Adherence to the Mediterranean diet and weight status in children: the role of parental feeding practices

The study examines Parental Feeding Practices (PFP) in relation to adherence to the Mediterranean Diet (MD) and children's weight status. It's a cross-sectional study of 402 parents (68.4% mothers), with children aged 2-12 years. Parents completed the Comprehensive Parental Feeding Questionnaire and the Mediterranean Diet Quality Index for children and adolescents (KIDMED), evaluating children's adherence to the MD. Logistic regression showed that in children aged 2-<6 years, "emotion regulation/food as reward" and "pressure" decrease MD adherence (OR = 0.186, p < 0.0001 and OR = 0.496, p = 0.004), and "monitoring" decrease excess body weight (OR = 0.284, p = 0.009). In older children (6-12 years), "healthy eating guidance" and "monitoring" increase MD adherence (OR = 3.262, p = 0.001 and OR = 3.147, p < 0.0001), "child control" decreases MD adherence (OR = 0.587, p = 0.049), "pressure" decrease excess body weight (OR = 0.495, p < 0.0001) and "restriction" increase excess body weight (OR = 1.784, p = 0.015). "Healthy eating guidance" and "monitoring" seem to be the best PFP employed, in terms of children's MD adherence and weight status.

Longitudinal association between body mass index and physical activity among adolescents with different parental risk: a parallel latent growth curve modeling approach

Background

Data available on the association between physical activity (PA) and body mass index (BMI) in different periods of life is controversial. Using a parallel latent growth curve modeling (LGCM) approach, the current study aimed to investigate the influence of daily PA on adolescents’ BMI over a 12 year follow-up, taking into account their parental risk.

Method

Participants comprised 1323 adolescents (53.5% girls), aged 12–18 years who had participated in the baseline phase of Tehran Lipid and Glucose Study (TLGS) (2001–2003), and were followed for an average period of 12 years. Physical activity, including leisure time and occupational activities, was assessed using the reliable and validated Iranian version of the Modifiable Activity Questionnaire (MAQ). Weight and height were objectively measured in order to calculateBMI.Atwo-step cluster analysis was conducted to classify parents into two high- and low-risk clusters. Parallel LGCM was fitted to estimate cross-sectional, prospective and parallel associations, which assessed the longitudinal association between simultaneous changes in PA and BMI during the study period. Analyses were stratified by gender and parental clusters.

Results

A rising trend of BMI per 3 years was observed in boys 1.39 kg.m²(95% CI; 1.32, 1.48) and girls 0.9 kg.m²(95% CI; 0.82, 0.98), as well as in the low risk 1.11 kg.m²(95% CI; 1.03, 1.18) and high-risk 1.12 kg.m²(95% CI; 1.03, 1.22) clusters. Moreover, a positive prospective association between PA at baseline and BMI change over the 12 year follow-up, was observed in adolescents in the low-risk parental cluster 0.27(95% CI; 0.14, 0.41) indicating that higher levels of PA at baseline may lead to greater BMI in adolescents over time. However, examining longitudinal parallel association between simultaneous changes of PA and BMI per 3 years revealed adverse associations for adolescents in the low-risk parental cluster − 0.07 (95% CI; − 0.13, − 0.01) and in boys − 0.06 (95% CI; − 0.11, − 0.01).

Conclusion

Despite a positive prospective association between BMI and PA at baseline, there was a weak inverse parallel association between these variables over time, particularly in boys and adolescents with low parental risk. These findings imply the potential role of other influential factors indetermining adolescents’ weight status which need to be considered in the future plannings.

Metabolic Syndrome, Lifestyle, and Dental Caries in Japanese School Children

The number of children with Metabolic Syndrome (MetS) has recently been increasing in Japan. Few studies have investigated the relationship between MetS and oral health. The aim of this study was to investigate the association between MetS, lifestyle, and oral health status in school children. Our goal is to utilize these results in health education aimed at preventing the onset of MetS in school children and adults. A total of 689 Japanese children (365 boys and 324 girls) aged between 10 and 13 years were examined and waist circumference (WC), ratio of WC to height, blood pressure, fasting blood sugar (FBS), high density lipoprotein-cholesterol, and triglyceride values determined together with oral health status, including dental caries experience (DMFT). The results revealed that 6.5% of the children fell under the health board recognized "MetS or high risk of MetS" (MetS/HR) classification. A total of 140 (20%) children had a high Streptococcus mutans count. The mean WC, FBS, and DMFT values were significantly greater in children with a high salivary S. mutans count (p<0.05). Multiple logistic regression analysis revealed a statistically significance association between MetS/HR, non-breakfast eaters (odds ratio (OR): 2.70), no regular exercise (OR: 2.60), and a high salivary S. mutans count (≥10(5) CFU/ml; OR: 2.18; p<0.05). The present results indicate that lifestyle and salivary S. mutans count could be useful in screening children for MetS/HR. These variables may be useful in targeting interventions aimed at preventing MetS in school children.

Lipid profile and dyslipidemia among school-age children in urban Ghana

Background

Dyslipidemia during childhood has been associated with higher risk of atherosclerosis later in life. Information on the lipid profile of Ghanaian children is scarce. The aim of this study was to assess the lipid profiles of school children between the ages of 9–15 years, living in urban Ghana.

Methods

A total of 802 randomly selected school-age children participated in the Ghana School Survey implemented in Kumasi and Accra, Ghana. A structured questionnaire was used to collect information on child and maternal socio-demographic characteristics (including age, education, and occupation), 7-day food frequency, home and school activity, as well as measurement of weight and standing height. Weight, height, and age data were converted into BMI-for-age indices to determine weight status. Finger-prick fasting blood samples were taken from the school-age children. Total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) cholesterol levels were determined using the CardioChek® PA Test System. Reference lipid levels based on the US National Cholesterol Education Program 2001 guidelines were used to determine the proportion of children with dyslipidemia.

