Determinants of weight and health status perception among Portuguese adults

2011 · Volume 17 · Nº 1/2/3 Alimen ação Humana 7 DETERMINANTS OF WEIGHT AND HEALTH STATUS PERCEPTION AMONG PORTUGUESE ADULTS Poínhos RI, Co eia FI,II, Du ão CII, F anchini BI,II, Rod igues SI,II, A onso CI,II, Mo ei a PI,II, Teixei a VHI,II, Pinho OI,II, Sil a DI,II, Lima Reis JPII, Ve íssimo MTII, de Almeida MDVI,II Abs ac The aims o his esea ch we e o e alua e BMI ca ego ies, disc epancies be ween measu ed and epo ed BMI, heal h s a us’ pe cep ion and ac o s pe cei ed as ha ing he g ea es impo ance in heal h, as well as o ela e hem wi h po encial de e minan s among he Po uguese adul popula ion. Da a om he s udy “Po - uguese Popula ion’s Food Habi s and Li es yles” we e used (na ional ep esen a i e sample o 3529 subjec s). Al hough he p e alence o obesi y seems o be dec easing, o e weigh is s ill obse ed in abou hal o he Po - uguese adul s; u he mo e, i s p opo ion may e en be inc easing in men. The e was a posi i e associa ion be ween age and BMI and he highes p opo ions o o e weigh we e ound in subjec s wi h lowe educa ion le els. Values o measu ed BMI we e highe han e e ed BMI. Olde and less educa ed men unde es ima ed mo e hei BMI, as well as subjec s wi h highe BMI. Po uguese adul s showed a high heal h s a us pe cep ion and selec ed “ ood”, “s ess”, “p ac icing exe cise”, “smoking” o “d inking alcohol” as ac o s wi h g ea e impo ance in heal h. These ac o s we e also associa ed wi h highe heal h s a us’ pe cep ion. Key-wo ds: Weigh ; Heal h; De e minan s; Adul s; Po uguese. Resumo Foi objec i o des e abalho a alia na população adul a po uguesa as ca ego ias de IMC, disc epâncias en e o IMC epo ado e medido, pe cepção do es ado de saúde e ac o es e e idos como endo maio impo - ância na saúde, bem como elacioná-los com os seus po enciais de e minan es. Fo am analisados dados do es udo “Alimen ação e Es ilos de Vida da População Po uguesa” (amos a de 3529 indi íduos ep esen a i a da população po uguesa). Apesa de a p e alência de obesidade pa ece es a a diminui , me ade dos po ugueses adul os ap esen am excesso de peso; pa a além disso, a sua p opo ção pode á es a a aumen a nos homens. Ve i icou-se uma associação posi i a en e a idade e o IMC, e as maio es p opo ções de excesso de peso o am encon adas nos indi íduos menos escola izados. Os alo es de IMC medidos o am supe io- es aos epo ados. Os homens mais elhos e menos escola izados subes ima am mais o seu IMC, al como os indi íduos com maio IMC. A população adul a po uguesa mos ou uma ele ada pe cepção do seu es ado de saúde e seleccionou “a alimen ação”, “o s esse”, “p a ica ac i idade ísica”, “ uma ” e “o consumo de bebidas alcoólicas” como os ac o es com maio impo ância na saúde. Es es ac o es es a am ambém as- sociados a uma pe cepção mais a o á el do es ado de saúde. Pala as-cha e: Peso; Saúde; De e minan es; Adul os; Po ugueses. INTRODUCTION The in luence o li es yles on he incidence and p e alence o non- ansmissible ch onic diseases, and hei impac on public and indi idual heal h, jus i ies he impo ance o s udying hei dis ibu ion in he popula ion and o iden i y he ela ionships be ween hem. The p e alence o o e weigh /obesi y is a majo public heal h p oblem wo ldwide, si ua ion which has mo i a ed esea ch aiming o unde s and i s de e minan s, in o de o I Uni e sidade do