Obesity prevention in children: physical activity and nutrition

Parental practices and children's lifestyle correlates of childhood overweight/obesity in Europe: The Feel4Diabetes study

BACKGROUND

Parental influences on children's eating and physical activity (PA) and consequently on their weight are fundamental. The present study aimed to identify the predominant correlates of childhood overweight/obesity among a variety of parental practices and children's lifestyle indices in a large sample of children in Europe.

METHODS

Families from low socio-economic status regions were recruited through schools, located in six European countries (Belgium, Finland, Greece, Spain, Bulgaria and Hungary). Seven thousand three hundred ninety-seven children 4-12 years old and their parents were selected using the FINDRISC-questionnaire. Parental practices assessed included parental role modelling, permissiveness and reward. Children's dietary intake and lifestyle behaviours were assessed through parent-reported questionnaires.

RESULTS

Regarding parental practices, it was revealed that being sometimes (odds ratio [OR] = 1.26; 95% confidence interval [CI] = 1.10-1.43) or rarely (OR = 1.43; 95% CI = 1.21-1.69) physically active with the child was associated with greater overweight/obesity risk, whereas rare permission of computer/mobile/tablet (OR = 0.81; 95% CI = 0.67-0.98) and sometimes (OR = 0.77; 95% CI = 0.68-0.88) or rare (OR = 0.77; 95% CI = 0.66-0.91) reward with PA were associated with lower risk. Regarding children's lifestyle factors, consuming > 3 cups/week fresh fruit juices (OR = 1.28; 95% CI = 1.13-1.45), skipping breakfast (OR = 1.37; 95% CI = 1.17-1.61), absence of 1 h of daily PA (OR = 1.40; 95% CI = 1.24-1.58) and increased daily screen time (ST) (OR = 1.23; 95% CI = 1.09-1.39) were associated with greater overweight/obesity risk. All the variables were adjusted for maternal education, child's sex and age.

CONCLUSIONS

These findings emphasize the necessity of family-centered approaches in health promotion and obesity prevention programs for children. Such programs should focus on parents as the primary role models in exerting positive influence and encouraging healthy eating habits, PA, and ST behaviors in their children, which in turn, may have a substantial impact on children's overall weight status.

Meeting the Canadian 24-Hour Movement Guidelines and physical-mental comorbidity among Chinese children and adolescents: Prevalence, associations, and the population impacts

OBJECTIVES

To examine the association between meeting the Canadian 24-Hour Movement Guidelines and physical-mental comorbidity among children and adolescents in a cross-sectional study.

METHODS

A total of 21,061 students aged 11-17 years from Zhejiang Province, China was recruited in the study. We examined the coexistence of five specific physical illnesses - hypertension, high myopia, dental caries, scoliosis, and obesity - with mental illness, specifically depressive symptoms. Generalized linear mixed models were performed to assess the association between overall and specific combinations of movement guidelines and physical-mental comorbidity, presented by odds ratio (OR) and 95% confidence interval (CI). Population attributable fraction (PAF) was calculated to estimate the preventable proportion of comorbid cases via meeting all three movement recommendations.

RESULTS

Of the included participants, 19.3% had physical-mental comorbidity. There were 3.8% and 17.0% meeting all three and none of the recommendations, respectively. Meeting at least one recommendation, except for moderate-to-vigorous physical activity recommendation only, was associated with a lower risk of physical-mental comorbidity, with ORs (95% CIs) ranging from 0.72 (0.66-0.79) to 0.40 (0.31-0.51). Meeting more recommendations was associated with decreased comorbid risks, and the association was stronger in 4th-6th graders. The association between specific combinations of recommendations and comorbid risks showed differences by gender and grade. Of the comorbid cases, 42.1% were attributed to not adhering to all three recommendations, and the PAFs varied from 27.4% to 55.7% across different genders and grades.

CONCLUSION

Adherence to the 24-h movement guidelines was associated with lower risks of physical-mental comorbidity among children and adolescents.

Anthropometric Characteristics and Weight Status of Early Adolescents (Aged 12-14) in Montenegro; Urban-Rural and Regional Differences

The aim of this study was to determine urban-rural and regional differences in anthropometric characteristics among adolescents aged 12-14, as well as to present the prevalence of weight status. A total of 534 adolescents aged 12-14 from primary schools across Montenegro participated in this cross-sectional study (283 boys, aged 13.52 ± 0.42, body height 169.43 ± 8.89, body weight 60.54 ± 13.47; 251 girls, aged 13.51 ± 0.40, body height 165.54 ± 6.67, body weight 55.28 ± 9.27). The sample was divided by geographic region in Montenegro into northern, central, and coastal regions, and according to settlement type into urban and rural inhabitants. Anthropometric characteristics were assessed using a battery of seven variables: arm span (AS); body height (BH); body weight (BW); waist circumference (WC); hip circumference (HC); body mass index (BMI); and waist-to-hip ratio (WHR). BMI was categorized based on the World Health Organization's (WHO) cut-offs. The results indicate that girls from urban areas exhibited significantly greater body height and lower BMI values compared to their rural counterparts. Similarly, boys from urban areas also demonstrated lower BMI values compared to their rural peers. However, no statistically significant differences were observed in other anthropometric characteristics between these two groups of adolescents. Based on analysis of variance (ANOVA) and post-hoc analysis, it was found that girls from central areas had significantly greater body height compared to those from northern and coastal areas. Likewise, boys from northern areas showed higher body mass and BMI values compared to those from central areas. Additionally, both boys and girls from central areas had higher values compared to those from coastal areas. Nevertheless, no significant differences were detected in other anthropometric characteristics among adolescents from these regions. This study identified significant differences in anthropometric parameters among participants based on urban-rural status and within regional divisions. However, further research encompassing a larger sub-sample and a broader array of anthropometric variables is needed to draw a more comprehensive conclusion.

Secular trends in motor performance in Swiss children and adolescents from 1983 to 2018

Introduction

Environmental changes, including globalization, urbanization, social and cultural changes in society, and exposure to modern digital technology undoubtedly have an impact on children’s activity and lifestyle behavior. In fact, marked reductions in children’s physical activity levels have been reported over the years and sedentary behavior has increased around the world. The question arises whether these environmental changes had an impact on general motor performance in children and adolescents. The study aimed to investigate secular trends of motor performance in Swiss children and adolescents, aged between 7 and 18 years, over a period of 35 years from 1983 to 2018.

Methods

Longitudinal data on the five motor components of the Zurich Neuromotor Assessment (ZNA) – pure motor (PM), fine motor (FM), dynamic balance (DB), static balance (SB), and contralateral associated movements (CAM) – were pooled with cross-sectional data on PM and FM from eight ZNA studies between 1983 and 2018. Regression models were used to estimate the effect of the year of birth on motor performance and body mass index (BMI) measurements. Models were adjusted for age, sex, and socioeconomic status.

Results

The secular trend estimates in standard deviation scores (SDS) per 10 years were − 0.06 [−0.33; 0.22, 95% Confidence Interval] for PM, −0.11 [−0.41; 0.20] for FM, −0.38 [−0.66; −0.09] for DB (−0.42 when controlled for BMI), −0.21 [−0.47; 0.06] for SB, and − 0.01 [−0.32; 0.31] for CAM. The mean change in BMI data was positive with 0.30 SDS [0.07; 0.53] over 10 years.

Discussion

Despite substantial societal changes since the 1980s, motor performance has remained relatively stable across generations. No secular trend was found in FM, PM, SB, and CAM over a period of 35 years. A secular trend in DB was present independent of the secular trend in body mass index.

Do maternal grandmothers influence breastfeeding duration and infant nutrition? Evidence from Merida, Mexico

OBJECTIVES

Breast-feeding is sensitive to somatic, hormonal, behavioral and psychological components of maternal capital. However, through grandmothering, older women may also influence breast-feeding by transferring informational resources to their daughters. We hypothesized that mothers with prolonged instrumental support from their own mother are more likely to have received advice and to have favorable attitudes/practices regarding breastfeeding, compared to those lacking such support, with implications for the grandchild's somatic capital.