Results

The mean TC, LDL-C, HDL-C, and TG levels were 149.0 ± 57.0 mg/dl, 80.1 ± 38.6 mg/dl, 53.5 ± 19.4 mg/dl, and 71.4 ± 54.7 mg/dl, respectively. Mean TC/HDL-C ratio was 3.0 ± 1.0. The proportion of children with abnormal values were 12.1% for TC, 4.5% for TG, 28.4% for HDL-C, 9.2% for LDL-C, and 6.6% for TC/HDL-C ratio. The levels of dyslipidemia (HDL, LDL, and TC/HDL-C ratio) were higher among overweight/obese compared to normal-weight children. More frequent fruit consumption was also linked with lower LDL-C (p = 0.020) while watching television (TV) in the mornings was linked with both higher TC (p = 0.011) and TG (p = 0.006).

Conclusions

Majority of urban-dwelling Ghanaian school children had normal lipid profiles. However, the higher levels of dyslipidemia observed among overweight and obese children suggest the need for population level physical activity and dietary interventions among children to reduce risk of cardiovascular diseases in adult life.

Prevalence and geographic variation of abdominal obesity in 7- and 9-year-old children in Greece; World Health Organization Childhood Obesity Surveillance Initiative 2010

Background

In children, abdominal obesity is a better predictor of the presence of cardiovascular risk factors than body mass index (BMI)-defined obesity. We aimed to evaluate the prevalence of abdominal obesity in the Greek pediatric population and to assess the impact of residence on the prevalence of both BMI-defined and abdominal obesity.

Methods

In the context of the Childhood Obesity Surveillance Initiative of the World Health Organization (WHO) Regional Office for Europe, a national representative sample of 7.0–7.9 and 9.0–9.9-year-old children was evaluated (n = 2,531 and 2,700, respectively). Overweight and obesity according to BMI were estimated using both the WHO and International Obesity Task Force cut-off points. Abdominal obesity was defined as waist circumference/height ratio >0.5.

Results

The prevalence of abdominal obesity did not differ between 7-year-old boys and girls (25.2 and 25.3%, respectively; p = NS). Among 9-year-old children, abdominal obesity was more prevalent in boys than in girls (33.2 and 28.2%, respectively; p = 0.005). Among normal weight and overweight children, the prevalence of abdominal obesity was 1.6–6.8 and 21.8–49.1%, respectively. The prevalence of abdominal and BMI-defined obesity did not differ between children living in the mainland, in Crete and in other islands except in 7-year-old girls, where the prevalence of BMI-defined obesity was highest in those living in Crete, intermediate in those living in other islands and lowest in those living in the mainland. In 9-year-old boys and in 7- and 9-year-old girls, the prevalence of abdominal obesity was highest in children living in Athens and lowest in children living in Thessaloniki, whereas children living in other cities and in villages showed intermediate rates. The prevalence of abdominal obesity in 7-year-old boys and the prevalence of BMI-defined obesity did not differ between children living in cities and villages.

Conclusions

The prevalence of pediatric abdominal obesity in Greece is among the highest worldwide. Boys and children living in the capital are at higher risk for becoming obese. Given that abdominal obesity is more prevalent than BMI-defined obesity and appears to be more sensitive in identifying cardiovascular risk, measurement of waist circumference might have to be incorporated in the screening for childhood obesity.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4061-x) contains supplementary material, which is available to authorized users.

Obese Children with Metabolic Syndrome Have 3 Times Higher Risk to Have Nonalcoholic Fatty Liver Disease Compared with Those without Metabolic Syndrome

BACKGROUND

The aim of this study was to investigate the relationship between metabolic syndrome (MS) and nonalcoholic fatty liver disease (NAFLD) in obese children. One hundred and twenty-five subjects aged 11-12 years old participated in the study.

METHODS

Anthropometric and biochemical indices were measured, including lipid and liver profile, blood glucose, serum insulin, and liver ultrasound.

RESULTS

Forty-four children (58.6%) were found to have MS. Insulin resistance was present in 78 (62.4%) children. Patients with MS were more likely to have NAFLD (P < 0.001). Children with NAFLD had significantly higher body mass index, waist circumference, triglycerides, fasting insulin, and lower high-density lipoprotein compared to patients with normal livers (P < 0.001). Insulin resistance was significantly higher in children with NAFLD (P < 0.001). Obese children presenting with MS were 3.01 (2.87-3.57, P < 0.002) times more likely to develop NAFLD compared to those without metabolic syndrome after adjustment of cofounders.

CONCLUSIONS

Obese children with MS have a higher risk of developing NAFLD. Weight management and early prevention should be the first line of treatment to prevent any possible health issues later on.

International variability in 20 m shuttle run performance in children and youth: who are the fittest from a 50-country comparison? A systematic literature review with pooling of aggregate results

OBJECTIVES

To describe and compare 20 m shuttle run test (20mSRT) performance among children and youth across 50 countries; to explore broad socioeconomic indicators that correlate with 20mSRT performance in children and youth across countries and to evaluate the utility of the 20mSRT as an international population health indicator for children and youth.

METHODS

A systematic review was undertaken to identify papers that explicitly reported descriptive 20mSRT (with 1-min stages) data on apparently healthy 9-17 year-olds. Descriptive data were standardised to running speed (km/h) at the last completed stage. Country-specific 20mSRT performance indices were calculated as population-weighted mean z-scores relative to all children of the same age and sex from all countries. Countries were categorised into developed and developing groups based on the Human Development Index, and a correlational analysis was performed to describe the association between country-specific performance indices and broad socioeconomic indicators using Spearman's rank correlation coefficient.

RESULTS

Performance indices were calculated for 50 countries using collated data on 1 142 026 children and youth aged 9-17 years. The best performing countries were from Africa and Central-Northern Europe. Countries from South America were consistently among the worst performing countries. Country-specific income inequality (Gini index) was a strong negative correlate of the performance index across all 50 countries.

CONCLUSIONS

The pattern of variability in the performance index broadly supports the theory of a physical activity transition and income inequality as the strongest structural determinant of health in children and youth. This simple and cost-effective assessment would be a powerful tool for international population health surveillance.

Associations of Apolipoprotein A, High-Sensitivity C-Reactive Protein and Fasting Plasma Insulin in Obese Children With and Without Family History of Cardiovascular Disease

BACKGROUND

The worldwide prevalence of childhood obesity has increased from 4.2% to 6.7% during the last two decades. Pediatric obesity is a major health problem, which is dramatically increasing in Greece. A variety of inflammatory variables have been also found to associate with cardiometabolic (CV) risk in obese children. The purpose of this study was to identify and examine the effects of possible CV risk factors in obese and non-obese children with and without family history (FH) of cardiovascular disease (CVD).

