Gendered dimensions of obesity in childhood and adolescence

Overweight and Obesity in Children of Immigrant Versus Native Parents: Exploring a Local Setting in Portugal

In Portugal, the majority of immigrants come from Portuguese-speaking countries. Among children, overweight and obesity are serious public health concerns, but a few studies include children with immigrant background. This study aimed to estimate the prevalence of overweight and obesity and risk of abdominal obesity in school-age children and to explore potential determinants, considering the origin of the children’s parents (both mother and father are non-Portuguese, only one Portuguese, and both are Portuguese). A cross-sectional study included a random sample of 789 children (5–11 years old, 49.2% of males and 50.8% female) attending public primary schools in Barreiro, district of Setubal, Portugal. Fieldwork occurred from 20th April to 3rd July 2009. Data concerning socioeconomic, eating habits, and sports outside school were obtained through a questionnaire applied to the children’s person in charge. Anthropometric measures were collected by certified technicians. One-third of the children presented overweight and obesity (33.7%, 95% CI [30.0; 37.7]) and risk of abdominal obesity (16.4%, 95% CI [13.6; 19.7]) without differences according to parents’ origin. Children with immigrant background presented higher consumption of low-priced, high-sugar, and high-fat foods, with a worse situation for girls. Females from both non-Portuguese parents also practiced less sports outside school than those where one or two parents are Portuguese. Thus, promoting and monitoring a healthy diet and physical activity in this group should be prioritized in this local setting.

Climate change is a major stressor causing poor pregnancy outcomes and child development

The climate crisis is the existential threat of our times and for generations to come. This is no longer a threat but a reality affecting us, our children, and the generations that follow. Pregnant mothers, their fetuses, and their children are among those at greatest risk in every population and every jurisdiction. A timely consideration is the health of racialized groups who are particularly vulnerable owing to the confluence of several risk factors that are compounded by climate change. Included among these are Indigenous communities that are the most directly threatened by climate change. This review discusses the main health challenges faced by mothers, fathers, and their children during the climate crisis, focusing on mental health as a causal factor. Exploration of this topic includes the role of prenatal maternal and paternal stresses, allostatic load, and the effect of degradation of the environment and ecosystems on individuals. These will be examined in relation to adverse pregnancy outcomes and altered developmental trajectories of children. The climate crisis is a health threat multiplier that amplifies the health inequities of the most at-risk populations and individuals. It accelerates the increase in allostatic load of those at risk. The path of tragedy begins with an accumulating allostatic load that overwhelms both individual and socio-ecological resilience. This can lead to worse mental health including depression and anxiety and, in the case of pregnant women and their children, more adverse pregnancy outcomes and impaired developmental trajectories for their newborn children. We argue that there is an urgent need to develop new (or re-discover or re-purpose existing) tools that will predict communities and individuals who are experiencing the highest levels of climate-related hazards and intervene to reduce stress and increase resilience in pre-conceptual women and men, pregnant and post-partum women, and their young children.

Social vulnerabilities as risk factor of childhood obesity development and their role in prevention programs

INTRODUCTION

Large socioeconomic, gender, and ethnic inequalities exist in terms of childhood obesity worldwide. Children from low socioeconomic status families are more likely to have overweight/obesity and related cardiometabolic problems and future cancer risk. A wider concept are social vulnerabilities defined as social or economic characteristics or experiences negatively affecting children through behavioral, biological factors, or mental health. Social vulnerabilities include also therefore low subjective perceptions of social position.

OBJECTIVE

This study aims to identify social vulnerabilities and to summarize their impact as obesity development risk factor. Preventive programs implemented targeting these vulnerable groups and their effectiveness are also discussed.

METHODS

Literature review based on the experience of the authors social vulnerabilities identified as risk factors for childhood obesity were children whose parents lack of a social network, low support from formal and informal sources, parental unemployment, belonging to a minority group or having migrant background, adverse childhood experiences including household dysfunction, violence and childhood maltreatment and other traumatic experiences, gender inequalities and being part of nontraditional families.

RESULTS

The impact of social vulnerabilities on childhood obesity is independent of SES; however, SES exacerbates or buffer the effect social vulnerabilities have on different lifestyles and stress. Behavioral, biological, and mental health mechanisms may explain the association between social vulnerabilities and childhood obesity.

CONCLUSIONS

Behaviors such as dietary intake, physical activity, sedentary behaviors, and sleep are negatively affected by the stress and low levels of mental health derived from social vulnerabilities. It seems that high energy intakes rather than low physical activity levels might be the main driving force behind the obesity epidemic in vulnerable groups. Most of the prevention programs identified did not take into account social vulnerabilities and inequalities making them ineffective in most vulnerable groups. Interventions conducted in children from socially vulnerable group suggest modest but promising effects.

Socioeconomics of Obesity

PURPOSE OF REVIEW

The purpose of this review is to evaluate and emphasize important findings in the recent literature regarding the socioeconomics of obesity. It is important to evaluate trends of this global epidemic and elucidate its impact on different demographic groups and across socioeconomic strata.

RECENT FINDINGS

Obesity rates continue to increase domestically and globally which is associated with a concomitant rise in medical and economic costs. There are disparities in obesity rates based on race/ethnicity, sex, gender and sexual identity, and socioeconomic status, yet these disparities are not explained fully by health behaviors, socioeconomic position, or cumulative stress alone-community and societal environmental factors have a significant role in the obesity epidemic. Socioeconomic factors contribute to obesity on an individual and community level, and any viable approach to sustainably addressing the obesity epidemic must take these factors into account.

Differential effects of a school-based obesity prevention program: A cluster randomized trial

School-based healthy living interventions are widely promoted as strategies for preventing obesity. The peer-led Healthy Buddies™ curriculum has been shown to improve obesity-related outcomes in school-aged children. We examined whether these improvements existed among subgroups of children stratified by sex, income level and urban/rural geography. In a cluster-randomized controlled trial, elementary schools in Manitoba, Canada, were randomly allocated to Healthy Buddies™ (10 schools, 340 students) or standard curriculum (10 schools, 347 students). Healthy Buddies™ participants had 21weekly lessons on healthy eating, physical activity and self-efficacy, delivered by children age 9-12 to children age 6-8. We assessed pre- and post-intervention body mass index (BMI) z-scores, waist circumference, healthy living knowledge, dietary intake and self-efficacy among the younger children. Compared to standard curriculum (n = 154), Healthy Buddies™ participants (n = 157) experienced a greater reduction in waist circumference (-1.7 cm; 95% confidence interval [CI][-2.8, -0.5 cm]) and improved dietary intake (4.6; 95% CI [0.9, 8.3]), healthy living knowledge (5.9; 95% CI [2.3, 9.5]) and self-efficacy (5.3; 95% CI [1.0, 9.5]) scores. In subgroup analyses, effects for waist circumference (-2.0 cm; 95% CI [-3.6, -0.5]), healthy living knowledge (9.1; 95% CI [4.4, 13.8]) and self-efficacy (8.3; 95% CI [3.3, 13.3]) were significant among boys. Dietary intake (10.5; 95% CI [5.5, 15.4]), healthy living knowledge (9.8; 95% CI [4.5, 15.0]) and self-efficacy (6.7; 95% CI [0.7, 12.7]) improved among urban-dwelling but not rural-dwelling children. Healthy Buddies™ was effective for boys and children living in urban settings. Enhanced curricula may be needed to improve program effectiveness for select subgroups of school-aged children.

Maladaptive Eating in Children and Adolescents With Obesity: Scrutinizing Differences in Inhibition

INTRODUCTION

In order to grasp the complex etiology of childhood obesity, we aim to clarify the relationship between external eating and weight. Based on theory and empirical evidence, we claim that inhibition is an important moderator in this association. In our first research question we expected that high external eating would be related to a higher weight status, especially for those with high inhibition problems. Secondly, we explored the moderating role of inhibition in the association between external eating and weight change after a multidisciplinary obesity treatment.