Po o – Faculdade de Ciências da Nu ição e Alimen ação. II Sociedade Po uguesa de Ciências da Nu ição e Alimen ação. Re is a SPCNA 8 Alimen ação Humana p e en and e e his pandemia. Heal h s a us pe cep ion is a gene al indica o o physical and psychological well-being and e lec s di e en li es yles’ a iables. The knowledge abou he ac o s pe cei ed o ha e majo in luence in heal h, and hei ela ion wi h heal h s a us, a e key ac o s o ailo public heal h in e en ions acco ding o he popula ion cha ac e is ics and o he success o hese in e en ions. The main aims o his esea ch we e: (1) o e alua e BMI ca ego ies’ among he Po uguese adul popula ion; (2) o compa e BMI assessed by measu ed and sel - epo ed weigh and heigh in Po uguese adul s; (3) o ela e he disc epancies be ween measu ed and epo ed BMI wi h socio-demog aphic a iables and measu ed BMI; (4) o e alua e he de e minan s o heal h s a us pe cep ion among he Po uguese adul popula ion; (5) o e alua e he ac o s pe cei ed by he Po uguese adul popula ion as ha ing he g ea es impo ance in heal h; (6) o ela e he selec ion o ac o s pe cei ed by he Po uguese adul popula ion as ha ing he g ea es impo ance in heal h wi h socio-demog aphic and heal h cha ac e is ics; and (7) o compa e heal h s a us’ pe cep ion among Po uguese adul s who iden i y di e en ac o s as main in luences in heal h. PARTICIPANTS AND METHODS Da a om he s udy “Po uguese Popula ion’s Food Habi s and Li es yles” we e used. This epidemiological c oss-sec ional s udy was designed and p omo ed by he Po uguese Socie y o Nu i ion and Food Sciences wi h he suppo o Nes lé, wi hin a p o ocol o scien i ic sponso ship be ween he wo ins i u ions. I s main aim is o e alua e he nu i ional s a us, ood in ake, heal h- ela ed a iables and o he li es yles’ dimensions o he po uguese popula ion. The da a used in his pape e e s o he i s phase o he s udy, which e alua ed Po uguese adul s. A na ional ep esen a i e sample o 3529 subjec s (52.2% emales; ages be ween 18 and 93 yea s-old) was in e iewed a home om Feb ua y o Ap il 2009. Due o incomple eness o some eco ds, he numbe o subjec s used in each analysis may a y bu his is indica ed in he co esponding able. The numbe o subjec s in each g oup is no p esen ed, because he sub-samples we e weigh ed o assu e na ional ep esen a i eness. The gene al me hodological aspec s o he s udy “Po uguese Popula ion’s Food Habi s and Li es yles” a e p esen ed elsewhe e1. We p esen below he me hodological aspec s di ec ly ela ed o he esul s p esen ed in his pape . Pa icipan s we e i s asked abou hei cu en weigh and heigh and subsequen ly hese measu emen s we e done acco ding o s anda dized p ocedu es. Fi y- i e subjec s e used o be weigh ed and/o o ha e hei heigh measu ed. BMI was calcula ed, as well as he pe cen ual disc epancies be ween measu ed and epo ed BMI ([measu ed – e e ed] / [measu ed x 100]). BMI was ca ego ized acco ding o WHO2. Heal h s a us was e alua ed by he EQ-5D3. The EQ isual analogue scale a es he subjec ’s own assessmen o heal h s a us (0 = wo s imaginable heal h; 100 = bes imaginable heal h). Subjec s we e asked o selec ( om a lis o nine) he wo ac o s which had he g ea e impo ance in heal h4. Physical ac i i y was e alua ed by he In e na ional Physical Ac i i y Ques ionnai e (IPAQ)5. Desc ip i e s a is ical analyses consis ed o he calcula ion o means and s anda d de