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E van Sonderen

Publications and source records attributed to E van Sonderen.

At least 19 recordsLinked to original sources
PubMed2001

How to validate clinically important change in health-related functional status. Is the magnitude of the effect size consistently related to magnitude of change as indicated by a global question rating?

Some clinical trials perform repeated measurement over time and estimate clinically relevant change in an instrument's score with global ratings of perceived change or so-called transition questions. The conceptual and methodological difficulties in estimating the magnitude of clinically relevant change over time in health-related functional status (HRFS) are discussed. This paper investigates the concordance between the amount of serially assessed change with effect size estimates (the researcher's perspective) and global ratings of perceived change (the patient's perspective). A total of 217 patients who were scheduled for diagnostic examination were included, and the Minnesota Living with Heart Failure Questionnaire, extended with MOS-20 items, was assessed before and after medical intervention (percutaneous transluminal coronary angioplasty, coronary artery bypass grafting or pharmaco-therapy). Global questions were applied to assess perceived change over time for every item from domains of physical and emotional functioning and used as the external criterion of relevant change in the analysis of items. Global questions corresponding with overall change in these domains were used in the comparison of change in physical and emotional functioning scales. Two effect size indices were used: (i) ES (mean change/SDpooled) and (ii) ES (mean change/SDchange). A method is described to calculate a value indicating the extent of discordance between the researcher's interpretation of magnitude of change and the external criterion (the patient's perspective). Findings suggest that effect size (ES) (mean change/SDpooled) was in keeping with the magnitude of change indicated by patients' judgements, or their category of subjective meaning, for all scales. Furthermore, in cases in which the magnitude of change estimated with the SRM (mean change/SDchange) was not confirmed empirically by the external criterion ratings, the discordance could be interpreted as a trivial discordance.

Activities of Daily Living↗
PubMed2001

Factors related to successful job reintegration of people with a lower limb amputation.

OBJECTIVE: To study demographically, amputation-, and employment-related factors that show a relationship to successful job reintegration of patients after lower limb amputation. DESIGN: Cross-sectional study. SETTING: University hospital. PATIENTS: Subjects had an acquired unilateral major amputation of the lower limb at least 2 years before, were aged 18 to 60 years (mean, 46yr), and were living in the Netherlands. All 322 patients were working at the time of amputation and were recruited from orthopedic workshops. INTERVENTION: Questionnaires sent to subjects to self-report (1) demographic and amputation information and (2) job characteristics and readjustment postamputation. Questionnaire sent to rehabilitation specialists to assess physical work load. MAIN OUTCOME MEASURES: Demographically related (age, gender); amputation-related (comorbidity; reason and level; problems with stump, pain, prosthesis use and problems, mobility, rehabilitation); and employment-related (education, physical workload) information about the success of job reintegration. RESULTS: Job reintegration was successful in 79% and unsuccessful in 21% of the amputees. Age at the time of amputation, wearing comfort of the prosthesis, and education level were significant indicators of successful job reintegration. Subjects with physically demanding jobs who changed type of job before and after the amputation more often successfully returned to work than subjects who tried to stay at the same type of job. CONCLUSIONS: Older patients with a low education level and problems with the wearing comfort of the prosthesis are a population at risk who require special attention during the rehabilitation process in order to return to work. Lowering the physical workload by changing to another type of work enhances the chance of successful reintegration.

Adolescent↗
PubMed2001

Recovery of physical function after limb injuries in independent older people living at home.

OBJECTIVES: to describe changes in physical functioning after fall-related injuries to the limbs in independently living older people. DESIGN: prospective cohort study, including a pre-injury assessment and post-injury assessments at 8 weeks and 5 and 12 months. SETTING: the study is part of the larger, population-based prospective and longitudinal Groningen Longitudinal Aging Study on the determinants of health-related quality of life of people aged 57 and over, who are living independently in the north of the Netherlands. SUBJECTS: 171 patients who sustained injuries at various sites on the limbs and who had completed all four assessments (66% of the eligible population). Patients were grouped according to injury site. OUTCOME MEASURE: self-reported grades of difficulties with performing basic and instrumental activities of daily living as measured by the Groningen Activity Restriction Scale. RESULTS: 1 year after the injury, pre-injury (mean) levels of functioning were not regained in any of the groups studied. However, only those with fractures of the wrist or hip experienced a substantial decrease in ability to perform basic and instrumental activities of daily living between baseline and the final assessment. Furthermore, of the 44 subjects with wrist fractures, seven (15.9%) needed help with at least one relevant activity at baseline and 18 (40.9%) at 12 months. Of the 34 subjects with hip fractures, four (11.8%) needed help with at least one activity at baseline and 18 (52.9%) at 12 months. Practically no changes were found in any of the groups after 5 months post-injury. CONCLUSIONS: not only hip fractures, but also wrist fractures may reduce older people's chances of remaining independent. Prospects of further recovery are minimal 5-6 months after the injury.