METHOD

We investigated n=572 participants (51% boys, aged 7-19) with moderate to extreme obesity recruited in a Belgian inpatient treatment center. At intake, parents reported on inhibition (BRIEF), while the children and adolescents reported on their eating behavior (DEBQ). Weight and length were objectively measured pre and post treatment (ADJUSTED BMI). Two hierarchical linear regression models were built to scrutinize the influence of inhibition on the association between external eating and both baseline weight and weight change.

RESULTS

First, predicting baseline weight, we found no significant moderating effect of inhibition problems. Second, predicting weight loss, inhibition turned out to be a substantial moderator, specifically in adolescents. Some unexpected gender differences occurred in favor of adolescent boys, in a way that those with high external eating and low inhibition problems lost most weight.

CONCLUSION

Inhibition problems act as a moderator explaining weight loss, but this only holds for adolescents. This suggests that external eating and inhibition play a complex role in weight loss in certain age and gender categories, and stresses the importance of identifying subgroups for tailoring interventions. For those with high inhibition problems, interventions aimed at increasing inhibition skills might be needed to optimize treatment outcomes.

Distinct age-related patterns of overweight development to guide school healthcare interventions

AIM

We aimed to identify groups of primary school children with similar overweight development, reveal age-related patterns of overweight development in the resulting groups and analyse overweight-related school healthcare interventions.

METHODS

This retrospective longitudinal register study utilised electronic health records from six primary school years. From a random sample of 2000 sixth graders, we derived a study cohort of 508 children meeting criteria for overweight at least once during primary school. We investigated how many different groups (latent classes) of children with similar weight development would emerge by applying flexible latent class mixed models on body mass index standard deviation score. We also explored the resulting groups with respect to offered overweight-related interventions.

RESULTS

Per child, the data consisted in median 7 growth measurements over 5.4 years. We identified five overweight development groups for girls and four for boys. The groups converged temporarily around age 10 after which only some continued into obesity. School nurses and physicians offered overweight-related interventions to children with obesity, less to children gaining weight or with overweight.

CONCLUSION

Obesity prevention might benefit from awareness of typical overweight development patterns when designing intervention studies or planning and timing multidisciplinary school health check programmes.

Correlates of body mass index among primary school children in Ho Chi Minh City, Vietnam

OBJECTIVES

To document the prevalence of overweight and obesity and examine associated risk factors.

STUDY DESIGN

A cross-sectional survey was conducted in 16 primary public schools in eight districts of Ho Chi Minh City in 2016. A multistage clustering sampling method was used to collect a sample of 1806 pupils attending the first, second, and third grades (7-9 years).

METHODS

Age- and sex-adjusted body mass index (BMI) status was defined using International Obesity Taskforce cut-offs. Ordered probit regression models were used to assess the association between child BMI and its socio-economic and demographic risk factors. The model was estimated separately for boys and girls to assess the extent to which the socio-economic gradients in BMI vary by gender.

RESULTS

The prevalence of obesity among boys was twice the rate for girls (24.7 vs 12.3%). The prevalence of overweight and obesity were also higher among pupils attending schools located in urban districts than in semi-rural districts. Gender, household wealth, the frequency of having breakfast at home, parental body weight, and school location were strong predictors of child BMI status. The protective effect of having breakfast more frequently at home against the risk of overweight/obesity was more pronounced in girls than in boys. Father's body weight and child BMI were more strongly associated with boys from poorer households than boys from wealthier households, while the differences were not significant for girls.

CONCLUSIONS

The high prevalence of childhood overweight and obesity indicates an urgent need for more gender-specific, effective intervention, and prevention programs.

Unraveling Complexity about Childhood Obesity and Nutritional Interventions: Modeling Interactions Among Psychological Factors

As the global prevalence of childhood obesity continues to rise, researchers and clinicians have sought to develop more effective and personalized intervention techniques. In doing so, obesity interventions have expanded beyond the traditional context of nutrition to address several facets of a child’s life, including their psychological state. While the consideration of psychological features has significantly advanced the view of obesity as a holistic condition, attempts to associate such features with outcomes of treatment have been inconclusive. We posit that such uncertainty may arise from the univariate manner in which features are evaluated, focusing on a particular aspect such as loneliness or insecurity, but failing to account for the impact of co-occurring psychological characteristics. Moreover, co-occurrence of psychological characteristics (both child and parent/guardian) have not been studied from the perspective of their relationship with nutritional intervention outcomes. To that end, this work looks to broaden the prevailing view: laying the foundation for the existence of complex interactions among psychological features. In collaboration with a non-profit nutritional clinic in Brazil, this paper demonstrates and models these interactions and their associations with the outcomes of a nutritional intervention.

Trends in overweight and obesity by socioeconomic status in Year 6 school children, Australian Capital Territory, 2006-2018

Background

Due to the high prevalence and adverse consequences, overweight and obesity in children continues to be a major public health concern worldwide. Socioeconomic background and health-related behaviours (such as diet, physical activity and sedentary behaviors) are important factors associated with weight status in children. Using a series of height and weight assessments from the Australian Capital Territory Physical Activity and Nutrition Survey (ACTPANS), trends in prevalence of overweight and obesity by socioeconomic status were examined in ACT Year 6 school children between 2006 and 2018.

Methods

The ACTPANS has been conducted every 3 years since 2006. A total of 6729 children were surveyed. Complete data on height and weight were available for 6384 (94.9%) participants. Trends in the prevalence of overweight and obesity and associations between weight status and risk factors (such as socioeconomic status, physical activity, screen time and consumption of sugar-sweetened soft drinks (SSD)) were examined using logistic regression.

Results

The prevalence of overweight and obesity remained stable in girls (from 22.5% in 2006 to 21.6% in 2018) but declined in boys (from 27.8 to 17.9%). During the same period, levels of physical activity increased slightly, while screen time and the consumption of fast food and SSD decreased. Socioeconomic gradient, based on the school-level Index of Community Socio-Educational Advantage (ICSEA), was highly associated with prevalence of overweight and obesity. Since 2006, the estimated prevalence of overweight and obesity has remained high in the lowest SES groups, but a concurrent downward trend was observed in the highest SES group, leading to increasing disparity between SES groups. Children in the lowest ICSEA quintile were more likely to be overweight or obese compared to those in the moderate and highest ICSEA quintiles. Children in lower ICSEA quintiles also reported lower levels of physical activity, higher levels of screen time, and higher levels of fast food and SSD consumption compared to those in higher ICSEA quintiles.

Conclusions

While recent trends in overweight and obesity in ACT children are encouraging, the prevalence remains unacceptably high, especially in those from low socioeconomic backgrounds. Additional prevention efforts are required to address the socioeconomic disparity.

Prevalence and Predictors of Obesity among 7- to 17-Year-Old Schoolchildren in Urban Arusha, Tanzania

BACKGROUND

Childhood obesity is currently increasing at an alarming rate worldwide. Childhood obesity research has not been reported in urban Arusha before. This is therefore the first study to investigate the prevalence and predictors of childhood obesity in urban Arusha.

METHODS

A cross-sectional study was conducted involving 451 schoolchildren. Overweight was defined to range from 85th to 94th BMI percentile for age and sex while obesity was defined as above 94th BMI percentile for age and sex. Chi-square test was used for comparison between child sex and sociobehaviors, and multiple logistic regression was used to determine the significant predictor factors at P values = 0.05.

RESULTS

The overall prevalence of overweight and obesity was 17.7% (80/451) with 12.6% (57/451) being obese and 5.1% (23/451) being overweight. Results from univariate logistic regression showed child sex, random sleeping time, and random eating habit were the significant predictor factors. However, when all the predictor factors were used in the final multiple logistic regression model, only random sleeping time and random eating habit of different food items irrespective of their nature were significant at P=0.000, AOR = 4.47, and 95% CI = 2.00-10.01, and P=0.012, AOR = 2.54, and 95% CI = 1.23-5.33, respectively.

CONCLUSIONS

The prevalence of obesity was as higher as twice the prevalence observed in other previous studies in Tanzania. Being a girl, random sleeping time and random eating habit were independent predictors. In addition to larger sample sizes, longitudinal studies are needed in order to track individuals and population level trends in BMI over time.