ia ions (ca dinal a iables) o equencies (o dinal and nominal a iables). Means we e compa ed using independen -samples es s and uni a ia e ANOVA. Mean anks we e compa ed using Mann-Whi ney and K uskal-Wallis es s. The associa ion be- ween a iables was measu ed using Pea son’s and Spea man’s co ela ion coe icien s. Bina y logis ic eg ession models we e compu ed o es ima e he odds o lowe pe cep ion o own heal h s a us (EQ isual analogue scale unde he median) among Po uguese adul s acco ding o hei sex, age and educa ion le els, ci il s a us, p o essional occupa ion, egion o esidence, BMI ca ego y, physical ac i i y le el, smoking habi s and p oblems iden i ica ed in each o he EQ-5D dimensions (mobili y, sel -ca e, usual ac i i ies, pain/discom o and anxie y/ dep ession) (OR adjus ed o all o he a iables). Bina y logis ic eg ession models we e compu ed o es ima e he odds o selec ing each o he ac o s wi h g ea e impo ance in heal h acco ding o sex, age, educa ion le el, ci il s a us, p o essional occupa ion, egion o esidence, BMI ca ego y, physical ac i i y le el and smoking hab- i s (OR adjus ed o all o he a iables). Heal h s a us’ pe cep ion was compa ed be ween subjec s who did o 2011 · Volume 17 · Nº 1/2/3 Alimen ação Humana 9 didn’ iden i y each o he ac o s wi h in luence in heal h. S a is ical analysis was pe o med wi h SPSS e sion 14.0 (SPSS, Inc., Chicago, USA) o Windows. A p- alue below 0.05 was conside ed o be s a is ically signi ican . RESULTS Table 1 shows he dis ibu ion o subjec s by BMI ca ego ies acco ding o sex, age and educa ion le el. Mos women ha e BMI in he ange co esponding o no mal-weigh , while 64.5% o men ha e BMI equal o o g ea - e han 25. In all age g oups he e was a highe p e alence o o e weigh in men. The e was a signi ican posi i e associa ion be ween age and BMI in bo h women ( = 0.399, p <0.001) and men ( = 0.354, p <0.001). The p e alence o unde weigh was highes among women be ween 18 and 29 yea s (7.8%). The highes p opo - ions o o e weigh we e ound in subjec s wi h lowe educa ion le els. Table 1 — BMI ca ego ies’ (%) by sex, age and educa ion le el (n=3474) UNDERWEIGHT (< 18.50) NORMAL WEIGHT (18.50-24.99) PRE-OBESITY (25.00-29.99) OBESITY (≥ 30.00) SEX WOMEN MEN WOMEN MEN WOMEN MEN WOMEN MEN 2.6 0.3 59.2 35.2 27.8 53.3 10.4 11.2 AGE 18-29 yea s 7.8 1.0 77.1 60.0 13.8 35.7 1.3 3.3 30-44 yea s 0.8 0.2 67.1 32.1 26.8 58.2 5.3 9.5 45-64 yea s 1.6 0.0 49.0 23.1 33.6 59.6 15.8 17.3 ≥ 65 yea s 0.0 0.0 44.0 19.9 37.0 64.9 19.0 15.2 EDUCATION < 4 h g ade 0.0 0.0 31.0 19.0 45.2 68.3 23.8 12.7 4 h g ade 0.0 0.0 33.9 20.5 44.5 56.0 21.6 23.6 6 h g ade 0.0 0.1 39.8 16.3 36.1 62.5 24.0 21.1 9 h g ade 2.5 0.2 58.2 31.8 29.8 59.0 9.6 8.9 12 h g ade 3.2 1.1 77.9 48.9 16.7 42.8 2.2 7.3 Bachelo / uni e si a y 5.3 0.0 74.8 45.3 17.1 50.5 2.7 4.2 Table 2 p esen s he mean BMI disc epancies by sex, age, educa ion le el and measu ed BMI ca ego y. Globally, alues o measu ed BMI we e signi ican ly highe han e e ed BMI. Howe e , he associa ions be ween e e ed and measu ed weigh , heigh and BMI we e e y s ong ( > 0.97 and p < 0.001 o all). The disc epancy be ween hem was lowe in women compa ed o men (1.19 s. 1.47%). Signi ican co ela ions be ween he pe cen ual disc epancy be ween measu ed and e e ed BMI and age and educa ion le el showed g ea e un- de es ima ion in olde and less educa ed men, al hough being