METHODS

Sixty-eight (68) healthy children and adolescents aged 7 - 13 years participated in the study. Anthropometrical and biochemical indexes were obtained from all children as well as FH of CVD.

RESULTS

Systolic blood pressure (SBP), total cholesterol (TC), triglyceride (TG), high-sensitivity C-reactive protein (hsCRP), fasting plasma insulin (FPI) and homeostasis model assessment of insulin resistance (HOMA-IR) levels were found statistically significantly higher in the obese group compared to the non-obese one. High-density lipoprotein (HDL) levels were observed to be statistically significantly lower in the obese children compared to their normal peers.

CONCLUSIONS

Apolipoprotein A, hsCRP and FPI levels were significantly higher in the obese children with FH of CVD compared to the ones without FH of CVD. TC and SBP were found to be independently associated with obesity (odds ratio (OR): 1.965, 95% confidence interval (CI): 1.935 - 2.97, P < 0.031 and OR: 1.045, 95% CI: 1.016 - 1.074, P < 0.002, respectively).

International normative 20 m shuttle run values from 1 142 026 children and youth representing 50 countries

OBJECTIVE

To develop sex-specific and age-specific international norms for the 20 m shuttle run test (20mSRT) in children and youth (aged 9-17 years), and to estimate the prevalence meeting the FITNESSGRAM criterion-referenced standards for healthy cardiorespiratory endurance (CRE).

METHODS

A systematic review was undertaken to identify papers explicitly reporting descriptive 20mSRT (with 1 min stages) data on children and youth since 1981. Data were included on apparently healthy (free from known disease/injury) 9-17 years old. Following standardisation to a common metric and for protocol differences, pseudo data were generated using Monte Carlo simulation, with population-weighted sex-specific and age-specific normative centiles generated using the Lambda Mu and Sigma (LMS) method. Sex-related and age-related differences were expressed as per cent and standardised differences in means. The prevalence with healthy CRE was estimated using the sex-specific and age-specific FITNESSGRAM criterion-referenced standards for [Formula: see text].

RESULTS

Norms were displayed as tabulated centiles and as smoothed centile curves for the 20mSRT using 4 common metrics (speed at the last completed stage, completed stages/minutes, laps and relative [Formula: see text]). The final data set included 1 142 026 children and youth from 50 countries, extracted from 177 studies. Boys consistently outperformed girls at each age group (mean difference±95% CI: 0.86±0.28 km/h or 0.79±0.20 standardised units), with the magnitude of age-related increase larger for boys than for girls. A higher proportion of boys (mean±95% CI: 67±14%) had healthy CRE than girls (mean±95% CI: 54±17%), with the prevalence of healthy CRE decreasing systematically with age.

CONCLUSIONS

This study provides the most comprehensive and up-to-date set of international sex-specific and age-specific 20mSRT norms for children and youth, which have utility for health and fitness screening, profiling, monitoring and surveillance.

Conceptual framework of a simplified multi-dimensional model presenting the environmental and personal determinants of cardiometabolic risk behaviors in childhood

Clinical manifestations of cardiometabolic risk (CMR) may be set early in childhood due to unfavorable behaviors or lifestyle patterns related to diet and physical activity. Several factors may determine the adoption of such lifestyle-related behaviors, which researchers have tried to cluster under certain frameworks or models. In this context, the framework developed and proposed by this review gathers all the present knowledge regarding these determining factors to date and groups them into three main categories related to personal characteristics and the social and physical environment. Based on the proposed framework, a large variety of personal, social and physical environmental factors can positively or negatively influence CMR-related behaviors (either directly or indirectly via their interrelations), thus leading to decreased or increased risk, respectively. This framework could be of great value to public health policy makers and legislators for designing and implementing interventional programs tailored to the needs of susceptible population groups who are most in need for such initiatives. Targeting the correlates as potential determinants of CMR-related behaviors, and not just on the behaviors themselves, has been shown previously to be the most effective approach for tackling health issues related to CMR starting from early life stages.

Dietary patterns and breakfast consumption in relation to insulin resistance in children. The Healthy Growth Study

OBJECTIVE

Insulin resistance is a significant cross-point for the manifestation of several chronic diseases in children and adults. The aim of the present study was to investigate the possible relationship of certain dietary patterns and breakfast consumption habits with insulin resistance in children.

SUBJECTS

A representative sample of 1912 schoolchildren (aged 9-13 years) participated in a cross-sectional epidemiological study, the Healthy Growth Study, which was initiated in May 2007 and completed in June 2009.

SETTING

It was conducted in seventy-seven primary schools in four large regions in Greece.

DESIGN

Dietary intake, breakfast consumption, anthropometric and physical examination data, biochemical indices and socio-economic information collected from parents were assessed in all children. Principal components analysis was used to identify dietary patterns.

RESULTS

A dietary pattern of increased consumption of margarine, sweets (candies, lollipops, jellies, traditional fruit in heavy syrup) and savoury snacks (chips, cheese puffs and not home-made popcorn) was associated with homeostasis model assessment of insulin resistance index (HOMA-IR; β = 0·08, P < 0·001) in multivariate models. Children in the third tertile of this dietary pattern had a 2·51 (95 % CI 1·30, 4·90) times higher risk of insulin resistance (HOMA-IR > 3·16) than those in the first tertile. Breakfast consumption had an inverse correlation with insulin resistance, but the correlation lost its significance after adjustments for waist circumference, birth weight, parental BMI and socio-economic status.

CONCLUSIONS

Increased consumption of margarine, sweets and savoury snacks, which is a common dietary pattern in childhood, was positively associated with insulin resistance, while breakfast consumption had an inverse association with HOMA-IR, in schoolchildren (aged 9-13 years). Identification of dietary behaviours that might affect insulin resistance in children offers valuable advice in cardiometabolic risk prevention strategies.

Sports drink consumption and diet of children involved in organized sport

BACKGROUND

Organized sport provides one option for children to be physically active. However, there is a paucity of information about the relationship between children's participation in organized sport and their diet, and specifically their sports drink consumption. Therefore, the relationship between sports participation in children and the consumption of sports drinks, sugar-sweetened beverages (SSBs) and other components of diet was examined.