Reproducibility of A Non-Quantitative Food Frequency Questionnaire (62-Item FFQ-6) and PCA-Driven Dietary Pattern Identification in 13-21-Year-Old Females

The aim of this study was to evaluate the test-retest reproducibility of a non-quantitative food frequency questionnaire (acronym: 62-item FFQ-6) and the possibility of identifying dietary patterns (DPs) in 13-21-year-old females. The study involved 97 females within three age groups: 13-15, 16-18, and 19-21 years, including 31, 38, and 28 subjects, respectively. The questionnaire was completed twice with a two-week interval (test and retest). For the total sample, using a principal component analysis (PCA), two similar PCA-driven DPs (DP1 and DP2) were identified separately from test data and retest data, considering two sets of input variables. 60-item-DP1 and 60-item-DP2 were identified after excluding two items-vegetables and fruits in general-due to including single items of various kinds of vegetables and fruits. After an aggregation of some items of the questionnaire, 25-item-DP1 and 25-item-DP2 were identified. The kappa statistic (test vs. retest) in the total sample averaged at 0.52 (0.32-0.72 for food items), while within age groups, it averaged at 0.41, 0.53, and 0.65, respectively. The percentage of subjects classified into the same food frequency category (test vs. retest) in the total sample averaged at 68% (51%-89% for food items), while within age groups, it averaged at 60%, 68%, and 77%, respectively. The Spearman correlations between dietary pattern scores (test vs. retest) in the total sample were: 0.84 (within age groups 0.83, 0.81, and 0.78, respectively) for 60-item-DP1, 0.68 (within age groups 0.24, 0.79, and 0.76, respectively) for 60-item-DP2, 0.76 (within age groups 0.56, 0.82, and 0.89, respectively) for 25-item-DP1, and 0.48 (within age groups 0.40, 0.57, and 0.53, respectively) for 25-item-DP2 (p < 0.05 for all). In conclusion, the test-retest reproducibility of the 62-item FFQ-6 was good or very good for most food items, with a tendency to be higher in older age groups of females under study. Due to the acceptable-to-good reproducibility of dietary pattern identification, the use of a 62-item FFQ-6 to describe the overall diet of young Polish females can be recommended.

The integrated role of multiple healthy weight behaviours on overweight and obesity among adolescents: a cross-sectional study

BACKGROUND

This study contributes to the limited number of studies that have explored the impact of not meeting the recommendations for moderate-to-vigorous physical activity, screen time, fruit and vegetable consumption and sleep on overweight and obesity among adolescents.

METHODS

A cross-sectional study of data from the 2015 Ontario Student Drug Use and Health Survey (OSDUHS), a provincially representative survey of students in publically funded schools in Ontario, Canada, was conducted. This study included self-reported data from students aged 11-17 years (n = 9866). The main outcome variable was overweight or obesity, classified using WHO BMI cut-points. Four independent variables for healthy weight behaviours were examined: (1) moderate-to-vigorous physical activity (MVPA) (≥ 60 mins vs. < 60 mins everyday over the last seven days); (2) screen time (< 2 h daily vs. ≥ 2 h daily); (3) fruit and vegetable consumption (≥ 5 times/day vs. < 5 times/day); (4) sleep (adequate based on guidelines vs. inadequate). Covariates included sex, age, Subjective Social Status (SSS), parental education and ethnicity. Binomial and multinomial logistic regression models were fitted to determine whether not meeting the recommendations for healthy weight behaviours was associated with overweight or obesity status.

RESULTS

Only 2% of students in Ontario met the recommendations for all four healthy weight behaviours and 33% of students did not meet any of the four recommendations. In both the binomial and multinomial models, not meeting the recommendations for MVPA was the only significant healthy weight behaviour associated with both overweight and obesity (AOR: 1.29, 95% CI: 1.03-1.62), and solely obesity (AOR: 1.45, 95% CI: 1.05-1.99). Males, students with lower SSS ratings, and students with parents with an education of 'High School' or less were also at significantly greater odds of being obese.

CONCLUSION

Findings from this study show that inadequate levels of MVPA is a critical behavioural predictor of obesity status in adolescents between the ages of 11-17 years, after controlling for differences in screen time, fruit and vegetable consumption, sleep, and demographics. Findings from this study could have implications toward policies and programs targeted at reducing obesity, and increasing the physical activity rates of adolescents.

Attitudes toward and beliefs about obese persons across Hong Kong and Taiwan: wording effects and measurement invariance

Background

The psychosocial consequences of obesity are important but often underrated. The Attitudes Toward Obese Persons (ATOP) and Beliefs About Obese Persons (BAOP) scales used to measure weight-related bias have little psychometric information, especially in East Asian contexts. The objective of this study was to use rigorous statistical methods to demonstrate the psychometric properties of these two instruments in Hong Kong and Taiwanese college students.

Methods

A convenience sample of 707 students was recruited from the universities in Hong Kong and Taiwan. Several competing confirmatory factor analyses (CFAs) were conducted to confirm the factorial structure of the ATOP and BAOP. The best fit models for the ATOP and BAOP were chosen for the examination of the measurement invariance across subcultures. We then compared configurable models with or without loading and/or intercept constrained before correlating the latent constructs between the best models for the ATOP and BAOP.

Results

The comparison in multiple CFAs found that the model with one factor and two correlated-wording-method factors outperformed the other models for both the ATOP and BOAP. However, the internal consistency was suboptimal (ATOP: α = .56 to .80; BTOP: α = .57 to .65) and the measurement invariance was somewhat unsupported among the Hong Kong and Taiwan samples. Moreover, after controlling wording effects, the latent construct of the ATOP was moderately associated with that of BAOP (r = .356; p < .001).

Conclusion

Chinese versions of the ATOP and BAOP can be treated as a unidimensional factor for use in Hong Kong and Taiwan university students. However, further refinements of both instruments may be needed before using them to capture the social attitudes and beliefs toward obesity individuals, which is expected to advance our understanding of weight-related bias in East Asian contexts.

Prevalence and knowledge of risk factors of childhood obesity among school-going children in Osogbo, south-western Nigeria

Background

The global prevalence of overweight and obesity in children is increasing. It is important to examine and monitor obesity critically among the young population who are vulnerable to be influenced by some risk factors in their environment. The objective of this study was to determine prevalence and knowledge of risk factors of childhood obesity among school-going children in Osogbo, south-western Nigeria.

Methods

This was a descriptive cross-sectional study among school children (n=480) selected using multistage sampling method. Research instruments used were self-administered semi-structured questionnaires. The taken anthropometric measurements followed standard methods. Data were analyzed using the Statistical Package for Social Sciences (SPSS) software version 17.0

Results

The 24-hour dietary recall showed that food was essentially of high carbohydrate content in 337(70.2%) of respondents, with regular consumption of sweets and soft drinks. Only 3.8% of the children were either overweight (2.1%) or obese (1.7%). About 76.1% had good knowledge score of risk factors for obesity. Predictors of good risk knowledge score were being older and being a female. However, predictors of being obese included being older, not regularly walking down to school and not regularly taking part in sporting activities

Conclusion

School children studied were at risk of being obese, stressing the need for a sustained promotion of both primary and primordial prevention strategies targeted at this vulnerable age group.

Socio-demographic factors associated with overweight and obesity among primary school children in semi-urban areas of mid-western Nigeria

BACKGROUND

Many developing countries are in a state of nutritional transition from prevalent under-nutrition to the emergent problem of over-nutrition (overweight and obesity), which is associated with increased morbidity and mortality, and whose complications can persist into adulthood with long-term consequences. However, data are limited on the risk factors for overweight and obesity (O&O) among primary school children, particularly those in rural and semi-urban areas in these countries.

AIM AND OBJECTIVES

To determine the socio-demographic factors associated with overweight and obesity among primary school children in semi-urban areas.

