Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity Among Registered
Nurses in A District Specialist Hospital
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
1Staff Nurse Special Care Nursery Hospital Seri Manjung
2Pharmacist Clinical Research Centre Hospital Seri Manjung
3Head of Paediatric Department Hospital Seri Manjung
4Nursing Sister Paediatric Ward Hospital Seri Manjung
5Staff Nurse Paediatric Ward Hospital Seri Manjung
6Staff Nurse Intensive Care Unit Hospital Seri Manjung
7Staff Nurse Psychiatric Clinic Hospital Seri Manjung
NMRR-16-766-28807
1
2
AREA LAND 1168kmsup2POPULATION 247603 ( 2015 )
3
The Manjung District is a district in the southwestern part of Perakstate 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 districts principal
urban center
while smaller towns include
Lumut Sitiawan Ayer Tawar Pantai
Remis and Beruas
HOSPITAL SERI MANJUNG 305 beds
NAVI HOSPITAL 1
HOSPITAL DESA PANGKOR 1
PRIVATE HOSPITAL 2
GOVERMENT HEALTH CLINIC 31
PRIVATE HEALTH CLINIC 72
5
6
Departments Units
bull Medical bull Surgicalbull Orthopaedicbull Ophthalmology bull Emergency amp Traumatology bull Paediatrics bull Obstetrics amp Gynaecologybull Psychiatry amp Mental Health bull Diagnostic amp Imaging bull Pharmacy amp Supply bull Pathology Departmentbull Dietetics amp Catering
bull Haemodialysis Unitbull ICU CCUbull Physiotherapy Unitbull Occupational
Rehabilitation bull Sterile Equipment Supply
Unitbull Health Education Unitbull Medical Social Work Unitbull Counselling Psychology
Unitbull Quality Unit Innovation amp
CRC(Clinical Research Centre)
7
8
Health burden
BMI = weight (kg) height (m2)
9
Overweight and obesity classificationCategory IBMI (kgm2) ABMI (kgm2 )
Underweight lt1850 lt1850
Normal 1850-2499 1850-2299
Overweight 2500-2999 2300-2749
Obese ge 3000 ge 2750
Source WHO 2004sup1 CPG on Management of Obesity 2004sup2
10
3) There has been some contention whether thegeneralisation of the IBMI (International Body Mass Index) tothe Asian population will underestimate theprevalence of overweight and obesity
4) In year 2004 WHO was recommended additionalBMI cut-off points for Asian populations for publichealth (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)
5) BMI cut-off points have been revised to suit Asianpopulation due to
(i) high prevalence of Type 2 Diabetes Mellitus among Asian individuals with BMI lt 250kgm2
(ii) higher cardiovascular risk factors among Asian individuals at any BMI level and
(iii) population based association between BMI body fat percentage and distribution
11
Prevalence of overweight and obesity is highest in developing countries and is associated with increase in incidence of cardiovascular disease
12
Lamon-Fava S et al 1996Hossain 2007 Bhurosy et al 2014
Deuremberg-Yap M et al 2001 (Singapore)
The BMI recommendation for public health was less than IBMI classification (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)
Feng R N et al 2012(China)
The optimal BMI for men and women to predict co-morbidities was less than IBMI classification ( 24 kgm2 )
Ren Q et al 2016(China)
The optimal BMI for men and women to predict Hypertension was less than IBMI classification(2353kgm2 and 2425kgm2)
Tanu et al 2014(India)
The optimal BMI to predict Hypertension was ge245kgm2 (men) and ge249kgm2( women)
13
Bogossian FE et al 2012
The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK
Miller SK et al 2008
The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively
Ogunjimi LO et al 2010
The prevalence of obesity among Nigerian nurses 626
Coomarasamy JD et al 2014
The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively
14
Malaysian National Health and Morbidity Survey(MNHMS)2006 2011
Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years
Malaysian National Health and Morbidity Survey 2015
IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306
bull Among obese population female Malaysians were more affected than the male counterparts
WHO- Non Communicable Disease Profile in Malaysia 2012
This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar
15
Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria
General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses
Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-
morbidities among those who were overweight and obese according to both definitions
2) To determine the factors associated with overweight and obesity in the study population
16
Sample size 384 (minimum)
- Stratified random sampling (working schedule)
- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5
(456- 556)
17
MREC approved
Cross-sectional Study
Hospital Seri Manjung
Nurses in all departments
September - October 2016
Inclusion criteria
All female registered nurses in HSM
Exclusion criteria
Pregnant on confinement paid unpaid leave refuse to consent
18
Data collection
Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire
Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005
Data analysis
Prevalence of outcome was presented as
Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated
Associating factors were analysed using multiple logistic regression
19
MREC approved
20
Consent taking process
Interviewing the respondent by using
questionnaire
Measuring of height and weight as well as BMI
calculation
Nurses who fulfilled the inclusion criteria
were given Respondent Information Sheet
Researchers explained to respondents about the study
Respondents were given sufficient time to understand ask
questions and consider before deciding on their participation
All respondents were asked to sign
2 sets of informed consent form
21
Figure 2 Information sheet amp Consent taking process
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
2
AREA LAND 1168kmsup2POPULATION 247603 ( 2015 )
3
The Manjung District is a district in the southwestern part of Perakstate 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 districts principal
urban center
while smaller towns include
Lumut Sitiawan Ayer Tawar Pantai
Remis and Beruas
HOSPITAL SERI MANJUNG 305 beds
NAVI HOSPITAL 1
HOSPITAL DESA PANGKOR 1
PRIVATE HOSPITAL 2
GOVERMENT HEALTH CLINIC 31
PRIVATE HEALTH CLINIC 72
5
6
Departments Units
bull Medical bull Surgicalbull Orthopaedicbull Ophthalmology bull Emergency amp Traumatology bull Paediatrics bull Obstetrics amp Gynaecologybull Psychiatry amp Mental Health bull Diagnostic amp Imaging bull Pharmacy amp Supply bull Pathology Departmentbull Dietetics amp Catering
bull Haemodialysis Unitbull ICU CCUbull Physiotherapy Unitbull Occupational
Rehabilitation bull Sterile Equipment Supply
Unitbull Health Education Unitbull Medical Social Work Unitbull Counselling Psychology
Unitbull Quality Unit Innovation amp
CRC(Clinical Research Centre)
7
8
Health burden
BMI = weight (kg) height (m2)
9
Overweight and obesity classificationCategory IBMI (kgm2) ABMI (kgm2 )
Underweight lt1850 lt1850
Normal 1850-2499 1850-2299
Overweight 2500-2999 2300-2749
Obese ge 3000 ge 2750
Source WHO 2004sup1 CPG on Management of Obesity 2004sup2
10
3) There has been some contention whether thegeneralisation of the IBMI (International Body Mass Index) tothe Asian population will underestimate theprevalence of overweight and obesity
4) In year 2004 WHO was recommended additionalBMI cut-off points for Asian populations for publichealth (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)
5) BMI cut-off points have been revised to suit Asianpopulation due to
(i) high prevalence of Type 2 Diabetes Mellitus among Asian individuals with BMI lt 250kgm2
(ii) higher cardiovascular risk factors among Asian individuals at any BMI level and
(iii) population based association between BMI body fat percentage and distribution
11
Prevalence of overweight and obesity is highest in developing countries and is associated with increase in incidence of cardiovascular disease
12
Lamon-Fava S et al 1996Hossain 2007 Bhurosy et al 2014
Deuremberg-Yap M et al 2001 (Singapore)
The BMI recommendation for public health was less than IBMI classification (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)
Feng R N et al 2012(China)
The optimal BMI for men and women to predict co-morbidities was less than IBMI classification ( 24 kgm2 )
Ren Q et al 2016(China)
The optimal BMI for men and women to predict Hypertension was less than IBMI classification(2353kgm2 and 2425kgm2)
Tanu et al 2014(India)
The optimal BMI to predict Hypertension was ge245kgm2 (men) and ge249kgm2( women)
13
Bogossian FE et al 2012
The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK
Miller SK et al 2008
The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively
Ogunjimi LO et al 2010
The prevalence of obesity among Nigerian nurses 626
Coomarasamy JD et al 2014
The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively
14
Malaysian National Health and Morbidity Survey(MNHMS)2006 2011
Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years
