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Obesity in Young Europeans: Genetic and Environmental In¯Uences

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Obesity in Young Europeans: Genetic and Environmental In¯Uences European Journal of Clinical Nutrition (2000) 54, Suppl 1, S56±S60 ß 2000 Macmillan Publishers Ltd All rights reserved 0954±3007/00 $15.00 www.nature.com/ejcn Obesity in young Europeans: genetic and environmental in¯uences JA MartõÂnez* Department Physiology and Nutrition, University of Navarra, Pamplona, Spain Background: Nutrition, lifestyles and genetics are increasingly involved in the maintenance of health and the prevalence of several non-communicable diseases, such as cardiovascular illnesses, diabetes, cancer etc. In this context, obesity appears as a complex multi-factorial condition resulting from an imbalance between energy intake and expenditure, which has been associated with the genetic background (more than 50 genes have been located in the human gene map associated to obesity), but also with environmental forces such as reduced physical activity (more than 60% of Europeans spend more than 3 h sitting at work) and with the over- consumption of fat-rich and high energy yielding foods (fat oxidation is poorly regulated as compared with other fuel substrates). Subjects: Furthermore, subject selection was quota-controlled to make the sample nationally representative by various socio-demographic factors based on the most recent of®cial statistics (census data) in each member state. Overall, there were 15,239 subjects older than 15 y in the EU (17% of them were younger than 24 y old). Results: The obesity problem appears to be increasing rapidly in children and adolescents as well as in adults with an average rate of obese subjects of about 10% in the European Union, however several factors should be taken into consideration, such as the cut-off references, the age group and the conditions of the data collection when processing the information about obesity prevalence. Conclusions: Management of the increasing epidemic of obesity in young people must involve prevention strategies concerning nutritional education and physical activity programmes. Descriptors: obesity; adolescents; genes; dietary habits; exercise European Journal of Clinical Nutrition (2000) 54, Suppl 1, S56±S60 Obesity prevalence in young Europeans Comprehensive data about obesity rates in Europe come from the Monica study (WHO-Monica, 1989). A great Obesity, which has been de®ned as a body fat excess, variability both within and between countries has been occurs as a consequence of an imbalance in the energy reported in that study, which pointed out that about 15% equation, where calorie intake is higher than energy expen- of men and 22% women are obese, while other data reveal diture (MartõÂnez & FruÈhbeck, 1996). This pathological a prevalence of obesity in the range of 8 ± 20% for men and condition, which involves high economic costs and health 10 ± 25% in women (Seidell, 1995). complications, has been assessed by many different meth- An integrated recent overview of the global prevalence ods, although the BMI (weight=height2) is by far the most of obesity in the European Union can be obtained from a common tool to identify overweight (BMI 25 ± 30 kg=m2) survey completed between February and April 1997 under and obese (BMI>30 kg=m2) subjects in epidemiological the auspices of the IEFS (Dublin), which developed a studies (Bray, 1998). However, classifying obesity during questionnaire on body-weight and health (Gibney et al, adolescence has the complication that height and body 1997; MartõÂnez et al, 1999). One of the objectives of the composition are still changing (Friedman, 1997, Page & survey was to determine the proportion and socio-demo- Fox, 1998). Furthermore, differences in the age of the onset graphic characteristics of the obese population (self- of puberty may affect fat deposition (OMS=WHO, 1998). reported) in the EU. Subjects were asked to report their Traditionally, obesity therapy and management have own height and weight to calculate the body mass index been based upon dietary strategies, physical activity and (BMI, kg=m2) in order to estimate the extent of under- behavior programs, different pharmacological approaches weight, normal weight, overweight and obese throughout (anorectics, thermogenic agents, enzyme-blocking com- the EU. In this report, BMI was classi®ed as follows under- pounds, etc.) and surgical procedures (Aronne, 1998; weight <19.99, normal-weight 20 ± 24.99, over-weight Barlow & Dietz, 1998. Weiser et al, 1997), although 25 ± 29.99 and obese >30 (MartõÂnez et al, 1999). The increasing evidence suggests that prevention is a key national samples were weighted according to the propor- factor to successfully overcoming the growing `epidemic' tional size of the population of each country. of overweight and obese