Obesity in Swedish schoolchildren is increasing in both prevalence and severity

Fatty fish intake in mothers during pregnancy and in their children in relation to the development of obesity and overweight in childhood: The prospective ABIS study

BACKGROUND

Although controversial, lower maternal intake of n-3 polyunsaturated fatty acid (PUFA) during pregnancy and lower levels of omega-3 PUFA in serum phospholipids during childhood have been related to obesity. The main source of omega-3 PUFA is fatty fish in the diet.

OBJECTIVES

To assess the relationship between overweight/obesity and the intake of fatty fish in maternal diet during pregnancy and in children up to 8 years of age.

METHODS

The prospective cohort All Children in South-East Sweden (ABIS) followed babies from birth to 8 years of age. A total of 6749 children at 5 years of age (boys 52.6%) and 3017 children at 8 years (boys 52.3%) participated. A "fatty-fish index" was constructed on the basis of self-reports of nutritional habits.

RESULTS

The prevalence of overweight and obesity in children at 5 years were 12.9% and 4.2%, respectively. At 8 years, 12.2% of the children presented overweight and 2.3% obesity. Girls were more affected than boys by overweight/obesity. A higher fish index during pregnancy was not related to overweight/obesity in the children, whereas a higher fish index in the children during the first years of life was related to obesity at 5 and 8 years of age. This relationship disappeared in a multivariable analysis. Maternal body mass index (BMI), maternal education, maternal smoking during pregnancy, birth weight, and physical activity all remained related to overweight/obesity at both 5 and 8 years of age.

CONCLUSION

No relationships were found between a lower intake of fatty fish in the diet, neither in mothers during pregnancy nor in early childhood, and increased risk of overweight/obesity.

Trends in prevalence of thinness, overweight and obesity among Swedish children and adolescents between 2004 and 2015

AIM

This study explored weight trends among children aged 4, 7, 11, 14 and 17 years in Jönköping County Sweden, from 2004 to 2015.

METHODS

The study had a repeated cross-sectional design, and body mass index (BMI) was calculated based on height and weight measurements collected from child health and school health records. The prevalence of thinness, overweight and obesity was estimated with international cut-offs, with linear trends calculated separately for boys and girls.

RESULTS

There were 190 965 measurements of BMI and these covered 82-97% of the younger children and 55-69% of the older children during the study period. The prevalence of thinness varied between 0.2% and 2.2% across time and age groups and did not change over the study period. There was a small decrease in overweight among both girls and boys aged four years. There were increasing trends in overweight and obesity in both girls and boys aged 11 and 14 years of age and a sharp increase among 17-year-old boys, with 7.3% obese in 2014/2015 and 3.6% in 2004/2005.

CONCLUSION

The prevalence of obesity decreased from 2004 to 2015 or was stable in younger Swedish children, but increased among older children, with a large increase in adolescent boys.

Do substantial BMI reduction episodes among Swedish schoolchildren have any impact on their final height?

AIM

This study investigated whether substantial body mass index (BMI) reductions in Swedish schoolchildren aged seven years to 19 years, caused by disease, healthy or unhealthy behaviour, had any impact on their final height.

METHODS

We used height and weight data on 6572 subjects from two nationally representative longitudinal samples of Swedish children born in 1973 and 1981. These provided information on their final height and any BMI reduction episodes.

RESULTS

Of the 6572 subjects (50.9% boys), among individuals with information on final height, 1118 had a BMI reduction of 5% and <10%, and 346 had at least one substantial BMI reduction of 10% or more. On a group level, there was no statistically significant difference in the final height of individuals with BMI reductions of 10% or more and those without. The findings were independent of age and the subject's BMI at the start of the reduction episode. However, there were a number of cases where a substantial BMI reduction probably had an impact on the subject's final height.

CONCLUSION

Our study found no evidence that a substantial BMI reduction had any impact on final height on a group level, but further analyses of specific case studies are necessary to determine whether substantial BMI reduction might have an impact on final height.

Using different growth references to measure thinness and overweight among Swedish primary school children showed considerable variations

AIM

The study compared how four different growth references determined the prevalence of thinness and overweight, based on height and weight measurements from a nationally representative sample of Swedish children from seven to nine years of age.

METHODS

The height and weight measurements of 4518 Swedish schoolchildren aged seven to nine years were carried out in 2008 using a standardised protocol. The prevalence of different degrees of thinness and overweight was calculated using international growth references from the World Health Organization, the International Obesity Task Force and two Swedish growth references from Werner and Karlberg.

