Secular increases in body fat percentage in male children of Zaragoza, Spain, 1980-1995

Secular changes in the waist, hips circumferences and selected associated indicators, among preschool children from Kraków (Poland), between 1983 and 2018

OBJECTIVES

Waist circumference and derived indicators are great for measuring the risk of abdominal obesity. The main aim of the study was to assess the changes in the waist, hips circumferences and selected associated indicators, among preschool children (3-7 years of age) from Kraków, Poland, between 1983, 2008 and 2018.

METHODS

The research was conducted in randomly selected kindergarten in Krakow (Poland). The 1983 cohort consisted of 1414 children and the 2008 and 2018 series included 1050 preschoolers each. Analyzed characteristics included waist and hip circumferences, body height, waist-to-hips ratio (WHR) and waist-to-height ratio (WHtR).

RESULTS

There was a negative secular trend regarding circumferences of the hips and waist, as well as WHtR. In girls, WHR was, the greatest in the 2018 cohort, while among boys there was a secular increase in the value of this parameter compared to the 2008 cohort, but not to the 1983 series.

CONCLUSIONS

The coexistence of currently noted trends with the previously described secular decrease in the prevalence of overweight/obesity and increase in trunk adiposity in the same population, suggests that WHR is preferable to body mass index in assessing the risk associated with excess adiposity in the population examined in the presented study.

Changes in adiposity and fat tissue distribution among preschool children from Kraków, Poland, from 2008 to 2018

In the light of changes in the living conditions of populations, excess adiposity is currently a serious public health problem worldwide. The aim of this study was to assess the changes in the body fat ratio among preschool children aged 3–7 years from Kraków, Poland, between 2008 and 2018. The study group consisted of children examined in two cross-sectional studies. Analysed characteristics included triceps, calf, subscapular, abdominal and suprailiac skinfold thicknesses, and adiposity calculated according to Slaughter’s equations. The trunk adiposity index and limbs-to-trunk fat ratio were also calculated. Statistical significance was obtained using two-way ANOVA and Tukey’s tests. Lower-limb adiposity was largest in the 2008 cohort and trunk adiposity was greater in the 2018 cohort. The mean values of the trunk adiposity index and limbs-to-trunk fat ratio were lower in the 2018 cohort than in the 2008 cohort. The 2018 cohort was also characterized by a lower overall adiposity. Regardless of the lower body adiposity percentage, in 2018 there was a tendency towards the central allocation of fat tissue. This is a negative phenomenon because, especially when co-existing with reduced lower-limb adiposity, it is associated with an increased risk of metabolic and cardiovascular diseases, even in young children.

Secular trends in adiposity within the context of changes in BMI across developmental periods among Polish schoolchildren-application of the Slaughter equation

OBJECTIVES

To estimate secular changes in the body fatness, assessed using the Slaughter equation, in the context of changes in BMI in different developmental periods among Polish schoolchildren studied over nearly 50 years.

METHODS

Data were collected during Polish Anthropological Surveys (1966, 1978, 1988, 2012). The total random sample consisted of 69,746 schoolchildren, aged 7-18. Three periods of development were identified: childhood, early adolescence, and late adolescence. Raw data of BMI were standardized for age classes. Based on the body fat percentage, calculated using Slaughter equation (involving triceps and subscapular skinfold thickness), fat mass (FM; kg), and then fat mass index (FMI = FM/height⁶; kg/m⁶) was assessed to enable comparison between body fatness and BMI. Statistical analyses included two-way ANOVA and post-hoc Tukey's tests.

RESULTS

In boys, in terms of changes per decade, between 1966 and 2012 acceleration in Z-BMI and deceleration in FMI were found, irrespective of developmental period. Regarding girls, deceleration of trend was found in terms of both features, with different intensity, depending on developmental period and year of study. The pattern of changes in FMI depending on developmental period was, to some extent, similar for both sexes.

CONCLUSIONS

Slaughter equation for abovementioned two skinfolds, as a method of body fatness assessment, might be a useful tool for research on boys across different developmental periods, but not on girls. Moreover, it should be used with caution when applied to secular changes in adiposity in both sexes, since the distribution of fat tissue varies across ontogenesis, but also over generations.

