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[A1CR]

It seems, in the paper below that, also among the very poor,
the
relationship, which we as CRers downplay for their
credibility, between
having lower http://en.wikipedia.org/wiki/Body_mass_index
http://en.wikipedia.org/wiki/Image:Body_mass_index_chart.svg
and disease.
Hospitalization rates were also higher with energy
malnutrition. Would the
greater, than appears to be the case for developed
countries, less risk from
being overweight than from being "CR"ed in such a poor
country suggest that
socioeconomic factors could be a reason for the lower risks
in developed
countries for being "CR"ed?

Bose K, Bisai S, DAS P, Dikshit S, Pradhan S.
INTER-RELATIONSHIPS OF INCOME, CHRONIC ENERGY DEFICIENCY,
MORBIDITY AND
HOSPITALIZATION AMONG ADULT MALE SLUM DWELLERS OF MIDNAPORE,
WEST BENGAL,
INDIA.
J Biosoc Sci. 2006 Nov 3;:1-8 [Epub ahead of print] No
abstract available.
PMID: 17083747

Summary. A cross-sectional study of 212 adult (>18 years)
male slum dwellers
(mean age=34.6±14.4 years) of Midnapore town, West Bengal,
India, was
undertaken to study the inter-relationships of chronic
energy deficiency
(CED), monthly family income (MFI), self-reported morbidity and
hospitalization
due to severe illness. The mean height, weight and body mass
index
(BMI) of the subjects were 160.0 cm, 50.8 kg and 19.9 kg/m2,
respectively.
The overall frequencies of CED (BMI<18.5 kg/m2), morbidity and
hospitalization
were 38.2%, 34.4% and 13.7%, respectively. Based on the WHO
classification, the prevalence of CED among this population
was high
(20-39%), indicating a serious situation. Overall, MFI was
significantly
(p<0.01) positively correlated with BMI (r=0.21). Linear
regression analyses
showed that MFI had a significant impact (t=3.08; p<0.002)
on BMI. Overall,
MFI explained 3.9% variation in BMI. Subjects belonging to
the lowest
family income group (FIG I) had the lowest mean BMI (19.1
kg/m2) and the
highest rate of CED (46.3%) and morbidity (36.6%). Those in
the highest
family income group (FIG III) had the largest mean BMI (20.8
kg/m2) and
lowest rate of CED (30.2%) and morbidity (30.2%). The
highest rate (18.9%)
of hospitalization was found in this group. There were
significant family
income group differences in mean BMI (F=3.134, p<0.05). The
frequency of
morbidity (24.6%) and hospitalization (11.9%) was lowest
among normal
BMI individuals. Morbidity was significantly higher
(Chi^2=11.92, p=0.0026)
among CED (48.2%) subjects compared with normal BMI individuals
(OR=2.85; CI=1.49-5.46). Similarly, compared with normal BMI
subjects,
morbidity was higher (38.5%; OR=1.92; 95% CI=0.50-7.18)
among overweight
subjects. Hospitalization was more common among CED subjects
(16.1%; OR=1.42; CI=0.58-3.45) compared with normal BMI
subjects.
Similarly, the frequency of hospitalization was more among
overweight
individuals (15.4%; OR=1.35; 95% CI=0.0-7.59). In
conclusion, this study
provides evidence that the frequency of CED among this
population is high,
indicating a serious situation. Moreover there exists strong
inter-relationships
between BMI, CED, MFI and morbidity.

... Body mass index is generally considered
a good indicator of not only the nutritional status but also
the
socioeconomic
condition of a population, especially adult populations of
developing
countries
... A BMI<18.5 kg/m2 is widely used as a practical measure
of chronic energy
deficiency
(CED), i.e. a 'steady' underweight in which an individual is
in energy
balance
irrespective of a loss in body weight or body energy stores
(Khongsdier,
2005). Such
a 'steady' underweight is likely to be associated with
morbidity or other
physiological
and functional impairments ...

... three income groups (FIG) - FIG I, FIG II
and FIG III - based on 25th and 75th percentile values of
MFI. ...

Results
The characteristics of the study sample are presented in
Table 1. The mean
age of the
subjects was 34.6 years (SD=14.0 years). Mean MFI was Rs
4563.5 (SD=3274.5),
slightly higher than the national average of Rs 2879.50, as
reported in a
recent report
by Stanford (2003). Mean years of schooling was 4.4 years
(SD=3.6). Mean
height,
weight and BMI of the subjects were 160.0 cm (SD=7.7 cm),
50.8 kg (SD=8.7
kg)
and 19.9 kg/m2 (SD=3.4 kg/m2), respectively.

Table 1. Characteristics of the study sample (n=212)
=================================
Variable Mean SD Range
=================================
Family income (Rs/month) 4563.5 3274.5 200-14,100
Age (years) 34.6 14.4 19-85
Schooling (years) 4.4 3.6 0-13
Height (cm) 160.0 7.7 107.0-175.8
Weight (kg) 50.8 8.7 21.0-85.0
BMI (kg/m2) 19.9 3.4 11.3-42.8