Activities of Daily Living↗
PubMed2001

Psychometric properties of the Minnesota Living with Heart Failure Questionnaire (MLHF-Q).

OBJECTIVE: To evaluate the psychometric properties of the Minnesota Living with Heart Failure Questionnaire (MLHF-Q) in patients with atrial fibrillation. DESIGN: A prospective study of the patients who underwent DC electrical cardioversion. SETTING: Clinics of cardiology and thoracic surgery of the University Hospital in Groningen, the Netherlands. MAIN OUTCOME MEASURES: The disease-specific MLHF-Q and generic measures of quality of life were administered. The sensitivity to change over time was tested with effect sizes (ES). Internal consistency of MLHF-Q scales was estimated with Cronbach's alpha. To evaluate the construct validity multitrait-multimethod analysis was applied. The 'known group validity' was evaluated by the comparison of mean scores and effect sizes between two groups of the New York Heart Association (NYHA) classification (NYHA I versus II-III). Stability of MLHF-Q scales was estimated in a subgroup of patients who remained stable. Perfect congruence analysis and factor analysis were applied to confirm the a priori determined structure. RESULTS: Cronbach's alpha was > or = 0.80 of the MLHF-Q scales. Perfect congruence analysis (PCA) showed that the results resemble quite well the a priori assumed factor structure. Multitrait-multimethod analysis showed convergent validity coefficients ranging from 0.59 to 0.73 (physical impairment dimension) and 0.39 to 0.69 (emotional dimension). The magnitude of change can be interpreted as medium (ES = 0.50). The results of a 'test-retest' analysis in a stable group can be valued as satisfactory for the MLHF-Q scales (Pearson's r > 0.60). The physical dimension and the overall score of the MLHF-Q discriminated significantly between the NYHA I and II-III groups (p < 0.001) with large effect sizes (ES > 1.0).

Adult↗
PubMed2000

Differential effects of high-frequency versus low-frequency exercise training in rehabilitation of patients with coronary artery disease.

OBJECTIVES: We sought to study the influence of frequency of exercise training during cardiac rehabilitation on functional capacity (i.e., peak oxygen consumption [VO2] and ventilatory anaerobic threshold [VAT]) and quality of life (QoL). BACKGROUND: Although the value of cardiac rehabilitation is now well established, the influence of the different program characteristics on outcome has received little attention, and the effect of frequency of exercise training is unclear. Functional capacity is regularly evaluated by peak VO2 but parameters of submaximal exercise capacity such as VAT should also be considered because submaximal exercise capacity is especially important in daily living. METHODS: Patients with coronary artery disease (n = 130, 114 men; mean age 52 +/- 9 years) were randomized to either a high- or low-frequency program of six weeks (10 or 2 exercise sessions per week of 2 h, respectively). Functional capacity and QoL were assessed before and after cardiac rehabilitation. Global costs were also compared. RESULTS: Compared with baseline, mean exercise capacity increased in both programs: for high- and low-frequency, respectively: peak VO2 = 15% and 12%, Wmax = 18% and 12%, VAT = 35% and 12% (all p < 0.001). However, when the programs were compared, only VAT increased significantly more during the high-frequency program (p = 0.002). During the high-frequency program, QoL increased slightly more, and more individuals improved in subjective physical functioning (p = 0.014). We observed superiority of the high-frequency program, especially in younger patients. Mean costs were estimated at 4,455 and 2,273 Euro, respectively, for the high- and low-frequency programs. CONCLUSIONS: High-frequency exercise training is more effective in terms of VAT and QoL, but peak VO2 improves equally in both programs. Younger patients seem to benefit more from the high-frequency training.

Adult↗
PubMed2000

The evaluation of the Center for Epidemiologic Studies Depression (CES-D) scale: Depressed and Positive Affect in cancer patients and healthy reference subjects.