METHODS

We recruited 90 mother-infant dyads (52 with grandmaternal support, 38 without) in Merida, Yucatan, Mexico. All children were first-borns, aged ~2 years. Anthropometry and body composition were assessed. Data on grandmother's breastfeeding advice and maternal breastfeeding duration were obtained by questionnaire. Maternal attitudes to breast-feeding were assessed using the Iowa Infant Feeding Attitude Scale.

RESULTS

Women with instrumental support were more likely to have received grandmaternal advice during pregnancy/infancy on exclusive breast-feeding duration (60% vs. 37%, p = 0.033) and the type of first complementary food (81% vs. 47%, p = 0.001). However, women with support had a less favorable attitude to breastfeeding than those without and breastfed their children for less time (median 5 vs. 10.5 months, p = 0.01). No group differences were found in children's length, weight, skinfolds or lean mass z-score.

DISCUSSION

Although grandmothers providing instrumental support provided advice regarding breastfeeding, their attitudes may reflect issues beyond nutritional health. Advice of maternal grandmothers did not promote extended breastfeeding, however the differences in breastfeeding attitudes were not associated with the children's nutritional status. Grandmothers should be included in public health interventions promoting breastfeeding.

Designing for downsizing: Home-based barriers and facilitators to reduce portion sizes for children

Evidence confirms that parents know that they should limit non-core foods for their children since these tend to be high in energy density (HED), fat, salt and sugar. However, it is unclear how knowledge of portion size limits, such as the 100 kcal guide from Public Health England are applied in practice. To observe in real-time children’s home food environment related to portion control and to explore with parents their reported portion size strategies, a mixed methods study was designed. Families with children aged 1–5 years were recruited (n = 21) to a three-part study: (1) to complete questionnaires and interviews on household food intake and portion control; (2) to report daily food intake for 4 days (n = 13) for one parent and their child(ren); (3) to observe home-based food provisioning via videorecording during dinner, breakfast and snack time (n = 6). Although the problem of large portion sizes of HED foods was recognised by mothers, strategies to downsize portions were not necessarily applied at home, as revealed in home observations and diaries. A mismatch between what was observed at home, what was reported in food diaries and what was said in interviews became apparent for some families. Mothers reported the need for greater support and guidance to downsize HED foods since they relied on pre-packaging as a guide to intake. Education and engagement were identified as important parameters for downsizing by mothers. One strategy which could be explored and applied by manufacturers is packaging design to faciliate the 100 kcal guidance using physical and engaging ways to assist parents in downsizing HED foods for their children. To facilitate effective government communication, innovative packaging design can be used to convey clear guidance and to tailor portion size messages for children. Packaging design, alongside government recommendations, can support parents’ goals to achieve healthy eating and can reinforce guidance for portion norms through innovation involving learning, playful engagement, and interaction.

Pedi-R-MAPP: The development of a nutritional awareness tool for use in remote paediatric consultations using a modified Delphi consensus

BACKGROUND & AIMS

The Remote Malnutrition Application (R-MAPP) was developed during the COVID-19 pandemic to provide support for health care professionals (HCPs) working in the community to complete remote nutritional assessments, and provide practical guidance for nutritional care. The aim of this study was to modify the R-MAPP into a version suitable for children, Pediatric Remote Malnutrition Application (Pedi-R-MAPP), and provide a structured approach to completing a nutrition focused assessment as part of a technology enabled care service (TECS) consultation.

METHODS

A ten-step process was completed: 1) permission to modify adult R-MAPP, 2) literature search to inform the Pedi-R-MAPP content, 3) Pedi-R-MAPP draft, 4) international survey of HCP practice using TECS, 5) nutrition experts invited to participate in a modified Delphi process, 6) first stakeholder meeting to agree purpose/draft of the tool, 7) round-one online survey, 8) statements with consensus removed from survey, 9) round-two online survey for statements with no consensus and 10) second stakeholder meeting with finalisation of the Pedi-R-MAPP nutrition awareness tool.

RESULTS

The international survey completed by 463 HCPs, 55% paediatricians, 38% dietitians, 7% nurses/others. When HCPs were asked to look back over the last 12 months, dietitians (n = 110) reported that 5.7 ± 10.6 out of every 10 appointments were completed in person; compared to paediatricians (n = 182) who reported 7.5 ± 7.0 out of every 10 appointments to be in person (p < 0.0001), with the remainder completed as TECS consultations. Overall, 74 articles were identified and used to develop the Pedi-R-MAPP which included colour-coded advice using a traffic light system; green, amber, red and purple. Eighteen participants agreed to participate in the Delphi consensus and completed both rounds of the modified Delphi survey. Agreement was reached at the first meeting on the purpose and draft sections of the proposed tool. In round-one of the online survey, 86% (n = 89/104) of statements reached consensus, whereas in round-two 12.5% (n = 13/104) of statements reached no consensus. At the second expert meeting, contested statements were discussed until agreement was reached and the Pedi-R-MAPP could be finalised.

CONCLUSION

The Pedi-R-MAPP nutrition awareness tool was developed using a modified Delphi consensus. This tool aims to support the technological transformation fast-tracked by the COVID-19 pandemic by providing a structured approach to completing a remote nutrition focused assessment, as well as identifying the frequency of follow up along with those children who may require in-person assessment.

Overweight and obesity by school socioeconomic composition and adolescent socioeconomic status: a school-based study

BACKGROUND

The main objective of this study was to investigate the interaction effect of school socioeconomic composition (SEC) and adolescent socioeconomic status (SES) in the prevalence of overweight and obesity among a representative sample of French adolescents of the third most populous département of France.

METHODS

1038 adolescents agreed to participate (response rate: 91.4%). They self-reported anthropomorphic variables, SES, school lunch and physical activity. The body mass index was divided into six categories according to the Center for Disease Control. Multivariable binary logistic regressions analysis without and with interaction term were performed on overweight or obesity. Models fit was compared using the Aikaike Information Criterion. Odds-ratios (OR) and their 95% accelerated-bootstrap confidence interval (95%BCa CI) were computed to estimate overweight or obesity risk.

RESULTS

8.9% of the adolescents were overweight. 3.4% were obese. No school-SEC effect was observed among low-SES adolescents. Medium-SES adolescents were at greater risk in low-SEC (OR = 10.75, 95%BCa CI = 2.67-64.57) and medium-SEC (OR = 5.08, 95%BCa CI = 1.55-24.84) compared with high-SEC schools. High-SES adolescents in low-SEC schools were at greater risk compared with those in medium-SEC (OR = 5.94, 95%BCa CI = 1.94-17.29) and high-SEC schools (OR = 4.99, 95%BCa CI = 1.71-13.14). A social gradient was observed in medium-SEC (OR_low/high = 2.79, 95%BCa CI = 1.22-7.41) and high-SEC (OR_low/medium = 6.86, 95%BCa CI = 1.06-5.22*10⁶) schools.

CONCLUSIONS

Physical activity and lunch at and outside school help to understand these differences. Implications for obesity prevention initiatives are discussed.

Internalizing symptoms modulate real-world affective response to sweet food and drinks in children

The purpose of the current study was to examine affective response to sweet foods and drinks as a function of children's internalizing symptoms using ecological momentary assessment (EMA). A sample of 192 8-12-year-old children completed a self-report measure of internalizing symptoms and EMA prompts of affect and food intake for eight days, excluding time at school. There was an interaction between sweet food intake and internalizing symptoms for positive affect and for sweet drink intake and internalizing symptoms for negative affect. Those low in internalizing symptoms had significantly lower positive affect after consumption of sweet foods compared to when they did not consume sweet foods whereas those higher in internalizing symptoms had slightly, but not significantly, higher positive affect after consumption of sweet foods. Those low in internalizing symptoms had significantly higher negtive affect after consumption of sweet drinks compared to when they did not consume sweet drinks whereas those higher in internalizing symptoms had slightly, but not significantly, lower negative affect after consumption of sweet drinks. Findings highlight the ways in which internalizing symptoms may modulate affective response to sweet foods and drinks.