Malaysian National Health and Morbidity Survey 2015
IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306
bull Among obese population female Malaysians were more affected than the male counterparts
WHO- Non Communicable Disease Profile in Malaysia 2012
This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar
15
Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria
General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses
Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-
morbidities among those who were overweight and obese according to both definitions
2) To determine the factors associated with overweight and obesity in the study population
16
Sample size 384 (minimum)
- Stratified random sampling (working schedule)
- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5
(456- 556)
17
MREC approved
Cross-sectional Study
Hospital Seri Manjung
Nurses in all departments
September - October 2016
Inclusion criteria
All female registered nurses in HSM
Exclusion criteria
Pregnant on confinement paid unpaid leave refuse to consent
18
Data collection
Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire
Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005
Data analysis
Prevalence of outcome was presented as
Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated
Associating factors were analysed using multiple logistic regression
19
MREC approved
20
Consent taking process
Interviewing the respondent by using
questionnaire
Measuring of height and weight as well as BMI
calculation
Nurses who fulfilled the inclusion criteria
were given Respondent Information Sheet
Researchers explained to respondents about the study
Respondents were given sufficient time to understand ask
questions and consider before deciding on their participation
All respondents were asked to sign
2 sets of informed consent form
21
Figure 2 Information sheet amp Consent taking process
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
3
The Manjung District is a district in the southwestern part of Perakstate 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 districts principal
urban center
while smaller towns include
Lumut Sitiawan Ayer Tawar Pantai
Remis and Beruas
HOSPITAL SERI MANJUNG 305 beds
NAVI HOSPITAL 1
HOSPITAL DESA PANGKOR 1
PRIVATE HOSPITAL 2
GOVERMENT HEALTH CLINIC 31
PRIVATE HEALTH CLINIC 72
5
6
Departments Units
bull Medical bull Surgicalbull Orthopaedicbull Ophthalmology bull Emergency amp Traumatology bull Paediatrics bull Obstetrics amp Gynaecologybull Psychiatry amp Mental Health bull Diagnostic amp Imaging bull Pharmacy amp Supply bull Pathology Departmentbull Dietetics amp Catering
bull Haemodialysis Unitbull ICU CCUbull Physiotherapy Unitbull Occupational
Rehabilitation bull Sterile Equipment Supply
Unitbull Health Education Unitbull Medical Social Work Unitbull Counselling Psychology
Unitbull Quality Unit Innovation amp
CRC(Clinical Research Centre)
7
8
Health burden
BMI = weight (kg) height (m2)
9
Overweight and obesity classificationCategory IBMI (kgm2) ABMI (kgm2 )
Underweight lt1850 lt1850
Normal 1850-2499 1850-2299
Overweight 2500-2999 2300-2749
Obese ge 3000 ge 2750
Source WHO 2004sup1 CPG on Management of Obesity 2004sup2
10
3) There has been some contention whether thegeneralisation of the IBMI (International Body Mass Index) tothe Asian population will underestimate theprevalence of overweight and obesity
4) In year 2004 WHO was recommended additionalBMI cut-off points for Asian populations for publichealth (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)
5) BMI cut-off points have been revised to suit Asianpopulation due to
(i) high prevalence of Type 2 Diabetes Mellitus among Asian individuals with BMI lt 250kgm2
(ii) higher cardiovascular risk factors among Asian individuals at any BMI level and
(iii) population based association between BMI body fat percentage and distribution
11
Prevalence of overweight and obesity is highest in developing countries and is associated with increase in incidence of cardiovascular disease
12
Lamon-Fava S et al 1996Hossain 2007 Bhurosy et al 2014
Deuremberg-Yap M et al 2001 (Singapore)
The BMI recommendation for public health was less than IBMI classification (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)
Feng R N et al 2012(China)
The optimal BMI for men and women to predict co-morbidities was less than IBMI classification ( 24 kgm2 )
Ren Q et al 2016(China)
The optimal BMI for men and women to predict Hypertension was less than IBMI classification(2353kgm2 and 2425kgm2)
Tanu et al 2014(India)
The optimal BMI to predict Hypertension was ge245kgm2 (men) and ge249kgm2( women)
13
Bogossian FE et al 2012
The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK
Miller SK et al 2008
The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively
Ogunjimi LO et al 2010
The prevalence of obesity among Nigerian nurses 626
Coomarasamy JD et al 2014
The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively
14
Malaysian National Health and Morbidity Survey(MNHMS)2006 2011
Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years
Malaysian National Health and Morbidity Survey 2015
IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306
bull Among obese population female Malaysians were more affected than the male counterparts
WHO- Non Communicable Disease Profile in Malaysia 2012
This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar
15
Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria
General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses
Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-
morbidities among those who were overweight and obese according to both definitions
2) To determine the factors associated with overweight and obesity in the study population
16
Sample size 384 (minimum)
- Stratified random sampling (working schedule)
- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5
(456- 556)
17
MREC approved
Cross-sectional Study
Hospital Seri Manjung
Nurses in all departments
September - October 2016
Inclusion criteria
All female registered nurses in HSM
Exclusion criteria
Pregnant on confinement paid unpaid leave refuse to consent
18
Data collection
Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire
Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005
Data analysis
Prevalence of outcome was presented as
Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated
Associating factors were analysed using multiple logistic regression
19
MREC approved
20
Consent taking process
Interviewing the respondent by using
questionnaire
Measuring of height and weight as well as BMI
calculation
Nurses who fulfilled the inclusion criteria
were given Respondent Information Sheet
Researchers explained to respondents about the study
Respondents were given sufficient time to understand ask
questions and consider before deciding on their participation
All respondents were asked to sign
2 sets of informed consent form
21
Figure 2 Information sheet amp Consent taking process
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
HOSPITAL SERI MANJUNG 305 beds
NAVI HOSPITAL 1
HOSPITAL DESA PANGKOR 1
PRIVATE HOSPITAL 2
GOVERMENT HEALTH CLINIC 31
PRIVATE HEALTH CLINIC 72
5
6
Departments Units
bull Medical bull Surgicalbull Orthopaedicbull Ophthalmology bull Emergency amp Traumatology bull Paediatrics bull Obstetrics amp Gynaecologybull Psychiatry amp Mental Health bull Diagnostic amp Imaging bull Pharmacy amp Supply bull Pathology Departmentbull Dietetics amp Catering
bull Haemodialysis Unitbull ICU CCUbull Physiotherapy Unitbull Occupational
Rehabilitation bull Sterile Equipment Supply
Unitbull Health Education Unitbull Medical Social Work Unitbull Counselling Psychology
Unitbull Quality Unit Innovation amp
CRC(Clinical Research Centre)
7
8
Health burden
BMI = weight (kg) height (m2)
9
Overweight and obesity classificationCategory IBMI (kgm2) ABMI (kgm2 )
Underweight lt1850 lt1850
Normal 1850-2499 1850-2299
Overweight 2500-2999 2300-2749
Obese ge 3000 ge 2750
Source WHO 2004sup1 CPG on Management of Obesity 2004sup2
10
3) There has been some contention whether thegeneralisation of the IBMI (International Body Mass Index) tothe Asian population will underestimate theprevalence of overweight and obesity
4) In year 2004 WHO was recommended additionalBMI cut-off points for Asian populations for publichealth (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)
5) BMI cut-off points have been revised to suit Asianpopulation due to
(i) high prevalence of Type 2 Diabetes Mellitus among Asian individuals with BMI lt 250kgm2
(ii) higher cardiovascular risk factors among Asian individuals at any BMI level and
(iii) population based association between BMI body fat percentage and distribution
11
Prevalence of overweight and obesity is highest in developing countries and is associated with increase in incidence of cardiovascular disease
12
Lamon-Fava S et al 1996Hossain 2007 Bhurosy et al 2014