A comparison of the Slaughter skinfold-thickness equations and BMI in predicting body fatness and cardiovascular disease risk factor levels in children

BACKGROUND

Although estimation of percentage body fat with the Slaughter skinfold-thickness equations (PBF(Slaughter)) is widely used, the accuracy of this method has not been well studied.

OBJECTIVE

The objective was to determine the accuracy of the Slaughter skinfold-thickness equations.

DESIGN

We compared agreement between PBF(Slaughter) and estimations derived from dual-energy X-ray absorptiometry (PBF(DXA)) in 1169 children in the Pediatric Rosetta Body Composition Project and the relation to cardiovascular disease risk factors, as compared with body mass index (BMI), in 6725 children in the Bogalusa Heart Study.

RESULTS

PBF(Slaughter) was highly correlated (r = 0.90) with PBF(DXA), but it markedly overestimated levels of PBF(DXA) in children with large skinfold thicknesses. In the 65 boys with a sum of skinfold thicknesses (subscapular- plus triceps-skinfold thicknesses) ≥ 50 mm, PBF(Slaughter) overestimated PBF(DXA) by 12 percentage points. The comparable overestimation in girls with a high skinfold sum was 6 percentage points. We also found that, after adjustment for sex and age, BMI showed slightly stronger associations with lipid, lipoprotein, insulin, and blood pressure values than did PBF(Slaughter).

CONCLUSIONS

These results indicate that PBF(Slaughter), which was developed among a group of much thinner children and adolescents, is fairly accurate among nonobese children, but markedly overestimates the body fatness of children who have thick skinfold thicknesses. Furthermore, PBF(Slaughter) has no advantage over sex- and age-adjusted BMIs at identifying children who are at increased risk of cardiovascular disease based on lipid, lipoprotein, insulin, and blood pressure values.

The timing of the rise in U.S. obesity varies with measure of fatness

There are several ways to measure fatness and obesity, each with its own strengths and weaknesses. The primary measure for tracking the prevalence of obesity has historically been body mass index (BMI). This paper compares long-run trends in the prevalence of obesity when obesity is defined using skinfold thickness instead of BMI, using data from the full series of U.S. National Health Examination Surveys. The results indicate that when one uses skinfold thickness rather than BMI to define obesity, the rise in the prevalence of obesity is detectable 10-20 years earlier. This underscores the importance of examining multiple measures of fatness when monitoring or otherwise studying obesity.

Percent body fat, skinfold thickness or body mass index for defining obesity or overweight, as a risk factor for asthma in schoolchildren: which one to use in epidemiological studies?

None of the epidemiological studies indicating that obesity is a risk factor for asthma in schoolchildren have used the percent body fat (PBF) to define obesity. The present study compares the definition of obesity using body mass index (BMI), PBF and the raw sum of the thickness of four skinfolds (SFT) to evaluate this condition as a risk factor for asthma. All classes of children of the target ages of 6-8 years of all schools in four municipalities of Murcia (Spain) were surveyed. Participation rate was 70.2% and the number of children included in the study was 931. Height, weight and SFT (biceps, triceps, subscapular and suprailiac) were measured according to standard procedures. Current active asthma was defined from several questions of the International Study of Asthma and Allergies in Childhood questionnaire. Obesity was defined using two standard cut-off points for BMI and PBF, and the 85th percentile for BMI, PBF and SFT. The highest quartile of each type of measurement was also compared with the lowest. A multiple logistic regression analysis was made for the various obesity definitions, adjusting for age, asthma in the mother and father and gender. The adjusted odds ratios of having asthma among obese children were different for boys and girls and varied across the different obesity definitions. For the standard cut-off points of BMI they were 1.19 [95% confidence interval (CI) 0.41-3.43] for girls and 2.00 (95% CI 0.97-4.10) for boys; however, for PBF (boys 25%, girls 30%) the corresponding figures were 1.54 (95% CI 0.63-3.73) and 1.20 (95% CI 0.66-2.21). BMI, PBF and SFT showed more consistency between each other when using the other cut-off points. BMI, PBF (except standard cut-off points) and SFT produce relatively comparable results when analysing the interaction between obesity and asthma.