60 Minutes Per Day in Moderate to Vigorous Physical Activity as a Natural Health Protector in Young Population

The aim of this study was to check whether following the recommendations of the World Health Organization (WHO) concerning physical activity protects children and adolescents against the occurrence of overweight and obesity. A total of 1002 children were included in the analysis. The average age of the studied children was 9.36 years ± 3.52 years. Measurement of height and body mass was performed for every child, followed by physical activity assessment over seven days. In each group analyzed, the overweight and obese children had a shorter time in moderate to vigorous physical activity (MVPA) than the children with normal body mass. Among the children spending < 60 min per day in MVPA, the risk of occurrence of overweight and obesity was greater than among children with physical activity > 60 min per day. It was also shown that the greatest risk of occurrence of body mass disorder was a situation in which the mother’s gestational weight gain (GWG) is over 18 kg and the child does not spend a minimum of 60 min/day in MVPA. Not meeting the recommendation is connected with an increased chance of the occurrence of overweight and obesity. The level of physical activity influences the incidence of overweight and obesity. The children with overweight and obesity spent less time per day in MVPA. An increased body mass in mothers during pregnancy associated with a child’s low level of physical activity increases the risk of the occurrence of overweight and obesity.

Snack Portion Sizes for Preschool Children Are Predicted by Caregiver Portion Size, Caregiver Feeding Practices and Children's Eating Traits

Caregivers are mostly responsible for the foods young children consume; however, it is unknown how caregivers determine what portion sizes to serve. This study examined factors which predict smaller or larger than recommended snack portion sizes in an online survey. Caregivers of children aged 2 to 4 years were presented with 10 snack images, each photographed in six portion sizes. Caregivers (n = 659) selected the portion they would usually serve themselves and their child for an afternoon snack. Information on child eating traits, parental feeding practices and demographics were provided by caregivers. Most caregivers selected portions in line with recommended amounts for preschool children, demonstrating their ability to match portion sizes to their child's energy requirements. However, 16% of caregivers selected smaller than recommended low energy-dense (LED, e.g., fruits and vegetables) snacks for their child which was associated with smaller caregiver's own portion size, reduced child food liking and increased satiety responsiveness. In contrast, 28% of caregivers selected larger than recommended amounts of high energy-dense (HED, e.g., cookies, crisps) snacks for their child which were associated with larger caregiver's own portion size, greater frequency of consumption, higher child body mass index (BMI), greater pressure to eat and lower child food liking. These findings suggest that most caregivers in this study select portions adjusted to suit their child's age and stage of development. Future interventions could provide support to caregivers regarding the energy and nutrient density of foods given the relatively small portion sizes of LED and large portions of HED snacks offered to some children.

Maternal Decisions on Portion Size and Portion Control Strategies for Snacks in Preschool Children

Caregivers are responsible for the type and amount of food young children are served. However, it remains unclear what considerations caregivers make when serving snacks to children. The aim of the study was to explore mothers' decisions and portion control strategies during snack preparation in the home environment. Forty mothers of children aged 24-48 months participated in the study. Mothers prepared five snack foods for themselves and their child whilst verbalizing their actions and thoughts. Mothers were then asked about their portion size decisions in a semi-structured interview. Transcripts were imported into NVivo and analyzed thematically. Three key themes were identified: (1) portion size considerations, (2) portion control methods, and (3) awareness and use of portion size recommendations. Transient, food-related situational influences influenced mothers and disrupted planning and portion control. Food packaging and dishware size were used as visual cues for portion control; however, these vary widely in their size, thus emphasizing mothers' uncertainty regarding appropriate portion sizes. Mothers called for portion size information to be accessible, child-centered, and simple. These findings reveal multiple considerations when deciding on the correct snack portion sizes for children. These decisions are complex and vary across situations and time, and according to the types of snacks offered.

Prevalence and associated factors of overweight and obesity among schoolchildren in Hanoi, Vietnam

BACKGROUND

The prevalence of overweight and obesity (OW/OB) has increased rapidly in Vietnam. This study aimed to elucidate the factors influencing OW/OB among secondary schoolchildren.

METHOD

A survey was conducted in January 2014 in four randomly selected state schools in two Hanoi urban districts, and 821 students in grade six (11-12 years old) participated. Definitions of OW/OB followed the World Health Organization standard cut-offs.

RESULTS

Overall, 4.1% of children were underweight, 59.7% were normal weight, 17.1% were overweight, and 19.1% were obese. The odds of OW/OB were lowest among children whose parents had college/university degrees [father (aOR =0.65, 95% CI: 0.42-1.00); mother (aOR =0.63, 95% CI: 0.41-0.97)] compared with those whose parents had only a primary education. Children with an OW/OB family history had an increased risk of OW/OB. Other associated factors include parental OW/OB and birth weight (BW). The odds of OW/OB were highest among children with parents with OW/OB [father (aOR =2.022, 95% CI: 1.34-3.04); mother (aOR =2.83, 95% CI: 1.51-5.30)] compared with those with normal-weight parents. Children with both parents having OW/OB [both parents (aOR =6.59, 95% CI: 1.28-33.87) had the highest risk, followed by one parent (aOR =2.22, 95% CI: 1.50-3.27)] and then neither parent having OW/OB. Moreover, high-birth-weight children [BW ≥ 3500 g (aOR =1.52, 95% CI: 1.07-2.15)] had greater odds than did normal-birth-weight children. Children who slept 11 h per day [8-11 h (aOR =0.57, 95% CI: 0.40-0.81) or more (aOR =0.44, 95% CI: 0.22-0.87)] had lower OW/OB odds than those who slept 8 h or less. Children with specific positive lifestyle behaviours had lower risk of OW/OB than those who did not engage in positive lifestyle behaviours. The odds were lower among children who exercised for weight reduction (OR = 0.16, 95% CI: 0.11-0.23), lowered food intake (aOR = 0.12, 95% CI: 0.09-0.17), and added vegetables to their diet (aOR = 0.26, 95% CI: 0.19-0.35).

CONCLUSION

The results suggest that parents and children with OW/OB parents or a high BW should be educated to prevent OW/OB at an early stage. Positive lifestyle behaviours should be adopted by the students.

The Relationship Between Electronic Gaming and Health, Social Relationships, and Physical Activity Among Males in Saudi Arabia

Physical and psychological effects of playing computer games cannot be ignored. Electronic games are considered to be an influential factor in growth, personality development, and positive sociability of children, and game duration has been associated with increased aggression, reduced mental health, and higher BMI. The aim of the present study was to explore the relationship between electronic gaming and health, social relationships, and physical activity among males aged 16-18 years in Saudi Arabia. An online survey designed by the authors containing 60 items and divided into 5 sections was used during one school semester. The sample was selected randomly from 30 high schools; 90 students were selected from each school, with 30 chosen from each of grades 9, 10, and 11. Respondents were 194 male students, aged 17.23 ± 1.52 years. The questionnaire was presented to six experts to assess validity, with Cronbach's α established at 0.87. Results showed that playing electronic games had a negative relation with health, social relationships, and physical activity among males. The most negative significant was the correlation between electronic games and physical activity (r = -.49), followed by that with social relationships (r = -.42) and BMI (r = -.31) . The lowest result was for health (r = .20). More empirical investigations are needed to explore deeper effects of electronic gaming on various groups in Saudi society, including the general population, employees, and different categories of school and university students.