This study examined the reliability and validity of a two-factor structure of the Center for Epidemiologic Studies Depression (CES-D) scale. The study was conducted in a large group of cancer patients (n = 475) and a matched reference group (n = 255). Both groups filled in a questionnaire at two points in time; patients 3 and 15 months after diagnosis. Factor analysis confirmed our hypothesis that the 16 negatively and four positively formulated items measure two relatively independent factors, i.e. Depressed Affect and Positive Affect. Therefore, these items should not be combined into an overall sumscore. In both groups, Depressed Affect proved to be a reliable and valid measure of depressive symptomatology, as indicated by its good internal consistency, its strong correlations with other measures of psychological distress and neuroticism, and its effectiveness in discriminating patients from the reference group on depressive symptomatology. In contrast, the validity of the Positive Affect factor could not be confirmed, since it was only weakly related to other measures of psychological distress and extraversion. Depressed and Positive Affect were about equally related to self-esteem, life satisfaction, and quality of life. These findings support the use of a sumscore based on the 16 negatively formulated CES-D items as a more valid measure of depressive symptomatology, in cancer patients and in healthy individuals from the general population.

Adult↗
PubMed2000

Diabetic neuropathy examination: a hierarchical scoring system to diagnose distal polyneuropathy in diabetes.

OBJECTIVE: Existing physical examination scoring systems for distal diabetic polyneuropathy (PNP) do not fulfill all of the following criteria: validity, manageability, predictive value, and hierarchy The aim of this study was to adapt the Neuropathy Disability Score (NDS) to diagnose PNP in diabetes so that it fulfills these criteria. RESEARCH DESIGN AND METHODS: A total of 73 patients with diabetes were examined with the NDS. Monofilaments and biothesiometry were used as clinical standards for PNP to modify the NDS. RESULTS: A total of 43 men and 30 women were studied; mean duration of diabetes was 15 years (1-43), and mean age was 57 years (19-90). A total of 24 patients had type 1 diabetes, and 49 patients had type 2 diabetes. Clinically relevant items were selected from the original 35 NDS items (specific item scored positive in >3 patients). The resulting 8-item Diabetic Neuropathy Examination (DNE) score could accurately predict the results of the clinical standards and is strongly hierarchical (H value 0.53). The sensitivity and specificity of the DNE at a cut-off level of 3 to 4 were 0.96 and 0.51 for abnormal monofilament scores, respectively. For abnormal vibration perception threshold scores, these values were 0.97 and 0.59, respectively. Reproducibility as assessed by inter- and intrarater agreement was good. CONCLUSIONS: The DNE is a sensitive and well-validated hierarchical scoring system that is fast and easy to perform in clinical practice.

Adult↗
PubMed1999

The relationship of functional limitations to disability and the moderating effects of psychological attributes in community-dwelling older persons.

This paper examines the moderating effects of three psychological attributes (neuroticism, self-efficacy expectancies and mastery) on the association between functional limitations (motor and cognitive limitation, vision and hearing loss) and disability ((instrumental) activities of daily living, role function and social function) in a sample of 624 community-dwelling older persons. In contrast to our hypothesis, we did not find any evidence for interaction effects. This means that low levels of psychological resources do not exacerbate the effect of functional limitation on disability in community-dwelling older persons. We found significant unique contributions of the psychological attributes to disability. Even when all three psychological attributes were taken into account, neuroticism and mastery had unique effects on social and role function, and self-efficacy expectancies had unique effects on (instrumental) activities of daily living. We conclude that the effects of functional limitation and psychological attributes on disability can be considered as additive. Older persons with less psychological resources are particularly at risk in developing disability.

Activities of Daily Living↗
PubMed1999

The impact of psychological attributes on changes in disability among low-functioning older persons.

We studied the impact of four psychological attributes (neuroticism, extraversion, mastery or perceived control, and general self-efficacy expectancies) on changes in disability in a community-based sample of 575 low-functioning elderly persons between 1993 and 1995. Unlike elderly persons with low or medium levels of mastery and general self-efficacy expectancies, older persons with high levels of such attributes showed no significant increase of disability between 1993 and 1995. However, multivariate analyses showed only unique contributions of mastery to changes in disability. Neuroticism and extraversion were found to be not related to changes in disability, supporting previous research outcomes. Findings highlight that, particularly, feelings of perceived control are crucial for maintaining functional ability in later life.

Activities of Daily Living↗
PubMed1999

Performance-based and self-reported physical functioning in low-functioning older persons: congruence of change and the impact of depressive symptoms.