Figure 1 presents the nutritional status (based on BMI) of
the subjects. The
prevalence of CED was 38.2%. Of these, 7.1%, 9.4% and 21.7%
belonged to CED
III,
CED II and CED I categories, respectively. Only 6.1%
belonged to the
overweight
category. Based on the WHO (1995) classification, the
prevalence of CED
among this
population was high (20-39%), and thus the situation is serious.
Table 2 presents mean BMI and the rates of CED, morbidity and
hospitalization
by family income group (FIG) categories. There was a
significant (F=3.134,
p<0.05)
difference in mean BMI between the three family income
groups with FIG I
(19.1
kg/m2) having the lowest mean value and FIG III (20.8 kg/m2)
having the
largest
mean value. Mean BMI in FIG II (19.7 kg/m2) was
intermediate. The rates of
CED
decreased consistently (Chi^2=2.62, p=0.2695) from FIG I
(46.3%) to FIG III
(30.2%),
with FIG II (38.9%) having an intermediate rate. Similarly,
the rates of
self-reported
morbidity decreased (Chi^2=0.58, p=0.7493) from FIG I
(36.6%) to FIG III
(30.2%) with
FIG II having an intermediate rate (35.6%). Results of
studies on
hospitalization
(Chi^2=1.61, p=0.4462) revealed that FIG I (12.2%) and FIG
II (11.9%) had
similar
rates. However, FIG III had much higher rates than both the
other two
groups.
The results of Pearson correlation analyses (results not
shown) showed that
age
did not have any significant relationship either with BMI or
with MFI.
Moreover, it
was observed that MFI were significantly positively
correlated (r=0.208;
p<0.01) with
BMI. The results of linear regression analyses of MFI with
BMI demonstrated
a
significant positive impact (t=3.08, p<0.01) of MFI on BMI.
A total of 3.9%
of
variation in BMI was explained by MFI. The regression
equation was:
BMI=18.863+0.00022 (MFI).

Table 2. Mean BMI and the rates of CED, morbidity and
hospitalization by
family income group (FIG) categories
==========================================
FIG n BMI^a Mean (SD) CED^b % Morbidity^c % Hospitalization^d %
==========================================
I 41 19.1 (3.2) 46.3 36.6 12.2
II 118 19.7 (2.9) 38.9 35.6 11.9
III 53 20.8 (4.2) 30.2 30.2 18.9
==========================================
a F=3.134, p=0.0456.
b Chi^2=2.62, p=0.2695.
c Chi^2=0.58, p=0.7493.
d Chi^2=1.61, p=0.4462.

There were significant differences (F=6.101; p=0.0027)
between BMI
categories in
mean years of schooling (results not presented). Persons
with CED had the
least
amount of schooling (mean 5.6 years), whereas overweight
individuals had the
most
(mean 7.37 years), with normal BMI subjects having an
intermediate amount of
schooling (mean 2.6 years). Similarly, FIG I subjects had
significantly
(F=4.675;
p<0.05) lower mean years of schooling (5.6 years) compared
with FIG III
individuals
(2.9 years).
Table 3 shows the rates of self-reported morbidity and
hospitalization by
BMI
categories. The frequency of morbidity (24.6%) and
hospitalization (11.9%)
was
lowest among normal BMI individuals. The frequency of
morbidity was
significantly
higher (Chi^2=11.92, p=0.0026) among CED subjects (48.2%)
compared with
normal
BMI individuals (OR=2.85; CI=1.49-5.46). Similarly, compared
with normal BMI
subjects, the frequency of morbidity was higher (38.5%;
OR=1.92; 95%
CI=0.50-
7.18) among overweight subjects. The frequency of
hospitalization
(Chi^2=0.75,
p=0.6885) was higher among CED subjects (16.1%; OR=1.42;
CI=0.58-3.45)
compared with normal BMI subjects. Similarly, the frequency of
hospitalization was
higher among overweight individuals (15.4%; OR=1.35; 95%
CI=0.0-7.59).

Table 3. Prevalence of morbidity and hospitalization by
nutritional status
of the subjects
=============================================
Catagory Morbidity^a, % OR (95% CI) Hospitalization^b, % OR
(95% CI)
=============================================
CED 48.2 2.85 (1.49-5.46) 16.1 1.42 (0.58-3.45)
Normal 24.6 1.00 11.9 1.00
Overweight 38.5 1.92 (0.50-7.18) 15.4 1.35 (0.00-7.59)
=============================================
a Chi^2=11.92, p=0.0026.
b Chi^2=0.75, p=0.6885.

... The present study
also demonstrated a strong association between income and
morbidity. This is
in
concordance with the earlier findings of Khongsdier (2002),
who also
reported a
similar relationship between income and morbidity. A very
interesting
finding of the
present study is that the highest rate of hospitalization
was found among
the highest
family income group. This was probably due to the fact that
individuals in
this group
had significantly higher mean years of schooling compared
with other family
income
groups, which in turn would have increased their level of
awareness about
the severity
of illnesses leading to greater hospitalization. Another
major factor could
have been
economic, i.e. they were more likely to afford the high
costs of
hospitalization.
The relationship of BMI status with morbidity tended to be
U-shaped, i.e.
normal
BMI individuals had the lowest morbidity compared with CED
and overweight
individuals. This had earlier been documented by Khonsgdier
(2002) among the
War
Khasis of Meghalaya, north-east India. The current study's
findings
highlight the
adverse health effects of low and high BMI as opposed to
normal BMI, which
is in
concordance with the recommendations of the World Health
Organization (1995)
about the desired benefits of a normal BMI. The present
study also found a
U-shaped
relationship between BMI and hospitalization. This finding
is novel since no
study
from India could be located that has dealt with BMI status and
hospitalization.
However, it could partly be explained by the fact that there
also existed a
similar
U-shaped relationship between BMI and morbidity.