Effects of childhood adversity and resilience on Taiwanese youth health behaviors

BACKGROUND

Adverse childhood experiences (ACEs) can leave negative impacts on one's health behaviors or social functioning later in life. Resilient characteristics have been shown to mitigate effects against risk behaviors in developing adolescents. However, clinical and research attention has rarely been given to jointly consider the effects of ACEs and resilient characteristics on health behaviors in Taiwanese youth.

METHOD

A total of 200 individuals aged 15-22 years were recruited from primary care settings, communities, and schools. Participants completed questionnaires assessing their ACEs, resilient characteristics, and health behaviors. Univariate analysis was firstly used to describe the correlates of ACEs and resilient characteristics. Further multivariate logistic regression analysis was used to examine the association of both factors with health behaviors.

RESULTS

More than half (61.5%) of those surveyed had been exposed to at least one category of ACE. Verbal (37%) and physical (21%) abuses were the most common types of ACEs. The counts in the ACE categories were associated with being involved in physical fights (odds ratio 1.28 [confidence interval 1.01-1.63]), property damage (1.29 [1.03-1.61]), running away from home (1.30 [1.05-1.60]), bullying victimization (1.37 [1.16-1.61]), and sleep problems/tiredness (1.25 [1.03-1.52]). Meanwhile, resilience scores were associated with decreased odds of infrequent seatbelt use (0.47 [0.23-0.97]), low fruit and vegetable intake (0.42 [0.21-0.86]) unsatisfied body image (0.46 [0.22-0.97]), and sleep problems/tiredness (0.37 [0.18-0.79]).

CONCLUSIONS

ACEs and resilience characteristics play a significant role in shaping youth health behaviors. Further research should be undertaken to identify ways to build resilience against health risks in youth with prior ACE exposure.

Relation between Environmental Factors and Children's Health Behaviors Contributing to the Occurrence of Diet-Related Diseases in Central Poland

Proper nutrition is a key element in maintaining normal body weight in children and one of the most important factors influencing their optimum development, growth, and health in the future. The aim of this cross-sectional study was to identify environmental factors which affect health behaviors of children aged 7–14, contributing to the occurrence of diet-related diseases. The study was performed with participation of 892 school children. The investigated environmental factors were as follows: the place of residence, maternal education level, and the level of family income. A questionnaire was used to collect the data from mothers. The study indicated a prevalence of overweight and obesity among children of 13.9% and 1.2%, respectively. Being underweight applied to 20.0% of examined children, more often to girls. In terms of nutritional behaviors an insufficient consumption of vegetables, fruit, whole grain products, dairy products, and fish was observed. The frequency of vegetable and fruit consumption significantly decreased with an increase in child’s body mass index (BMI) (G = −0.110, p < 0.05 and G = −00.114, p < 0.05). Overall, 29.7% of children devoted less than 30 minutes a day to physical activity, besides the physical education classes at school. Boys were more often physically active than girls (G = 0.205, p < 0.0005). There was a positive correlation between frequency of vegetable (G = 0.167, p < 0.0005) and fruit (G = 0.155, p < 0.005) consumption and mothers’ education level. Girls ate fruit more frequently than boys (G = 0.116, p < 0.05). Higher family income was associated with more frequent whole grain consumption (G = 0.095, p < 0.05), while living in the city was negatively correlated with activity (G = −0.121, p < 0.05) and dairy consumption (G = −0.186, p < 0.005). Continuous investigation of environmental factors affecting children eating behaviors may help to bring benefits in increasing the effectiveness of health promotion and educational programs.

The Feasibility and Acceptability of Two Methods of Snack Portion Control in United Kingdom (UK) Preschool Children: Reduction and Replacement

Large portions of high energy dense (HED) snacks are offered to children from a young age and are pervasive in our food environment. This study aimed to explore the feasibility, acceptability, and preliminary efficacy of two strategies of snack portion control: reduction and replacement. Forty-six mother-child dyads aged 22⁻56 months (36.6 ± 9.5 m, 48% female) completed a three-week intervention. In week 1 (baseline) no changes were made to the child's diet; week 2 (acclimation) children received a standardised selection of HED snacks, and in week 3 (intervention) participants were randomly assigned to snack replacement (n = 24) or snack reduction (n = 22). Snack replacement involved swapping HED snacks for fruits and vegetables, whilst snack reduction involved reducing the size of HED snacks by 50%. Food and energy intake were measured using a weighed food diary for four consecutive days. Snack replacement resulted in more positive changes to children's diets; vegetable intake increased (p < 0.01), and total daily energy intake decreased when compared to snack reduction (p < 0.05). Mothers expressed a more favourable attitude to snack replacement, although snack reduction was also well received by mothers. Despite increased preliminary efficacy of snack replacement on dietary intake, both strategies were feasible and acceptable. The current pilot study provides the necessary information to inform the design of future interventions.

BMI and recommended levels of physical activity in school children

Background

Physical activity (PA) and its health benefits are a continuous point of discussion. Recommendations for children’s daily PA vary between guidelines. To better define the amount of PA necessary to prevent overweight and obesity in children, further research is needed. The present study investigates children’s compliance to physical activity guidelines (PAGs) and the association between objectively measured PA and body mass index (BMI).

Methods

Participating children were 11 years old (n = 419) and part of the European CHOP trial, which was conducted in Germany, Belgium, Poland, Spain, Italy. At least 2 days of PA measurements were collected from each child using a SenseWear™ armband. BMI was calculated from children’s height and weight. Thresholds of min·day⁻¹ in PA needed to differentiate between normal and excess weight (overweight/obesity) were determined with Receiver Operator Characteristics (ROC) analysis. Additionally, adjusted linear and logistic regressions models were calculated for group differences and effects of a 5, 15 and 60 min·day⁻¹ increases in PA on BMI.

Results

Median time spent in total PA was 462 min·day⁻¹ (25th percentile; 75th percentile: 389; 534) and 75 min·day⁻¹ (41; 115) in moderate to vigorous PA (MVPA). Girls spent 36 min·day⁻¹ less in MVPA than boys and overweight/obese children 24 min·day⁻¹ less than normal weight children (linear regression, p < 0.001). 63.2% of the children met PAGs of 60 min·day⁻¹ in MVPA. The optimal threshold for min·day⁻¹ in MVPA determined with ROC analysis was 46 min·day⁻¹. Comparing 5, 15 and 60 min·day⁻¹ increases in PA revealed that an additional 15 min·day⁻¹ of vigorous PA had the same effect as 60 min·day⁻¹ of MVPA. Sedentary time and light PA showed contrary associations to one another, with light PA being negatively and sedentary time being positively associated with excessive weight.

Conclusions

Current PAGs are met by 2/3 of children and seem appropriate to prevent excess weight in children. An official recommendation of daily 15–20 min of vigorous PA and further reduction of sedentary time could help to fight youth overweight and thus be of potential public health importance.

Trial registration

ClinicalTrials.gov Identifier: NCT00338689. Registered: June 19, 2006 (retrospectively registered).

The role of the consumption of beverages in the obesity epidemic

This paper is intended to demonstrate to nutritionists, dietitians, paediatricians and other health care professionals as well as parents, primary and secondary school authorities, nutritional concerns pertaining to the consumption of soft drinks. High intake of soft drinks is associated with: 1) overweight or obesity because of the intake of additional calories in the diet; 2) increased risk of osteoporosis due to displacement of milk consumption, resulting in calcium deficiency and subsequent bone resorption; and 3) increased risk of dental caries and potential enamel erosion. School officials and parents should be aware of the health implications of vended drinks in schools before making a decision about pupils’ and students’ access to them.