This prospective cohort study examines the impact of depressive symptoms on changes in self-reported physical functioning in 574 low-functioning older persons. The data were collected in two waves in 1993 and 1995. Initial levels of depressive symptoms were not predictive for subsequent change in self-reported physical functioning. Changes in self-reported physical functioning were only moderately associated with changes in performance-based physical functioning. The strongest congruence of measured change between self-reported and performance-based physical functioning was found in older persons with increased depressive symptoms. The results suggest that preventing an increase in depressive symptoms may help prevent further deterioration in physical functioning in poorly functioning older persons.

Aged↗
PubMed1999

Longer pre-hospital delay in acute myocardial infarction in women because of longer doctor decision time.

STUDY OBJECTIVE: To measure the pre-hospital delay times in patients with proven acute myocardial infarction (AMI) and to identify possibilities for reduction of treatment delay. DESIGN: Descriptive three centre study. SETTING: One university teaching hospital and two regional hospitals in Groningen, the Netherlands. PATIENTS: 400 consecutive confirmed AMI patients, age below 75 years, admitted to coronary care departments. MAIN RESULTS: Mean age was 59 years and 78% of patients were men. Within two hours after onset of symptoms half of the patients with AMI arrived at the hospital. Patient, doctor, and ambulance delay times (median values) were 30, 38, and 35 minutes respectively. Calling the personal general practitioner (GP) or the locum tenens and whether or not the AMI occurred during a weekend or on a working day had no consequences for pre-hospital delay times. At night patients waited longer before calling a GP than in the daytime. There was a positive correlation between patient and doctor delay. Twenty two per cent of AMI patients waited two hours or more before calling a GP. Total pre-hospital delay times differed between men and women. Longer doctor delay in women (36 minutes for men and 52 minutes for women) was caused by displacement of specific symptoms, in particular in women. AMI patients who were alone during onset of symptoms showed higher patients delay (72 compared with 23 minutes). CONCLUSION: In hospital admitted patients younger than 75 years pre-hospital delay times are within acceptable limits. In some subgroups further reduction is attainable, for example in patient delay outside office hours and when patients are alone during onset of symptoms, in doctor delay in cases where women present with symptoms suggestive for AMI. Improvement of facilities for pre-hospital electrocardiographic diagnosis may facilitate decision making by GPs. Good opportunities for further reduction of treatment delay exist in shortening of hospital delay.

Acute Disease↗
PubMed1999

A comprehensive model of stress. the roles of experienced stress and neuroticism in explaining the stress-distress relationship.

BACKGROUND: In this study, a complex theoretical model regarding the stress-distress relationship was evaluated. The various components in the model included experienced stress (daily hassles), psychological distress, neuroticism, problem-focused coping, avoidant coping, satisfaction with received social support and unassertiveness. On the basis of various previous findings, experienced stress was assumed to have a direct effect on psychological distress. In addition, neuroticism was assumed to have a direct effect on psychological distress as well as an indirect effect through its association with experienced stress, problem-focused coping, avoidant coping, satisfaction with social support and unassertiveness. Further, both problem-focused and avoidant coping were assumed to affect the level of psychological distress directly as well as indirectly through their influence on experienced stress. Similarly, satisfaction with social support was assumed to have a direct beneficial effect on psychological distress in addition to an indirect effect through its association with coping and experienced stress. Finally, unassertiveness was assumed to have a direct effect on psychological distress as well as an indirect effect through its influence on experienced stress and coping. METHODS: A covariance path analysis technique (LISREL) was used. RESULTS: A considerable predictive power of the model could be demonstrated. Experienced stress and neuroticism turned out to be most predictive of psychological distress. The effects of social support, coping and unassertiveness on psychological distress were seriously attenuated by their common association with neuroticism. CONCLUSION: Above all, the present findings underscore the need to investigate all variables that are expected to play a role simultaneously so as to be able to take their interdependency into account. It is argued that although such comprehensive models may be more difficult to interpret as of yet, they are likely to more closely resemble reality.

Adaptation, Psychological↗
PubMed1998

Impairment of exercise capacity and peak oxygen consumption in patients with mild left ventricular dysfunction and coronary artery disease.