Prevalencia de obesidad y tendencia de los factores de riesgo cardiovascular en escolares de 1992 a 2004: estudio de Cuenca

BACKGROUND AND OBJECTIVE

The assess the prevalence of overweight and obesity in school children from the province of Cuenca in 2004, and to examine changes in the main cardiovascular risk factors in school children from the city of Cuenca from 1992 through 2004.

SUBJECTS AND METHOD

Cross sectional survey of 1166 schoolchildren 9-10 years old from 22 public schools of the province of Cuenca. We also analyzed data from 3 earlier, methodologically similar, cross-sectional surveys of school children from the city of Cuenca carried out in 1992, 1996 and 1998.

RESULTS

In 2004, among children aged 9-10 years from the province of Cuenca, 22.0% (95% confidence interval [CI], 19.53-24.37) were overweight and 8.8% (95% CI, 7.16-10.50) were obese. From 1992 through 2004, among children aged 9-10 years from the city of Cuenca, we registered a 12.2% absolute increase in the prevalence of overweight or obesity among males, which did no reach statistical significance (p > 0.05). Among women, changes in body mass index were of lower magnitude and with no statistical significance. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased (p < 0.05) in both sexes, with a greater decline in females. Among the latter, SBP decreased -9.22 mmHg (95% CI, -7.0 to -11.5) and DBP -5.9 mmHg (95% CI, -4.23 to -7.50). Non high density lipoproteins-cholesterol decreased among males (-18.1 mg/dl; 95% CI, -26.0 to -10.1 mg/dl) and among females (-23.7 mg/dl; 95% CI, -30.8 to -16.6 mg/dl). High density lipoproteins-cholesterol increased 6.3 mg/dl (95% CI, 2.6-10.0 mg/dl) in males and 5.1 mg/dl (95% CI, 1.9-8.2 mg/dl) in females. Triglycerides did not show substantial changes over the study period.

CONCLUSIONS

Prevalence of overweight or obesity in schoolchildren of Cuenca is among the highest in Europe. From 1992 through 2004 in the city of Cuenca, frequency of overweight or obesity might have increased among males, while blood pressure and the lipid profile improved in both sexes.

Insight into the causes of the recent secular trend in pediatric obesity: Common sense does not always prevail for complex, multi-factorial phenotypes

Although the secular increase in pediatric obesity is well-documented, there has been no serious attempt to systematically address the causes of this secular trend. The aim of this paper is to provide a better understanding of the possible causes of the recent secular increase in pediatric obesity by reviewing and synthesizing the available literature pertaining to the topic. The paper addresses caveats and important considerations regarding the body mass index, physical activity, and diet and also considers alternative explanations (stress, sleep, maternal health, epigenetic mechanisms) for the secular trend. It is likely that the increased BMI is due to both an increased fat-free mass and fat mass (including waist circumference). Although total caloric intake has remained unchanged, there was a clear trend in increased simple sugar consumption. It is conceivable that total energy expenditure has decreased because of a decline in spontaneous but not voluntary physical activity. Several indicators of psycho-social stress (antidepressant medication prescriptions and suicide attempts, anxiety) have increased along with a decreased sleep duration. Finally, there is intriguing evidence that suggests that the secular trend is related to a common origin in fetal life that is exacerbated by postnatal events/stressors. The insight gained from examining the possible causes of the trend provides a better understanding of the basic etiology of pediatric obesity and should be incorporated into prevention and intervention models.

Age-dependent changes in body size of Greek boys from 1982 to 2002

OBJECTIVE

The prevalence of childhood obesity has been rising during the past decades in many parts of the world, including Greece. The dispersion of these trends across age, however, is less clear. The aim of this study was to examine the relationship between age and 20-year changes in anthropometric characteristics of Greek boys.