Effects of an Obesity Intervention Integrating Physical Activity and Psychological Strategy on BMI, Physical Activity, and Psychological Variables in Male Obese Adolescents

The current study investigated the effect of an obesity intervention incorporating physical activity and behavior-based motivational enhancement intervention on BMI, physical activity levels, and psychological variables toward physical activity in male obese adolescents. Single group study without having a control group was carried out in Korea. Sixty-eight obese male adolescents who had BMI greater than 25 kg/m(2) participated in the 16-week obesity intervention. During this period, the study participants' BMI, physical activity levels, self-efficacy, and perceived benefits and barriers were measured at the three time point (baseline, after week 8, and after week 16). Results indicated that obese adolescents' BMI significantly decreased (F = 3.51, p = .03) and physical activity (F = 4.01, p = .02) significantly increased over the 16-week obesity intervention. In addition, Exercise self-efficacy (F = 5.02) and perceived benefits toward physical activity (F = 5.34) significantly increased but perceived barriers of physical activity (F = 5.10) gradually decreased over the intervention. This study suggests that an obesity intervention combining physical activity and behavior-based motivational enhancement intervention significantly contributed to decreased BMI, increased physical activity, and positively changed psychological variables related to physical activity. This first application has resulted in preliminary support for this intervention modality within non-western obese adolescents.

Correlation of Body Mass Index and Physical Activity Among 7- to 11-Year Children at Zahedan, Iran

Background:

Childhood obesity is currently one of the major concerns in pediatric field. In recent literature, correlation of obesity with some behavioral factors such as physical activity (PA) received attention.

Objective:

The purpose of this study was to determine the relationship between body mass index (BMI) and PA.

Materials and Methods:

This cross-sectional study was carried out in 2012 on 548 randomly selected 7- to 11-year schoolchildren from Zahedan, Iran. The underweight, normal weight, overweight, and obesity status were all based on BMI percentiles for age and sex. Moderate to vigorous PA during the previous 7 days was assessed by a modified version of the Physical Activity Questionnaire for Children.

Results:

The prevalence of underweight, normal weight, overweight, and obesity among the participants was 18.3%, 47.9%, 11.8%, and 22.1%, respectively. Overweight and obesity were significantly higher among girls than boys. Mean PA score in participants was 2.4 ± 0.5. The results showed the PA score was significantly higher among boys than girls. The PA score had a significant association with BMI ( P = .018), and it was greater in normal participants than in obese participants.

Conclusion:

On the basis of observed data and due to the impact of PA on BMI as an indicator of nutritional status and health, teaching children to have better nutrition and lifestyle changes is very important. Therefore, more studies should focus on childhood obesity prevention programs to prevent nonoverweight children from becoming overweight or obese in the future.

Prevalence of Internet Addiction and Its Association With Psychological Distress and Coping Strategies Among University Students in Jordan

PURPOSE

The purpose of this study was to measure the prevalence of Internet addiction (IA) and its association with psychological distress and coping strategies among university students in Jordan.

DESIGN AND METHODS

A descriptive, cross-sectional, correlational design was used with a random sample of 587 university students in Jordan. The Perceived Stress Scale, Coping Behavior Inventory, and Internet Addiction Test were used.

FINDINGS

The prevalence of IA was 40%. IA was associated with high mental distress among the students. Students who used problem solving were more likely to experience a lower level of IA.

PRACTICE IMPLICATIONS

This study should raise awareness in nurses and other healthcare providers that IA is a potential problem for this population.

Current perspectives on physical activity and exercise for youth with diabetes

Regular physical activity (PA) for youth with diabetes improves cardiorespiratory fitness, body composition, bone health, insulin sensitivity, and psychosocial well-being. However many youth with diabetes or pre-diabetes fail to meet minimum PA guidelines and a large percentage of youth with diabetes are overweight or obese. Active youth with type 1 diabetes tend to have lower HbA1c levels and reduced insulin needs, whereas activity in adolescents at-risk for type 2 diabetes improves various measures of metabolism and body composition. Insulin and nutrient adjustments for exercise in type 1 diabetes is complex because of varied responses to exercise type and because of the different times of day that exercise is performed. This review highlights the benefits of exercise and the established barriers to exercise participation in the pediatric diabetes population. A new exercise management algorithm for insulin and carbohydrate intake strategies for active youth with type 1 diabetes is presented.

Does maternal psychopathology increase the risk of pre-schooler obesity? A systematic review

The preschool years may be a critical period for child obesity onset; however, literature examining obesity risk factors to date has largely focused on school-aged children. Several links have been made between maternal depression and childhood obesity risks; however, other types of maternal psychopathology have been widely neglected. The aim of the present review was to systematically identify articles that examined relationships between maternal psychopathology variables, including depressive and anxiety symptoms, self-esteem and body dissatisfaction, and risks for pre-schooler obesity, including weight outcomes, physical activity and sedentary behaviour levels, and nutrition/diet variables. Twenty articles meeting review criteria were identified. Results showed positive associations between maternal depressive symptoms and increased risks for pre-schooler obesity in the majority of studies. Results were inconsistent depending on the time at which depression was measured (i.e., antenatal, postnatal, in isolation or longitudinally). Anxiety and body dissatisfaction were only measured in single studies; however, both were linked to pre-schooler obesity risks; self-esteem was not measured by any studies. We concluded that maternal depressive symptoms are important to consider when assessing risks for obesity in preschool-aged children; however, more research is needed examining the impact of other facets of maternal psychopathology on obesity risk in pre-schoolers.

Towards a behavioral vaccine: exposure to accessible temptation when self-regulation is endorsed enhances future resistance to similar temptations in children

BACKGROUND

Access to temptation is blamed for the rising prevalence of obesity in children. A popular way to counter this is to restrict physical access to temptation. As restrictions cannot be widely applied and may have adverse long-term effects, we examine whether accessible temptations in situations that endorse self-regulation train self-regulation. Specifically, we design a method that enhances children's self-regulatory skills in the long term.

METHOD

In two studies, participants were exposed to temptation in phase one and their self-regulatory skills were measured in phase two. In Study 1, we endorsed self-regulation in the presence of accessible temptation for four consecutive days and measured consumption on the fifth day. In Study 2, we exposed children to temptation similarly and, in addition, manipulated temptation strength to show that being tempted is crucial for the skill to develop. Next, we measured saliva and preferences.

RESULTS

The findings suggest that exposure to temptation in a situation that supports self-regulation leads to better resistance to temptations in later contexts of accessible temptation in girls, but not boys.

CONCLUSIONS

Our findings suggest that interventions aiming at strengthening children's self-regulatory skills through controlled exposure to temptation might be a productive long-term strategy to reduce consumption of unhealthy food.

Effects of a multidisciplinary childhood obesity treatment intervention on adipocytokines, inflammatory and growth mediators

BACKGROUND/AIMS

To examine the effects of a 3-month multidisciplinary intervention on anthropometric measures, physical activity patterns and fitness, inflammatory cytokines, adipocytokines, and growth mediators in obese children.

METHODS

21 obese subjects completed the 3-month intervention and were compared with 20 age-, gender- and maturity-matched controls. Subjects underwent anthropometric measurements (weight, height, BMI percentile and waist circumference), blood tests (IL-6, CRP, leptin, adiponectin, insulin, IGF-I and glucose), a progressive treadmill exercise test to evaluate fitness, and habitual activity assessment before and after the intervention.

RESULTS

The intervention led to a significant change of differences in body weight (-1.3 ± 4.1 vs. 2.5 ± 3.3 kg), BMI percentile (-0.96 ± 1.29 vs. 0.19 ± 0.8), waist circumference (-2.1 ± 2.7 vs. 2.9 ± 3.0 cm) and running time (149.9 ± 86.3 vs. -8.2 ± 88.0 s) in the intervention compared to control. There was a significant increase in leisure-time physical activity (Godin questionnaire, 29.04 ± 6.8 vs. -1.3 ± 9.2) and a decrease in sedentary activity (-1.4 ± 0.73 vs. 0.02 ± 0.62 h/day) in the intervention compared to control. Significant change differences in adiponectin (2,308 ± 1,640 vs. -801 ± 465 ng/ml), IGF-I (33.8 ± 37.8 vs. -1.0 ± 36.2 ng/ml), CRP (-0.06 ± 0.29 vs. 0.5 ± 0.86 mg/dl) and HOMA-IR (-0.15 ± 0.57 vs. 0.55 ± 0.84) were found in the intervention group compared to control.