e y weak (| | < 0.1). BMI was signi ican ly associa ed wi h i s pe cen ual unde es ima ion. Table 3 shows mean alues on he EQ isual analogue scale, as well as he de e minan s o lowe (below median) heal h s a us pe cep ion. Po uguese adul s showed high heal h s a us pe cep ion, wi h a median o 80 on he EQ isual analogue scale. Only 7.0% o he Po uguese adul popula ion a ed hei heal h s a us below he middle poin o he scale. Olde , unde weigh ( s. no mal weigh ), widowed ( s. ma ied), unemployed ( s. ac i e) and li ing in any egion excep he No h we e ound o ha e a lowe pe cep ion o heal h s a us. The p esence o p oblems in h ee o he i e EQ-5D dimensions (mobili y, pain/discom o and anxie y/dep ession) was also associa ed wi h lowe pe cep ion o heal h s a us. Re is a SPCNA 10 Alimen ação Humana Table 2 — Mean (sd) BMI disc epancies by sex, age, educa ion le el and measu ed BMI ca ego y (n=3474) TOTAL 1.32 (3.44) SEX Women 1.19 (3.55) p = 0.001 Men 1.47 (3.31) AGE 18-29 yea s 1.14 (2.83) Co ela ions be ween BMI disc epancies and age (yea s): Women: = –0.031 (p = 0.252) Men: = 0.071 (p = 0.014) 30-44 yea s 1.26 (3.34) 45-64 yea s 1.61 (3.64) ≥ 65 yea s 1.22 (3.95) EDUCATION < 4 h g ade 1.26 (4.57) Co ela ions be ween BMI disc epancies and educa ion le el: Women: = –0.044 (p = 0.111) Men: = –0.087 (p = 0.003) 4 h g ade 1.90 (3.91) 6 h g ade 1.70 (3.45) 9 h g ade 1.31 (3.46) 12 h g ade 1.11 (2.84) Bachelo /uni e si a y 0.95 (3.19) BMI Unde weigh (< 18.50) –0.03 (4.16) Co ela ions be ween BMI disc epancies and measu ed BMI (kg/m2): Women: = 0.162 (p < 0.001) Men: = 0.238 (p < 0.001) No mal weigh (18.50-24.99) 0.83 (3.18) P e-obesi y (25.00-29.99) 1.51 (3.32) Obesi y (≥ 30.00) 3.02 (4.18) BMI disc epancy = (measu ed BMI – e e ed BMI) / (measu ed BMI x 100) Table 4 p esen s he p opo ion o subjec s who selec ed each ac o as ha ing g ea e impo ance in heal h, as well as he de e minan s o his choice. Mos o he sample conside ed “ ood” as one o he mos impo an heal h de e minan s, ollowed by 27.9% who iden i ied hei heal h o be in luenced by “s ess”. Due o hei impo ance o he design o heal h p omo ion in e en ions, we highligh he ela ionships be ween sex, age and BMI ca ego y and ac o s pe cei ed as in luen in heal h. Men selec ed mo e o en “p ac icing exe cise” and “smoking”, while women selec ed mo e o en “ he suppo om amily and iends”. Younge subjec s selec ed mo e o en “s ess”, “p ac icing exe cise” and “d inking alcohol”, while olde subjec s selec ed mo e o en “smoking”, “gene ic ac o s” and “ he suppo om amily and iends”. Compa ed o no mal weigh subjec s, o e weigh and/o obese subjec s selec ed less “ ood” and “ he en i onmen ”, and selec ed mo e “ he weigh ”. 2011 · Volume 17 · Nº 1/2/3 Alimen ação Humana 11 Table 3 — De e minan s o lowe heal h s a us pe cep ion (n=2811) HEALTH STATUS Mean OR OR adj SEX p=0.001 p=0.520 Female 74.8 1 ( e e ence) 1 ( e e ence) Male 77.9 0.786 (p=0.001) 0.935 (p=0.520) AGE p<0.001 p<0.001 18-29 yea s 85.6 1 ( e e ence) 1 ( e e ence) 30-44 yea s 80.9 1.972 (p<0.001) 1.691 (p=0.002) 45-64 yea s 72.7 4.726 (p<0.001) 2.987 (p<0.001) ≥ 65 yea s 62.6 14.300 (p<0.001) 4.389 (p<0.001) EDUCATION LEVEL p<0.001 p=0.495 < 4 h g ade 59.1 14.024 (p<0.001) 1.863 (p=0.042) 4 h g ade comple ed 66.2 4.025 (p<0.001) 1.224 (p=0.255) 6 h g ade comple ed 73.4 2.369 (p<0.001) 1.143 (p=0.473) 9 h g ade comple