Deuremberg-Yap M et al 2001 (Singapore)
The BMI recommendation for public health was less than IBMI classification (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)
Feng R N et al 2012(China)
The optimal BMI for men and women to predict co-morbidities was less than IBMI classification ( 24 kgm2 )
Ren Q et al 2016(China)
The optimal BMI for men and women to predict Hypertension was less than IBMI classification(2353kgm2 and 2425kgm2)
Tanu et al 2014(India)
The optimal BMI to predict Hypertension was ge245kgm2 (men) and ge249kgm2( women)
13
Bogossian FE et al 2012
The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK
Miller SK et al 2008
The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively
Ogunjimi LO et al 2010
The prevalence of obesity among Nigerian nurses 626
Coomarasamy JD et al 2014
The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively
14
Malaysian National Health and Morbidity Survey(MNHMS)2006 2011
Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years
Malaysian National Health and Morbidity Survey 2015
IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306
bull Among obese population female Malaysians were more affected than the male counterparts
WHO- Non Communicable Disease Profile in Malaysia 2012
This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar
15
Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria
General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses
Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-
morbidities among those who were overweight and obese according to both definitions
2) To determine the factors associated with overweight and obesity in the study population
16
Sample size 384 (minimum)
- Stratified random sampling (working schedule)
- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5
(456- 556)
17
MREC approved
Cross-sectional Study
Hospital Seri Manjung
Nurses in all departments
September - October 2016
Inclusion criteria
All female registered nurses in HSM
Exclusion criteria
Pregnant on confinement paid unpaid leave refuse to consent
18
Data collection
Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire
Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005
Data analysis
Prevalence of outcome was presented as
Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated
Associating factors were analysed using multiple logistic regression
19
MREC approved
20
Consent taking process
Interviewing the respondent by using
questionnaire
Measuring of height and weight as well as BMI
calculation
Nurses who fulfilled the inclusion criteria
were given Respondent Information Sheet
Researchers explained to respondents about the study
Respondents were given sufficient time to understand ask
questions and consider before deciding on their participation
All respondents were asked to sign
2 sets of informed consent form
21
Figure 2 Information sheet amp Consent taking process
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
6
Departments Units
bull Medical bull Surgicalbull Orthopaedicbull Ophthalmology bull Emergency amp Traumatology bull Paediatrics bull Obstetrics amp Gynaecologybull Psychiatry amp Mental Health bull Diagnostic amp Imaging bull Pharmacy amp Supply bull Pathology Departmentbull Dietetics amp Catering
bull Haemodialysis Unitbull ICU CCUbull Physiotherapy Unitbull Occupational
Rehabilitation bull Sterile Equipment Supply
Unitbull Health Education Unitbull Medical Social Work Unitbull Counselling Psychology
Unitbull Quality Unit Innovation amp
CRC(Clinical Research Centre)
7
8
Health burden
BMI = weight (kg) height (m2)
9
Overweight and obesity classificationCategory IBMI (kgm2) ABMI (kgm2 )
Underweight lt1850 lt1850
Normal 1850-2499 1850-2299
Overweight 2500-2999 2300-2749
Obese ge 3000 ge 2750
Source WHO 2004sup1 CPG on Management of Obesity 2004sup2
10
3) There has been some contention whether thegeneralisation of the IBMI (International Body Mass Index) tothe Asian population will underestimate theprevalence of overweight and obesity
4) In year 2004 WHO was recommended additionalBMI cut-off points for Asian populations for publichealth (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)
5) BMI cut-off points have been revised to suit Asianpopulation due to
(i) high prevalence of Type 2 Diabetes Mellitus among Asian individuals with BMI lt 250kgm2
(ii) higher cardiovascular risk factors among Asian individuals at any BMI level and
(iii) population based association between BMI body fat percentage and distribution
11
Prevalence of overweight and obesity is highest in developing countries and is associated with increase in incidence of cardiovascular disease
12
Lamon-Fava S et al 1996Hossain 2007 Bhurosy et al 2014
Deuremberg-Yap M et al 2001 (Singapore)
The BMI recommendation for public health was less than IBMI classification (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)
Feng R N et al 2012(China)
The optimal BMI for men and women to predict co-morbidities was less than IBMI classification ( 24 kgm2 )
Ren Q et al 2016(China)
The optimal BMI for men and women to predict Hypertension was less than IBMI classification(2353kgm2 and 2425kgm2)
Tanu et al 2014(India)
The optimal BMI to predict Hypertension was ge245kgm2 (men) and ge249kgm2( women)
13
Bogossian FE et al 2012
The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK
Miller SK et al 2008
The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively
Ogunjimi LO et al 2010
The prevalence of obesity among Nigerian nurses 626
Coomarasamy JD et al 2014
The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively
14
Malaysian National Health and Morbidity Survey(MNHMS)2006 2011
Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years
Malaysian National Health and Morbidity Survey 2015
IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306
bull Among obese population female Malaysians were more affected than the male counterparts
WHO- Non Communicable Disease Profile in Malaysia 2012
This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar
15
Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria
General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses
Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-
morbidities among those who were overweight and obese according to both definitions
2) To determine the factors associated with overweight and obesity in the study population
16
Sample size 384 (minimum)
- Stratified random sampling (working schedule)
- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5
(456- 556)
17
MREC approved
Cross-sectional Study
Hospital Seri Manjung
Nurses in all departments
September - October 2016
Inclusion criteria
All female registered nurses in HSM
Exclusion criteria
Pregnant on confinement paid unpaid leave refuse to consent
18
Data collection
Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire
Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005
Data analysis
Prevalence of outcome was presented as
Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated
Associating factors were analysed using multiple logistic regression
19
MREC approved
20
Consent taking process
Interviewing the respondent by using
questionnaire
Measuring of height and weight as well as BMI
calculation
Nurses who fulfilled the inclusion criteria
were given Respondent Information Sheet
Researchers explained to respondents about the study
Respondents were given sufficient time to understand ask
questions and consider before deciding on their participation
All respondents were asked to sign
2 sets of informed consent form
21
Figure 2 Information sheet amp Consent taking process
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
7
8
Health burden
BMI = weight (kg) height (m2)
9
Overweight and obesity classificationCategory IBMI (kgm2) ABMI (kgm2 )
Underweight lt1850 lt1850
Normal 1850-2499 1850-2299
Overweight 2500-2999 2300-2749
Obese ge 3000 ge 2750
Source WHO 2004sup1 CPG on Management of Obesity 2004sup2
10
3) There has been some contention whether thegeneralisation of the IBMI (International Body Mass Index) tothe Asian population will underestimate theprevalence of overweight and obesity
4) In year 2004 WHO was recommended additionalBMI cut-off points for Asian populations for publichealth (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)
5) BMI cut-off points have been revised to suit Asianpopulation due to
(i) high prevalence of Type 2 Diabetes Mellitus among Asian individuals with BMI lt 250kgm2
(ii) higher cardiovascular risk factors among Asian individuals at any BMI level and
(iii) population based association between BMI body fat percentage and distribution
11
Prevalence of overweight and obesity is highest in developing countries and is associated with increase in incidence of cardiovascular disease
12
Lamon-Fava S et al 1996Hossain 2007 Bhurosy et al 2014
Deuremberg-Yap M et al 2001 (Singapore)