METHODS

A cross-sectional descriptive study was conducted using baseline data from the Action Schools! BC Dissemination study cohort (n = 1421; 9.90 (0.58) y; 736 girls, 685 boys). The differences between the dietary behaviours of children participating in organized sport (sport) versus those that did not participate (non-sport) was examined. A modified Physical Activity Questionnaire for Older Children (PAQ-C) was used to measure physical activity levels and participation in organized sport. A Food Frequency Questionnaire (FFQ) and 24-hour dietary recall were used to assess eating behaviour and macronutrient intake (including protein, fat, and carbohydrate as well as sugar, fibre and total calories). Fruit, vegetable and beverage quantities were hand-tallied from the dietary recall. Fruit, vegetable and beverage frequency was assessed using the FFQ. Analysis of covariance (ANCOVA) was used to analyse differences between groups and a chi-square test of association was use to determine if participation in sport was significantly associated with the proportion of children consuming sports drinks and SSBs, and with gender.

RESULTS

Children involved in sport had a lower body mass index (BMI) and were more physically active than children in the non-sport group (p < 0.01). Only a small number (n = 20/1421) of children consumed sports drinks and no difference in consumption of sports drink between sport and non-sport participants (p > .05) was observed. However, children involved in organized sport consumed more total calories, fat, fibre, fruit, vegetables and non-flavoured milk (p < 0.01) than non-sport children.

CONCLUSIONS

Children involved in organized sport were more physically active, consumed a healthier diet than non-participants and on average had lower BMI's despite consuming more calories. As consumption of sports drinks among this age group was low, this may be an ideal time to begin educating children and their parents about the appropriate consumption of sports drinks and the perils of consuming too many SSBs, specifically.

Relationships between health behaviors and weight status in American Indian and white rural children

PURPOSE

Preventing obesity in childhood is an increasingly important public health goal. Prevention efforts can be improved by better understanding relationships between health behaviors and overweight and obesity. This study examined such relationships in young American Indian and white children living in the rural United States.

METHODS

Self-report measures of diet, screen time (passive and active), and physical activity were combined with cardiovascular fitness in cross-sectional analyses to predict weight categories based on body mass index percentiles in 306 American Indian and white children (aged 8-9 years) from a rural area in the upper Midwestern United States.

FINDINGS

Multinomial logistic regression models were statistically significant for girls (χ2 [20] = 42.73, P < .01), boys (χ2 [20] = 50.44, P < .001), American Indian (χ2 [20] = 36.67, P < .05), and white children (χ2 [20] = 55.99, P < .001). Obesity was associated with poorer cardiovascular fitness in girls (OR = 0.82), boys (OR = 0.83), American Indian (OR = 0.79), and white children (OR = 0.85), and with passive screen time in girls (OR = 1.69), boys (OR = 2.1), and white children (OR = 1.81). Overweight was associated with passive screen time (OR = 2.24) and inversely with active screen time (OR = 0.54), but only in boys.

CONCLUSIONS

Logistic regression models were more successful at predicting obesity than overweight in all groups of participants. Poorer cardiovascular fitness showed the strongest and most consistent association with obesity, but passive screen time was also a significant and important contributor to the prediction of obesity in most prediction models. Prediction models were similar in girls, boys, American Indian, and white children.

High prevalence and diminished awareness of overweight and obesity in a mediterranean population. An alarming call for action

Introduction:

The epidemic proportions of overweight, obesity and diabetes in most European countries stress the need for the implementation of an effective action plan for the prevention of cardiovascular (CV) disease. This ques-tionnaire study was designed to evaluate the viewpoint of the general population regarding the relative significance of CV risk factors in the cumulative risk of CV disease.

Methods:

All participants answered a questionnaire regarding the self-reported presence of CV disease risk factors and the perceived notion of having excess weight. They were also asked to list CV disease risk factors, ranking them in order of perceived relative significance. Participants were also subjected to total cholesterol measurement using a portable total cholesterol testing meter.

Results:

The survey population consisted of 32,736 individuals (49.1% males). According to participant self reporting, 32.9% were smokers, 24.7% had hypertension, 9.8% had diabetes, 74.8% reported having stress, 41.9% had insufficient physical activity and 43.3% had hyperlipidemia. The prevalence of overweight was 43.9% and the prevalence of obesity (BMI ≥30 kg/m²) was 18.6%. Only 24.4% of participants reported that they had excess weight. The 45.2% of the ques-tioned individuals considered that stress was the most important CV risk factor.

Conclusions:

Despite the high prevalence of overweight and obesity, the majority of participants were unaware of the contribution of these well-established risk factors to the occurrence of CV disease. Improving public awareness is impor-tant in order to control the epidemic proportions of these modifiable risk factors.

Prevalence and risk factors of excess weight in school children in West Greece

The present study estimated the prevalence of childhood obesity and identified risk factors in 10-13 year old children. A cross-sectional study was conducted, including 200 children and their parents, in seven randomly-selected primary schools across Patras, Greece. Height, weight, and waist circumference were measured, and self-reported information was collected via face-to-face interviews. Body mass index was calculated for the children and their parents. The effect of risk factors on overweight and obesity was analyzed using regression analysis. The prevalence of overweight and obesity was 32% and 10.5%, respectively. The odds of being overweight/obese increased in children whose parents had a lower educational level and/or higher body mass index. Fewer daily meals and more time spent in front of the television and/or on the computer were significantly associated with obesity in 10-13 year old children. The prevalence of excess weight in primary school children in Patras is of concern, especially for boys. Children's nutritional habits, leisure activities, and parental characteristics influence their somatometric characteristics. These findings highlight the need for future weight loss interventions targeted at this population.

Do youth sports prevent pediatric obesity? A systematic review and commentary

Sport is a promising setting for obesity prevention among youth, but little is known about whether it prevents obesity. We reviewed research comparing sport participants with nonparticipants on weight status, physical activity, and diet. Among 19 studies, we found no clear pattern of association between body weight and sport participation. Among 17 studies, we found that sport participants are more physically active than those who do not participate. We found seven studies that compared the diet of sport participants with non-participants. These studies reported that youth involved in sport were more likely to consume fruits, vegetables, and milk, and also more likely to eat fast food and drink sugar-sweetened beverages and consume more calories overall. It is unclear from these results whether sports programs, as currently offered, protect youth from becoming overweight or obese. Additional research may foster understanding about how sport, and youth sport settings, can help promote energy balance and healthy body weight.