RESEARCH METHODS AND PROCEDURES

A total of 204 and 106 boys 9 years old, 163 and 274 boys 12 years old, and 161 and 240 boys 15 years old were randomly recruited in 1982 and 2002, respectively, throughout the county of Iraklio, Crete, Greece. Height, weight, and BMI were measured.

RESULTS

Contemporary 9 and 12 year olds were taller than their peers in 1982 (+2.9% and +1.2%, respectively; p < 0.005), but this was not the case for 15 year olds (-0.8%; p = 0.083). Body weight and BMI were higher now than in the 1980s, and this held true for all age groups (p < 0.001). Increases in weight also showed a decline with advancing age (+17.4%, +13.9%, and +4.0% for 9, 12, and 15 year olds, respectively), whereas BMI changes were similar for those 9 and 12 years of age (approximately 10.5%), but were almost 2-fold higher than in 15 year olds (+5.5%).

DISCUSSION

Contemporary boys are taller, heavier, and have higher BMI values than their peers in 1982, but the magnitude of these increases gradually declines with advancing age. Rates of increase in BMI, however, seem to have greatly accelerated compared with previous decades.

Prediction of total body water in infants and children

BACKGROUND

In paediatric clinical practice treatment is often adjusted in relation to body size, for example the calculation of pharmacological and dialysis dosages. In addition to use of body weight, for some purposes total body water (TBW) and surface area are estimated from anthropometry using equations developed several decades previously. Whether such equations remain valid in contemporary populations is not known.

METHODS

Total body water was measured using deuterium dilution in 672 subjects (265 infants aged <1 year; 407 children and adolescents aged 1-19 years) during the period 1990-2003. TBW was predicted (a) using published equations, and (b) directly from data on age, sex, weight, and height.

RESULTS

Previously published equations, based on data obtained before 1970, significantly overestimated TBW, with average biases ranging from 4% to 11%. For all equations, the overestimation of TBW was greatest in infancy. New equations were generated. The best equation, incorporating log weight, log height, age, and sex, had a standard error of the estimate of 7.8%.

CONCLUSIONS

Secular trends in the nutritional status of infants and children are altering the relation between age or weight and TBW. Equations developed in previous decades significantly overestimate TBW in all age groups, especially infancy; however, the relation between TBW and weight may continue to change. This scenario is predicted to apply more generally to many aspects of paediatric clinical practice in which dosages are calculated on the basis of anthropometric data collected in previous decades.

Dysmetabolic syndrome in childhood and adolescence

The dysmetabolic syndrome, consisting of dyslipidaemia, hypertension, hyperinsulinaemia and central obesity, has been well recognized as a major risk for cardiovascular disease in adults. Although the clustering of cardiovascular risk factors has also been identified in childhood, the occurrence of full-blown dysmetabolic syndrome at younger ages has only recently been investigated. In this article we attempted an overview of the data for children and adolescents, focused on the mechanisms and natural history of the disease, the prevalence among paediatric populations, the assessment and the treatment approaches.

CONCLUSION

There is substantial evidence that the dysmetabolic syndrome has its origins in childhood. In the face of the epidemic increase of obesity in children and adolescents, the development of effective screening and preventive strategies would be a major challenge for paediatricians.

Overweight, obesity and body fat composition in spanish adolescents. The AVENA Study

OBJECTIVE

To describe the prevalence of overweight and obesity in the Spanish adolescent population and its relationship with the socioeconomic status, and to assess their body fat composition and compare these results with previous data from our own country.

DESIGN

Cross-sectional multicenter study conducted in five Spanish cities (Granada, Madrid, Murcia, Santander and Zaragoza) in 2000-2002.

SUBJECTS

2,320 adolescents with complete set of anthropometric measurements, 1,192 boys and 1,128 girls.

MEASUREMENTS

Body mass index calculated from weight and height measurements, and body fat percentage calculated from skinfold thickness measurements.