The BMI recommendation for public health was less than IBMI classification (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)
Feng R N et al 2012(China)
The optimal BMI for men and women to predict co-morbidities was less than IBMI classification ( 24 kgm2 )
Ren Q et al 2016(China)
The optimal BMI for men and women to predict Hypertension was less than IBMI classification(2353kgm2 and 2425kgm2)
Tanu et al 2014(India)
The optimal BMI to predict Hypertension was ge245kgm2 (men) and ge249kgm2( women)
13
Bogossian FE et al 2012
The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK
Miller SK et al 2008
The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively
Ogunjimi LO et al 2010
The prevalence of obesity among Nigerian nurses 626
Coomarasamy JD et al 2014
The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively
14
Malaysian National Health and Morbidity Survey(MNHMS)2006 2011
Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years
Malaysian National Health and Morbidity Survey 2015
IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306
bull Among obese population female Malaysians were more affected than the male counterparts
WHO- Non Communicable Disease Profile in Malaysia 2012
This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar
15
Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria
General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses
Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-
morbidities among those who were overweight and obese according to both definitions
2) To determine the factors associated with overweight and obesity in the study population
16
Sample size 384 (minimum)
- Stratified random sampling (working schedule)
- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5
(456- 556)
17
MREC approved
Cross-sectional Study
Hospital Seri Manjung
Nurses in all departments
September - October 2016
Inclusion criteria
All female registered nurses in HSM
Exclusion criteria
Pregnant on confinement paid unpaid leave refuse to consent
18
Data collection
Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire
Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005
Data analysis
Prevalence of outcome was presented as
Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated
Associating factors were analysed using multiple logistic regression
19
MREC approved
20
Consent taking process
Interviewing the respondent by using
questionnaire
Measuring of height and weight as well as BMI
calculation
Nurses who fulfilled the inclusion criteria
were given Respondent Information Sheet
Researchers explained to respondents about the study
Respondents were given sufficient time to understand ask
questions and consider before deciding on their participation
All respondents were asked to sign
2 sets of informed consent form
21
Figure 2 Information sheet amp Consent taking process
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
8
Health burden
BMI = weight (kg) height (m2)
9
Overweight and obesity classificationCategory IBMI (kgm2) ABMI (kgm2 )
Underweight lt1850 lt1850
Normal 1850-2499 1850-2299
Overweight 2500-2999 2300-2749
Obese ge 3000 ge 2750
Source WHO 2004sup1 CPG on Management of Obesity 2004sup2
10
3) There has been some contention whether thegeneralisation of the IBMI (International Body Mass Index) tothe Asian population will underestimate theprevalence of overweight and obesity
4) In year 2004 WHO was recommended additionalBMI cut-off points for Asian populations for publichealth (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)
5) BMI cut-off points have been revised to suit Asianpopulation due to
(i) high prevalence of Type 2 Diabetes Mellitus among Asian individuals with BMI lt 250kgm2
(ii) higher cardiovascular risk factors among Asian individuals at any BMI level and
(iii) population based association between BMI body fat percentage and distribution
11
Prevalence of overweight and obesity is highest in developing countries and is associated with increase in incidence of cardiovascular disease
12
Lamon-Fava S et al 1996Hossain 2007 Bhurosy et al 2014
Deuremberg-Yap M et al 2001 (Singapore)
The BMI recommendation for public health was less than IBMI classification (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)
Feng R N et al 2012(China)
The optimal BMI for men and women to predict co-morbidities was less than IBMI classification ( 24 kgm2 )
Ren Q et al 2016(China)
The optimal BMI for men and women to predict Hypertension was less than IBMI classification(2353kgm2 and 2425kgm2)
Tanu et al 2014(India)
The optimal BMI to predict Hypertension was ge245kgm2 (men) and ge249kgm2( women)
13
Bogossian FE et al 2012
The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK
Miller SK et al 2008
The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively
Ogunjimi LO et al 2010
The prevalence of obesity among Nigerian nurses 626
Coomarasamy JD et al 2014
The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively
14
Malaysian National Health and Morbidity Survey(MNHMS)2006 2011
Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years
Malaysian National Health and Morbidity Survey 2015
IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306
bull Among obese population female Malaysians were more affected than the male counterparts
WHO- Non Communicable Disease Profile in Malaysia 2012
This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar
15
Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria
General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses
Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-
morbidities among those who were overweight and obese according to both definitions
2) To determine the factors associated with overweight and obesity in the study population
16
Sample size 384 (minimum)
- Stratified random sampling (working schedule)
- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5
(456- 556)
17
MREC approved
Cross-sectional Study
Hospital Seri Manjung
Nurses in all departments
September - October 2016
Inclusion criteria
All female registered nurses in HSM
Exclusion criteria
Pregnant on confinement paid unpaid leave refuse to consent
18
Data collection
Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire
Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005
Data analysis
Prevalence of outcome was presented as
Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated
Associating factors were analysed using multiple logistic regression
19
MREC approved
20
Consent taking process
Interviewing the respondent by using
questionnaire
Measuring of height and weight as well as BMI
calculation
Nurses who fulfilled the inclusion criteria
were given Respondent Information Sheet
Researchers explained to respondents about the study
Respondents were given sufficient time to understand ask
questions and consider before deciding on their participation
All respondents were asked to sign
2 sets of informed consent form
21
Figure 2 Information sheet amp Consent taking process
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
BMI = weight (kg) height (m2)
9
Overweight and obesity classificationCategory IBMI (kgm2) ABMI (kgm2 )
Underweight lt1850 lt1850
Normal 1850-2499 1850-2299
Overweight 2500-2999 2300-2749
Obese ge 3000 ge 2750
Source WHO 2004sup1 CPG on Management of Obesity 2004sup2
10
3) There has been some contention whether thegeneralisation of the IBMI (International Body Mass Index) tothe Asian population will underestimate theprevalence of overweight and obesity
4) In year 2004 WHO was recommended additionalBMI cut-off points for Asian populations for publichealth (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)
5) BMI cut-off points have been revised to suit Asianpopulation due to
(i) high prevalence of Type 2 Diabetes Mellitus among Asian individuals with BMI lt 250kgm2
(ii) higher cardiovascular risk factors among Asian individuals at any BMI level and
(iii) population based association between BMI body fat percentage and distribution
11
Prevalence of overweight and obesity is highest in developing countries and is associated with increase in incidence of cardiovascular disease
12
Lamon-Fava S et al 1996Hossain 2007 Bhurosy et al 2014
Deuremberg-Yap M et al 2001 (Singapore)
The BMI recommendation for public health was less than IBMI classification (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)
Feng R N et al 2012(China)
The optimal BMI for men and women to predict co-morbidities was less than IBMI classification ( 24 kgm2 )
Ren Q et al 2016(China)
The optimal BMI for men and women to predict Hypertension was less than IBMI classification(2353kgm2 and 2425kgm2)
Tanu et al 2014(India)
The optimal BMI to predict Hypertension was ge245kgm2 (men) and ge249kgm2( women)
13
Bogossian FE et al 2012
The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK
Miller SK et al 2008
The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively
Ogunjimi LO et al 2010
The prevalence of obesity among Nigerian nurses 626
Coomarasamy JD et al 2014
The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively
14
Malaysian National Health and Morbidity Survey(MNHMS)2006 2011
Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years
Malaysian National Health and Morbidity Survey 2015
IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306
bull Among obese population female Malaysians were more affected than the male counterparts
WHO- Non Communicable Disease Profile in Malaysia 2012
This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar
15
Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria
General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses
Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-
morbidities among those who were overweight and obese according to both definitions
2) To determine the factors associated with overweight and obesity in the study population
16
Sample size 384 (minimum)
- Stratified random sampling (working schedule)
- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5
(456- 556)
17
MREC approved
Cross-sectional Study
Hospital Seri Manjung
Nurses in all departments
September - October 2016
Inclusion criteria
All female registered nurses in HSM
Exclusion criteria
Pregnant on confinement paid unpaid leave refuse to consent
18
Data collection
Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire
Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005
Data analysis
Prevalence of outcome was presented as
Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated
Associating factors were analysed using multiple logistic regression
19
MREC approved
20
Consent taking process
Interviewing the respondent by using
questionnaire
Measuring of height and weight as well as BMI
calculation
Nurses who fulfilled the inclusion criteria
were given Respondent Information Sheet
Researchers explained to respondents about the study
Respondents were given sufficient time to understand ask
questions and consider before deciding on their participation
All respondents were asked to sign
2 sets of informed consent form
21
Figure 2 Information sheet amp Consent taking process
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
10
3) There has been some contention whether thegeneralisation of the IBMI (International Body Mass Index) tothe Asian population will underestimate theprevalence of overweight and obesity
4) In year 2004 WHO was recommended additionalBMI cut-off points for Asian populations for publichealth (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)
5) BMI cut-off points have been revised to suit Asianpopulation due to
(i) high prevalence of Type 2 Diabetes Mellitus among Asian individuals with BMI lt 250kgm2
(ii) higher cardiovascular risk factors among Asian individuals at any BMI level and
(iii) population based association between BMI body fat percentage and distribution
11
Prevalence of overweight and obesity is highest in developing countries and is associated with increase in incidence of cardiovascular disease
12
Lamon-Fava S et al 1996Hossain 2007 Bhurosy et al 2014
Deuremberg-Yap M et al 2001 (Singapore)
The BMI recommendation for public health was less than IBMI classification (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)
Feng R N et al 2012(China)
The optimal BMI for men and women to predict co-morbidities was less than IBMI classification ( 24 kgm2 )
Ren Q et al 2016(China)
The optimal BMI for men and women to predict Hypertension was less than IBMI classification(2353kgm2 and 2425kgm2)
Tanu et al 2014(India)
The optimal BMI to predict Hypertension was ge245kgm2 (men) and ge249kgm2( women)
13
Bogossian FE et al 2012
The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK
Miller SK et al 2008
The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively
Ogunjimi LO et al 2010
The prevalence of obesity among Nigerian nurses 626
Coomarasamy JD et al 2014
The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively
14
Malaysian National Health and Morbidity Survey(MNHMS)2006 2011
Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years
Malaysian National Health and Morbidity Survey 2015
IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306
bull Among obese population female Malaysians were more affected than the male counterparts
WHO- Non Communicable Disease Profile in Malaysia 2012
This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar
15
Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria
General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses
Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-
morbidities among those who were overweight and obese according to both definitions
2) To determine the factors associated with overweight and obesity in the study population
16
Sample size 384 (minimum)
- Stratified random sampling (working schedule)
- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5
(456- 556)
17
MREC approved
Cross-sectional Study
Hospital Seri Manjung
Nurses in all departments
September - October 2016
Inclusion criteria
All female registered nurses in HSM
Exclusion criteria
Pregnant on confinement paid unpaid leave refuse to consent
18
Data collection
Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire
Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005
Data analysis
Prevalence of outcome was presented as
Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated
Associating factors were analysed using multiple logistic regression
19
MREC approved
20
Consent taking process
Interviewing the respondent by using
questionnaire
Measuring of height and weight as well as BMI
calculation
Nurses who fulfilled the inclusion criteria
were given Respondent Information Sheet
Researchers explained to respondents about the study
Respondents were given sufficient time to understand ask
questions and consider before deciding on their participation
All respondents were asked to sign
2 sets of informed consent form
21
Figure 2 Information sheet amp Consent taking process
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
5) BMI cut-off points have been revised to suit Asianpopulation due to
(i) high prevalence of Type 2 Diabetes Mellitus among Asian individuals with BMI lt 250kgm2
(ii) higher cardiovascular risk factors among Asian individuals at any BMI level and
(iii) population based association between BMI body fat percentage and distribution
11
Prevalence of overweight and obesity is highest in developing countries and is associated with increase in incidence of cardiovascular disease
12
Lamon-Fava S et al 1996Hossain 2007 Bhurosy et al 2014
Deuremberg-Yap M et al 2001 (Singapore)
The BMI recommendation for public health was less than IBMI classification (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)
Feng R N et al 2012(China)
The optimal BMI for men and women to predict co-morbidities was less than IBMI classification ( 24 kgm2 )
Ren Q et al 2016(China)
The optimal BMI for men and women to predict Hypertension was less than IBMI classification(2353kgm2 and 2425kgm2)
Tanu et al 2014(India)
The optimal BMI to predict Hypertension was ge245kgm2 (men) and ge249kgm2( women)
13
Bogossian FE et al 2012
The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK
Miller SK et al 2008
The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively
Ogunjimi LO et al 2010
The prevalence of obesity among Nigerian nurses 626
Coomarasamy JD et al 2014
The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively
14
Malaysian National Health and Morbidity Survey(MNHMS)2006 2011
Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years
Malaysian National Health and Morbidity Survey 2015
IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306
bull Among obese population female Malaysians were more affected than the male counterparts
WHO- Non Communicable Disease Profile in Malaysia 2012
This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar
15
Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria
General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses
Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-
morbidities among those who were overweight and obese according to both definitions
2) To determine the factors associated with overweight and obesity in the study population
16
Sample size 384 (minimum)
- Stratified random sampling (working schedule)
- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5
(456- 556)
17
MREC approved
Cross-sectional Study
Hospital Seri Manjung
Nurses in all departments
September - October 2016
Inclusion criteria
All female registered nurses in HSM
Exclusion criteria
Pregnant on confinement paid unpaid leave refuse to consent
18
Data collection
Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire
Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005
Data analysis
Prevalence of outcome was presented as
Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated
Associating factors were analysed using multiple logistic regression
19
MREC approved
20
Consent taking process
Interviewing the respondent by using
questionnaire
Measuring of height and weight as well as BMI
calculation
Nurses who fulfilled the inclusion criteria
were given Respondent Information Sheet
Researchers explained to respondents about the study
Respondents were given sufficient time to understand ask
questions and consider before deciding on their participation
All respondents were asked to sign
2 sets of informed consent form
21
Figure 2 Information sheet amp Consent taking process
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
Prevalence of overweight and obesity is highest in developing countries and is associated with increase in incidence of cardiovascular disease
12
Lamon-Fava S et al 1996Hossain 2007 Bhurosy et al 2014
Deuremberg-Yap M et al 2001 (Singapore)
The BMI recommendation for public health was less than IBMI classification (ge23 kgm2 as increased risk and ge275 kgm2 as high risk)
Feng R N et al 2012(China)
The optimal BMI for men and women to predict co-morbidities was less than IBMI classification ( 24 kgm2 )
Ren Q et al 2016(China)
The optimal BMI for men and women to predict Hypertension was less than IBMI classification(2353kgm2 and 2425kgm2)
Tanu et al 2014(India)
The optimal BMI to predict Hypertension was ge245kgm2 (men) and ge249kgm2( women)
13
Bogossian FE et al 2012
The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK
Miller SK et al 2008
The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively
Ogunjimi LO et al 2010
The prevalence of obesity among Nigerian nurses 626
Coomarasamy JD et al 2014
The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively
14
Malaysian National Health and Morbidity Survey(MNHMS)2006 2011
Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years
Malaysian National Health and Morbidity Survey 2015
IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306
bull Among obese population female Malaysians were more affected than the male counterparts
WHO- Non Communicable Disease Profile in Malaysia 2012
This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar
15
Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria
General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses
Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-
morbidities among those who were overweight and obese according to both definitions
2) To determine the factors associated with overweight and obesity in the study population
16
Sample size 384 (minimum)
- Stratified random sampling (working schedule)
- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5
(456- 556)
17
MREC approved
Cross-sectional Study
Hospital Seri Manjung
Nurses in all departments
September - October 2016
Inclusion criteria
All female registered nurses in HSM
Exclusion criteria
Pregnant on confinement paid unpaid leave refuse to consent
18
Data collection
Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire
Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005
Data analysis
Prevalence of outcome was presented as
Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated
Associating factors were analysed using multiple logistic regression
19
MREC approved
20
Consent taking process
Interviewing the respondent by using
questionnaire
Measuring of height and weight as well as BMI
calculation
Nurses who fulfilled the inclusion criteria
were given Respondent Information Sheet
Researchers explained to respondents about the study
Respondents were given sufficient time to understand ask
questions and consider before deciding on their participation
All respondents were asked to sign
2 sets of informed consent form
21
Figure 2 Information sheet amp Consent taking process
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
13
Bogossian FE et al 2012
The prevalence of overweight and obesity among nurses and midwives were higher compared to the general population in Australia New Zealand and UK
Miller SK et al 2008
The prevalence of overweight obesity and morbidly obesity among American nurses were 30 187 and 52 respectively
Ogunjimi LO et al 2010
The prevalence of obesity among Nigerian nurses 626
Coomarasamy JD et al 2014
The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively
14
Malaysian National Health and Morbidity Survey(MNHMS)2006 2011
Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years
Malaysian National Health and Morbidity Survey 2015
IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306
bull Among obese population female Malaysians were more affected than the male counterparts
WHO- Non Communicable Disease Profile in Malaysia 2012
This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar
15
Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria
General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses
Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-
morbidities among those who were overweight and obese according to both definitions
2) To determine the factors associated with overweight and obesity in the study population
16
Sample size 384 (minimum)
- Stratified random sampling (working schedule)
- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5
(456- 556)
17
MREC approved
Cross-sectional Study
Hospital Seri Manjung
Nurses in all departments
September - October 2016
Inclusion criteria
All female registered nurses in HSM
Exclusion criteria
Pregnant on confinement paid unpaid leave refuse to consent
18
Data collection
Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire
Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005
Data analysis
Prevalence of outcome was presented as
Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated
Associating factors were analysed using multiple logistic regression
19
MREC approved
20
Consent taking process
Interviewing the respondent by using
questionnaire
Measuring of height and weight as well as BMI
calculation
Nurses who fulfilled the inclusion criteria
were given Respondent Information Sheet
Researchers explained to respondents about the study
Respondents were given sufficient time to understand ask
questions and consider before deciding on their participation
All respondents were asked to sign
2 sets of informed consent form
21
Figure 2 Information sheet amp Consent taking process
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
Coomarasamy JD et al 2014
The prevalence of overweight and obesity among female nurses in Malaysia were 335 and 171 respectively
14
Malaysian National Health and Morbidity Survey(MNHMS)2006 2011
Increase of obesity prevalence from 14 (2006) to 151 (2011)in local population aged above 18 years
Malaysian National Health and Morbidity Survey 2015
IBMI classification - overweight 300 and obesity 177ABMI classification ndash overweight 334 and obesity 306
bull Among obese population female Malaysians were more affected than the male counterparts
WHO- Non Communicable Disease Profile in Malaysia 2012
This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar
15
Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria
General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses
Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-
morbidities among those who were overweight and obese according to both definitions
2) To determine the factors associated with overweight and obesity in the study population
16
Sample size 384 (minimum)
- Stratified random sampling (working schedule)
- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5
(456- 556)
17
MREC approved
Cross-sectional Study
Hospital Seri Manjung
Nurses in all departments
September - October 2016
Inclusion criteria
All female registered nurses in HSM
Exclusion criteria
Pregnant on confinement paid unpaid leave refuse to consent
18
Data collection
Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire
Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005
Data analysis
Prevalence of outcome was presented as
Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated
Associating factors were analysed using multiple logistic regression
19
MREC approved
20
Consent taking process
Interviewing the respondent by using
questionnaire
Measuring of height and weight as well as BMI
calculation
Nurses who fulfilled the inclusion criteria
were given Respondent Information Sheet
Researchers explained to respondents about the study
Respondents were given sufficient time to understand ask
questions and consider before deciding on their participation
All respondents were asked to sign
2 sets of informed consent form
21
Figure 2 Information sheet amp Consent taking process
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
This study endeavours to answer whetherby using IBMI classification among Asianpopulation would lead to a significantproportion of the overweight individualsgoing below the radar
15