RESULTS

Depending on which growth reference we used, the prevalence of different degrees of thinness varied from 7.5% to 16.9% for the boys and 6.9% to 13.7% for the girls, while the prevalence of overweight, including obesity and severe obesity, varied from 16.5% to 25.7% for the boys and 18.2 to 25.2% for the girls. There were also significant gender differences depending on the growth reference we used.

CONCLUSION

Using four different growth references, two international and two Swedish, produced wide variations in the prevalence of thinness and overweight, together with significant gender differences. In the absence of a global definition, we need both national and international growth references.

Increased risk for overweight among Swedish children born to mothers with gestational diabetes mellitus

OBJECTIVE

Investigate the effects of maternal gestational diabetes mellitus (GDM) on height, weight, and body mass index (BMI) in offspring compared both to their siblings and to age-specific BMI reference values in Sweden. Their parents present BMI was also investigated.

METHODS

The growth of 232 offspring to 110 women with at least one pregnancy with GDM, were studied up to 12 yr of age. Height and weight of children were collected from Health Care Centres and compared to age-specific reference values in Sweden. Self-reported height and weight of the parents were collected at follow-up.

RESULTS

For boys, weight was higher at birth and at 8-10 yr of age, giving a higher BMI at 7-10 yr of age. Girls had an accelerated height growth at all ages, combined with an increased weight of varying degree resulting in higher BMI at birth and at 4-12 yr of age. A similar pattern was observed in siblings born after a normal pregnancy. Median BMI of mothers at follow-up was 25.4 (18.3-59.5 n = 105) and 26.5 (18.6-38.1 n = 90) for fathers.

CONCLUSIONS

Children born to mothers with prior GDM have a higher risk of overweight and obesity later in life. This is most likely due to life style habits rather than intrauterine factors, as the same BMI pattern was found in siblings born after a normal pregnancy. However, the design of the study could not rule out the role of genetic factors. Priority should be given to early life style intervention in these families.

Peer clustering of exercise and eating behaviours among young adults in Sweden: a cross-sectional study of egocentric network data

Background

Research suggests that the growing prevalence of obesity may be related to the influence of the health behaviours of peers. We look at clustering of exercise and eating behaviours amongst a previously unstudied group, young adults in Sweden. Previous research has mainly been conducted in the United States and Britain, countries that have relatively high rates of obesity.

Methods

Using ego-alter dyads from the egocentric network data as the unit of analysis, we conduct logistic regressions to investigate the association between ego and alter exercise and eating behaviours.

Results

Respondents have a significantly greater probability of engaging in regular exercise and eating healthily if a nominated peer also does so. Furthermore, the degree to which this behavior is shared is modulated by the strength of the relationship between the two individuals, with a greater probability of engaging in these behaviours observed when the relationship with the nominated peer is strong relative to when the relationship is weak. However, we find that ego-alter homogeneity in terms of gender and migration status was not associated with a significantly greater probability of behaving in a similar manner to a nominated peer. Furthermore, the status of the nominated peer as a relative or not did not impact the probability that the ego would engage in similar health behaviours to that alter.

Conclusions

We observe strong associations between ego and alter health behaviours for young adults, consistent with previous research. Although we cannot draw causal inferences, these results suggest that the health behaviours of an individual’s peers may play a role in shaping their own health behaviours.

Appendicitis in obese children

During the past two decades, the incidence of childhood obesity has increased at alarming rates throughout the world. Obesity is associated with a variety of physiological changes that may impair a patient's response to surgery. With the rising rates of childhood obesity, pediatric surgeons must appreciate differences in the management and outcomes of these patients. Difficult physical examination, elevated inflammatory blood markers, and negative influence of obesity on the detection rate of the appendix on ultrasound have been reported causing diagnostic challenging of appendicitis in obese children. Moreover, obesity is associated with longer hospital stay and higher morbidity and minimal invasive techniques' superior outcomes over open technique in children undergoing appendectomy.

Body change techniques in Iranian adolescents. Relationship to sex and body weight status

OBJECTIVE

Several studies indicated that techniques to change body weight and appearance were prevalent and different among adolescents. The aim of the study, therefore, was to assess differences in frequency and type of body change techniques used among adolescents by sex and body weight status.