Associations between screen time and physical activity among Spanish adolescents

BACKGROUND

Excessive time in front of a single or several screens could explain a displacement of physical activity. The present study aimed at determining whether screen-time is associated with a reduced level of moderate to vigorous physical activity (MVPA) in Spanish adolescents living in favorable environmental conditions.

METHODOLOGY/PRINCIPAL FINDINGS

A multi-stage stratified random sampling method was used to select 3503 adolescents (12-18 years old) from the school population of Gran Canaria, Spain. MVPA, screen-time in front of television, computer, video game console and portable console was assessed in the classroom by fulfilling a standardized questionnaire. Bivariate and multivariate logistic regression analyses adjusted by a set of social-environmental variables were carried out. Forty-six percent of girls (95% CI±2.3%) and 26% of boys (95% CI±2.1%) did not meet the MVPA recommendations for adolescents. Major gender differences were observed in the time devoted to vigorous PA, video games and the total time spent on screen-based activities. Boys who reported 4 hours•week(-1) or more to total screen-time showed a 64% (OR = 0.61, 95% CI, 0.44-0.86) increased risk of failing to achieve the recommended adolescent MVPA level. Participation in organized physical activities and sports competitions were more strongly associated with MVPA than screen-related behaviors.

CONCLUSIONS/SIGNIFICANCE

No single screen-related behavior explained the reduction of MVPA in adolescents. However, the total time accumulated through several screen-related behaviors was negatively associated with MVPA level in boys. This association could be due to lower availability of time for exercise as the time devoted to sedentary screen-time activities increases. Participation in organized physical activities seems to counteract the negative impact of excessive time in front of screens on physical activity.

Prevalence of obesity and body mass index correlates in a representative sample of Cretan school children

OBJECTIVE

This study aimed to estimate the prevalence of overweight and obesity and investigate associated factors in a representative sample of Cretan school children.

METHODS

As part of a cross-sectional study in children aged 10-12 years (n = 481, 48% boys) in 27 (urban and rural) schools in Crete, Greece, the rates of overweight and obesity were estimated and multiple logistic regression was used to explore the relationship between several factors and body mass index (BMI).

RESULTS

It was shown that 28% and 13% of children were overweight and obese, respectively. Factors affecting children's BMI classification included: gender (95% CI: 0.21 to 0.56); birth weight (95% CI: 1.33 to 3.46); parental overweight or obesity (95% CI: 1.11 to 6.5 and 95% CI: 4.37 to 30.7 for one and both overweight or obese parents, respectively), paternal educational level (95% CI: 0.89 to 3.48 and 95% CI: 1.49 to 6.13 for low and high educational level, respectively); and cardiovascular fitness levels (95% CI: 0.87 to 0.92).

CONCLUSION

The combined prevalence of overweight and obesity was alarmingly high in the current population (41%); several physiological, behavioural and social factors were shown to affect children's BMI status. These findings highlight the extent of the child obesity problem in Crete and support the need for actions to be taken at a national level to tackle the obesity epidemic.

Risk factors for childhood obesity in a Greek paediatric population

OBJECTIVE

Obesity in children is a serious public health issue in Greece. The purpose of the current study was to identify risk factors such as birth weight, breast-feeding, dietary patterns, family history of obesity and sedentary behaviours that are possibly associated with paediatric obesity.

DESIGN

Two hundred and five overweight and obese children (OW/OB; group 1) aged 7-15 years from eight primary and secondary schools and a control group (group 2) of normal-weight children were matched for age and sex. Overweight and obesity were calculated based on the International Obesity Taskforce criteria. Lifestyle parameters as well as anthropometric data were collected in all children. Conditional logistic regression analysis was used to identify risk factors for obesity.

RESULTS

Breast-feeding (> or =3 months) and leisure-time physical activity proved to be protector factors against obesity (OR = 0.21, 95 % CI 0.11, 0.79, P < 0.001 and OR = 0.87, 95 % CI 0.85, 0.89, P < 0.001 respectively). On the other hand, family history of obesity (OR = 3.79, 95 % CI 2.61, 4.18, P < 0.001), sugar-sweetened beverage consumption (OR = 1.77, 95 % CI 1.03, 2.76, P < 0.001) and watching television (OR = 1.99, 95 % CI 1.54, 2.76, P = 0.04) were found to be positively associated with a higher obesity risk.

CONCLUSIONS

The current findings support the literature according to which duration of breast-feeding (<3 months), a family history of obesity, watching television, sedentary lifestyle and consumption of sugar-sweetened beverages are important risk factors for childhood obesity. More studies are needed to elucidate the relationship of paediatric obesity and possible predictor factors in order to avoid health consequences in these children later on in life.

Epidemiology and predisposing factors of obesity in Greece: from the Second World War until today

Over the last 30 years overweight and obesity among adults and children have been on the rise, and since 1997 WHO has designated obesity as a major public health problem. In Greece both adult and childhood obesity is now recognized as an epidemic problem, probably more important than in other European countries. The issue is more serious in male adolescents and adults. There is also a tendency for weight increase along the last 30 years. Metabolic syndrome and type 2 diabetes mellitus are also rising rapidly in the Greek population. The reasons for this epidemic in Greece are not clear. Possible explanations could emerge from the delayed but sharp economic evolution of the country, as well as the abandonment of the traditional Mediterranean diet. Other predisposing factors in Greek children are parental obesity, frequent television viewing, low rates of breastfeeding and, in adolescent girls, smoking and alcohol consumption. Emerging measures are needed to confront this epidemic.

Breakfast skipping and body mass index among adolescents in Greece: whether an association exists depends on how breakfast skipping is defined

Many studies have found an association between breakfast skipping and either body mass index (BMI; calculated as kg/m(2)) or overweight/obesity among adolescents, but several studies have found no association. This cross-sectional study investigated the hypothesis that this discrepancy is partly due to three differences in methodology. First, some studies have examined BMI, but other studies have examined overweight/obesity. Second, some studies have controlled for potential confounders, but other studies have not. Third, different studies have used different definitions of breakfast skipping. This study examined both the relationship between breakfast skipping and BMI and the relationship between breakfast skipping and overweight/obesity, compared unadjusted results with results adjusted for potential confounders, and compared results for 24 definitions of breakfast skipping. The sample consisted of 811 students at high schools in Piraeus, Greece, who completed a questionnaire and had their height and weight measured. The results supported this hypothesis. First, fewer breakfast-skipping variables were associated with BMI than with overweight/obesity. Second, fewer associations were found when controlling than when not controlling for potential confounders. Third, fewer associations were found for variables corresponding to some definitions of breakfast skipping than for variables corresponding to other definitions.