CONCLUSIONS

Our results highlight the short-term beneficial effects of a childhood obesity multidisciplinary intervention on anthropometrics, habitual activity, fitness, inflammatory and metabolic measures. The longer-term effects of these changes on obesity-associated metabolic risks are yet to be determined.

Decreased cardiotrophin-1 levels are associated with a lower risk of developing the metabolic syndrome in overweight/obese children after a weight loss program

OBJECTIVE

Cardiotrophin-1 (CT-1) shares some similarities with other cytokines, and participates in the control of energy metabolism. Higher circulating levels are observed in obese humans, but little information is gathered in weight loss (WL) programs. Therefore, we aimed to investigate the association of serum CT-1 levels with metabolic variables and the risk of developing metabolic syndrome (MetS) after a WL program in overweight/obese children.

SUBJECTS AND METHODS

Forty-four overweight/obese children (mean age 11.5 y; 50% males) undergoing a 10-week WL program were enrolled. Subjects were dichotomized at the median of Body Mass Index-Standard Deviation Score (BMI-SDS) change, as high and low responders after intervention.

RESULTS

CT-1 levels were significantly reduced (-48 fmol/mL, p=0.043) in the high responder group after the WL program. They had significantly lower body weight (-3.7 kg, p<0.001), body fat mass (-8%, p<0.001), BMI-SDS (-0.78, p<0.001) and waist circumference (-5.4 cm, p<0.001), and a significant improvement in lipid and glucose profiles (p<0.05). Interestingly, decreased CT-1 levels significantly predicted changes in total cholesterol (41%) and LDL-cholesterol (28%). Moreover, in our participants the lower the CT-1 levels, the higher the reduction in MetS risk components, after the 10-week intervention, (p-ANCOVA=0.040, p-trend=0.024).

CONCLUSION

We showed, for the first time, a reduction in serum CT-1 levels after a WL program and this decrease in CT-1 was strongly associated with a reduction in cholesterol levels and in MetS risk factors in overweight/obese children. Our findings may suggest that CT-1 could be an indirect marker for the diagnosis of MetS in this population.

Decreased prevalence of overweight and obesity in the newfoundland and labrador preschool population

OBJECTIVE

This study was conducted to determine the prevalence of overweight and obesity in preschool-aged (42-66 months) children in Newfoundland and Labrador in 2009/10. Second, 2009/10 rates were compared to those reported for 2001/02 and 1988/89 to ascertain whether the previous rising trend had continued, stabilized or decreased while public health prevention and intervention efforts increased.

METHODS

Heights and weights of children measured in clinics in 2009/10, 2001/02 and 1988/89 were sampled, representing 29%, 77% and 45% of provincial births in 2005, 1997 and 1984, respectively. Body mass indices were calculated and classified as overweight, obese or neither, using World Health Organization (WHO) growth charts. ANOVA and regression procedures were used to compare cohorts.

RESULTS

Combined overweight and obesity was significantly lower in 2009/10 (35.7%) than in 2001/02 (38.9%), (OR 0.87, 95% CI 0.76-0.99). Considered separately, both overweight and obesity rates stabilized. Boys were 1.4 times more likely to be overweight or obese than girls in all samples. In 2009/10, combined overweight and obesity was higher in rural areas (OR 1.67, 95% CI 1.28-2.18). In three of four public health jurisdictions, prevalence in 2009/10 remained significantly higher than 20 years earlier. In one region, rates returned to 1988/89 levels.

CONCLUSION

Progress has been made in stabilizing, even reversing, overweight and obesity in the Newfoundland and Labrador preschool population, however, prevalence rates remain high. Surveillance and intervention efforts must continue. Given the jurisdictional and regional differences found, further research should compare ecological contexts and thus attempt to isolate and identify important contributing factors and effective interventions.

Factors influencing whether children walk to school

Few studies have simultaneously evaluated multiple levels of influence on whether children walk to school. A large cohort of 4338 subjects from 10 communities was used to identify the determinants of walking through (1) a one-level logistic regression model for individual-level variables and (2) a two-level mixed regression model for individual and school-level variables. Walking rates were positively associated with home-to-school proximity, greater age, and living in neighborhoods characterized by lower traffic density. Greater land use mix around the home was, however, associated with lower rates of walking. Rates of walking to school were also higher amongst recipients of the Free and Reduced Price Meals Program and attendees of schools with higher percentage of English language learners. Designing schools in the same neighborhood as residential districts should be an essential urban planning strategy to reduce walking distance to school. Policy interventions are needed to encourage children from higher socioeconomic status families to participate in active travel to school and to develop walking infrastructures and other measures that protect disadvantaged children.

Long term effects of a health promotion intervention in low socioeconomic Arab- Israeli kindergartens

Background

Obesity is the most common chronic pediatric disease in westernized, especially low socioeconomic societies. We previously demonstrated the beneficial effects of a randomized prospective school-based health education program for low socioeconomic status Arab-Israeli kindergarten children.

Methods

To examine whether the effects of our program on nutrition and physical activity knowledge and preferences, anthropometric measures, and fitness persisted one year after the end of intervention.

We were able to perform the one year follow-up in 203 kindergarten children (59% of our 342 original cohort; 85 control, 118 intervention).

Results

At one year following the intervention BMI and BMI percentiles approached baseline level in both the intervention (16.4±0.2 kg/m² and 61.5±2.4%, respectively) and control group participants (16.5±0.2 kg/m² and 58.5±3.3%, respectively). Yet, a year after the end of the intervention, the decrease in BMI%ile from baseline was significantly greater in the intervention group (-7.8±1.5 vs. -1.9±1.9, p<0.012). Nutritional and physical activity knowledge and preferences, and physical fitness remained significantly elevated in the intervention compared to the control group participants.

Conclusions

The beneficial effects of a kindergarten dietary-physical activity intervention applied by the kindergarten teachers, on nutrition and physical activity knowledge and preferences, fitness, and BMI percentile were evident one year after the end of intervention. This promising program may play a role in health promotion, prevention and treatment of childhood obesity.

Prevalence of obesity in children aged 6-12 years in Greece: nutritional behaviour and physical activity

INTRODUCTION

During the last two decades, obesity has proved to be one of the most important problems of public health, and it is considerably more frequent in developed countries, not only in adults, but in children, too. The aim of the current study is to evaluate the prevalence of overweight and obesity in children.

MATERIAL AND METHODS

Two thousand three hundred and seventy-four pupils in primary education were considered for the study (1206 boys and 1168 girls).

RESULTS

In the population-based study, the proportion of overweight children was 23.9%, of obese children 7.3%, and of those with central obesity 35.5%. The boys were obese in a higher percentage than the girls (9.2% vs. 5.3%, p < 0.05). The obesity rates were gradually reduced as the children were growing older. The nutritional habits which were identified to have a positive association with obesity were the following: skipping breakfast, not consuming fruits and vegetables, and consuming bread and soft drinks. Children's healthy nutrition in school was related to lower rates of generalised and central obesity, while the hours spent watching TV were positively associated with all types of obesity.

CONCLUSIONS

Results from the study suggest that a high proportion of children are overweight or obese. Therefore, it is important to adhere to a healthy lifestyle which emphasizes healthy food choices and habits, regular physical activity, and limiting screen time.

