[Prevention of overweight and obesity in children and adolescents : Critical appraisal of the evidence base]

Do family characteristics contribute to a socioeconomic gradient in overweight in early childhood? - Single mediation analyses of data on preschool children of Germany

Children's overweight is strongly associated with family socioeconomic position (SEP) and family characteristics (FC). There is limited research on the extent to which FC account for a socioeconomic gradient in childhood overweight. This study examined whether FC explain SEP differences in the prevalence of overweight. The study used baseline data of preschool-aged children from the German 'PReschool INtervention Study'. The sample (n = 872, 48% girls) was recruited at kindergartens in Baden-Württemberg, Germany. Data included children's measured weight status and parents' reports on socioeconomic indicators (e.g., school education, vocational education, income) and FC. Variables represent main determinants of overweight (nutrition: sweets consumption in front of TV, soft drink consumption, regular breakfast, child sets table; physical activity: outdoor sports; parental role model). In single mediation analyses indirect effects of SEP on overweight were analysed (OR[95%CI]). Preschool girls and boys with low parental education had higher odds for overweight than children with high parental education. Among boys, low levels of parental education contributed to the odds of overweight via indirect effects by both factors 'sweets consumption in front of TV' (OR = 1.31[1.05-1.59]) and 'no sports' (OR = 1.14[1.01-1.38]). Among girls, FC measured did not explain SEP differences in overweight. Family nutrition and parental/family physical activity contribute to inequalities in overweight among preschool boys, but not girls. Research is needed to identify FC that explain inequalities in overweight for both.

[Health-Related Goals of Digital Prevention and Health Promotion in Families]

STUDY AIM

There is an increase in digital technologies to support health promotion. The majority of offerings is aimed at the individual but are less adapted to social life constellations such as families. The goal of this is study was to highlight the need and the requirements for an addressee-oriented app development. This was to be achieved by determining the initial situation and health goals of the surveyed families in the fields of exercise, nutrition and relaxation, and identifying points of intersection of the family members for a health app.

METHODS

The online survey was conducted with n=1008 parents (Ø 48 years, 59% female, 39.3% male, 1.7% diverse) on health status as well as exercise, nutrition and relaxation, smartphone use, app features and gamification. Quantitative data analysis (frequency analyses, Chi² test, factor analysis, and single-factor analysis of variance) was performed using IBM SPSS Analytics (25; Armonk, NewYork).

RESULTS

The majority of those surveyed considered their state of health to be good. The minority met the WHO reference values for physical activity and nutrition. In addition, the respondents were exposed to a high level of stress with simultaneously low coping skills. The identified target areas were active relaxation measures, nutrition, general competence, physical activity, nature activities and sports-recreation opportunities. Significant differences were found in age, in the active relaxation measures [F(2)=3.367; p=0.035] and sports-recreation opportunities [F(2)=7.480; p=0.001].

CONCLUSION

The study reveals intersections of families' content for a behavior change process with digital support. The interest in individual offers differs between the age groups of the children surveyed. Further research should identify health app usage preferences in families and in different family constellations as well as a family-friendly approach.

Overnutrition and Associated Factors Among High School Adolescents in Mid COVID-19 Pandemic in Ethiopia: Neglected Public Health Concern

BACKGROUND

Adolescent overnutrition is becoming a global public health problem, increasing at an alarming rate in developing countries. Overnutrition increases the risks of serious diet-related chronic diseases, including type 2 diabetes, hypertension, cardiovascular disease, and stroke. However, there is limited evidence on the magnitude and risk factors of overnutrition in the study area.

OBJECTIVE

To determine the magnitude of overnutrition and associated factors among school adolescents in Dire Dawa, Eastern Ethiopia.

METHODS

A cross-sectional study was conducted from May to June 2021 among 498 adolescent students selected using a multi-stage sampling procedure. A systematic random sampling technique was employed. Self-administered questionnaires, including food frequency and anthropometric measurement, were used to collect the data. The BMI-for-age Z score was calculated using the WHO Anthro-Plus. A binary logistic regression model was fitted with an odds ratio, and 95% confidence levels. Statistical significance is declared at a p-value below 0.05.

RESULTS

A total of 498 (98.4%) were included with the overall prevalence of overnutrition of 26.1% (95% CI: 22.3-29.9), where 23.7% and 2.4% had overweight and obesity, respectively. Being female (AOR = 3.32; 95% CI: 1.65-6.63), attending at private school (AOR = 4.97; 95% CI: 1.72-14.35), having sweet food preferences (AOR = 6.26; 95% CI: 3.14-12.5), snacking (AOR = 3.05; 95% CI: 1.11-8.36), sedentary behavior (AOR = 3.20; 95% CI: 1.67-6.09), and eating while watching TV (AOR= 2.95; 95% CI: 1.47-5.95) were significantly associated with overnutrition.

CONCLUSION

Overnutrition is a major emerging public health problem in eastern Ethiopia. School type, sex, sweet food preferences, habits of snacking, sedentary behaviors, and eating while watching TV were significantly associated with overnutrition. Therefore, public health strategies to curb overweight and obesity among high school adolescents are urgently needed in order to reduce the prevalence and its adverse complications.