SUBJECTS AND METHODS

1187 school pupils aged 6-11 years recruited from semi-urban areas using multistage sampling were interviewed for risk factors of overweight and obesity using a structured questionnaire. Nutritional status was assessed using body mass index and this was classified using a standard method. The proportions were compared using Pearson's chi-squared. Multivariate logistic regression analysis was also carried out with overweight and obesity as the dependent variable and socio demographic factors as independent variables. The level of statistical significance was set at p <0.05 in all the statistical analyses.

RESULTS

Fifty-eight pupils (4.9%) had overweight and obesity while 1129 (95.1%) were either of normal nutritional status (1088, 91.6%) or were thin/severely thin (41, 3.5%). Among those with overweight and obesity, 41 (3.5%) were overweight and 17 (1.4%) obese. A higher prevalence of overweight and obesity was significantly associated (in unadjusted analysis) with female gender [unadjusted Odds Ratio, OR (95% CI) = 2.42 (1.37, 4.28)], attendance at private schools [OR (95% CI) = 3.34 (1.86, 6.00)], higher socio-economic status families [OR (95% CI) = 2.32 (1.65, 5.80)] and presence of a television in the pupil's bedrooms [OR (95% CI) = 2.22 (1.02, 4.82)] on bivariate analyses. However, only gender, school type and family socioeconomic status were independently associated with overweight and obesity on multivariate logistic regression analysis.

CONCLUSION

We conclude that overweight and obesity among primary school pupils in semi-urban areas is associated with female gender, attendance at private schools and higher socioeconomic status families. Preventive programmes should accordingly be more directed at children from affluent families; particularly those who are females and those attending private schools.

Exploring the relationship between the big five personality characteristics and dietary habits among students in a Ghanaian University

BACKGROUND

Adherence to good dietary practices has been linked to disease prevention and better quality of life yet, University students are known to have poor dietary intake and diet quality. For an effective behaviour modification in dietary habits, an understanding of the association between an individual's personality traits and dietary habits are of much significance. The aim of this study was to determine the relationship between personality traits and dietary habits among University students in Ghana.

METHODS

A cross-sectional design involving 400 students was employed. Information on socio-demographic characteristics and Body Mass Index were obtained. The big 5 Personality traits (extraversion, conscientiousness, agreeableness, openness and neuroticism) was assessed using a 50-item International Personality Item Pool (IPIP) by Goldberg. The three factor eating questionnaire (TFEQ) was used to obtain further information on dietary habits.

RESULTS

The majority of the students had high scores for conscientiousness. Except for neuroticism, all the personality traits had a significant association with at least one of the dietary habits explored. Extraversion was positively associated with neophagia (p = 0.028) and food interest (p = 0.008), conscientiousness was associated with variety (p = 0.045) and sugar moderation (p = 0.006), agreeableness was associated with neophagia (p = 0.005), skipping of meals (p = 0.007) and variety (p = 0.005) and openness associated with food interest (p = 0.009).

CONCLUSION

Personality traits showed associations with certain dietary habits but further studies are required to identify persons who are at risk of diet related diseases to inform the development of appropriate interventions.

Developmental trajectories of body mass index from childhood into late adolescence and subsequent late adolescence-young adulthood cardiometabolic risk markers

Background

Reports on body mass index (BMI) trajectories from childhood into late adolescence, their determinants, and subsequent cardiometabolic risk markers, particularly among European populations have been few. Moreover, sex-specific investigation is necessary considering the sex difference in BMI, and the sex-specific association between BMI and some cardiometabolic risk markers.

Methods

Using a sample from the DOrtmund Nutritional and Anthropometric Longitudinally Designed study, we explored sex-specific trajectories of the BMI standard deviation score (SDS) from 4 to 18 years of age in 354 males and 335 females by latent (class) growth models. The determinants of trajectory were assessed by logistic regression. We identified cardiometabolic risk markers that were highly associated with BMI SDS trajectory by random forest regression, and finally we used generalized linear models to investigate differences in the identified cardiometabolic risk markers between pairs of trajectories.

Results

We observed four: ‘low-normal weight’, ‘mid-normal weight’, ‘high-normal weight’, and ‘overweight’, and three: ‘‘low-normal weight’, ‘mid-normal weight’, and ‘high-normal weight’ trajectories in males and females, respectively. Higher maternal prepregnancy BMI was associated with the ‘overweight’ trajectory, and with ‘high-normal weight’ trajectory in both sexes. In addition, employed mothers and first-born status were associated with ‘high-normal weight’ trajectory in females. BMI SDS trajectory was associated with high-density lipoprotein-cholesterol and interleukin-18 (IL-18) in males, and diastolic blood pressure and interleukin-6 (IL-6) in females. However, only males following the ‘overweight’ trajectory had significantly higher IL-18 when compared to their ‘low-normal weight’ counterpart.

Conclusions

We identified sex-specific distinct trajectories of BMI SDS from childhood into late adolescence, higher maternal prepregnancy BMI as a common determinant of the ‘high-normal weight’ and ‘overweight’ trajectories, and ‘overweight’ trajectory being associated with elevated IL-18 in late adolescence–young adulthood. This study emphasizes the role of maternal prepregnancy BMI in overweight, and highlights IL-18 as a cardiometabolic signature of overweight across life.

Electronic supplementary material

The online version of this article (10.1186/s12933-019-0813-5) contains supplementary material, which is available to authorized users.

Antibiotic and acid-suppression medications during early childhood are associated with obesity

OBJECTIVE

Gut microbiota alterations are associated with obesity. Early exposure to medications, including acid suppressants and antibiotics, can alter gut biota and may increase the likelihood of developing obesity. We investigated the association of antibiotic, histamine-2 receptor antagonist (H2RA) and proton pump inhibitor (PPI) prescriptions during early childhood with a diagnosis of obesity.

DESIGN

We performed a cohort study of US Department of Defense TRICARE beneficiaries born from October 2006 to September 2013. Exposures were defined as having any dispensed prescription for antibiotic, H2RA or PPI medications in the first 2 years of life. A single event analysis of obesity was performed using Cox proportional hazards regression.

RESULTS

333 353 children met inclusion criteria, with 241 502 (72.4%) children prescribed an antibiotic, 39 488 (11.8%) an H2RA and 11 089 (3.3%) a PPI. Antibiotic prescriptions were associated with obesity (HR 1.26; 95% CI 1.23 to 1.28). This association persisted regardless of antibiotic class and strengthened with each additional class of antibiotic prescribed. H2RA and PPI prescriptions were also associated with obesity, with a stronger association for each 30-day supply prescribed. The HR increased commensurately with exposure to each additional medication group prescribed.

CONCLUSIONS

Antibiotics, acid suppressants and the combination of multiple medications in the first 2 years of life are associated with a diagnosis of childhood obesity. Microbiota-altering medications administered in early childhood may influence weight gain.

Comparison of Obesity Prevalence and Dietary Intake in School-Aged Children Living in Rural and Urban Area of Croatia

The aim of this study was to explore the differences in nutritional status and dietary intakes in 12~17 year-old children living in urban (Zagreb) and the rural (Sinj and Drniš) area of Croatia. A validated food frequency questionnaire was used to assess dietary intake. For each participant, body weight and body height were measured and bioelectrical impedance was used to estimate the body fat percentage. There was an overall of 310 children included: 105 (33.9%) from urban area and 205 (66.1%) from rural area; 191 (61.6%) were female with a mean age 14.9 (range 12~17) years. When adjusted for age and gender, there was no statistically significant difference in body mass index for age Z-scores between urban and rural parts (0.23±0.07 vs. 0.30±1.15; P=0.650) or in average daily energy intake (2,479.2±1,111.2 kcal vs. 2,338.2±920.2 kcal; P=0.702). There was a statistically significant difference in nutritional status between genders, with a higher percentage of boys being overweight or obese compared to girls. When combined, 'Fast food' and 'Snacks' were major contributors to the total energy intake for both areas. The mean contribution of 'Fast food' to total energy intake was significantly higher in the urban area. The prevalence of obesity among Croatian children is high and unrelated to the urban/rural setting, which could be partially explained by the high intake of 'Fast food' and 'Snacks'.