Effect of chicory seed extract on glucose tolerance test (GTT) and metabolic profile in early and late stage diabetic rats

Background and purpose of the study

The goal was to evaluate and compare the effects of aqueous extract of the seeds of chicory, Cichorium intybus L., on glucose tolerance test (GTT) and blood biochemical indices of experimentally-induced hyperglycemic rats.

Methods

Late stage and early stage of Type 2 diabetes mellitus (T2DM) were induced in rats by streptozotocin (STZ) and a combination of STZ and niacinamide (NIA/STZ), respectively. Within each group, one subgroup received daily i. p. injections of chicory extract (125 mg/kg body weight, for 28 days). Body weight and fasting blood sugar (FBS) were measured weekly. Blood was analyzed for glycosylated hemoglobin (HbA1c) and sera for alanine aminotransferase (ALT), aspartate aminotransferase (AST), nitric oxide (NO), triacylglycerol (TG), total cholesterol (TC), total protein, and insulin on days 10 and 28 after treatment. Intraperitoneal glucose tolerance test (IPGTT) along with insulin determination was performed on a different set of rats in which the chicory-treated groups received the extract for 10 days.

Results

During 4 weeks of treatment, chicory prevented body-weight loss and decreased FBS. ALT activities and levels of TG, TC and HbA1c decreased, and concentration of NO increased in the chicory treated groups (p < 0.05). Unlike late-stage diabetes, fasting serum insulin concentrations were higher and GTT pattern approximated to normal in chicory-treated early-stage diabetic rats.

Conclusions

Chicory appeared to have short-term (about 2 hours, as far as GTT is concerned) and long-term (28 days, in this study) effects on diabetes. Chicory may be useful as a natural dietary supplement for slowing down the pace of diabetes progress, and delaying the development of its complications.

Childhood Obesity: Review of a growing Problem

The consequences of obesity in adulthood are well known. Obesity has a direct influence on mortality and acts as a risk factor for various diseases and health problems. It is associated with nonfatal but debilitating illnesses, such as respiratory difficulties, musculoskeletal disorders, skin problems and infertility. The association with fatal chronic diseases includes cardiovascular diseases, conditions related to insulin resistance and noninsulin-dependent diabetes. There has been a marked increase in the number of obese children coming for treatment to dentists, thus it is the moral responsibility of the dentists to educate both the patient and the parents of the problems of obesity and its control. A dentist may actually be the first person to inform the patient about this problem thus, a basic knowledge about it is important. How to cite this article: Shivpuri A, Shivpuri A, Sharma S. Childhood Obesity: Review of a growing Problem. Int J Clin Pediatr Dent 2012;5(3):237-241.

Rompendo fronteiras na Educação Física através dos videogames com interação corporal

Os videogames, uma das mais fortes correntes da indústria do entretenimento, têm também influenciado a área da Educação Física através de novos dispositivos digitais que possibilitam a interação corporal. O videogame Wii Fit, objeto desta pesquisa, é um destes jogos, que tem como principal objetivo incentivar a prática de atividades físicas de maneira lúdica. Este artigo apresenta um estudo com base na etnografia virtual, envolvendo uma análise de conteúdo on-line sobre como os usuários do jogo Wii Fit o têm percebido. Três comunidades virtuais foram pesquisadas, buscando relatos sobre as percepções dos usuários quanto à influência do jogo em suas práticas de atividade física e manutenção de uma alimentação saudável. A investigação realizada permitiu concluir que o jogo Wii Fit funciona como uma ferramenta educativa capaz de levar os usuários a práticas físicas mais regulares bem como aos hábitos alimentares mais saudáveis.

Childhood obesity: a life-long health risk

Childhood obesity has become major health concern for physicians, parents, and health agencies around the world. Childhood obesity is associated with an increased risk for other diseases not only during youth but also later in life, including diabetes, arterial hypertension, coronary artery disease, and fatty liver disease. Importantly, obesity accelerates atherosclerosis progression already in children and young adults. With regard to pathophysiological changes in the vasculature, the striking similarities between physiological changes related to aging and obesity-related abnormalities are compatible with the concept that obesity causes "premature" vascular aging. This article reviews factors underlying the accelerated vascular disease development due to obesity. It also highlights the importance of recognizing childhood obesity as a disease condition and its permissive role in aggravating the development of other diseases. The importance of childhood obesity for disease susceptibility later in life, and the need for prevention and treatment are also discussed.

Childhood obesity: a life-long health risk

Childhood obesity has become major health concern for physicians, parents, and health agencies around the world. Childhood obesity is associated with an increased risk for other diseases not only during youth but also later in life, including diabetes, arterial hypertension, coronary artery disease, and fatty liver disease. Importantly, obesity accelerates atherosclerosis progression already in children and young adults. With regard to pathophysiological changes in the vasculature, the striking similarities between physiological changes related to aging and obesity-related abnormalities are compatible with the concept that obesity causes "premature" vascular aging. This article reviews factors underlying the accelerated vascular disease development due to obesity. It also highlights the importance of recognizing childhood obesity as a disease condition and its permissive role in aggravating the development of other diseases. The importance of childhood obesity for disease susceptibility later in life, and the need for prevention and treatment are also discussed.

Is maternal nutrition knowledge more strongly associated with the diets of mothers or their school-aged children?

Objective

Maternal nutrition knowledge has frequently been identified as an important target for nutrition promotion interventions. The aim of the present study was to investigate whether maternal nutrition knowledge is more strongly associated with the mother's own diet or that of her child.

Design

Cross-sectional multivariate linear regression with interactions analyses of survey data.

Setting

Socio-economically disadvantaged neighbourhoods in Victoria, Australia.

Subjects

Five hundred and twenty-three mothers and their children who participated in the Resilience for Eating and Physical Activity Despite Inequality (READI) study, a cross-sectional survey study conducted in 2009 among women and their children residing in socio-economically disadvantaged neighbourhoods.

Results

In adjusted models, for three (vegetable, chocolate/lollies and soft drink consumption) out of the seven dietary outcomes assessed, there was a significant association between maternal nutrition knowledge and maternal diet, whereas for the children's diets none of the seven outcomes were associated with maternal nutrition knowledge. Statistical comparison of regression coefficients showed no difference between the maternal nutrition knowledge–maternal diet association and the maternal nutrition knowledge–child diet association.

Conclusions

Promoting maternal nutrition knowledge may represent an important avenue for improving diet in mothers from socio-economically disadvantaged neighbourhoods, but more information is needed on how and when this knowledge is translated to benefits for their children's diet.

Competitive Food Sales in Schools and Childhood Obesity: A Longitudinal Study

The vast majority of American middle schools and high schools sell what is known as "competitive foods", such as soft drinks, candy bars, and chips, to children. The relationship between consumption of sugar-sweetened drinks and snacks and childhood obesity is well established but it remains unknown whether competitive food sales in schools are related to unhealthy weight gain among children. We examined this association using data from the Early Childhood Longitudinal Study Kindergarten Cohort. Employing fixed effects models and a natural experimental approach, we found that children's weight gain between 5(th) and 8(th) grades was not associated with the introduction or the duration of exposure to competitive food sales in middle school. Also, the relationship between competitive foods and weight gain did not vary significantly by gender, race/ethnicity, or family SES, and remained weak and insignificant across several alternative model specifications. One possible explanation is that children's food preferences and dietary patterns are firmly established before adolescence. Also, middle school environments may dampen the effects of competitive food sales because they so highly structure children's time and eating opportunities.

Health promotion intervention in low socioeconomic kindergarten children

OBJECTIVE

To prospectively examine the effects of a randomized school-based intervention on nutrition and physical activity knowledge and preferences, anthropometric measures, and fitness in low socioeconomic kindergarten children.

STUDY DESIGN

A total of 376 children completed a school-year combined dietary-behavioral-physical activity intervention and were compared with 349 control subjects (age 3.8 to 6.8 years).