METHODS

A sample of 758 adolescents aged 12-18 years were recruited from private and public schools in Tehran. Information about socio-demographic background and body change techniques were collected via a self-administered questionnaire.

RESULTS

A high percentage of adolescents used body change techniques frequently to alter their body appearance. Girls changed normal eating pattern significantly (p=0.007) to lose weight more frequently than boys while boys used this method significantly (p=0.01) to gain weight more frequently than girls. Overweight/obese adolescents exercised significantly to change muscle size (p=0.03) and changed normal diet to lose weight (p<0.001) more frequently than normal weight adolescents. The relation between sex and body weight status with body change techniques (p<0.0) implied that male and female adolescents especially overweight/obese adolescents were frequently trying to change their body appearance.

CONCLUSION

Significant differences existed in using body change techniques according to sex and body weight status and these should be considered in obesity prevention programs for adolescents.

The landscape of overweight and obesity in Icelandic adolescents: geographic variation in body-mass index between 2000 and 2009

The prevalence of overweight and obesity has increased globally. This study examined the geographic variation in overweight and obesity trends among Icelandic adolescents in urban and rural areas. Data from two cross-sectional population-based samples of 14- and 15-year-old students attending the compulsory 9th and 10th grades of the Icelandic secondary school system in 2000 and 2009 were used to calculate body mass index (BMI). Overweight and obesity rates were represented for 17 zones on maps created with the ArcGis geographic information and imaging software. Results were that males had higher rates of overweight and obesity than females in both 2000 and 2009, with a significant difference for both genders between years. Mean BMI was higher for rural areas than urban areas in both study years. Out of 17 geographic zones, the prevalence of obesity increased between 2000 and 2009 for males in 16; however, the one remaining zone had the highest increase in overweight. Obesity increased in 13 zones for girls and decreased in four from 2000 to 2009. Mean BMI rose between the study years but fewer zones differentiated from each other in 2009 than 2000. The prevalence of overweight and obesity increased among Icelandic adolescents in both urban and rural areas; however, rural areas have higher rates of obesity, overweight, and mean BMI than urban areas. Because of diminishing differences between areas from 2000 to 2009 the increase in mean BMI, increases in overweight, and obesity appear to be more rapid in urban areas than rural areas.

Trajectories of weight disturbances during adolescence in relation to gender in a Swedish cohort

AIM

To explore developmental trajectories among adolescents of thinness and overweight in relation to gender.

METHODS

A group-based procedure was used to determine patterns of weight disturbances in a school-based sample of 3020 Swedish adolescents followed from age 11 to 18. A sensitivity analysis was performed to compensate for an increasing number of missing height and weight data after grade 8.

RESULTS

Six trajectories represented the best description of developmental weight disturbances with the exception of thinness among boys, which was best described by four trajectories. Concerning thinness, 5.9% of girls and 4.2% of boys developed this condition during the study period, while 1.9% of girls and 3.0% of boys recovered from their initial thinness. For overweight, (including obesity) 1.5% of girls and 3.1% of boys developed this weight disturbance during the study period, while 10.1% of girls and 9.3% of boys recovered from overweight/obesity. Non-reporting of height and weight was biased towards an underestimation of the true prevalence of overweight and obesity in girls and of thinness in boys.

CONCLUSIONS

Developmental trajectories provide a novel method to describe the dynamics of weight disturbances during adolescence. Similar patterns were found for overweight and thinness in boys and girls but group sizes varied between genders. Non-reporting of height and weight was found in a gender-specific pattern.

Prediction of obesity from infancy to adolescence

AIM

To examine the development of childhood obesity and to determine the earliest age when estimating body mass using only weight and height data is associated with a corresponding estimate at the age of 15.

METHODS

Subjects included are all children born in 1991 in Östergötland County, Sweden. Weight and height data collected during regular check-ups at well-child centres and school health care assessments up to 15 years of age were assembled from health records. Correlations between childhood estimates of body mass and the body mass index (BMI) at 15 years of age were computed pairwise. Correlations with r > 0.5 were defined as reliably strong.

RESULTS

Complete data were available for 3579 children (62%). Fewer girls (2.6%; C.I. 1.9-3.3) than boys (4.6%; C.I. 3.7-5.5) were obese at 15 years of age. Correlations with BMI at 15 years of age were strong (significantly higher than 0.5) from 5 years of age. Only 23% of girls and 8% of boys found to be obese at 5 years of age were of normal weight at the age of 15.

