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The Association of Dietary Behaviors and Physical Activity Levels with General and Central Obesity among ASEAN University Students

1 HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council, Private Bag X41, Pretoria 0001, South Africa
2 Department of Research and Innovation, University of Limpopo, Sovenga 0727, South Africa
3 ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhonpathom 73170, Thailand

Objective: To quantify the prevalence of obesity and obesity-related factors (dietary behaviors and physical activity levels) in a cross-sectional, observational study of ASEAN undergraduate students. Material and Methods: A total of 6783 (35.5% male and 64.5% female) undergraduate students (Mean age: 20.5, SD = 2.0) from eight ASEAN countries completed questionnaires and anthropometric measurements. Multivariable logistic regression was used to estimate odds ratios (ORs) for the association of nutrition behaviors with prevalence of general obesity (body mass index ≥ 25 kg/m²), elevated waist-to-height ratio (WHtR) (>0.50), and high waist circumference (WC) (≥80 cm in females, ≥90 cm in males). Covariates included sociodemographic factors, dietary behavior, physical activity and sitting time (using the “International Physical Activity Questionnaire”). Results: There was a higher prevalence of general obesity (24.2% versus 9.3%), and high WHtR (16.6% versus 12.1) in males relative to females, while high WC (9.4% versus 10.4%) did not significantly differ between genders. In multivariable logistic regression analyses, compared to females, males had higher odds of obesity (odds-ratio, OR: 2.13, confidence interval, CI: 1.80, 2.77), and high WHtR (OR: 1.90, CI: 1.48, 2.43) (P < 0.001 for both). Snacking frequency and avoiding fatty foods were associated with all three obesity indicators; obesity (OR: 1.16, CI: 1.05, 1.28 and OR: 1.54, CI: 1.24, 1.92, respectively), WHtR (OR: 1.17, CI: 1.04, 1.32 and OR: 1.46, CI: 1.04, 1.54), and high WC (OR: 1.16, CI: 2.01, 1.33 and OR 1.52, CI: 1.14, 2.04, respectively). Physical activity and sedentary behavior were not significantly associated with any obesity measure. Conclusions: There was a low prevalence of healthy behaviors and a high prevalence of obesity in this sample of ASEAN young adults. Specific dietary behaviors but not physical activity nor sedentary behavior were associated with obesity.
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