individuals in both developed and From the EU average results, it can be noted that almost developing societies (Jeffery, 1995, Gill, 1997). half of the EU population are within the normal weight range (MartõÂnez et al, 1998). The UK had the highest prevalence of obesity (12%), while the Italians, the *Correspondence: J Alfredo MartõÂnez, Department of Physiology and French and the Swedes have the lowest levels of obesity Nutrition, University of Navarra, c= Irunlarrea s=n, 31008-Pamplona (Navarra) Spain. (about 7%). The data concerning the occurrence of obesity E-mail: [email protected] (BMI>30) in young subjects (15 ± 24 y old) revealed a Obesity in young Europeans JA MartõÂnez S57 regional in¯uence (Figure 1), the values ranging between through the control of afferent mechanisms (leptin, nutri- 5.2% in Austria and 1% in Italy, as well as in young adults ents, etc.), the central nervous system (hypothalamic neuro- (25 ± 34 y old), where British (14.4%) and Italians (3.2%) transmitters) or efferent mechanisms (SNS, insulin etc.), showed the highest and the lowest rates of obesity pre- which may be affected by environmental in¯uences (Mar- valence, respectively. tõÂnez & FruÈhbeck, 1996; Hill & Peter, 1998). The genetic The lack of consistency between studies in children and epidemiology of human obesity tries to identify those traits, adolescents has been attributed to methodological reasons that are associated with the genotype and more affected by and classi®cation criteria, but also to genetic and societal external forces such as dietary habits and sedentary life- factors (Bray et al, 1998). In this context, the BMI is widely styles (Bouchard et al, 1998, Cowburn et al, 1997). In this used, despite some limitations (WHO Expert Committee, context, four types of the obesity phenotype can be dis- 1998, Page & Fox, 1998). Nevertheless, whatever method tinguished from an anatomical perspective: type I (excess is used to classify obesity, studies investigating obesity body mass or body fat), type II (excess subcutaneous during childhood and adolescence have generally reported abdominal fat or android), type III (excess abdominal a high prevalence of obesity, and that rates are on the visceral fat) and type IV (excess gluteo-femoral fat or increase (OMS=WHO,1998). In a survey carried out in the gynoid). USA, the prevalence of overweight people (de®ned by the Evidence for the relationships of genetic heritability or 85th percentile of weight-for height) among 5 ± 24-year-old transmission to the BMI or body fat phenotype have been rose approximately two-fold in two decades (Friedman, obtained by using many different research approaches 1997). A similar trend has been observed in Japan, where (Beales & Kopelman 1996; Chagnon et al, 1997; MartõÂnez, the rates of obese schoolchildren (>120% standard body 1999; Garcia et al, 1998) such as map location of obesity- weight (SBW)) aged 6 ± 14 y increased from 5% to 10% related Mendelian disorders, single gene mutations and between 1974 and 1993 (Kotani, 1997). Moreover, child- transgenic models of obesity in rodents and quantitative hood and adolescence obesity is already evident in some traits locus by crossbreeding experiments as well as developing countries. Thus, in a study concerning 6 ± 18-y- through association or linkage studies concerning candidate old male schoolchildren in Saudi Arabia, the prevalence of genes (family segregation, adoption and twin surveys). obesity was found to be 15.8% (Al-Nuaim et al, 1996), Thus at the end of the twentieth century, more than 50 while the prevalence of obesity among schoolchildren aged genes (ADBR3, LPL, UCP's, PPAR, Ob, LEPR, POMC, 6 ± 12 y in Thailand, as diagnosed by weight-for- etc.) have been related directly or indirectly to obesity height>120% of the reference, was about 15.6% (Mo- heritability (Chagnon et al, 1998), located in different loci suvan et al, 1993). of the human gene obesity map (Figure 2). From data currently available on the global prevalence of obesity during childhood compiled by the WHO Pro- gramme of Nutrition (WHO, 1990 and 1997), children were Sedentary habits and obesity classi®ed as obese when they exceeded the NCHS median weight-for-height plus two standard deviations or z-scores. Sedentary lifestyles are increasingly involved in the pre- However, some obese children under this criteria may valence of obesity (Taubes, 1998; Bar et al, 1998). Thus, actually have a higher relative weight due to stunting the process of modernization transport, labour-saving rather than as a result of excess adiposity (Popkin et al, devices, TV viewing etc has brought about a number of 1996). consequences affecting physical activity patterns that con- tribute to obesity (OMS=WHO, 1998; Goldblatt et al, 1995). In fact, the growing increase in the number of Gene in¯uences on obesity obese people in Europe appears
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