ed 79.3 1.261 (p=0.044) 1.079 (p=0.580) 12 h g ade comple ed 81.9 0.823 (p=0.078) 1.098 (p=0.486) Bachelo /uni e si a y 80.0 1 ( e e ence) 1 ( e e ence) CIVIL STATUS p<0.001 p=0.028 Ma ied 75.7 1 ( e e ence) 1 ( e e ence) Single 83.7 0.393 (p<0.001) 0.895 (p=0.464) Sepa a ed/di o ced 73.1 1.455 (p=0.005) 1.323 (p=0.079) Widowed 61.2 5.000 (p<0.001) 1.590 (p=0.019) PROFESSIONAL OCCUPATION p<0.001 p<0.001 Ac i e 79.1 1 ( e e ence) 1 ( e e ence) S uden 87.3 0.353 (p<0.001) 0.981 (p=0.922) Unemployed 74.4 1.923 (p<0.001) 2.570 (p<0.001) Housewi e/househusband 67.1 3.636 (p<0.001) 1.217 (p=0.402) Re i ed 64.1 4.609 (p<0.001) 0.905 (p=0.607) REGION OF RESIDENCE p<0.001 p<0.001 No e 82.9 1 ( e e ence) 1 ( e e ence) Cen o 72.6 3.091 (p<0.001) 4.364 (p<0.001) LVT 72.1 2.559 (p<0.001) 3.657 (p<0.001) Alen ejo 74.0 1.940 (p<0.001) 1.792 (p=0.009) Alga e 70.7 3.061 (p<0.001) 4.744 (p<0.001) Madei a 71.2 3.050 (p<0.001) 4.177 (p<0.001) Aço es 76.7 1.862 (p=0.020) 2.157 (p=0.017) BMI CATEGORY p<0.001 p=0.042 Unde weigh (< 18.50) 75.0 1.371 (p=0.300) 2.201 (p=0.028) No mal (18.50-24.99) 80.0 1 ( e e ence) 1 ( e e ence) P e-obesi y (25.00-29.99) 73.9 1.878 (p<0.001) 1.208 (p=0.081) Obesi y (≥ 30.00) 68.7 3.571 (p<0.001) 1.304 (p=0.127) PHYSICAL ACTIVITY LEVEL p<0.001 p=0.155 High 79.0 1 ( e e ence) 1 ( e e ence) Mode a e 76.7 1.240 (p=0.013) 1.241 (p=0.053) Low 72.2 2.071 (p<0.001) 1.149 (p=0.304) SMOKING HABITS p<0.001 p=0.370 Ne e smoked 76.1 1 ( e e ence) 1 ( e e ence) Ex-smoke 72.8 1.338 (p=0.007) 0.999 (p=0.996) Smoke 78.8 0.750 (p=0.001) 1.161 (p=0.178) MOBILITY p<0.001 p<0.001 No p oblems 79.0 1 ( e e ence) 1 ( e e ence) Some/se e e p oblems 55.1 23.755 (p<0.001) 5.027 (p<0.001) SELF-CARE p<0.001 p=0.340 No p oblems 77.2 1 ( e e ence) 1 ( e e ence) Some/se e e p oblems 52.6 19.874 (p<0.001) 1.603 (p=0.340) USUAL ACTIVITIES p<0.001 p=0.794 No p oblems 78.1 1 ( e e ence) 1 ( e e ence) Some/se e e p oblems 56.1 10.844 (p<0.001) 1.075 (p=0.794) PAIN/DISCOMFORT p<0.001 p<0.001 No p oblems 81.2 1 ( e e ence) 1 ( e e ence) Some/se e e p oblems 62.9 7.525 (p<0.001) 2.699 (p<0.001) ANXIETY/DEPRESSION p<0.001 p<0.001 No p oblems 79.6 1 ( e e ence) 1 ( e e ence) Some/se e e p oblems 65.9 4.297 (p<0.001) 2.520 (p<0.001) Re is a SPCNA 12 Alimen ação Humana Table 4 — De e minan s o ac o s pe cei ed as in luen in heal h (n=2855) Food S ess P ac icing exe cise Smoking The weigh The en i onmen Gene ic ac o s D inking alcohol The suppo om amily and iends 57.5% 27.9% 20.5% 19.5% 15.6% 13.5% 10.3% 8.6% 5.9% OR adj p OR adj p OR adj p OR adj p OR adj p OR adj p OR adj p OR adj p OR adj p SEX ( s. Female) 0.526 0.255 0.017 0.007 0.136 0.432 0.716 0.213 < 0.001 Male 1.057 0.526 0.896 0.255 1.289 0.017 1.345 0.007 0.840 0.136 0.907 0.432 0.950 0.716 1.208 0.213 0.492 < 0.001 AGE ( s. 18-29 yea s) 0.948 < 0.001 0.008 0.014 0.699 0.072 0.011 0.001 0.005 30-44 yea s 1.057 0.710 1.150 0.361 0.883 0.447 1.070 0.718 1.028 0.895 1.671 0.022 1.690 0.041 0.357 < 0.001 1.103 0.780 45-64 yea s 1.082 0.616 0.658 0.012 0.581 0.003 1.590 0.018 1.165 0.484 1.849 0.009 2.336 0.001 0.466 0.004 1.707 0.125 ≥ 65 yea s 1.022 0.920 0.498 0.006 0.523 0.032 1.890 0.027 0.988 0.965 1.774 0.068 2.663 0.005 0.395 0.011 3.995 0.002 EDUCATION LEVEL ( s. Bachelo / uni e si a y) 0.102 0.105 < 0.001 0.056 0.055 0.026 0.047 0.203 < 0.001 < 4 h g ade 0.773 0.214 0.489 