Hypothesis Are we missing a significant number of overweight nurses with associated comorbidities by using IBMI criteria
General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses
Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-
morbidities among those who were overweight and obese according to both definitions
2) To determine the factors associated with overweight and obesity in the study population
16
Sample size 384 (minimum)
- Stratified random sampling (working schedule)
- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5
(456- 556)
17
MREC approved
Cross-sectional Study
Hospital Seri Manjung
Nurses in all departments
September - October 2016
Inclusion criteria
All female registered nurses in HSM
Exclusion criteria
Pregnant on confinement paid unpaid leave refuse to consent
18
Data collection
Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire
Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005
Data analysis
Prevalence of outcome was presented as
Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated
Associating factors were analysed using multiple logistic regression
19
MREC approved
20
Consent taking process
Interviewing the respondent by using
questionnaire
Measuring of height and weight as well as BMI
calculation
Nurses who fulfilled the inclusion criteria
were given Respondent Information Sheet
Researchers explained to respondents about the study
Respondents were given sufficient time to understand ask
questions and consider before deciding on their participation
All respondents were asked to sign
2 sets of informed consent form
21
Figure 2 Information sheet amp Consent taking process
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
General ObjectiveTo compare the prevalence of overweight and obesity based on IBMI and ABMI among female registered nurses
Specific Objectives1)To compare the prevalence of cardiovascular (CV) related co-
morbidities among those who were overweight and obese according to both definitions
2) To determine the factors associated with overweight and obesity in the study population
16
Sample size 384 (minimum)
- Stratified random sampling (working schedule)
- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5
(456- 556)
17
MREC approved
Cross-sectional Study
Hospital Seri Manjung
Nurses in all departments
September - October 2016
Inclusion criteria
All female registered nurses in HSM
Exclusion criteria
Pregnant on confinement paid unpaid leave refuse to consent
18
Data collection
Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire
Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005
Data analysis
Prevalence of outcome was presented as
Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated
Associating factors were analysed using multiple logistic regression
19
MREC approved
20
Consent taking process
Interviewing the respondent by using
questionnaire
Measuring of height and weight as well as BMI
calculation
Nurses who fulfilled the inclusion criteria
were given Respondent Information Sheet
Researchers explained to respondents about the study
Respondents were given sufficient time to understand ask
questions and consider before deciding on their participation
All respondents were asked to sign
2 sets of informed consent form
21
Figure 2 Information sheet amp Consent taking process
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
Sample size 384 (minimum)
- Stratified random sampling (working schedule)
- A random number list was generated by using Epical 2000 software - Proportions were set at 506 and precision at 5
(456- 556)
17
MREC approved
Cross-sectional Study
Hospital Seri Manjung
Nurses in all departments
September - October 2016
Inclusion criteria
All female registered nurses in HSM
Exclusion criteria
Pregnant on confinement paid unpaid leave refuse to consent
18
Data collection
Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire
Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005
Data analysis
Prevalence of outcome was presented as
Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated
Associating factors were analysed using multiple logistic regression
19
MREC approved
20
Consent taking process
Interviewing the respondent by using
questionnaire
Measuring of height and weight as well as BMI
calculation
Nurses who fulfilled the inclusion criteria
were given Respondent Information Sheet
Researchers explained to respondents about the study
Respondents were given sufficient time to understand ask
questions and consider before deciding on their participation
All respondents were asked to sign
2 sets of informed consent form
21
Figure 2 Information sheet amp Consent taking process
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
Inclusion criteria
All female registered nurses in HSM
Exclusion criteria
Pregnant on confinement paid unpaid leave refuse to consent
18
Data collection
Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire
Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005
Data analysis
Prevalence of outcome was presented as
Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated
Associating factors were analysed using multiple logistic regression
19
MREC approved
20
Consent taking process
Interviewing the respondent by using
questionnaire
Measuring of height and weight as well as BMI
calculation
Nurses who fulfilled the inclusion criteria
were given Respondent Information Sheet
Researchers explained to respondents about the study
Respondents were given sufficient time to understand ask
questions and consider before deciding on their participation
All respondents were asked to sign
2 sets of informed consent form
21
Figure 2 Information sheet amp Consent taking process
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
Data collection
Demography health work environment dietary physical activity were collected via interview by trained researchers by using questionnaire
Adapted from Canadian National Survey of the Work and Health of Nursessup1sup2 2005
Data analysis
Prevalence of outcome was presented as
Sensitivity amp specificity of both definitions in predicting CV-related co-morbidities were calculated
Associating factors were analysed using multiple logistic regression
19
MREC approved
20
Consent taking process
Interviewing the respondent by using
questionnaire
Measuring of height and weight as well as BMI
calculation
Nurses who fulfilled the inclusion criteria
were given Respondent Information Sheet
Researchers explained to respondents about the study
Respondents were given sufficient time to understand ask
questions and consider before deciding on their participation
All respondents were asked to sign
2 sets of informed consent form
21
Figure 2 Information sheet amp Consent taking process
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
20
Consent taking process
Interviewing the respondent by using
questionnaire
Measuring of height and weight as well as BMI
calculation
Nurses who fulfilled the inclusion criteria
were given Respondent Information Sheet
Researchers explained to respondents about the study
Respondents were given sufficient time to understand ask
questions and consider before deciding on their participation
All respondents were asked to sign
2 sets of informed consent form
21
Figure 2 Information sheet amp Consent taking process
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
Nurses who fulfilled the inclusion criteria
were given Respondent Information Sheet
Researchers explained to respondents about the study
Respondents were given sufficient time to understand ask
questions and consider before deciding on their participation
All respondents were asked to sign
2 sets of informed consent form
21
Figure 2 Information sheet amp Consent taking process
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
22
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
23
Result
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
Characteristics n ()
Demographic Data
Age in years median (quartiles) 36 (32-41)
Ethnicity
Malay
Chinese
Indian
Others
361 (919)
3 (08)
23 (59)
6 (15 )
Marital Status
Single
Married
Divorced
Widow
9 (23)378 (962)
2 (05)4 (10)
Body Mass Index (BMI)BMI in kgm2 median (quartiles) 2630 (2363-3013)
Weight satisfaction
Satisfied
Not satisfied
118 (300)275 (700)
24
Table 1 Characteristics of Respondents total respondents = 393
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
1 The denominator was total respondents (393)
2 The denominator was respondents in the particular BMI category
CVD = cardiovascular disease
25
Category
IBMI
Category
ABMI
No amp of
respondents in
each category1CVD
(n )2
No amp of
respondents in
each category1CVD
(n )2
Overweight
(25-299kgm2)146 (372) 21 (144)
Overweight
(23-2749kgm2)136 (346) 14 (103)
Obese
(ge 30kgm2)102 (260) 25 (245)
Obese
(ge 275kgm2)172 (438) 35 (203)
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
Table 3 Sensitivity and specificity of IBMI and ABMI