Association of blood pressure, obesity and serum homocysteine levels in healthy children

AIM

Obesity, hypertension and total serum homocysteine levels are well-known risk factors for cardiovascular disease in adults. However, there is limited data on the relation of these risk factors in children.

METHODS

Five hundred twenty-four healthy school children aged 6-15 years participated in the study. BMI were used to categorize our subjects in normal overweight and obese groups based on Internationally Obesity Task Force criteria.

RESULTS

The prevalence of overweight and obesity was 21.1% and 8.4% for boys and 17.6% and 7.3% for girls, respectively. Diastolic blood pressure (DBP), systolic blood pressure (SBP) and waist circumference (WC) were significantly higher in overweight and obese group compared to normal ones, whereas for homocysteine levels no difference was observed. Based on the results derived from the multiple regression analysis, BMI was positively related to energy intake (beta=0.247, p<0.001) and WC (beta=0.014, p<0.001). Both SBP and DBP were positively related to age ([beta=0.251, p<0.001] and [beta=0.301, p<0.001, respectively]), and BMI ([beta=0.096, p<0.001] and [beta=0.022, p<0.001], respectively).

CONCLUSION

The current study revealed an association of blood pressure and WC with overweight and obesity in children, and even though these children may not have increased homocysteine levels, they still have enough reasons to reduce weight in order to avoid cardiovascular disease in their life later on.

Physical activity, overweight and central adiposity in Swedish children and adolescents: the European Youth Heart Study

Background

The aim of this work was to study the associations of physical activity (PA) and other factors predisposing to overweight, with overweight and central adiposity in children and adolescents.

Methods

A total of 557 Swedish children (9.5 ± 0.3 y) and 517 adolescents (15.6 ± 0.4 y) from the European Youth Heart Study participated in this study. Logistic regression analyses were used to examine the associations of PA, as measured by accelerometry, and other determinants (i.e. television viewing, birth weight, maternal educational level and parental overweight) with total and central adiposity. Body mass index and waist circumference cut-off values proposed by the IOTF and the Bogalusa Heart Study (i.e. waist measures for predicting risk factors clustering, hereinafter called high-risk waist circumference), respectively, were used. Fatness was estimated from skinfold thicknesses and dichotomized using the 85^th sex- and age-specific percentile (high/low).

Results

Children and adolescents who had a low level (first tertile) of vigorous PA, were more likely to be overweight (including obesity) and to have a high-risk waist circumference, than those with a high level (third tertile) of vigorous PA. Similarly, those subjects who had a low or middle level (second tertile) of total PA were more likely to be overweight than those who had a high level of total PA. Among the PA variables, only vigorous PA was associated with high total fatness. Birth weight and television viewing, were also associated with higher odds of having a high-risk waist circumference, but these associations were attenuated once either total or vigorous PA variable was included in the model. Those subjects who had two overweight parents were more likely to be overweight and to have a high-risk waist circumference independently of PA variables, compared to those whose parents were not overweight.

Conclusion

Low levels of total PA and especially vigorous PA may play an important role in the development of overweight and excess of central adiposity in children and adolescents, independently of a number of factors such as television viewing and birth weight. In addition, the data suggest that the association between television viewing and central fat deposition could be attenuated if enough vigorous PA is accumulated. Longitudinal and intervention studies are needed to confirm these findings.

Factors associated with overweight in preschool-age children in southwestern France

BACKGROUND

Pediatric overweight and obesity are becoming an epidemic worldwide, which indicates the need for formulating preventive programs and policies during a child's early years.

OBJECTIVE

We identified factors associated with overweight in young children in southwestern France.

DESIGN

Children [n = 1780; x (+/-SD) age: 3.9 +/- 0.4 y] were recruited in kindergarten. Medical information on the parents, grandparents, and child as well as the child's 3-d dietary intake, participation in organized sports, and television-viewing habits were ascertained, and anthropometric measurements of the child were taken.

RESULTS

The prevalence of overweight was 9.1% when using body mass index >or= 90th percentile of French reference curves as a cutoff. In a multivariate logistic regression, overweight at 4 y was associated with female sex, having an overweight mother, and having >or=1 diabetic grandparent; odds ratios (ORs; 95% CIs) for these variables were 1.9 (1.2, 3.0), 2.2 (1.0, 4.7), and 2.6 (1.6, 4.1), respectively. Being small or large for gestational age was not associated with the risk of overweight at 4 y, whereas this risk was increased for children who were overweight at 9 or 24 mo: ORs (95% CIs) were 4.0 (2.4, 6.9) and 11.7 (6.1, 22.2), respectively. Nutrient intakes did not differ significantly with weight status in girls; however, overweight boys had significantly greater energy and lipid intakes than did their nonoverweight counterparts. Overweight was positively associated with television viewing (>1 h/d) in both sexes and with participation in organized sports in girls only.

CONCLUSIONS

A family history of overweight or diabetes, overweight in the first 2 y of life, and television viewing are associated with overweight at 4 y. These factors should be considered in developing programs for the prevention of overweight in early childhood.

Gene-diet interactions in childhood obesity: paucity of evidence as the epidemic of childhood obesity continues to rise

Childhood obesity is growing rapidly worldwide. Although there have been enormous advances in the genetic underpinnings of obesity in recent years, the pathways that lead to obesity are still not completely understood. One of the ongoing challenges is the lack of a comprehensive definition of the obese phenotype that encompasses intermediary phenotypic expressions of biological and behavioral nature. Interactions between genetic and environmental factors, including nutrient exposures and dietary behaviors, can influence the development of the obese phenotype. Specifically, genes play a decisive role in the etiology of childhood obesity under the permissive circumstances of an obesogenic environment (increase in energy intake with a decrease in physical activity). Like many diseases, the causes of obesity are complex and their investigation requires novel approaches. Given the many contributors to obesity (weight gain, weight loss, weight maintenance, variability in body composition), as well as the dynamic nature of this issue, genomic tools must continue to be employed to evaluate all dimensions of the obesity phenotype, such as biochemical characteristics, susceptibility markers, nutrient intake, feeding practices and gene-environment interactions. Fundamental knowledge of the types of genes involved and available gene-diet interaction studies in children's obesity are reviewed. Although there is a paucity of existing literature in this specific domain of childhood obesity, ongoing investigations utilizing large cohorts have potential for providing the knowledge needed for targeted interventions in the future.