0.013 0.168 < 0.001 0.670 0.165 0.761 0.323 0.506 0.030 0.684 0.231 1.773 0.118 0.742 0.507 4 h g ade 1.208 0.209 0.677 0.025 0.353 < 0.001 0.760 0.157 0.816 0.307 1.080 0.708 0.549 0.013 1.688 0.042 1.508 0.207 6 h g ade 0.866 0.374 0.943 0.738 0.271 < 0.001 0.909 0.637 1.321 0.177 0.715 0.169 0.911 0.708 1.515 0.138 3.313 < 0.001 9 h g ade 0.903 0.394 0.904 0.428 0.645 0.001 1.241 0.131 0.872 0.419 0.836 0.308 0.850 0.403 1.202 0.389 1.417 0.239 12 h g ade 1.003 0.978 0.885 0.324 0.479 < 0.001 0.912 0.530 1.216 0.226 1.158 0.378 1.188 0.358 0.912 0.676 1.592 0.101 CIVIL STATUS ( s. Ma ied) 0.053 < 0.001 0.083 0.217 0.829 0.689 0.894 0.438 0.242 Single 0.993 0.960 0.879 0.353 1.433 0.016 1.399 0.038 0.855 0.386 0.889 0.535 0.979 0.919 0.820 0.398 1.172 0.566 Sepa a ed/di o ced 0.919 0.544 1.271 0.097 1.097 0.606 1.057 0.751 1.030 0.872 1.071 0.718 0.873 0.536 1.176 0.515 0.768 0.405 Widowed 0.670 0.006 0.441 < 0.001 0.838 0.468 1.122 0.563 0.949 0.777 1.204 0.356 0.881 0.580 0.736 0.241 1.532 0.095 PROFESSIONAL OCCUPATION ( s. Ac i e) 0.359 0.001 0.069 0.034 0.047 0.016 0.494 0.189 0.243 S uden 0.936 0.681 0.802 0.193 1.231 0.225 1.307 0.165 1.333 0.203 1.157 0.566 0.857 0.606 0.930 0.783 1.250 0.534 Unemployed 0.725 0.039 0.497 < 0.001 1.139 0.479 0.979 0.914 1.601 0.017 1.898 0.001 1.130 0.625 1.448 0.138 1.447 0.223 Housewi e/househusband 0.922 0.669 1.420 0.094 1.924 0.009 0.357 0.005 1.097 0.703 1.390 0.184 1.425 0.192 0.583 0.158 0.750 0.406 Re i ed 0.926 0.631 1.075 0.702 1.035 0.883 0.783 0.256 1.504 0.042 0.957 0.845 0.906 0.682 1.181 0.533 0.547 0.069 REGION OF RESIDENCE ( s. No e) < 0.001 0.004 0.582 0.002 0.027 < 0.001 < 0.001 0.001 0.015 Cen o 1.101 0.397 0.998 0.985 0.871 0.329 0.688 0.014 0.607 0.002 2.928 < 0.001 1.917 < 0.001 0.332 < 0.001 1.076 0.780 LVT 0.712 < 0.001 1.218 0.064 0.891 0.329 1.186 0.147 1.032 0.799 1.757 < 0.001 0.539 < 0.001 0.830 0.240 1.853 0.003 Alen ejo 0.883 0.505 1.831 0.002 1.040 0.871 0.607 0.068 0.758 0.287 1.413 0.219 0.361 0.018 0.486 0.051 1.879 0.070 Alga e 0.703 0.132 0.820 0.472 1.340 0.285 0.797 0.468 1.019 0.952 1.633 0.154 0.661 0.343 0.765 0.511 2.755 0.011 Madei a 0.394 0.001 1.275 0.384 0.956 0.892 1.452 0.217 1.122 0.723 2.178 0.030 1.220 0.610 0.986 0.973 2.030 0.150 Aço es 0.762 0.322 2.130 0.008 1.377 0.335 1.522 0.189 0.551 0.153 1.114 0.823 0.680 0.454 1.120 0.777 2.232 0.098 BMI CATEGORY ( s. No mal 18.50-24.99) < 0.001 0.619 0.669 0.853 < 0.001 0.024 0.314 0.071 0.063 Unde weigh (< 18.50) 1.313 0.404 1.140 0.683 0.734 0.386 0.865 0.717 2.040 0.050 0.512 0.236 1.185 0.757 0.596 0.436 1.780 0.300 P e-obesi y (25.00-29.99) 0.634 < 0.001 0.894 0.268 0.901 0.359 1.037 0.755 1.406 0.006 0.991 0.942 1.202 0.202 1.134 0.440 1.084 0.683 Obesi y (≥ 30.00) 0.441 < 0.001 1.021 0.895 0.977 0.908 1.149 0.429 2.412 < 0.001 0.544 0.007 0.820 0.428 1.748 0.013 1.826 0.016 PHYSICAL ACTIVITY LEVEL ( s. High) < 0.001 < 0.001 0.038 0.213 0.057 0.001 0.359 0.981 0.580 Low 1.131 0.272 1.629 < 0.001 0.703 0.016 1.266 0.098 1.208 0.199 0.681 0.016 0.808 0.238 0.964 0.855 0.789 0.318 Mode a e 1.560 < 0.001 1.323 0.008 0.953 0.669 1.178 0.163 0.890 0.367 0.624 < 0.001 0.812 0.178 0.993 0.967 0.940 0.753 SMOKING HABITS ( s. Ne e smoked) < 0.001 < 0.001 0.087 < 0.001 0.008 0.003 0.046 0.117 0.035 Ex-smoke 0.862 0.201 1.037 0.782 0.919 0.577 1.880 < 0.001 0.929 0.624 1.257 