AIMS: Most studies in chronic heart failure have only included patients with marked left ventricular systolic dysfunction (i.e. ejection fraction < or =0.35), and patients with mild left ventricular dysfunction are usually excluded. Further, exercise capacity strongly depends on age, but age-adjustment is usually not applied in these studies. Therefore, this study sought to establish whether (age-adjusted) peak VO2 was impaired in patients with mild left ventricular dysfunction. METHODS: Peak VO2 and ventilatory anaerobic threshold were measured in 56 male patients with mild left ventricular dysfunction (ejection fraction 0.35-0.55; study population) and in 17 male patients with a normal left ventricular function (ejection fraction >0.55; control population). All patients had an old (>4 weeks) myocardial infarction. By using age-adjusted peak VO2 values, a 'decreased' exercise capacity was defined as < or = predicted peak VO2 - 1 x SD (0.81 of predicted peak VO2), and a severely decreased exercise capacity as < or = predicted peak VO2 - 2 x SD (0.62 of predicted peak VO2). RESULTS: Patients in the study population (age 52+/-9 years; ejection fraction 0.46+/-0.06) were mostly asymptomatic (NYHA class I: n=40, 76%), while 16 patients (24%) had mild symptoms, i.e. NYHA class II. All 17 controls (age 57+/-8 years) were asymptomatic. Mean peak VO2 was lower in patients with mild left ventricular dysfunction (23.6+/-5.7 vs 27.1+/-4.6 ml x min(-1) x kg(-1) in controls, P<0.05). In 75% of the study population patients (n=42) age-adjusted peak VO2 was decreased (NYHA I/II: n=29/13) and in 18% of them severely decreased (n=10; NYHA I/II: n=6/4). In contrast, only three patients (18%) in the control population had a decreased and none a severely decreased age-adjusted peak VO2. CONCLUSION: In patients with mild left ventricular dysfunction, who have either no or only mild symptoms of chronic heart failure, a substantial proportion has an impaired exercise capacity. By using age-adjustment, impairment of exercise capacity becomes more evident in younger patients. Patients with mild left ventricular dysfunction are probably under-diagnosed, and this finding has clinical and therapeutic implications.

Adult↗
PubMed1998

Functioning, well-being, and health perception in late middle-aged and older people: comparing the effects of depressive symptoms and chronic medical conditions.

OBJECTIVES: To expand the landmark Medical Outcomes Study (MOS) and World Health Organization (WHO) findings on the unique association of symptoms of depression with multiple domains of functioning, health perception, and well-being in consulting populations to the late middle-aged and older community-dwelling population and to contrast this unique association to that of specific chronic medical conditions and sensory and cognitive impairment (collectively denoted as medical conditions (MCs)). DESIGN: Population-based, cross-sectional health survey. SETTING AND PARTICIPANTS: A total of 5279 noninstitutionalized late middle-aged and older persons living independently or in residential homes for older people housing in the northern part of The Netherlands. MEASUREMENTS: Behavioral: physical functioning, (Independent) Activities of Daily Living ((1)ADL), and role functioning. Subjective: health perception, life satisfaction and well-being. Mixed: discretionary activities and activity level. Two aspects of the association were examined: the unique risk (adjusted difference in mean outcome between those with the condition and those without, expressed in SD units) and the unique contribution (adjusted proportion of variance in outcome accounted for by the condition). The latter takes the prevalence of the condition into account. RESULTS: Among both individuals with MCs and those without, persons with symptoms of depression did worse on all outcomes than those without. Depressive symptoms were more consequential for subjective and mixed outcomes compared with behavioral outcomes. For all outcomes, none of the unique contributions of MCs exceeded that of depressive symptoms, whereas the unique contribution of depressive symptoms typically outranked those of the MCs. For behavioral outcomes, the unique risks associated with neurological conditions, persistent back problem, arthritis, and stroke exceeded that of depressive symptoms, but risk associated with depressive symptoms exceeded that of nine of 18 MCs, on average. For the mixed and subjective outcomes, none of the unique risks associated with MCs exceeded that of depressive symptoms, but risks of depressive symptoms exceeded those of 16 of the 18 MCs, on average. The effects of depressive symptoms and medical conditions were largely additive although depressive symptoms amplified the effect of some medical conditions on (I)ADL. The pattern of unique risks and contributions was similar across all ages (57-64, 65-74, 75+). CONCLUSION: The unique contribution of depressive symptoms in dysfunction, poor health perception, and well-being typically exceeds that of medical conditions because depressive symptoms combine a moderately large unique risk with a rather high prevalence. Results expand the MOS and WHO findings to the community-dwelling late middle-aged and older population and to additional outcomes as well. Results underscore the importance of detection and management of (comorbid) symptoms of depression in older people.

Activities of Daily Living↗
PubMed1997

Chronic medical conditions and mental health in older people: disability and psychosocial resources mediate specific mental health effects.