Measurement of television viewing in children and adolescents: a systematic review

The relationship between television (TV) viewing and overweight in children is likely to be influenced by the quality of measures used. We systematically reviewed studies related to overweight in children that had included a measure of TV exposure. Literature searches were conducted in MedLINE, PsychInfo, SportDiscus and ISIWeb of Science. Methods of assessing TV viewing were evaluated, including the type of measure, the administration procedure and reported psychometric properties. The majority of studies assessed TV viewing using self-report surveys and very few studies used direct observation. The validity or reliability of measures was often not examined. The majority of tools that were evaluated were compared with another self-report measure or an objective measure of physical activity. TV viewing measures should be selected that are specific to the research question, the study design, as well as methodological feasibility. However, it is recommended that measures of TV viewing be used only if they have psychometric data to support their validity and reliability. Selecting measures that are valid and reliable enables us to examine with greater accuracy the influence of TV viewing on childhood overweight, as well as the efficacy of interventions designed to reduce TV viewing in children.

Validity of self-reported anthropometric values used to assess body mass index and estimate obesity in Greek school children

PURPOSE

To examine the validity of self-reported values of body height and weight, used for the estimation of body mass index (BMI), as a diagnostic method for the evaluation of overweight and obesity in Greek school children.

METHOD

Self-reported height and weight was recorded and then measured in 378 primary (mean age 11.4 +/- .4 years) and 298 high school students (mean age 12.5 +/- .3 years). The BMI cutoff points adopted by the International Obesity Task Force were used to compare prevalence estimates of overweight and obesity obtained from self-reported and actual measures.

RESULTS

Significant differences were found between self-reported and measured anthropometric indices in all subgroups, except for height in elementary school girls. The degree of self-report bias did not differ between genders; however, it was higher for high school students and heavier children, compared to elementary school pupils and lighter children, respectively. Based on self-reports, prevalence estimates were 23.1% for overweight and 4.3% for obesity, but according to measured data the corresponding rates were 28.8% and 9.5%, respectively.

CONCLUSIONS

The present findings imply that the observed discrepancy between self-reported and measured anthropometric data in Greek children and adolescents might lead to erroneous estimating rates of overweight and obesity. Although self-reported data are easy to obtain, health surveys of overweight and obesity in youth need valid and accurate procedures.

Patterns in sedentary and exercise behaviors and associations with overweight in 9-14-year-old boys and girls--a cross-sectional study

Background

Before starting interventions addressing energy-balance related behaviors, knowledge is needed about the prevalence of sedentary behaviors and low physical exercise, their interrelationships, possible gender differences. Therefore this study aimed to describe gender differences in sedentary and physical exercise behaviors and their association with overweight status in children from nine European countries. Additionally, to identify clusters of children sharing the same pattern regarding sedentary and physical exercise behavior and compare these groups regarding overweight status.

Methods

Cross-sectional study among 11-year-old children in nine countries (n = 12538). Self-administered questionnaires assessed the time spent on TV viewing during dinner and during the day, PC use and on physical exercise. The parents reported children's weight and height. Descriptive statistics, cluster analyses, and logistic regression analyses were used for data analyses.

Results

Boys spent more time on sedentary behaviors but also more on physical exercise than girls. High TV viewing and low exercise behavior independently increased the risk of being overweight. Based on the behaviors, five clusters were identified. Among boys, clear associations with being overweight were found, with the most unhealthy behavior pattern having the highest risks of being overweight. Among girls, high TV viewers and high PC users had increased risk of being overweight. In girls sedentary behaviors seemed more important than physical exercise with regard to overweight status.

Conclusion

Despite selective non-response on BMI and reliance on self-reports, the associations between clusters and overweight in boys were clear, and differences between boys and girls regarding the behaviors and risks for overweight are noteworthy. These differences need to be considered when developing tailored intervention strategies for prevention of overweight.

Relationship between BMI, physical fitness, and motor skills in youth with mild intellectual disabilities

INTRODUCTION

The negative impact of obesity on physical fitness and motor abilities has been documented in youth of various ages; however, this issue has not been explored in youth with mild intellectual disabilities (ID). Youth with ID are considered more overweight, less physically fit, and less motor proficient than peers without ID, so it is important to determine if these variables are associated in this population. The purpose of this study was to examine the relationship between body mass index (BMI), physical fitness, and motor skills in a large sample of youth with mild ID.

METHOD

A systematic, stratified sampling method was used to select 444 youth with mild ID, aged 6-18 years, from eight special education schools in Hong Kong. Physical fitness was assessed using items from the national Hong Kong assessment: 6- (ages 6-8 years) or 9- (ages 9-18 years) minute run, sit-up, isometric push-up, sit and reach, and sum of skinfold. Functional motor skills were assessed in 244 youth from the fitness sample using the Test of Gross Motor Development-II. Subjects were categorized into normal or overweight/obese BMI groups based on international cutoff points.

RESULTS

Approximately 20% of the sample was classified as overweight/obese (average BMI normal = 17.47+/-2.69; overweight/obese = 24.78+/-4.05). ANCOVA controlling for age and gender revealed group differences in the run (P = 0.001) and push-ups (P = 0.05), but not in the motor or other fitness variables. After controlling for age and gender, BMI was correlated with the run (r = -0.27, P < 0.001) and push ups (r = -0.18, P = 0.008). Age and gender were entered as the first block in hierarchical regression and accounted for most of the variance in all dependent variables, except sit and reach. The inclusion of BMI in the second block added to the model for run and push-ups only (deltaR2 run = 0.04, push-ups = 0.03, P<0.001).

CONCLUSION

Overweight/obesity is minimally associated with aerobic fitness and muscular strength in youth with mild ID. BMI did not impact other fitness measures (sit-up, sit and reach) or motor skills in the sample. The undesirable level of overweight/obesity in this sample requires increased attention and immediate intervention.

