Noncommunicable diseases risk factors in Bhutan: A secondary analysis of data from Bhutan’s nationwide STEPS survey 2014

Abstract

Background Bhutan is facing an epidemic of noncommunicable diseases; they are responsible for 53% of all deaths. Four main modifiable risk factors, including tobacco use, harmful use of alcohol, physical inactivity, and unhealthy diet, are the causes of most noncommunicable diseases (NCDs). This study aimed to assess 1) the prevalence of NCDs modifiable risk factors in Bhutan’s adult population and 2) associations between the sociodemographic factors and the NCDs modifiable risk factors with overweight or obesity, hypertension, and diabetes. Methods We used the 2014 Bhutan WHO Stepwise Approach to NCD Risk Factor Surveillance (STEPS) Survey dataset in this study. Data were analyzed using multiple logistic regressions, constructed with overweight or obesity, hypertension, and diabetes as outcome variables and modifiable risk factors as independent variables. Results The prevalence of tobacco use, harmful use of alcohol, unhealthy diet (low fruits and vegetables intake) and physically inactive was 24.8% (95% CI: 21.5, 28.5), 42.4% (95% CI: 39.4, 45.5), 66.9% (95% CI: 61.5, 71.8), and 6.2% (95% CI: 4.9, 7.8), respectively. The prevalence of overweight or obesity, hypertension and diabetes was 32.9% (95%CI: 30.0, 36.0), 35.7% (95% CI: 32.8, 38.7) and 6.4% (95% CI: 5.1, 7.9), respectively. Multiple logistic regression showed that older age groups were more likely to be overweight or obese, hypertensive, and diabetic. Our analysis also found that tobacco users were less likely to be overweight or obese (aOR 0.71, 95% CI 0.52, 0.96), and to be hypertensive (aOR 0.74, 95% CI 0.56, 0.97); but they were more likely to be diabetic (aOR 1.64, 95% CI 1.05, 2.56). Alcohol users were more likely to be hypertensive aOR 1.41 (95% CI 1.15, 1.74). Furthermore, vigorous physical activity could protect people from being overweight or obese, aOR 0.47 (95% CI 0.31, 0.70), and those consuming more than five serves of fruits and vegetables per day were more likely to be overweight or obese, aOR 1.46 (95% CI 1.17, 1.82). Conclusion The prevalence of NCDs modifiable risk factors and overweight or obesity and hypertension was high in Bhutan. We found strong associations between tobacco use and diabetes, alcohol use, hypertension, physically inactive, and overweight or obesity. The results suggest that the government should prioritize NCDs prevention and control programs, focusing on reducing modifiable risk factors. The health sector alone cannot address the NCDs epidemic in Bhutan, and we recommend the whole of government approach to tackle NCDs through the Bhutan Gross National Happiness framework.

Assessment of competencies in the prevention and control of chronic diseases and their influencing factors among health assistants in Bhutan: a cross-sectional study

“…Lifestyle changes, population ageing, globalization and urbanization are the predominant key drivers of the increase of chronic diseases [ 6 ]. Consistent with previous study [ 7 ] found that the prevalence of NCD modifiable risk factors such as overweight or obesity and hypertension was high in Bhutan.…”

Trends in behavioral and biological risk factors for non-communicable diseases among adults in Bhutan: results from cross-sectional surveys in 2007, 2014, and 2019

“…Furthermore, since the main source of alcohol is home-brewed Ara, "intervention targeting a reduction in the production of the local alcohol Ara should be undertaken urgently" [SIC] (34). We also found an increase in the prevalence of inadequate fruit and vegetable consumption, which may be due to seasonal availability, dietary habits (8), and the decline in fruit production (35). The government can increase interventions in terms of body weight control, tobacco use cessation, reduction of alcohol use, healthy eating, and screening and control of high levels of blood glucose, cholesterol, and blood pressure.…”

“…Early screening targeting men, urban dwellers, and those with higher education should be promoted to prevent risk factors for NCDs in Bhutan. Compared to the 2013 Nepal paper, this study showed a higher rate of current tobacco use (24.8% in 2014) than in Nepal (18.5%), low physical activity (11.9% in 2014) than Nepal (3.4%), higher obesity (≥25 kg/m 2 , 32.9% in 2014) than Nepal (≥25 kg/m 2 , 21.4%), elevated blood pressure (35.7% in 2014) than Nepal (25.7%), and a lower rate of inadequate fruit and vegetable intake (66.9% in 2014) than Nepal (98.9%) ( 8 ), lower elevated blood glucose (2.3% in 2014) than Nepal (3.6%), and lower elevated total cholesterol (12.5% in 2014) than Nepal (22.7%) ( 9 ).…”

“…A 2014 population-based study of adults in Bhutan ( N = 2,822) found that 67% had inadequate fruit and vegetable intake (<5 servings/day), 6% did low physical activity, 7% were heavy alcohol users (>40 g for men/>20 g for women), 13% had elevated total cholesterol (≥190 mg/dL/or on anti-lipid medication), 36% had hypertension, 11% had elevated impaired fasting glucose, 33% were overweight/obese (≥25 kg/m 2 ), and 24.8% were current tobacco users ( 7 , 8 ). In Nepal in 2013, 27.7% of the population (15–69 years) had 3–8 NCD risk factors (98.9% inadequate fruit/vegetable intake, 25.7% elevated blood pressure, 22.6% elevated total cholesterol, 21.4% overweight or obesity, 18.5% current smoking, 3.6% elevated blood glucose, 3.4% low physical activity, and 2.0% harmful alcohol use) ( 9 ).…”

Physical Inactivity and Food Insecurity Are Associated with Social Capital: A Large-Scale Population-Based Study in Tehran

“…Physical inactivity is also one of the main preventable causes of mortality worldwide as it is a modifable risk factor for chronic diseases such as cardiovascular disease, hypertension, type 2 diabetes mellitus, depression, cancers, and obesity [13][14][15][16]. Sedentary lifestyle would increase the chance of being overweight and obese, and both have an additive impact on the increasing prevalence of noncommunicable diseases in populations [17][18][19]. Along with unhealthy habits like smoking and environmental risk factors, physical inactivity will eventually lead to higher odds of morbidity and mortality due to preventable causes, which puts a considerable burden on healthcare systems, especially in older ages [20,21].…”