Interaction between Parental Education and Household Wealth on Children's Obesity Risk

Parents’ education and household wealth cannot be presumed to operate independently of each other. However, in traditional studies on the impact of social inequality on obesity, education and financial wealth tend to be viewed as separable processes. The present study examines the interaction of parents’ education and household wealth in relation to childhood obesity. Anthropometric measurement and questionnaire surveys were carried out on 3670 children (aged 9–12 years) and their parents from 26 elementary schools in northeast China. Results showed that the interaction term was significant for household wealth and father’s education (p < 0.01), while no significant interaction between household wealth and mother’s education was found. In a separate analysis, the interaction was statistically significant among girls for obesity risk based on BMI (p = 0.02), and among urban children for both obesity risk based on BMI (p = 0.01) and abdominal obesity risk based on WHR (p = 0.03). Specifically, when household wealth increased from the first quintile to the fifth quintile, OR for father’s education decreased from higher than 1 (OR = 1.95; 95% CI: 1.12–3.38) to non-significant for girl’s obesity risk, from non-significant to lower than 1 for urban children’s obesity risk (OR = 0.52; 95% CI: 0.32–0.86 for the fourth quintile; OR = 0.37; 95% CI: 0.19–0.73 for the fifth quintile) and from higher than 1 (OR = 1.61; 95% CI: 1.04–2.05) to non-significant for urban children’s abdominal obesity risk. These findings indicate that father’s education level interacts with household wealth to influence obesity among girls and urban children in northeast China.

School-Level Socioeconomic Status Influences Adolescents' Health-Related Lifestyle Behaviors and Intentions

BACKGROUND

School-level socioeconomic status (SES) influences on adolescents' lifestyle behaviors is understudied. We examined how school-level SES and sex influence adolescents' health-related lifestyle behaviors and intentions.

METHODS

Grade 8 students aged 13-14 years completed an online questionnaire regarding their sociodemographic characteristics, dietary behaviors, physical activity participation and recreational screen-time, and intentions regarding these behaviors. School-level SES, based on an Index of Community Socio-Educational Advantage (ICSEA), was categorized as low or high. Generalized estimating equations estimated individual-level summary statistics, adjusted for clustering.

RESULTS

Students (N = 2538; response rate = 79%) from 23 high schools (low ICSEA = 16) participated. Compared with low ICSEA students, high ICSEA students were more likely to report eating breakfast daily (OR 1.9 [95% CI 1.5, 2.4]), not drinking sugar-sweetened beverages (SSBs) daily (2.9 [1.9, 4.3]), and were more likely to have intentions to eat breakfast (1.8 [1.3, 2.3]) and ≥ 5 vegetable serves (1.2 [1.0, 1.5]) daily. Boys were more likely than girls to meet recommendations for breakfast eating, vegetable intake, moderate-to-vigorous physical activity and screen-time, but boys were less likely to meet recommendations regarding SSB intake.

CONCLUSIONS

Students from low ICSEA schools would benefit from additional support to improve dietary-related behaviors and intentions. More research is required to identify what targeted approaches will address sex differences in adolescents' lifestyle behaviors.

Longitudinal Effects of Body Mass Index and Self-Esteem on Adjustment From Early to Late Adolescence: A Latent Growth Model

BACKGROUND

Mental and physical development during adolescence is a factor that may affect quality of life in adulthood.

PURPOSE

The aims of this study were to investigate the developmental trajectories of body mass index (BMI), self-esteem, and adjustment among students from early to late adolescence and to examine the longitudinal relationships among these variables.

METHODS

Data from 2006 to 2012 were collected from the Korean Welfare Panel Study. Of the initial sample of 521 students, 487 completed a validated questionnaire measuring BMI, self-esteem, and adjustment. Latent growth curve modeling analyses were conducted to examine the relationships among the variables.

RESULTS

Univariate linear growth models showed a significant increase in BMI and significant declines in both self-esteem and adjustment across three time points from childhood to adolescence. The goodness of fit of the multivariate conditioned model supported the validity of the proposed longitudinal model (comparative fit index = .93, root mean square error of approximation = .08). Change in BMI was significantly linked with change in adjustment (β = .18, p < .05) but not with change in self-esteem, whereas change in self-esteem exerted a statistically significant effect on change in adjustment (β = .47, p < .001).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Our findings indicate that BMI and self-esteem are key determinants of student adjustment in school settings. Therefore, future health education interventions should focus on enhancing the positive physical and mental self-concepts of students, which should improve health and social behavior among students and subsequently afford a better quality of life for these students in adulthood.

Substantial variation across geographic regions in the obesity prevalence among 6-8 years old Hungarian children (COSI Hungary 2016)

Background

There have been previous representative nutritional status surveys conducted in Hungary, but this is the first one that examines overweight and obesity prevalence according to the level of urbanization and in different geographic regions among 6–8-year-old children. We also assessed whether these variations were different by sex.

Methods

This survey was part of the fourth data collection round of World Health Organization (WHO) Childhood Obesity Surveillance Initiative which took place during the academic year 2016/2017. The representative sample was determined by two-stage cluster sampling. A total of 5332 children (48.4% boys; age 7.54 ± 0.64 years) were measured from all seven geographic regions including urban (at least 500 inhabitants per square kilometer; n = 1598), semi-urban (100 to 500 inhabitants per square kilometer; n = 1932) and rural (less than 100 inhabitants per square kilometer; n = 1802) areas.

Results

Using the WHO reference, prevalence of overweight and obesity within the whole sample were 14.2, and 12.7%, respectively. According to the International Obesity Task Force (IOTF) reference, rates were 12.6 and 8.6%. Northern Hungary and Southern Transdanubia were the regions with the highest obesity prevalence of 11.0 and 12.0%, while Central Hungary was the one with the lowest obesity rate (6.1%). The prevalence of overweight and obesity tended to be higher in rural areas (13.0 and 9.8%) than in urban areas (11.9 and 7.0%). Concerning differences in sex, girls had higher obesity risk in rural areas (OR = 2.0) but boys did not. Odds ratios were 2.0–3.4 in different regions for obesity compared to Central Hungary, but only among boys.

Conclusions

Overweight and obesity are emerging problems in Hungary. Remarkable differences were observed in the prevalence of obesity by geographic regions. These variations can only be partly explained by geographic characteristics.

Trial registration

Study protocol was approved by the Scientific and Research Ethics Committee of the Medical Research Council (61158–2/2016/EKU).

Second-Generation Antipsychotics in Adolescent Psychiatric Patients: Metabolic Effects and Impact of an Early Weight Change to Predict Longer Term Weight Gain

OBJECTIVES

To examine the metabolic profile of adolescents at baseline and to determine the potential predictive power of a 1-month weight gain (WG) on weight changes during longer term second-generation antipsychotic (SGA) treatment.

METHODS

A retrospective chart review study, including patients between 13 and 18 years of age and treated with SGA, was conducted. Available data at baseline, 1, 3, and 12 months of treatment were recorded.

RESULTS

Four hundred fifty-six patients were included, with a median age of 15 years. Ten percent of the patients were obese (>95th percentile) and abdominal obesity (>90th percentile) was observed in 12% of patients. In a subgroup of 42 patients with both baseline, 1, and 3-month weight data available, WG >4.5% after 1 month was found to be the best predictor (sensitivity: 100; specificity: 66; area under the curve: 83) for a WG >15% after 3 months. After adjusting for potential confounders, a threshold of WG >4% was found as being the best predictor.

CONCLUSIONS

A worrisome prevalence of metabolic disorders was observed in an adolescent psychiatric cohort. In such patients, a WG >4% during the first month of treatment should raise concerns about weight controlling strategies. Further research is needed to confirm the present results and to determine the impact of a 1-month WG on a 1-year weight change.

Duration of Breastfeeding and Subsequent Adolescent Obesity: Effects of Maternal Behavior and Socioeconomic Status

PURPOSE

Previous research has shown that longer duration of breastfeeding is associated with less risk of obesity in childhood and adolescence. However, although putative physiological mechanisms have been proposed, less work has focused on psychosocial or environmental factors, including socioeconomic status (SES) and stressful family environments.