0.136 0.867 0.448 1.130 0.530 0.470 0.010 Smoke 0.631 < 0.001 1.562 < 0.001 0.776 0.027 3.074 < 0.001 0.652 0.002 0.689 0.013 0.660 0.013 0.741 0.085 0.842 421 2011 · Volume 17 · Nº 1/2/3 Alimen ação Humana 13 Table 5 compa es heal h s a us pe cep ion be ween subjec s who e e ed o no each o he ac o s pe cei ed as in luen in heal h. Heal h s a us’ pe cep ion was signi ican ly di e en be ween subjec s who e e ed o no each o he heal h de e minan s, excep “d inking alcohol”. Pa icipan s who indica ed “ ood”, “s ess”, “p ac icing exe cise” o “smoking” as main in luences in heal h epo ed highe heal h s a us’ pe cep ion. On he con a y, hose who e e ed “ he weigh ”, “ he en i onmen ”, “gene ic ac o s” o “suppo om amily and iends” epo ed lowe heal h s a us’ pe cep ion. Conside ing all he nine ac o s in he ANOVA model, he ones wi h signi ican in luence in heal h s a us’ pe cep ion we e “ ood”, “s ess”, “p ac icing exe cise”, “smoking” and “d inking alcohol”. Pa icipan es who indica ed hese ac o s epo ed highe heal h s a us’ pe cep ion. Table 5 — Heal h s a us’ pe cep ion and ac o s pe cei ed as in luen in heal h (n=2835) Independen -samples es ANOVA YES NO p YES NO p EQ-VAS Mean (sd) EQ-VAS Mean (sd) EQ-VAS EMM EQ-VAS EMM Food 77.8 (17.3) 74.1 (18.1) < 0.001 85.7 80.0 < 0.001 S ess 78.2 (16.6) 75.4 (18.1) < 0.001 86.2 79.5 < 0.001 P ac icing exe cise 83.1 (14.6) 74.4 (18.0) < 0.001 88.5 77.2 < 0.001 Smoking 77.9 (17.5) 75.8 (17.8) 0.009 85.5 80.3 < 0.001 The weigh 74.1 (17.5) 76.6 (17.8) 0.005 83.4 82.4 0.318 The en i onmen 72.7 (17.4) 76.8 (17.7) < 0.001 82.7 83.1 0.737 D inking alcohol 76.9 (15.5) 76.1 (17.9) 0.486 84.9 80.9 0.002 Gene ic ac o s 72.1 (16.0) 76.7 (17.9) < 0.001 82.7 83.1 0.734 The suppo om amily and iends 72.4 (17.6) 76.4 (17.7) 0.003 81.7 84.1 0.112 EMM = Es ima ed ma ginal mean DISCUSSION To ou knowledge his is he i s s udy o assess he heal h s a us pe cep ion o a ep esen a i e sample o Po uguese adul s. Al hough he c oss-sec ional na u e o his s udy doesn’ allow us o conclude on he di ec ion o causali y, he knowledge on he associa ion be ween he s udied a iables is ce ainly aluable o maximize he esul s o public heal h in e en ions. The ac ha da a om a na ionally ep esen a i e sample we e analysed ega ding such a b oad se o a iables con ibu es o he impo ance o he indings. When compa ed wi h p e ious esul s6, he p e alence o obesi y be ween 2003-05 and 2009 in he po uguese adul popula ion educed om 14.2 o 10.8%. This educ ion was obse ed bo h o women (13.4 o 10.4%) and men (15.0 o 11.2%). Al hough he p e alence o obesi y seems o be dec easing, o e weigh is s ill obse ed in abou hal o he Po uguese adul s. Fu he mo e, i s p opo ion may e en be inc easing in men: while in women he global p e alence o o e weigh dec eased om 47.8 o 38.2%, in men i inc eased om 60.2 o 64.5%. The highe p opo ions o o e weigh in olde and less educa ed subjec s ound in his wo k also was ound in 2003-056. The unde es ima ion o BMI has been ound in o he s udies, namely in a sample o Po uguese adul s7 and in a e iew by Go be e al.8. Howe e , Ramos e al.7 epo g ea e disc epancy be ween measu ed and es ima ed BMI in women, while ou indings indica e he opposi e. Rega ding he associa ion be ween BMI disc epancy and age o BMI, ou esul s a e in line wi h hose o Ramos e al.7; al hough Go be e al.8 don’ quan i a i ely combine he esul