.2%) but IBMI had much higher specificity (40.4%) than ABMI (23.6%).

 However, IBMI is still a good tool to be used and we

need a larger scale study to support the utilization

• f ABMI in Malaysian population.

30

Studies ies Factors rs van Drongelen A et al¹⁴, 2011 (Systematic Review) shift work Kim MJ et al¹³, 2013 shift work Smith P et al¹⁵, 2013 shift work Bogossian FE et al¹º, 2012 increasing age, male, pre- menopause as well as menopause Ogunjimi LO et al⁹, 2010 Eating habit and being married Current study, 2016 Age, being married & compliance to food pyramid

 The

co-morbidities, food pyramid adherence and intensity of physical activities were self-reported.

 Less privacy during interview sessions.

1. The prevalence of overweight by both classifications was similar but the prevalence of obesity was higher with ABMI.

• 2. The prevalence of CV related co-morbidities among
• verweight and obese nurses were similar by using both

definitions.

• 3. Increasing age, being married and the lack of adherence to

food pyramid are associated with a higher risk of being

• verweight and obese.

Conc

• nclusion

lusion

1.

Further studies need to be done to evaluate ABMI as a screening tool in the local population.

2.

Although maintaining an ideal BMI is in our yearly SKT, this study indicates that it is not being achieved among with increasing age and married. Therefore, we need to look at workplace-based intervention to overcome this.

 We would like to thank

• Hospital Director, Chief Matron (KPJH), Matrons, Sisters,

CRC unit staffs, attendants and guards who support this research.

• All the respondents (all categories of female nurses) in

Hospital Seri Manjung.

• Pathology & Pharmacy departments’ staffs who involved

in answering the questionnaire during pre-test.

• Administrative & CRC unit staffs who involved during

interviewer training session.

• 05176546. Assessed: 29/01/16

• 10. Bogossian FE, et al. A cross-sectional analysis of patterns of obesity in a cohort of working nurses and

• 11. Coomarasamy JD, Wint NN, Donna Lou EN,Sukumaran S. Prevalence of Obesity and Daily Lifestyles of the

• 12. Canadian National Survey of the Work and Health of Nurses 2005.
• 13. Kim MJ et al. Association between shift work and obesity among female nurses. Korean Nurses' Survey.

• 14. van Drongelen A, Boot CR, Merkus SL, Smid T, van der Beek AJ. The effects of shift work on body

• 15. Smith P, Fritschi L, Reid A, Mustard C. The Relationship Between Shift Work and Body Mass Index Among

• 16. Tee E-S. Development and promotion of Malaysian Dietary Guidelines. Asia Pac J Clin Nutr 2011;20

• 18. Aryee PA, Helegbe GK, Baah B, Sarfo-Asante RA & Quist-Therson R. Prevalence and Risk Factors for Overweight

• n of Two Clinical Case Definiti

• ns in Detecti

• ducti

• n

• verweight/obesity. Number of subjects in this research is 384. This study will be carried over a period of 3 months.

Appendix A : Respondent Information Sheet & Consent Form

Appendix B: Questionnaire

Appendix B: Questionnaire

Appendix B: Questionnaire

Appendix B : Questionnaire