BACKGROUND: This study describes the differences in psychological distress, disability and psychosocial resources between types of major medical conditions and sensory impairments (collectively denoted as CMCs); and tests whether disability and psychosocial resources mediate CMC-specific mental health effects. METHODS: Data were obtained from a population-based, cross-sectional survey of 5078 non-institutionalized, late middle-aged and older Dutch persons. The predictors were 16 types of CMCs, including all major chronic medical diseases as well as impairment of hearing, vision, and cognition. The outcomes were assessed in terms of psychological distress as measured by the Hospital Anxiety and Depression Scale. Two aspects of disability were measured (namely, physical and role functioning) and also three psychosocial resources (namely, mastery, self-efficacy and social support). RESULTS: Level of psychological distress varied across type of CMC. Hearing impairment, neurological disease, vision impairment, and lung and heart disease had particularly strong associations with distress. The level of distress in patients with hearing impairment was 0.45 standard deviation higher than in those without hearing impairment (adjusted for demographics and all other CMCs). Roughly similar patterns of association were found between type of CMC and disability, and also, but to a lesser extent, mastery and self-efficacy. Stepwise multiple regression revealed that type of CMC accounted for 9% of the variance in distress initially, but this fell to 1% after the variance due to disability, mastery and self-efficacy was taken out. Social support was not a mediator. Disability and psychosocial resources accounted for 13% and 14% of the variance in distress, respectively. CONCLUSION: These results support the conventional wisdom that it is not the nature of the condition that determines psychological distress, but instead the severity of the disability and loss of psychological resources associated with the condition on the one hand and the psychological characteristics of the patient on the other.

Activities of Daily Living↗
PubMed1997

Measuring health status with the Dartmouth COOP charts in low-functioning elderly. Do the illustrations affect the outcomes?

The Dartmouth COOP method consists of seven questions measuring seven domains of health status: physical fitness, feelings, daily activities, social activities, change in health status, current overall health perceptions and bodily pain. Each question has five response options and each option is accompanied by an illustration. In this paper, we present the results of a randomized study of the effects of the illustrations of the seven Dartmouth COOP charts in a low-functioning elderly sample. In addition, the subjective evaluation of the illustrations was examined. The results showed no significant differences between the outcomes obtained with the illustrated COOP charts and the unillustrated COOP charts: the mean scores, patterns of intercorrelations and associations with other measures for the research participants who filled in the illustrated COOP charts hardly differed from those obtained from the participants who filled in the unillustrated charts. Furthermore, the results showed that approximately three-quarters of the research participants considered the illustrations informative, while approximately 17% of the participants considered the pictures exaggerated. We conclude that, as long as there is no empirical support for the advantages of the COOP charts with respect to cross-cultural standardization or use in subjects who have, for example, difficulty in reading, there seems to be no need for the illustrated COOP charts. The results of our study showed that both types of COOP charts appear to be interchangeable.

Aged↗
PubMed1997

Alarmingly high prevalence of obesity in Curaçao: data from an interview survey stratified for socioeconomic status.

OBJECTIVE: The aim of the article is to report the prevalence of obesity, abdominal fatness and waist circumference in different socioeconomic classes in Curaçao. DESIGN: In 1993/1994 a health interview survey (the Curaçao Health Study) was carried out among a random sample (n = 2248, response rate = 85%) of the adult non-institutionalized population of Curaçao. METHODS: We analyzed the association between obesity (BMI > or = 30), abdominal fatness (waist hip ratio (WHR) > or = 0.95 for men, WHR > or = 0.80 for women) waist circumference (WC > or = 100 cm for men, WC > or = 91 cm for women) and socioeconomic status (SES) by age adjusted logistic regressions, for men and women separately. RESULTS: The prevalence of obesity was about 27%: 36% of the women and 19% of the men were obese. An at risk WHR was reported among 62.2% of the women and among 20.4% of the men. A WC above the cut-off point was reported for 44.3% women and 25.3% men. Compared to women of higher SES, the lower SES women have a two to three times higher risk of a BMI, WHR or WC exceeding the cut-off points. Among men, no statistically significant difference between an increased BMI, WHR or WC and SES factors was found. The overlap between the three measures is large, about 56% of the women scored similarly on all three measurements. Among men the overlap is even greater (73%). CONCLUSIONS: The prevalence of obesity in Curaçao is alarming. Low SES women are at the greatest risk of an increased BMI, WHR or WC. The obesity figures can be placed between industrialized societies and less modernized cultures. Action and additional research on the prevention of obesity in Curaçao are deemed necessary. The cut-off points in our study for WC in the non-white population are preliminary and need to be elucidated further.

Adult↗