Family socioeconomic status and childhood adiposity in Europe - A scoping review

Individual and school correlates of body mass index and cardiorespiratory fitness in primary school children from the REACT project: A multivariate multilevel analysis

OBJECTIVE

This paper examines the relationship between body mass index (BMI) and cardiorespiratory fitness (CRF) using a multivariate multilevel approach and investigates the links between individual and school-related correlates with children's BMI and CRF.

METHODS

This cross-sectional sample included 1014 children (6-10 years) from 25 Portuguese primary schools. BMI was calculated, and CRF was assessed with the PACER test. Fundamental movement skills (FMS) included five object control tasks. Moderate-to-vigorous physical activity (MVPA), sleep, and sedentary time were assessed with the ActiGraph wGT3X-BT accelerometer. Socioeconomic status (SES) and school variables were also obtained. A multivariate multilevel model was used, and alpha was set at 5%.

RESULTS

BMI and CRF systematically increased with age. Most of the joint variance (94.4%) was explained at the child level, and BMI and CRF were correlated at this level (ρ = -.37). More active children demonstrated higher CRF levels and had lower BMI levels; sedentary and sleep time were not significantly associated with BMI or CRF. FMS were positively associated with CRF but were not significantly associated with BMI. Children at higher SES were more fit and had lower BMI than their peers of lower SES. Finally, school-level variables were not significantly related to BMI and CRF.

CONCLUSION

BMI and CRF had a low but statistically significant negative correlation in this sample of children. Most of the variation in BMI and CRF was explained by child-level characteristics.

Prevalence of obesity and associated sociodemographic and lifestyle factors in Ecuadorian children and adolescents

BACKGROUND

Given the increasing prevalence of obesity in young people in Ecuador, there is a need to understand the factors associated with this condition. The aim of this study was to assess the prevalence of obesity in Ecuadorian children and adolescents aged 5-17 years and identify its associated sociodemographic and lifestyle factors.

METHODS

This cross-sectional study was conducted using data from the Encuesta Nacional de Salud y Nutrición (ENSANUT-2018). The final sample consisted of 11,980 participants who provided full information on the variables of interest.

RESULTS

The prevalence of obesity was 12.7%. A lower odd of having obesity was observed for adolescents; for those with a breadwinner with an educational level in middle/high school or higher; for each additional day with 60 or more minutes of daily moderate-to-vigorous physical activity; and for those with greater daily vegetable consumption (one, two, or three or more servings). Conversely, there were greater odds of obesity in participants from families with medium, poor, and very poor wealth and those from the coast and insular region.

CONCLUSIONS

The high prevalence of obesity in Ecuadorian children and adolescents is a public health concern. Sociodemographic and lifestyle behavior differences in young people with obesity should be considered when developing specific interventions.

IMPACT

As the prevalence of obesity among children and adolescents increases in Latin America, with a particular focus on Ecuador, it becomes crucial to delve into the factors linked to this condition and identify the most successful strategies for its mitigation. The elevated prevalence of obesity among young individuals in Ecuador raises significant public health concerns. To develop targeted interventions, it is crucial to account for sociodemographic variables and lifestyle behaviors that contribute to obesity in this population.

Postpartum Obesity Is Associated With Increases in Child Adiposity in Midchildhood in a Cohort of Black and Dominican Youth

Background

Obesity disproportionately affects marginalized and low-income populations. Birth parent obesity from the prenatal period and childhood has been associated with child obesity. It is unknown whether prenatal or postnatal birth parent obesity has differential effects on subsequent changes in adiposity and metabolic health in children.

Objectives

We evaluated how birth parent obesity 7 y after delivery was associated with child body composition changes and cardiometabolic health in midchildhood and further assessed the influence of the perinatal and postpartum period on associations.

Methods

Black and Dominican pregnant individuals were enrolled, and dyads (n = 319) were followed up at child age 7 and 9 y. Measures included, height, weight, waist circumference (WC), and percent body fat (BF%). Multiple linear regression was used to relate postpartum weight status with child outcomes accounting for attrition, and a series of secondary analyses were conducted with additional adjustment for perinatal weight status, gestational weight gain (GWG), and/or long-term weight retention to evaluate how these factors influenced associations.

Results

Almost one-quarter (23%) of birth parents and 24.1% children were classified with obesity at child age 7 y, while at 9 y, 30% of children had obesity. Birth parent obesity at child age 7 y was associated with greater changes, from ages 7 to 9 y, in child BMI z-score (β: 0.13; 95% CI: 0.02, 0.24) and BF% (β: 1.15; 95% CI: 0.22, 2.09) but not obesity at age 9 y. All observed associations crossed the null after additional adjustment for prenatal factors.