Impact of the intervention program "JolinchenKids - fit and healthy in daycare" on energy balance related-behaviors: results of a cluster controlled trial

BACKGROUND

The purpose of this study was to evaluate the multi-component health promotion program, JolinchenKids - fit and healthy in daycare, designed to promote physical activity (PA), healthy eating, and mental wellbeing among 3- to 6-year-old preschoolers.

METHODS

For this cluster controlled trial, 62 daycare facilities (DFs) from thirteen different federal states in Germany were recruited (31 intervention, 31 control DFs). Outcome measures were children's habitual PA, fruits and vegetable consumption, consumption of unsweetened beverages and snacks with parents as raters. Study nurses assessed children's body composition and motor skills. Data was collected at baseline and 12 months later. To track adherence to the implementation of intervention modules at individual DF groups, an implementation calendar was used from baseline to follow-up. Linear mixed models were used to investigate effects for survey, group and their interaction at the individual level while accounting for clustering.

RESULTS

Samples of 831 (baseline) and 641 (follow-up) children aged 4.3 ± 0.8 and 5.2 ± 0.8 years were analysed. More than half of the intervention DFs chose the nutrition or PA module for the first year of implementation while an implementation level of > 50% was only achieved in less than a third. A significant intervention effect (survey × group interaction) was found for the standing long jump favouring children at intervention DFs (β = 3.08; 95% Confidence interval [CI]: (0.09; 6.07)). No significant intervention effects were found for time spent on PA, total screen time, dietary habits, and body composition, i.e. body-mass-index and percentage of body fat.

CONCLUSIONS

Participation in JolinchenKids - fit and healthy in daycare led to improvements in some indicators for motor skills. However, other health outcomes and behaviours were not affected by program participation over the course of 1 year.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00011065 (Date of registration 16-09-2016).

Bidirectional association between weight status and motor skills in adolescents : A 4-year longitudinal study

BACKGROUND

Despite considerable efforts the prevalence of overweight and obesity in youth remains high. Poor motor skills have been associated with increased body weight but there is still limited information on the longitudinal association of these health parameters.

AIM

This study examined the prospective association between motor skills and body weight in 10- to 14-year-old youth.

METHODS

Body weight, height and motor skills, assessed via the German motor test 16-18 (Deutscher Motorik Test, DMT6-18), were measured in 213 middle school students (57% male) every year over a 4‑year period. Club sports participation and migration status were assessed via a questionnaire.

RESULTS

Besides an inverse cross-sectional association between body weight and motor skills, excess body weight was associated with impaired development of motor skills (p < 0.05). Furthermore, weight loss was associated with enhanced motor development and allowed previously overweight students to catch up with their normal weight peers. High motor skills at baseline also reduced the odds of becoming overweight/obese during the observation period. These results were independent of club sports participation.

CONCLUSION

There is a bidirectional, synergistic association between body weight and motor skills. Facilitating the development of motor skills in children and adolescents may therefore be a viable intervention strategy targeting weight management and physical activity in youth.

Design and methods for a cluster-controlled trial conducted at sixty-eight daycare facilities evaluating the impact of "JolinchenKids - Fit and Healthy in Daycare", a program for health promotion in 3- to 6-year-old children

BACKGROUND

The prevention of overweight and obesity during infancy is a highly relevant public health topic given the significant impact of childhood obesity on acute and chronic diseases, general health, and well-being in later stages of life. Apart from the family setting, daycare facilities (DFs) represent a key setting for health promotion among children under the age of six years. "JolinchenKids - Fit and Healthy in Daycare" is a multi-component program promoting physical activity (PA), healthy eating, and mental well-being in 3- to 6-year-old preschoolers at DFs, originally designed by the German health insurance AOK. To evaluate program effectiveness, a cluster-controlled trial involving 68 DFs is currently conducted. The objective of this article is to describe the background, study design, and aims of this trial.

METHODS/DESIGN

Sixty-eight DFs across Germany will be recruited to take part in the study, half of them serving as intervention DFs and half of them as delayed intervention control DFs (which receive the program upon completion of the study). At each DF, height, weight, and body composition, as well as motor skills, will be assessed in twenty 3- to 6-year-old children. Children's eating and PA habits, and mental well-being will be assessed via parental questionnaires. A subsample of children (i.e., at 24 DFs which are randomly selected within a geographic region) will be asked to wear accelerometers at their wrists to objectively measure PA over the course of seven days. To compare changes in body composition, motor skills, eating and PA habits, and mental well-being of children at intervention DFs with those observed among children at delayed intervention control DFs over one year, all measurements will take place at baseline and twelve months after the launch of the program at all DFs.

DISCUSSION

This study investigates the influence of a health promotion program in the daycare setting on various outcomes, including body composition and objectively measured PA, in a nationwide sample of 3- to 6-year-old preschoolers. This study will provide evidence regarding the effectiveness of a multi-component program for health promotion in this setting and may provide insights into new strategies for preventing obesity in early life.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00011065 (Date of registration 16-09-2016).