s om he wo ks e iewed, hei da a show he same end ega ding BMI. Finally, al hough bo h s udies ound an associa ion be ween educa ion and BMI only o males, ou esul s indica e a g ea e BMI unde es ima ion in less educa ed men, while Ramos e al.7 epo he opposi e. Re is a SPCNA 14 Alimen ação Humana Po uguese adul s showed a high heal h s a us pe cep ion and selec ed “ ood”, “s ess”, “p ac icing exe cise”, “smoking” o “d inking alcohol” as ac o s wi h g ea e impo ance in heal h. These ac o s we e also associa ed wi h highe heal h s a us’ pe cep ion. O e all, “ ood” was he ac o mo e o en selec ed as one o he mos impo an heal h de e minan s. I is in e es ing o no ice ha o e weigh subjec s ended o selec less o en “ ood” han no mal weigh subjec s. When hese esul s a e compa ed o hose om a p e ious na ionally ep esen a i e sample4,9, i is wo h no icing ha “p ac icing exe cise”, “s ess” and “gene ic ac o s” a e hose which a e inc easingly e e ed as ha ing g ea e impo ance in heal h. On he o he hand, he impo ance o “d inking alcohol”, “ he en i onmen ” and “smoking” seems o be dec easing. The knowledge on ac o s pe cei ed as majo heal h de e minan s is use ul o design e ec i e heal h p omo ion in e en ions. Ou esul s con ibu e o unde s and he de e minan s o heal h s a us’ pe cep ion, which may assis he use o mo i a ional s a egies in hose in e en ions, specially in g oups wi h lowe pe cep ion o heal h s a us. Fu u e esea ch should explo e he causes o lowe heal h s a us pe cep ion being associa ed wi h demog aphic cha ac e is ics, as well as he easons unde lying he pe cep ion o which ac o s a e mo e in luen in heal h. REFERENCES 1 Poínhos R, F anchini B, A onso C, Co eia F, Teixei a VH, Mo ei a P, e al. Alimen ação e es ilos de ida da população po uguesa. Alim Hum. 2009; 15(3):43-60. 2 WHO. Obesi y: p e en ing and managing he global epidemic. Repo o a WHO consul a ion on obesi y. Gene a: Wo ld Heal h O ganisa ion; 1998. 3 Szende A, Oppe M, De lin N, edi o s. EQ-5D Value Se s: In en o y, Compa a i e Re iew and Use Guide. Do d ech : Sp inge ; 1997. 4 Ka a os A, Manios Y, Ma ka ji I, Giache i I, de Almeida MDV, Engs om LM. Regional, demog aphic and na ional in luences on a i- udes and belie s wi h ega d o physical ac i i y, body weigh and heal h in na ionally ep esen a i e sample in he Eu opean Union. Public Heal h Nu . 1999; 2(1a):87-95. 5 C aig CL, Ma shall AL, Sjös öm M, Bauman AE, Boo h ML, Ainswo h BE, e al. In e na ional physical ac i i y ques ionnai e: 12-coun y eliabili y and alidi y. Med Sci Spo s Exe c. 2003; 35:1381-95. 6 Ca mo I, San os O, Camolas J, Viei a J, Ca ei a M, Medina L, e al. O e weigh and obesi y in Po ugal: na ional p e alence in 2003- 2005. Obesi y Res. 2008; 9:11-9. 7 Ramos E, Lopes C, Oli ei a A, Ba os H. Unawa eness o weigh and heigh - The e ec on sel - epo ed p e alence o o e weigh in a popula ion-based s udy. J Nu Heal h Aging. 2009; 13:310-4. 8 Go be SC, T emblay M, Mohe D, Go be B. A compa ison o di ec s. sel - epo measu es o assessing heigh , weigh and body mass index: A sys ema ic e iew. Obes Re . 2007; 8:307-26. 9 A onso C. Saúde, ac i idade ísica e peso co po al: Con ibu o pa a o seu conhecimen o numa amos a da população adul a po u- guesa. Tese de Mes ado em Saúde Pública ap esen ada à Faculdade de Medicina da Uni e sidade do Po o e Ins i u o de Ciências Biomédicas Abel Salaza . 1999.