METHODS

The current study examined the role of observed maternal emotional behavior and SES (parental education) in the association between duration of breastfeeding and adolescent body mass index (BMI). One hundred fifteen mothers and adolescents participated in interaction tasks when adolescents were approximately 12 years of age. We measured adolescent BMI at approximately 15 years of age and, at one point over the course of the study, mothers retrospectively reported on duration of breastfeeding.

RESULTS

Controlling for adolescent gender, age, physical activity, number of perinatal complications, SES, birth weight, and mother's depressive symptoms, longer duration of breastfeeding was associated with lower adolescent BMI (p = .019), and this association was moderated by the mother's observed behavior during interactions with her adolescent, such that greater frequency of dysphoric behavior was associated with a stronger association between breastfeeding and adolescent BMI (p = .002). Longer duration of breastfeeding mediated the association between higher family SES and lower adolescent BMI.

CONCLUSIONS

This study is the first to show that observed parental behavior during adolescence may be an important moderator of the association between breastfeeding and obesity. The findings provide justification for future intervention research examining family environment factors in improving adolescent health.

Gender-related differences in cardiometabolic risk factors and lifestyle behaviors in treatment-seeking adolescents with severe obesity

BACKGROUND

Obesity during adolescence is associated with cardiovascular mortality in adulthood. The adverse obesity-related cardiometabolic risk profile is already observed in adolescence. We aimed to examine possible gender differences in cardiometabolic risk factors and lifestyle behaviors among adolescents with severe obesity, hypothesizing that boys would have both a higher prevalence of the metabolic syndrome as well as less healthy lifestyle behaviors than girls.

METHODS

Cross-sectional study of treatment-seeking adolescents with severe obesity who attended the Morbid Obesity Centre at Vestfold Hospital Trust and who were consecutively enrolled in the Vestfold Register of Obese Children between September 2009 and September 2015. A total of 313 adolescents aged 12 to 18 years were recruited, whereof 268 subjects (49% boys) completed a food and activity frequency questionnaire and were included in the analysis.

RESULTS

Mean (SD) age, BMI and BMI SDS were 15 (1.6) years, 38.6 (5.9) kg/m² and 3.5 (0.6). Levels of LDL cholesterol, fasting insulin and glucose and diastolic blood pressure (DBP) did not differ between genders. Compared to girls, boys had significantly higher triglycerides (p = 0.037) and systolic blood pressure (SBP) (p = 0.003), as well as lower HDL cholesterol (p = 0.002). The metabolic syndrome was present in 27% of the boys and 19% of the girls (p = 0.140), and the prevalence of high DBP, dyslipidemia and dysglycemia also did not differ significantly between genders. The prevalence of high SBP was higher in boys than in girls (19% vs. 9%, p = 0.021). Gender was associated with a number of lifestyle habits, as a larger proportions of boys had higher screen time (p = 0.032), more regular breakfast eating (p = 0.023), higher intake of sugar sweetened soda (p = 0.036), and lower intake of vegetables than girls (p = 0.011). By contrast, physical activity level and intake of fruit and berries did not differ between genders.

CONCLUSIONS

Male treatment-seeking adolescents with severe obesity had a more unfavorable set of metabolic and behavioral risk factors for cardiovascular disease than girls. Our results indicate that lifestyle behavioral markers should be thoroughly assessed in both genders, and possible gender-related differences in risk profile should be taken into account in future treatment programs.

Phytochemical Analysis and Central Effects of Annona Muricata Linnaeus: Possible Involvement of the Gabaergic and Monoaminergic Systems

Annona muricata Linnaeus (Annonaceae), popularly known as graviola, is used in folk medicine as both sedative and anticonvulsant. This study correlates the neurochemical profile with the behavioral effects of the hydroalcoholic extract from the leaves of Annona muricata (HLEAM) in mice, proposing to elucidate their mechanism of action on the central nervous system. Flavonoids and phenolic compounds were identified and quantified by High Performance Liquid Chromatography (HPLC) method. The acute toxicity (median lethal dose - LD50) was determined by probitos method using the percentage of mortality based on the Hippocratic screen. HLEAM (25, 50 and 100 mg/kg) was tested, intraperitoneally (i.p.), in models of sedation, anxiety, motor coordination, and seizures. The endogenous levels of dopamine, norepinephrine and DOPAC were assayed by reverse-phase HPLC with electrochemical detection. The HPLC analysis of the extract revealed the presence of flavonoids (quercetin, isoquercitrin, quercitrin, rutin, and kaempferol) and phenolics acids (gallic, chlorogenic, ellagic and caffeic acids). The LD50 was 1091.7 mg/kg and Hippocratic screening indicated central nervous system depressant effect. HLEAM presented sedative effects at doses of 25, 50, and 100 mg/kg, as well as anxiolytic and anticonvulsant effects at a dose of 100 mg/kg. In addition, these effects were partially reversed by flumazenil. The monoamines analysis by HPLC showed that HLEAM decreased the level of norepinefrine and dopamine in the mouse brain striatum. Thus, the results indicate a possible interaction of HLEAM with the GABAergic and monoaminergic systems, adding medicinal value to the popular use of the plant for the treatment of behavioral and neurological disorders.

Association Between Sleep Duration and Body Mass Index Among US Low-Income Preschoolers

OBJECTIVE

To verify whether sleep duration was related to body mass index z scores (zBMI) and whether bedtimes or ethnicity was a moderator of the sleep duration-zBMI association among preschoolers from low-income families.

METHODS

Two hundred twenty-eight African American and Hispanic parents and their preschoolers were recruited from Head Start Centers. Parents reported their preschoolers' sleep duration and bedtimes (using the Children's Sleep Habits Questionnaire) and their television watching. Food intake was measured using multiple days of digital photography to estimate energy intake at dinner. The Parenting Stress Index and the Center for Epidemiologic Studies Depression Scale were used to measure stress and depression. Parents' and preschoolers' height and weight were measured by trained staff.

RESULTS

Longer sleep duration was significantly associated with lower zBMI when controlling for demographics, bedtimes, energy intake at dinner, and television watching, but not when also controlling for parents' demographics, BMI, stress, and depression. Preschoolers' sleep duration-zBMI association was not moderated by bedtimes or ethnicity.

CONCLUSIONS

Longer sleep duration was associated with lower zBMI among low-income preschoolers when controlling for preschoolers' characteristics, but this was no longer the case when also controlling for parents' characteristics. Additional studies are needed on the moderators of the sleep duration-zBMI association among low-income preschoolers.

Gender differences and the role of parental education, school types and migration on the body mass index of 2930 Austrian school children : A cross-sectional study

BACKGROUND

Austria faces increasing numbers of childhood overweight and obesity. Despite increasing numbers of studies, associations between parental body mass index (BMI) and education and the school type on overweight/obesity in students have not been reported. The objective of this study was to evaluate the influence of these parameters on the genesis of overweight/obesity in a large cohort representative of youth in Upper Austrian.

METHODS

A cross-sectional analysis of data from 2930 children and adolescents aged 10, 14 or 17 years from 11 different state school types was conducted. Students and their parents completed a questionnaire and heights and weights were measured.

RESULTS

Of the students 16.9% fulfilled the criteria for overweight and 5.6% for obesity, with the highest rates in the 10-year-olds (19.6% and 5.8%, respectively). While no gender differences were present in the youngest age group, the body mass index (BMI) during adolescence remained higher in boys but decreased significantly in girls. Male gender remained a risk factor through all calculations. Boys were overrepresented in schools with lower education levels and more often had BMIs ≥ 85th and ≥95th percentile. Higher parental education levels and lower parental BMIs were associated with lower BMIs of their offspring. Migration was an additional association factor for BMIs ≥ 85th percentile.

CONCLUSION

Low parental education levels, higher parental BMIs and migration background were associated with overweight and obesity in 10-year-olds. In adolescence, male gender and higher parental BMIs remained risk factors.