CONCLUSION

From 5 years of age, point estimates of body mass using only weight and height data are strongly associated with BMI at the age of 15. More data sources are needed to predict weight trajectories in younger children.

Nutritional status of students in Kocaeli, Turkey: a population-based study

BACKGROUND

  The aim of this study was to determine the nutritional status of students in Kocaeli, Turkey.

METHODS

  This cross-sectional study was carried out among the students of secondary schools in Kocaeli. Of the students, 2491 subjects were selected using multi-stage stratified sampling.

RESULTS

  Of the students, 51.1% were male and 48.9% were female. Mean age was 14.35±1.87 (range 10.1-19.8) in overall subjects, 14.38±1.87 in boys and 14.31±1.85 in girls. The prevalence of obesity and of overweight was estimated as 7.3% and 11.8%, respectively. Also, 3.1% of the subjects were underweight and 2.9% were thin. The rate of obesity was 1.5 times higher in girls and that of overweight was 1.2 times higher in girls. Similarly, students aged 15 years old and younger were 1.2 times more obese and 1.7 times more overweight than older students. Students living in urban areas had a higher prevalence of obesity and of overweight.

CONCLUSION

  Nutritional problems in students should be dealt with by some regulations in schools; for example, providing healthy food in schools or food aid, particularly in poor regions.

Trends in body mass index among Icelandic adolescents and young adults from 1992 to 2007

Trends in body mass index (BMI) among 51,889 14- to 20-year-old Icelandic adolescents and young adults were examined using data from cross-sectional population surveys conducted from 1992 to 2007. Prevalence of overweight increased for both genders in all age groups, except for 14- and 20-year-old girls. Obesity prevalence increased among boys in all age groups, except for 16-year-olds, and among 15- and 20-year-old girls. The largest increase in obesity rates among both genders was found in the oldest age group. Moreover, not only has the prevalence of obesity increased, but also the extent of obesity has grown more severe among 15- and 17-year-olds boys and among girls in the oldest age group.

Trends in body mass in Swedish adolescents between 2001 and 2007

AIM

(1) Compare BMI standard deviation scores (BMIsds) in 16-year olds in 2001 and 2007 to assess trends. (2) Describe tracking of BMIsds between ages 10 and 16 years, in a longitudinal 6-year follow-up. (3) Identify possible predictors in 2001 for high BMIsds in 2007 and increase in BMIsds between 2001 and 2007.

METHODS

A six-year follow-up study on 296 subjects, aged 10 years at baseline and a panel study among 16-year olds. BMIsds was used as the main outcome. RESULTS. No difference in BMIsds in 16-year-old adolescents was found between 2001 and 2007. Strong tracking (r = 0.80, 95% CI: 0.75-0.84) was found for BMIsds between ages 10 and 16 years. Low aerobic capacity and high BMIsds at age 10 years predicted overweight at age 16 years. High BMIsds in 2001 predicted a decline in BMIsds (OR: 0.58, 95% CI: 0.43-0.76) and high level of self-reported moderate-to-vigorous physical activity predicted an increased BMIsds (OR: 1.38, 95% CI: 1.13-1.67).

CONCLUSION

There was no difference in prevalence of overweight plus obesity between the 2001 and 2007 samples. Normal weight and good aerobic fitness in 10-year-old children seems to decrease the risk of elevated relative BMI in 16-year olds.

Epidemic increase in overweight and obesity in Chinese children from 1985 to 2005

This study tracks the temporal changes in prevalence of childhood and adolescent overweight and obesity in different regions of China from 1985 to 2005. Using a series data of the Chinese National Survey on Students Constitution and Health, we compared the temporal changes over a 20-year period of the prevalence of overweight and obesity among ten regions in China for school-aged children between 7 and 18 years of age. Large disparities in the temporal changes of obesity prevalence exist in different regions of China. North coastal residents, especially those of the upper socioeconomic status, had the earliest and largest increase in prevalence. Similar increases then followed successively in other regions of upper, moderate and low socioeconomic status, and finally in the affluent rural regions. No significant increase was found in the developing rural areas. Regions where the obesity epidemic occurred late also began to show rather rapid increases in prevalence in recent years. In 2005, the national estimates indicated that 7.73% of Chinese youth are overweight and 3.71% of them are obese, representing an estimated 21.37 million Chinese children (13.43 million boys and 7.94 million girls).