(overweight + obesity) definitions in prediction
of CV-related co-morbidities
In predicting CV-related comorbidities IBMI was slightly less sensitive [852 (95
CI 7234 9295)] than ABMI [907 (95 CI 7889 9652)] but more specific
[404 (95 CI 3517 4585)] than ABMI [236 (95 CI 1926 2856)]
26
CVD ()
Sensitivity Specificity PPV NPV
IBMI definition 852 404 185 945
ABMI definition 907 236 159 941
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
The risk of overweight or obese will be double in 10 years time (OR=183 95CI 124 270 p=0002)
Married nurses were 13 times more likely to be overweight or obese (OR=1311 95CI 244 7063 p=0003) than single nurses
Nurses who adhered to food pyramid less than 50 of the time were 2 times more likely to be overweight or obese (OR=241 95CI 133 435 p=0004) compared to nurses who were adherent
27
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
1a Prevalence of Overweight amp Obesity among Nurses
28
Country of overweight
of obesity
IBMI
1 Ogunjimi LO et al 2010 Nigeria - 626
2 Kim MJ et al 2013 Korea 186 74
3 Miller SK et al 2007 US 30 239
4 Coomarasamy JD et al2014
Malaysia 335 171
Current study 2016 Malaysia 372 260
ABMI
1 Aryee PA et al 2013 Ghana 182 155
Current study 2016 Malaysia 346 438
SLIM
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
1b Comparison with GENERAL POPULATION
NHMS National Health Morbidity Survey⁷ 2015
29
Subjects of overweight of obesity
IBMI
1 NHMS 2015 General Population
300 177
2 Current study 2016 Nurses 372 260
ABMI
1 NHMS 2015 General Population
334 306
2 Current study 2016 Nurses 346 438
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
Both ABMI amp IBMI definitions had good sensitivity
(907 vs 852) but IBMI had much higher
specificity (404) than ABMI (236)
However IBMI is still a good tool to be used and we
need a larger scale study to support the utilization
of ABMI in Malaysian population
30
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
31
Studies Factors
van Drongelen A et alsup1⁴ 2011
(Systematic Review)shift work
Kim MJ et alsup1sup3 2013 shift work
Smith P et alsup1⁵ 2013 shift work
Bogossian FE et alsup1ordm 2012increasing age male pre-
menopause as well as menopause
Ogunjimi LO et al⁹ 2010 Eating habit and being married
Current study 2016Age being married amp compliance to
food pyramid
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
The co-morbidities food pyramid adherence andintensity of physical activities were self-reported
Less privacy during interview sessions
32
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 overweight 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 overweight and obese
Conclusion
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
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
33
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
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 amp Pharmacy departmentsrsquo staffs who involved in answering the questionnaire during pre-test
- Administrative amp CRC unit staffs who involved during interviewer training session
34
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
1 WHO expert consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies The Lancet 2004 157-163
2 Malaysian Clinical Practice Guidelines (CPG) on Management of Obesity 2004
3 Lamon-Fava S Wilson PW Schaefer JS Impact of Body Mass Index on Coronary Heart Disease Risk Factors in Men and Women Arteriosclerosis Thrombosis and Vascular Biology 199616 1509-1515doi10116101ATV16121509
4 Hossain P Kawar B Nahas EL Obesity and Diabetes in the Developing World mdash A Growing Challenge N Engl J Med 2007 356213-215
5 Bhurosy T Rajesh Jeewon R Overweight and Obesity Epidemic in Developing Countries A Problem with Diet Physical Activity or Socioeconomic Status The Scientific World Journal 20147
6 National Health and Morbidity Survey 2011httpwwwmohgovmyindexphpfile_managerdl_item624746305a584e305833426b5a69394f51305176546 Assessed 290116
7 National Health and Morbidity Survey 2015 httpwwwikugovmyindexphpresearch-englist-of-research-engiku-engnhms-engnhms-2016 Assessed 2542016
8 Milier S K Alpert PT Cross CL Overweight And Obesity In Nurses Advanced Practiced Nurses And Nurses Educators Journal of The American Academy Of Nurse Practitioners 2008 20259-65
9 Ogunjimi LO Ikorok MM Olayinka YO Prevalence of obesity among Nigeria nurses The Akwa Ibom state experience International NGO Journal 2010 545-49
10 Bogossian FE et al A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia New Zealand and the United Kingdom IntJ Nurs Stud 2012 49(6)727-38
35
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
11 Coomarasamy JD Wint NN Donna Lou ENSukumaran S Prevalence of Obesity and Daily Lifestyles of the
Registered Nurses in Malaysia International Journal of Innovation and Applied Studies 2014
7(3)1202-1208
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
BMC Public Health 2013 131204
14 van Drongelen A Boot CR Merkus SL Smid T van der Beek AJ The effects of shift work on body
weight change - a systematic review of longitudinal studies Scand J Work Environ Health 2011
13263ndash275
15 Smith P Fritschi L Reid A Mustard C The Relationship Between Shift Work and Body Mass Index Among
Canadian Nurses Appl Nurs Res 20132624-31
16 Tee E-S Development and promotion of Malaysian Dietary Guidelines Asia Pac J Clin Nutr 201120
(3)455-461
17WHO | Global recommendations on physical activity for health 2015
httpwwwwhointdietphysicalactivityphysical_activity_intensityen Assessed 2742016
18 Aryee PA Helegbe GK Baah B Sarfo-Asante RA amp Quist-Therson R Prevalence and Risk Factors for Overweight and Obesity among Nurses in the Tamale Metropolis of Ghana Journal of Medical and Biomedical Sciences20132(2) 13-23
36
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
37
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
Questionnaire of ldquoComparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District SpecialistHospitalrdquo
Introduction
We are doing the nursing research regarding Body - Mass Index (BMI) among registered female nurses in in Hospital Seri Manjung (HSM) Information from this survey will help us to compare the prevalence of overweight and obesity based on the 2 clinical case definitions of IBMI and ABMI among the female registered nurses in our hospital Furthermore to determine the prevalence of comorbidities among those who were overweight according to the ABMI classification and understand the association between demographic data work environment status dietary intake and pattern physical activity and overweightobesity Number of subjects in this research is 384 This study will be carried over a period of 3 months
You are required to answer a questionnaire Your height and weight will be measured by the researcher We do not foresee any risk in this research Your answers will be kept strictly confidential and used only for statistic purpose Only the researcher has access to the research data You may request for the results of the study by the end of the study
While participation in this survey is voluntary your cooperation is important to ensure that the information collected in this survey is as accurate and as comprehensive as possible
I _______________________________ (name of participant) hereby consent to participate in Comparison of Two Clinical Case Definitions in Detecting Overweight and Obesity among Registered Nurses in a District Specialist Hospital
I understand that
I understand that my participation is voluntary I can stop participating in this survey at any time
While information gained in this study may be used in a conference presentation and may also be published in a journal article I will not be identified Information concerning me will remain strictly confidential
I may not directly benefit from taking part in this survey
I can ask the researcher at any time for any additional information
Participantrsquos name _______________
IC No __________________________
Date ___________________________
Participants signature
____________________________
Investigatorrsquos name _______________
IC No __________________________
Date ___________________________
Investigators signature
____________________________
Principal Investigator KUP Teh Pei Nee
SCN Hospital Seri Manjung
Tel 05 ndash 689 6833 Email peinee71gmailcom
38
Appendix A Respondent Information Sheet amp Consent Form
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
Appendix B Questionnaire
39
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
40
Appendix B Questionnaire
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
Appendix B Questionnaire
41
Source Tee ES 2011sup1⁶
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
Appendix B Questionnaire
42
Reference
WHO | Global recommendations on physical activity for health
httpwwwwhointdietphysicalactivityphysical_activity_intensityen
Appendix 1
43
43