Understanding the Relationship of Cigarette Smoking Trajectories Through Adolescence and Weight Status in Young Adulthood in the United States

PURPOSE

Adolescent cigarette smoking has steadily declined since 1999, whereas adolescent obesity rates have quadrupled since the 1980s. Few studies address the longitudinal relationship of smoking and weight in youth and young adulthood. This study examines the relationship of smoking trajectories beginning in adolescence on weight status in young adulthood in a nationally representative longitudinal sample.

METHODS

The study sample was drawn from the National Longitudinal Study of Adolescent to Adult Health Waves I-IV (N = 13,361). Four trajectories were generated through repeated-measures latent class analyses using current cigarette smoking status in Waves I-IV and age of initiation: nonsmokers (44%), early establishers (23%), late establishers (21%), and former smokers (12%). Wave IV weight status included self-reported body mass index (BMI) and measured waist circumference. Bivariate analyses addressed associations between smoking trajectory and BMI at each wave. Multivariate linear regression models tested the relationship of smoking trajectory and weight status at Wave IV.

RESULTS

In bivariate analyses, early and late establishers had a significantly lower BMI at Wave III and all smoking trajectories had a significantly lower BMI at Wave IV versus nonsmokers. All smoking trajectories had a significantly lower BMI than nonsmokers (early establishers: β = -1.27, confidence interval [CI]: -1.56 to -.98]; late establishers: β = -.84, CI: -1.16 to -.52; and former smokers: β = -.63, CI: -.93 to -.34; p < .05) in an adjusted multivariable regression model.

CONCLUSIONS

This study reveals that weight status increased over time for all trajectories; thus smoking does not mitigate obesity risk. These results have implications for both research and interventions to help youth and young adults avoid both smoking and obesity.

Self-Concept in Childhood: The Role of Body Image and Sport Practice

The purpose of this study was to explore the differences in satisfaction with body image depending on whether the subject practices organized sport or not, as well as the gender of the children. In addition, the study aims to examine the role of body image and the practice of organized sport on the process of building the academic, social, emotional, family and physical dimensions of self-concept in childhood. To do so, a sample of 944 pupils was used. These children were attending primary school in different centers of the Autonomous Community of Extremadura (Spain) and were between 9 and 12 years of age. The main results of the study show that three out of every four children participating in this study were not satisfied with their figure and one out of every five was very dissatisfied. The satisfaction or dissatisfaction with the figure was similar in boys and girls, although it could be appreciated that the ideal body image is partly conditioned by gender stereotypes. The children most satisfied with their body image had a greater academic and physical self-concept. The children that practiced organized sports had a greater physical and emotional self-concept. The children most dissatisfied with their body image and practiced organized sports had a lower family self-concept. All these findings are discussed with reference to previous research literature.

The Association between Parent Diet Quality and Child Dietary Patterns in Nine- to Eleven-Year-Old Children from Dunedin, New Zealand

Previous research investigating the relationship between parents’ and children’s diets has focused on single foods or nutrients, and not on global diet, which may be more important for good health. The aim of the study was to investigate the relationship between parental diet quality and child dietary patterns. A cross-sectional survey was conducted in 17 primary schools in Dunedin, New Zealand. Information on food consumption and related factors in children and their primary caregiver/parent were collected. Principal component analysis (PCA) was used to investigate dietary patterns in children and diet quality index (DQI) scores were calculated in parents. Relationships between parental DQI and child dietary patterns were examined in 401 child-parent pairs using mixed regression models. PCA generated two patterns; ‘Fruit and Vegetables’ and ‘Snacks’. A one unit higher parental DQI score was associated with a 0.03SD (CI: 0.02, 0.04) lower child ‘Snacks’ score. There was no significant relationship between ‘Fruit and Vegetables’ score and parental diet quality. Higher parental diet quality was associated with a lower dietary pattern score in children that was characterised by a lower consumption frequency of confectionery, chocolate, cakes, biscuits and savoury snacks. These results highlight the importance of parental modelling, in terms of their dietary choices, on the diet of children.

The clinical importance of quantifying body fat distribution during androgen deprivation therapy for prostate cancer

Androgen deprivation therapy (ADT) is now considered a mainstay in the treatment of metastatic and locally advanced prostate cancer (PCa). Despite well-established benefits of ADT in relation to overall survival, this treatment has been associated with a number of adverse effects, particularly with regard to key cardiometabolic risk factors including the development of insulin resistance, dyslipidemia and increases in total and regional fat mass. In non-ADT populations, increased levels of visceral adipose tissue (VAT) are thought to be a key mediator of the increased cardiometabolic risk associated with weight gain, but this has received limited attention in men treated with ADT. VAT is best assessed using tools such as computed tomography or magnetic resonance imaging; however, these tools are not readily accessible for the majority of researchers or clinicians. Recent advances allow for a method of estimating VAT using a whole-body dual-energy X-ray absorptiometry (DXA) scan that shows promise as a practical tool for researchers to evaluate changes in body fat distribution during ADT. The aim of this narrative review is to (1) review the available evidence with regard to the relationship between ADT and cardiometabolic risk; (2) discuss the role of body fat distribution on cardiometabolic risk in non-ADT populations, with a particular emphasis on the importance of visceral adiposity; (3) examine the potential influence of ADT on body fat distribution and visceral adiposity and (4) provide an overview of current tools used to measure changes in body fat distribution in men treated with ADT, highlighting the potential utility of a recently developed DXA-derived measure of VAT.

The prevalence of overweight/obesity in high school adolescents in Jeddah and the association of obesity association with dental caries

BACKGROUND

The prevalence of overweight/obesity in children in Saudi Arabia is among the highest in the world. The prevalence of dental caries is also high in Saudi children. Studies on the relationship between caries and obesity in Saudi adolescents are lacking.

OBJECTIVES

To study the prevalence of overweight/obesity in adolescents, and determine any association between obesity and caries.

DESIGN

An analytical cross-sectional study.

SETTING

Private and public schools in Jeddah.

PATIENTS AND METHODS

The study sample comprised high school children from public and private schools selected by multistage stratified random sampling. Height, weight, waist circumference (WC), and body mass index (BMI) were measured for all children, who were then classified as underweight/normal, overweight, or obese according to their BMI values, and nonobese or obese according to their WC values. The presence of caries was assessed using the Association of State and Territorial Dental Directors criteria.

MAIN OUTCOME MEASURE(S)

The prevalence of overweight/obesity and the association of obesity with the number of decayed permanent teeth.

RESULTS

801 high school children (48% boys, 49% from public schools) with a mean (SD) age of 16.5 (0.9) years. When the BMI classification was used, 24%, 16%, and 60% adolescents were obese, overweight, and underweight/normal, respectively. When the WC classification was used, 19% and 81% were obese and nonobese, respectively. Obesity was more prevalent in boys and in students attending private schools (P < .05). The number of decayed permanent teeth showed a very weak and insignificant correlation with BMI and WC.

CONCLUSION

One in every four adolescents residing in Jeddah was obese, with a high obesity prevalence in boys and in children attending private schools. The prevalence of caries in the permanent dentition was not associated with BMI or WC.

LIMITATIONS

It was difficult to establish temporality in this cross-sectional study. Data on common risk factors were not adjusted for in the analyses.

Changing Characteristics of Obese Children and Adolescents Entering Pediatric Lifestyle Intervention Programs in Germany over the Last 11 Years: An Adiposity Patients Registry Multicenter Analysis of 65,453 Children and Adolescents

OBJECTIVE

To examine whether characteristics of children and adolescents who start lifestyle intervention (LI) for obesity in Germany changed over the last decade.

METHODS

65,453 subjects (<21 years) from the APV database (Adiposity Patients Registry) with a BMI ≥ 90th percentile were included (years 2005-2015). Logistic regression models (confounders: age, sex, migration background) were created for overweight, obesity, extreme obesity, and obesity-related comorbidities. Comorbidities were further adjusted for weight category. Results were stratified by inpatient or outpatient care.