RESULTS

Overweight + obesity prevalences were 25.69 and 19.13% in boys and girls, respectively. Overweight + obesity prevalence increased in boys from high to medium-low socioeconomic status categories (p = 0.015); meanwhile, there was not a significant effect of socioeconomic status in girls. In males, overweight + obesity prevalence changed from 1985 to 2000-2002 from 13 to 35% and in females from 16 to 32%. The rate of change in overweight + obesity prevalences seems to increase in the last years; from 0.88 (1985 to 1995) to 2.33%/year (1995 to 2000-2002) in males and from 0.5 (1985 to 1995) to 1.83%/year (1995 to 2000-2002) in females. The rate of body fat percentage increase was similar between 1980 and 1995 and between 1995 and 2000-2002: 0.26 and 0.23%/year, respectively, at 13 years of age, and 0.16 and 0.17%/year, respectively, at 14 years of age.

CONCLUSION

We observed elevated overweight and obesity prevalences in Spanish adolescents, similar to those observed in other European countries. There is a significant inverse relationship between socioeconomic status and overweight + obesity, but only in boys. The rate of change in overweight prevalence in Spanish adolescents seems to increase, and the rate of increase of body fat percentage seems to be similar as in previous years.

Composition of the fat-free mass in obese and nonobese children: matched case-control analyses

OBJECTIVE

Most body composition techniques assume constant properties of the fat-free mass (FFM), such as hydration, density and mineralisation. Previous studies suggested that FFM composition may change in childhood obesity; however, this issue has not been investigated in detail.

AIM

To compare FFM composition in obese and nonobese children.

DESIGN

Observational matched case-control analyses.

SUBJECTS

A total of 28 obese children (13 boys, 15 girls) and 22 nonobese children (10 boys, 12 girls) aged 7-14 y. Obesity was defined as body mass index centile >95.

METHODS

Measurements were made of weight, height, total body water, and body volume. Bone mineral content was estimated in a subsample. Body composition was calculated using three- and four-component models.

RESULTS

According to the three-component model (n=22 matched pairs), obese children had greater hydration (P<0.05), and reduced density (P=0.057) of FFM. According to the four component model (n=11 pairs), obese children had greater hydration (P<0.01) and reduced density (P<0.002) of FFM. The mineralisation of FFM was increased, but not significantly so.

CONCLUSION

The greater hydration and reduced density of FFM of obese children should be taken into account if body composition is to be measured with optimum accuracy during treatment programmes. These differences may be addressed by using multicomponent rather than two-component models of body composition. Although the greater mineralisation of FFM in obese children was not significant in the present study, the four-component model is best able to address the combined differences in hydration and mineralisation that occur in childhood obesity.

Harmonization of anthropometric measurements for a multicenter nutrition survey in Spanish adolescents

OBJECTIVE

Although the need for accurate anthropometric measurement has been repeatedly stressed, reports on growth and physical measurements in human populations rarely include estimates of measurement error. We describe the standardization process and reliability of anthropometric measurements carried out in a pilot study.

METHODS

For the intraobserver assessment of anthropometric measurements, we studied 101 adolescents (58 boys and 43 girls) from five cities. For interobserver assessment, we studied 10 adolescents from the same class in Zaragoza and different from those in the intraobserver sample.

RESULTS

For skinfold thickness, intraobserver technical errors of measurement (TEMs) in general were smaller than 1 mm; for circumferences, TEMs in general were smaller than 1 cm. Intraobserver reliability for skinfold thickness was greater than 95% for almost all cases; for circumferences, intraobserver reliability generally was greater than 95%. Interobserver TEMs ranged from 1 to 2 mm for the six skinfold thicknesses measured; for circumferences, TEMs were smaller than 1 cm for the arm, biceps, and waist and between 1 and 2 cm for the hip and thigh. Interobserver reliabilities for skinfold thickness and circumference were always greater than 90%, except for biceps skinfold.

CONCLUSIONS

Our results are in agreement with those recommended in the literature. Therefore, these anthropometric measures seem to be adequate to assess body composition in a multicenter survey in adolescents.

Time trend in height, weight, and obesity prevalence in school children from Northern France, 1992-2000

OBJECTIVE

The aim of this study was to evaluate the changes in height, weight and in the prevalence of overweight and obesity between 1992 and 2000 in children living in two towns of northern France.