Fitness levels of Greek primary schoolchildren in relationship to overweight and obesity

OBJECTIVES

The aim of the present cross-sectional study was to provide estimates for overweight and obesity in a sample of Greek schoolchildren and to determine their possible relation with selected motor and health-related fitness parameters.

MATERIALS AND METHODS

The study sample consisted of 709 healthy children (328 girls, 381 boys, mean age = 8.9+/-1.6 years), living in the towns of Agios Stefanos (approximately 12,000 citizens) and Alexandroupolis (approximately 60,000 citizens), Greece. All pupils underwent anthropometric, motor and cardiovascular fitness assessments (Eurofit test battery). The body mass index (BMI) cut-off points adopted by the International Obesity Task Force were utilized for the assessment of overweight and obesity.

RESULTS

59.4% of the participants had a normal BMI, 25.8% were overweight and 14.8% were obese, without significant differences between genders.

DISCUSSIONS

In general, the higher BMI categories were strongly associated with inferior performances in all fitness tests, except flexibility. This graded relationship was consistent for both boys and girls, although the statistical relationship between BMI categories and fitness performance varied by gender.

CONCLUSIONS

In conclusion, the findings of the current study offer some support to the reported high prevalence of childhood obesity in Greece and suggest that overweight and obesity are limiting factors for fitness performance in primary schoolchildren. The present data suggest that interventions promoting children's health should, ideally, begin early in life and involve measures that simultaneously improve fitness and lower fatness.

Relations between obesity and hypertension: preliminary data from a cross-sectional study in primary schoolchildren: The children study

OBJECTIVE

To record the prevalence of overweight, obesity and hypertension in primary schoolchildren living in one of the poorest regions in Europe and furthermore to identify certain behavioural, lifestyle and physiological parameters associated with body mass index (BMI) and blood pressure (BP).

DESIGN

Cross-sectional study.

SETTING

Nineteen primary schools within the county of Ioannina, Greece.

SUBJECTS AND METHODS

Demographic, dietary and physical activity data as well as anthropometrical, BP and cardiorespiratory fitness measurements were obtained from a representative sample of 312 school children (153 boys and 159 girls) attending 5th grade. Inclusion of subjects in the study was voluntary. One-way analysis of variance and multiple linear regression analysis were mainly applied for the evaluation of the tested hypotheses.

RESULTS

The prevalence of overweight and obesity was 29.4 and 11.8% for boys and 39.0 and 7.5% for girls. The prevalence of systolic and diastolic hypertension was 28.1 and 7.8% for boys and 26.4 and 17.0% for girls. Furthermore, BMI and BP (systolic and diastolic) were positively related to frequency of fast food meals (rho: + 0.28, P = 0.033, rho: + 1.09, P = 0.03 and rho: +0.86, P = 0.014, respectively) but negatively to leisure time physical activity (rho: -5.55, P = 0.005, rho: -3.32 x 10(-2), P < 0.001 and rho: -2.08 x 10(-2), P < 0.001, respectively).

CONCLUSIONS

The current study revealed an increased prevalence of overweight, obesity and hypertension among schoolchildren in Ioannina, indicating the need for early preventive measures in one of the less privileged regions of Europe.

Implication of socio-economic status on the prevalence of overweight and obesity in Greek adults: the ATTICA study

BACKGROUND

Although ooverweight and obesity are considered as a health problem that affects millions of people worldwide, the implication of socio-economic status (SES) in these healthy conditions have rarely been investigated. We evaluated the associations of overweight and obesity with SES, in a population based sample of Greek adults.

METHODS

During 2001-2002 we randomly enrolled 1514 men (18-87 years old) and 1528 women (18-89 years old), stratified by the age-sex distribution (census 2001) of the Attica area, Greece. We studied several demographic, anthropometric, lifestyle, dietary and bio-clinical factors of the participants. SES (low, middle and high) was defined through the education and economical level of the participants.

RESULTS

The prevalence of overweight and obesity was 53 and 20% in men, and 31 and 15% in women, respectively, while an increase in the prevalence of obesity was observed with progressing age. Both men and women in the higher SES group had significantly lower prevalence of obesity as compared to the middle and lower SES group (p<0.001). However, multivariate analysis showed that the observed associations between SES and obesity were mainly explained by differences in physical activity status and energy intake of the participants.

CONCLUSION

Overweight and obesity seems to be a serious health problem, affecting more prominently people in the lower SES. However, eating and other lifestyle habits mainly explained the association between SES and obesity.

Parental educational level and cardiovascular disease risk factors in schoolchildren in large urban areas of Turkey: directions for public health policy

BACKGROUND

It is widely accepted that the development of atherosclerosis starts at an early age. However, there are very few studies evaluating the prevalence of the common clinical and behavioral cardiovascular disease (CVD) risk factors among children, especially in developing countries. The aim of the present cross-sectional survey was to evaluate the distribution of blood lipid profile and various behavioral (i.e. dietary habits, physical activity status) factors related to CVD risk and its relationships to paternal (PEL) and maternal educational level (MEL) among primary schoolchildren in Turkey.

METHODS

In three major metropolises in Turkey (Istanbul, Ankara and Izmir), a random sample of 1044 children aged 12 and 13 years old was examined. ANOVA was applied to evaluate the tested hypothesis, after correcting for multiple comparisons (Tukey correction).

RESULTS

After controlling for energy and fat intake, physical activity status and Body Mass Index (BMI), it was found that mostly PEL had a significant positive effect for most of the subgroups examined (Lower vs. Higher and Medium vs. Higher) on TC and HDL-cholesterol and a negative effect on TC/HDL ratio for both genders. Furthermore, both boys and girls with higher PEL and MEL were found to have higher energy intake derived from fat and protein than their counterparts with Medium and Lower PEL and MEL, while the opposite was observed for the percentage of energy derived from carbohydrates.

CONCLUSIONS

Our study provides indications for a possible association between an adverse lipid profile, certain dietary patterns and Higher PEL and MEL among schoolchildren in Turkey. These findings underline the possible role of social status, indicated by the degree of education of both parents, in developing certain health behaviors and health indices among Turkish children and provide some guidance for Public Health Policy.