RESULTS

Extreme obesity was found to be more frequent at the onset of LI (2005: 11.6; 2015: 12.7%) with a similar trend in subgroups (p < 0.001). Obesity increased (2005: 50.3%; 2015: 55.1%), and overweight decreased (2005: 34.1%; 2015: 29.0%) in the whole study population. Trends were similar for inpatient or outpatient care (all p < 0.001). Hypertension increased from 45.7% to 49.2% in the whole study population, and similar data were obtained in the subgroup of inpatients (both p < 0.0001). Dyslipidemia increased in all patients (2005: 21.9%; 2015: 28.0%) and in inpatients (2005: 20.2%; 2015: 25.7%; both p < 0.0001). Abnormal carbohydrate metabolism rose in all patients (from 5.2 to 6.4%; p = 0.0002) without significant trends in subgroups.

CONCLUSION

During the last decade, children and adolescents presented with higher BMI SDS at the onset of LI and the proportion with obesity-related comorbidities increased. Particularly the presence of comorbidities differed between outpatients and inpatients.

School Context Matters: The Impacts of Concentrated Poverty and Racial Segregation on Childhood Obesity

BACKGROUND

Schools are important sites for interventions to prevent childhood obesity. This study examines how variables measuring the socioeconomic and racial composition of schools and counties affect the likelihood of obesity among third to fifth grade children.

METHODS

Body mass index data were collected from third to fifth grade public school students by teachers from 317 urban and rural North Carolina schools in 38 counties. Multilevel models are used to examine county-, school-, and individual-level effects.

RESULTS

Low concentrations of poverty at the school level are associated with lower odds of obesity. Schools in rural counties had significantly higher rates of obesity, net the other variables in the model. Students in minority-segregated schools had higher rates of obesity than those in more racially diverse schools, but the effect was not statistically significant once school-level poverty was controlled.

CONCLUSIONS

Place-based inequalities are important determinants of health inequalities. The results of this study show that school-level variables related to poverty are important for understanding and confronting childhood obesity.

Hazardous Health Behaviour among Medical Students: a Study from Turkey

BACKGROUND

Hazardous health behaviour in young people is an important factor that affects the individual risk for non-communicable diseases and other disorders later in life. This study aimed to determine the hazardous health behaviour of first and last class medical students of Erciyes University.

MATERIALS AND METHODS

This descriptive study was carried out with 240 medical students from the first and 130 students from the last (sixth) class. Data were obtained by questionnaire between March-April 2012. In total, 339 students were included with a response rate of 91.6%. Socio-demographic characteristics, school success, self-reported economic difficulties, health perceptions, hazardous health behaviour related to chronic disease, tobacco, alcohol, substance use, body weight, height, traffic, violence and nutrition were assessed in line with the literature.

RESULTS

Of the participants; 64.0% were from first and 36.0% were from the last class. Mean ages for the first and last classes were 19.4 ± 1.5 and 24.0 ± 1.5 years, respectively. In the current study, males exhibited more hazardous behaviour than females. Sime 19.8% of the students in the study group used alcohol, 35.4% used a waterpipe, and 24.8% used tobacco at least once. These rates increased in both genders in the last class and the increase in males was significant. Some 3.8% of the students in the current study used pleasure-inducing illegal substances at least once. All the students participating in the current study were single, the number of males reported not using condoms (8.6%) was 4.56 times higher compared to females. Some 64.0% of the students did not perform physical activity lasting at least 30 minutes for five times a week, 13.0% did not sleep for mean 7-8 hours daily, males having a 2.9 times higher risk. More than 1/3 of the students did not consume cooked vegetable dishes and 1/4 did not consume fresh fruits and salads, the rates were higher among males.

CONCLUSIONS

In the current study, hazardous health behaviour was prevalent among medical students, with higher risks among males and last class students. According to these results, medical curriculum may be focused on decreasing hazardous health behaviour. In addition, in order to prevent unhealthy behaviour, the number of youth-friendly health facilities should be increased.

Childhood overweight and obesity trends in Canada

INTRODUCTION

Excess weight is a key risk factor for chronic disease, and the systematic collection, analysis and reporting of key trends are important to surveillance of overweight and obesity.

METHODS

We used univariate analyses to calculate current prevalence estimates of excess weight among Canadian children and youth.

RESULTS

Almost 1 in 7 children and youth is obese. Rates vary based on sociodemographic factors such as age, sex, socioeconomic status and place of residence. Overall, the rates of excess weight have been relatively stable over the past decade.

CONCLUSION

Ongoing monitoring of childhood obesity will provide useful information to assist with sustained actions to promote healthy weights.

Association between problematic internet use, socio-demographic variables and obesity among European adolescents

BACKGROUND

Overweight of children and adolescents continues to be an important and alarming global public health problem. As the adolescent's time spent online has increased, problematic internet use (PIU) potentially leads to negative health consequences. This study aimed to examine the relation between PIU and overweight/obesity among adolescents in seven European countries and assess the effect of demographic and lifestyle factors recorded in the European Network for Adolescent Addictive Behaviour (EU NET ADB) survey (www.eunetadb.eu).

METHODS

A cross-sectional school-based survey of 14- to 17-year-old adolescents was conducted in seven European countries: Germany, Greece, Iceland, the Netherlands, Poland, Romania and Spain. Anonymous self-completed questionnaires included sociodemographic data, internet usage characteristics, school achievement, parental control and the Internet Addiction Test. Associations between overweight/obesity and potential risk factors were investigated by logistic regression analysis, allowing for the complex sample design.

RESULTS

The study sample consisted of 10 287 adolescents aged 14-17 years. 12.4% were overweight/obese, and 14.1% presented with dysfunctional internet behavior. Greece had the highest percentage of overweight/obese adolescents (19.8%) and the Netherlands the lowest (6.8%). Male sex [odds ratio (OR) = 2.89, 95%CI: 2.46-3.38], heavier use of social networking sites (OR = 1.26, 95%CI: 1.09-1.46) and residence in Greece (OR = 2.32, 95%CI: 1.79-2.99) or Germany (OR = 1.48, 95%CI: 1.12-1.96) were independently associated with higher risk of overweight/obesity. A greater number of siblings (OR = 0.79, 95%CI: 0.64-0.97), higher school grades (OR = 0.74, 95%CI: 0.63-0.88), higher parental education (OR = 0.89, 95%CI: 0.82-0.97) and residence in the Netherlands (OR = 0.49, 95%CI: 0.31-0.77) independently predicted lower risk of overweight/obesity.

CONCLUSIONS

The results indicate an association of overweight/obesity with PIU and suggest the importance of formulating preventive public health policies that target physical health, education and sedentary online lifestyle early in adolescence with special attention to boys.

Adolescent Overweight and Obesity: Links to Socioeconomic Status and Fruit and Vegetable Intakes

Whether adolescent overweight/obesity is linked to socioeconomic status (SES) and fruit and vegetable (F/V) intakes has not been confirmed. We aimed to determine whether there is an association between SES and adolescent overweight/obesity and to test the mediating effect of F/V intakes. This cross-sectional study included the data of 63,111 adolescents extracted from the 2013 Korea Youth Risk Behavior Web-based Survey. Overweight/obesity was defined as a body mass index ≥ 85th percentile, while F/V intakes were categorized as high (recommended levels: ≥1 fruit serving and ≥3 vegetable servings per day) versus low. Among girls, low SES (beta = 0.50, p < 0.001) and F/V intakes (beta = −0.17, p = 0.038) were both significantly associated with overweight/obesity; the former association was significantly mediated by F/V intakes (Sobel test: z = 2.00, p = 0.046). Among boys, neither SES nor F/V intakes was significantly associated with overweight/obesity. Adolescent overweight/obesity was significantly linked to low SES and F/V intakes among girls only; low SES indirectly increased the risk of overweight/obesity via low F/V intakes. Therefore, promoting F/V intakes for socially disadvantaged girls should be prioritized as a population-based strategy for preventing adolescent overweight/obesity in South Korea.