METHODS

Two cross-sectional studies were performed in every pre-school (last section) and primary schools of the two towns in 1992 (383 girls and 421 boys enrolled) and 2000 (296 girls and 305 boys). Children were 5 to 12 year old in both studies.

MEASUREMENTS

Body height and weight were measured, and BMI was calculated (weight/height(2)). Prevalence of overweight and obesity was determined according to the gender- and age- specific cut-offs of the new international reference (IOTF). We also used the 90(th) and the 97(th) percentiles of the French reference gender- and age-specific BMI curves to define two grades of overweight.

RESULTS

After adjustment for age, boys were on average 1.5 cm taller in 2000 than in 1992 (p<0.001), and the same trend was observed in girls (+ 0.9 cm, p<0.075). Height-adjusted or age-adjusted weight and BMI were significantly higher in 2000 than in 1992. In girls, obesity defined by IOTF criteria increased from 1.6 to 4.4% (p<0.03) and overweight from 14.1 to 18.6% (p<0.11). In boys, the change in prevalences was significant only when the less stringent criteria (i.e. the 90(th) percentile of French references) was used (13.8% in 1992 vs 20% in 2000, p=0.03).

CONCLUSION

Over an 8 years period, there was an increase in height and BMI in both boys and girls. These results show that the increase in the prevalence of obesity is accompanied by a global trend of accelerated growth.

Anthropometric measurements in both sides of the body in the assessment of nutritional status in prepubertal children

OBJECTIVE

To analyze the impact of choosing the left or the right side of the body on the anthropometric measurements and derived nutritional indices, in prepubertal children.

DESIGN

Cross-sectional pilot nutrition survey.

SETTING

General prepubertal school-age population.

SUBJECTS

One-hundred and sixty-four children (97 boys and 67 girls) aged 7-9 y.

INTERVENTIONS

None.

RESULTS

The agreement between anthropometric measurements in both sides of the body showed that in males and in females, suprailiac skinfold thickness and arm circumference were significantly higher in the left than in the right side of the body. The agreement between body composition assessed by anthropometric measurements in both sides of the body showed that only in males was arm muscle area significantly higher in the left than in the right side, and arm fat percentage was higher in the right than in the left side of the body. Total body fat percentage calculated from skinfold thickness did not show statistically significant differences when skinfolds were obtained in the both sides of the body, either in boys and in girls.

CONCLUSIONS

Our results show that differences between the sides of the body were lower than the technical error of measurement of the anthropometric measurements obtained and seem not to be biologically significant in this age group. It is necessary to standardize the method of anthropometric assessment of the nutritional status in terms of body side.

The nutrition transition in Spain: a European Mediterranean country

BACKGROUND

Mediterranean diets are felt to be healthful diets linked with reduced mortality from diet-related noncommunicable diseases.

OBJECTIVE

To examine trends in diet, activity, obesity and diet-related noncommunicable diseases for Spain and compare these with other European countries, particularly those from the Mediterranean area.

DESIGN

A combination of large-scale primary and secondary nationally representative data analysis are used.

DATA

Nationally representative data on household food consumption, physical activity, adult obesity, and cause of death are combined with regionally representative adolescent obesity data, obtained in the last four decades. Comparative diet and obesity data come from nationally representative comparable data, obtained during the same period.

RESULTS

The Spanish diet has shifted toward a very high level of fat intake, high fruit and dairy intake and moderate vegetable intake. Dairy and fruit intakes were the highest in Europe, as was the proportion of energy from fat, when we compared with the available data. Adult overweight and obesity trends show a marked increase in the past decade to levels as high as Italy and far above France. Overweight for children aged 6-7 is above that of even the USA, while adolescent overweight levels are among the highest in the world. Cardiovascular disease mortality is low, as with Italy and France, and the cancer mortality rate is lower than Italy and France.

CONCLUSIONS

We have observed that, in Spain, relatively high obesity prevalences and dairy intake levels are related to much lower levels of cardiovascular disease and cancer mortality than are found in other European countries. This unique Spanish dietary and obesity pattern should be further explored in order to clarify the causal links.

SUPPORT

The National Institutes of Health (NIH; R01-HD30880 and R01-HD38700).