RESULTS

The prevalence of overweight and obesity among the kindergarten children was 27.7%. Even though the intervention was not associated with between group differences in body mass index changes, it was associated with significantly (P < .05) greater increase in nutrition knowledge and preferences, physical activity knowledge and preferences, and improvement in fitness. There was a greater (P < .05) decrease in the number of overweight children in the intervention group (-31.9%) compared with the controls (-17.5%).

CONCLUSIONS

A kindergarten dietary-physical activity intervention applied by the kindergarten teachers, had no effect on body mass index changes between the groups, but improved nutrition and physical activity knowledge and preferences, improved fitness, and decreased the percent of overweight children. This intervention may play an important role in health promotion, prevention and treatment of childhood obesity.

What helps children eat well? A qualitative exploration of resilience among disadvantaged families

It is well known that persons of low socioeconomic position consume generally a less healthy diet. Key determinants of unhealthy eating among disadvantaged individuals include aspects of the family and external environment. Much less is known about family and environmental determinants of healthy eating among social disadvantaged children. The aim of this study was to gain insight into the family and environmental factors underlying resilience to poor nutrition among children and their mothers living in disadvantaged neighbourhoods. Semi-structured interviews were conducted with 38 mother-child pairs (N = 76) from disadvantaged neighbourhoods. Children were selected if they were a healthy weight, consumed adequate intakes of fruit and vegetables and were physically active. Two main themes emerged from the interviews: active strategies from parents to promote healthy eating and external barriers and supports to healthy eating. Mothers believed that exercising control over access to unhealthy food, providing education and encouragement for consumption of healthy food and enabling healthy food options aided their child to eat well. Children did not perceive food advertisements to be major influences on their eating preferences or behaviour. The results of the current study offer insight into potential avenues for nutrition promotion among disadvantaged children.

Health promotion intervention in Arab-Israeli kindergarten children

BACKGROUND

Obesity is the most common chronic pediatric disease in westernized societies, with minorities and children from low socioeconomic status being mostly affected. Arab-Israelis are the largest minority population in Israel.

OBJECTIVE

The aim of this study is to examine the prevalence of obesity and to prospectively study the effects of a health promotion, school-based intervention on nutrition and physical activity knowledge and preferences, anthropometric measures, and fitness in Arab-Israeli kindergarten children.

PARTICIPANTS

One hundred fifty-four children completed a school year with combined dietary-behavioral-physical activity intervention and were compared with 188 controls (age 4.2-6.5 years).

RESULTS

The prevalence of overweight and obesity among Arab-Israeli kindergarten children was 28.9%. Compared with control, the intervention led to a significantly greater (control vs. intervention, respectively, p < 0.05) increase in nutrition knowledge (51.2+/- 1.5%-48.9 +/- 1.6% vs. 48.9 +/- 1.6%-85.9 +/- 1.4%) and preferences (47.4 +/- 1.5%-47.7 +/- 1.6% vs. 45.2 +/- 1.8%-87.1 +/- 1.4%), increase in physical activity knowledge (47.2 +/- 1.3%-47.0 +/- 1.7% vs. 49.2 +/- 1.7%-90.8 +/- 1.3%) and preferences (52.3 +/- 1.3%-54.2 +/- 1.8% vs. 56.2 +/- 1.4%-92.8 +/- 1.0%), and improvement in fitness (-10.2 +/- 1.6 vs. 11.6 +/- 1.4 shuttle run laps). The intervention was associated with favorable changes in height gain (5.0 +/- 0.1 vs. 6.2 +/- 0.1cm), body mass index (BMI-0.41 +/- 0.06 vs. -0.71 +/- 0.06 kg/m2) and BMI percentile (-10.0 +/- 1.3% vs. -16.2 +/- 1.2%) in the control and intervention groups, respectively.

CONCLUSIONS

A kindergarten dietary-physical activity intervention applied by the kindergarten teachers led to a decrease in BMI, BMI percentile, improved nutrition and physical activity knowledge and preferences, and improved fitness. Such programs may play important role in health promotion, prevention, and treatment of childhood obesity in minority communities from early age.

Population trends toward increasing cardiovascular risk factors in Canadian adolescents

OBJECTIVE

To determine prevalence and cross-sectional trends over time for cardiovascular risk factors in Canadian adolescents.

STUDY DESIGN

Cross-sectional trends in cardiovascular risk and lifestyle factors were gathered annually in 14- to 15-year-old students in the Niagara region, Ontario, Canada.

RESULTS

A total of 20 719 adolescents were screened between 2002 and 2008. The proportion of obese adolescents (>95th percentile for body mass index [BMI]) increased significantly, by +0.34%/year (P = .002). The proportions of adolescents with borderline high cholesterol (4.4-5.1 mmol/L) (+0.57%/year; P <.001) and with high cholesterol (≥5.2 mmol/L) (+0.43%/year; P <.001) both increased significantly over time. The proportion of adolescents with prehypertension decreased by -0.23%/year (P = .02), whereas the proportion of those with stage I hypertension (5%-6%) or stage II hypertension (2%-4%) remained constant. The proportion of adolescents classified as being at high cardiovascular risk increased by +0.67%/year (P <.001). Family history, low levels of physical activity, sedentary behaviors, poor nutrition, and lower socioeconomic status were all independently and negatively associated with all aspects of cardiovascular risk.

CONCLUSIONS

A significant proportion of 14- to 15-year-old Canadian adolescents have at least one cardiovascular risk factor, and the cross-sectional trends worsened during the period 2002-2008.

Are overweight and obese youth at increased risk for physical activity injuries?

OBJECTIVE

To determine whether relationships between physical activity and physical activity injuries are modified by BMI status in youth.

METHOD

Data were obtained from the 2006 Canadian Health Behaviour in School-Aged Children survey; a representative study of 7,714 grade 6-10 youth. A sub-sample of 1,814 were re-administered the survey in 2007. Analyses considered relationships among the major variables in theory-driven cross-sectional and longitudinal analyses.

RESULT

Among normal weight youth, cross-sectional analyses indicated that those who reported high levels of physical activity outside of school experienced 2.28 (95% confidence interval 1.95-2.68) the relative odds for physical activity injury in comparison to those with low levels of physical activity outside of school. Analogous odds ratios for overweight and obese youth were 1.89 (1.31-2.72) and 3.72 (1.89-7.33), respectively. BMI status was not an effect modifier of the relationship between physical activity and physical activity injury. Similar observations were made in the confirmatory longitudinal analyses.

CONCLUSION

Concerns surrounding the design of physical activity programmes include side-effects such as injury risk. This study provides some re-assurance that physical activity participation relates to injury in a consistent manner across BMI groups.

Multivitamin/Mineral supplementation does not affect standardized assessment of academic performance in elementary school children

Limited research suggests that micronutrient supplementation may have a positive effect on the academic performance and behavior of school-aged children. To determine the effect of multivitamin/mineral supplementation on academic performance, students in grades three through six (approximate age range=8 to 12 years old) were recruited from 37 parochial schools in northern New Jersey to participate in a double-blind, placebo-controlled clinical trial conducted during the 2004-2005 academic school year. Participants were randomized to receive either a standard children's multivitamin/mineral supplement (MVM) or a placebo. MVM or placebo was administered in school only during lunch or snack period by a teacher or study personnel who were blinded to group assignment. The main outcome measured was change in scores on Terra Nova, a standardized achievement test administered by the State of New Jersey, at the beginning of March 2005 compared to March 2004. Compared with placebo, participants receiving MVM supplements showed no statistically significant improvement for Terra Nova National Percentile total scores by treatment assignment or for any of the subject area scores using repeated measures analysis of variance. No significant improvements were observed in secondary end points: number of days absent from school, tardiness, or grade point average. In conclusion, the in-school daily consumption of an MVM supplement by third- through sixth-grade inner-city children did not lead to improved school performance based upon standardized testing, grade point average, and absenteeism.