BMC public health · 2026
Country-specific differences in the association between obesity risk factors in two high-income countries: a cross-sectional analysis from the Prospective Urban Rural Epidemiology (PURE) study.
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Lundberg Christina E, Adiels Martin, Miller Victoria, Poirier Paul, Rangarajan Sumathy, Lindgren Martin, Edqvist Jon, Mir Hassan, Teo Koon K, Joseph Philip, Lear Scott A, Leong Darryl P, Yusuf Salim, Dagenais Gilles R, Rosengren Annika
Аннотация
BACKGROUND: Although Sweden and Canada are high-income countries with similar social structures, obesity prevalence is significantly higher in Canada. This study explored country-specific differences in the association between socioeconomic and behavioural risk factors for obesity in Sweden and Canada, using data from the Prospective Urban Rural Epidemiological (PURE) study.
METHODS: This cross-sectional study included 9 790 adults aged 34-60 years from Canada (n = 6 652, 55% women) and Sweden (n = 3 138, 54% women). The Boruta algorithm was used to identify relevant factors that were associated with obesity among individual with normal weight (body mass index [BMI]: 18.5-<25 kg/m2) compared to individuals with obesity (BMI > 30 kg/m2). Logistic regression models with 95% confidence intervals (CI) estimated odds ratios (OR) of obesity by country in relation to selected risk factors for obesity.
RESULTS: More Canadians than Swedes had obesity (26 vs. 16%, p-value: <0.001). Ultra-processed food (UPF) and the Alternative Healthy Eating Index (AHEI-2010) score were identified as the main drivers of obesity risk. The highest UPF intake group was strongly associated with obesity in both Canada (OR = 2.31 [CI = 1.57-3.37]) and Sweden (OR = 2.83 [CI = 2.30-3.49]). Canadian men had higher UPF intake and were found to have a significantly higher risk of obesity (p for interaction: 0.032 and 0.021 for middle and highest tertiles), compared to Swedish males. Among women, low socioeconomic status (rural residence (OR = 2.30 [CI = 1.66-3.17] vs. OR = 1.42 [CI = 1.19-1.70]), low income (OR = 4.75 [CI = 2.71-8.95] vs. OR = 2.62 [CI = 2.16-3.18]), not working (OR = 2.24 [CI = 1.51-3.29] vs. OR = 1.32 [CI = 1.07-1.63]), and unskilled occupation (OR = 5.08 [CI = 3.05-8.45] vs. OR = 1.78 [CI = 1.38-2.28]) was more strongly associated with obesity in Sweden than in Canada.
CONCLUSIONS: This study highlights important differences in obesity-related risk factors between Sweden and Canada. UPF consumption, the AHEI-2010 score and socioeconomic disadvantage emerged as key drivers of obesity, with notable sex- and country-specific patterns. These findings underscore the importance of tailored, context-specific public health strategies to address obesity in different national settings.
METHODS: This cross-sectional study included 9 790 adults aged 34-60 years from Canada (n = 6 652, 55% women) and Sweden (n = 3 138, 54% women). The Boruta algorithm was used to identify relevant factors that were associated with obesity among individual with normal weight (body mass index [BMI]: 18.5-<25 kg/m2) compared to individuals with obesity (BMI > 30 kg/m2). Logistic regression models with 95% confidence intervals (CI) estimated odds ratios (OR) of obesity by country in relation to selected risk factors for obesity.
RESULTS: More Canadians than Swedes had obesity (26 vs. 16%, p-value: <0.001). Ultra-processed food (UPF) and the Alternative Healthy Eating Index (AHEI-2010) score were identified as the main drivers of obesity risk. The highest UPF intake group was strongly associated with obesity in both Canada (OR = 2.31 [CI = 1.57-3.37]) and Sweden (OR = 2.83 [CI = 2.30-3.49]). Canadian men had higher UPF intake and were found to have a significantly higher risk of obesity (p for interaction: 0.032 and 0.021 for middle and highest tertiles), compared to Swedish males. Among women, low socioeconomic status (rural residence (OR = 2.30 [CI = 1.66-3.17] vs. OR = 1.42 [CI = 1.19-1.70]), low income (OR = 4.75 [CI = 2.71-8.95] vs. OR = 2.62 [CI = 2.16-3.18]), not working (OR = 2.24 [CI = 1.51-3.29] vs. OR = 1.32 [CI = 1.07-1.63]), and unskilled occupation (OR = 5.08 [CI = 3.05-8.45] vs. OR = 1.78 [CI = 1.38-2.28]) was more strongly associated with obesity in Sweden than in Canada.
CONCLUSIONS: This study highlights important differences in obesity-related risk factors between Sweden and Canada. UPF consumption, the AHEI-2010 score and socioeconomic disadvantage emerged as key drivers of obesity, with notable sex- and country-specific patterns. These findings underscore the importance of tailored, context-specific public health strategies to address obesity in different national settings.