Conclusions

Birth parent obesity at 7-y postpartum is associated with greater gains in child BMI z-score and BF% in midchildhood. These associations diminish after accounting for prenatal size, suggesting a lasting impact of the perinatal environment and that interventions supporting families from the prenatal period through childhood are needed.

The role of adipokines and ghrelin in interactions and clinical implications in childhood obesity

BACKGROUND

Childhood obesity is a growing global health concern, especially prevalent in the Arabian Peninsula, and is known to contribute to metabolic syndrome and insulin resistance. This study aimed to investigate the interplay between adipokines (leptin and adiponectin), ghrelin, and insulin homeostasis in childhood obesity.

MATERIAL AND METHODS

A case-control study was conducted in Babylon involving 120 children/adolescents (7-17 years). The participants were divided into two groups: 60 obese and 60 healthy controls. Anthropometric and biochemical measures were examined, applying World Health Organization (WHO) growth standards to categorize weight status. Data on blood lipids, glucose, adipokines, and ghrelin were collected in Babylon (Merjan Medical City), ensuring accuracy and providing insights into pediatric obesity's metabolic and hormonal status.

RESULT

Clinical, anthropometric, and laboratory attributes of children were evaluated, with classification as normal-weight or obese based on BMI/Z-score and Waist Circumference. The obese group exhibited elevated triglycerides and insulin levels, as well as reduced adiponectin levels (P ≤ 0.001). Leptin levels showed a positive correlation with BMI/Z-score (r = 0.352, P = 0.006). A diagnostic model demonstrated the significant diagnostic capacity of leptin (AUC > 99%) and its importance in predicting childhood obesity. Each unit increase in leptin elevated the probability of obesity by a factor of 1.197 (95% CI: 1.0507-1.3632, P = 0.0068).

CONCLUSION

The study revealed significant differences in clinical, biochemical, and biological markers of obesity between the research groups and the control group. Leptin emerged as a significant predictor of obesity, demonstrating high diagnostic accuracy. The complex interactions among these adipokines underscore the necessity for comprehensive obesity management strategies.

The Effects of Using a Cycling Desk at School on Executive Function, Physical Fitness, and Body Composition in Primary School Children: Impact of Socioeconomic Status

CONTEXT

Physical inactivity and sedentary behaviors are associated with adverse health outcomes in both adults and children. The purpose of this study was to investigate the effects of a 9-week program using a Cycle Desk during school time in French primary school children from high or low socioeconomic status (SES) on body composition, physical fitness (PF), and executive function.

METHODS

Seventy-five (n = 75) children completed a test battery before and after 9 weeks of use of Cycle Desk to evaluate anthropometric characteristics, body composition, PF, and executive function.

RESULTS

Body mass index increased significantly (P = .0095), while body fat decreased after the use of Cycle Desks (P < .0001). Specifically, lean mass increased in the high-SES group while it decreased in the low-SES group (P < .0001). After 9 weeks, there was an improvement in motor skills (P < .0001), upper and lower limbs' strength (P < .0001), and executive function performance (P < .0001). More specifically, the low-SES group had a greater improvement in motor skills and maximal aerobic speed between T0 and T1, compared to the high-SES group (P = .001, P = .023, respectively). In contrast, the high-SES group had a greater improvement in executive function at 9 weeks of use of Cycle Desk compared with the low-SES group (P = .0084).

CONCLUSIONS

The promotion of low-intensity physical activity with the use of a Cycle Desk at school may help offset some adverse effects of excess sedentary behavior among children. Moreover, this strategy appears to be particularly effective in children from low-SES backgrounds. What's New: The use of a Cycle Desk during school time has no deleterious effects on PF as well as cognitive executive functions in primary children. Modifications are more beneficial in children from low SES.

Assessing readiness for childhood obesity prevention in German municipalities: application of the community readiness model

The World Health Organization has identified childhood obesity as one of the most serious public health problems of the 21st century. Understanding a municipality's readiness to address it is crucial to achieve successful interventions. However, the preparedness of German municipalities to address childhood obesity has not yet been investigated. This study is the first in Germany to apply the community readiness model (CRM) in this context. The purpose was to determine readiness of five municipalities for childhood obesity prevention and to identify factors that influence their readiness. Therefore, 27 semi-structured key informant interviews were conducted. First, the interviews were analysed following the CRM protocol to categorize the municipalities into a readiness level between one and nine. In a second step, a content analysis was carried out for an in-depth interpretation of the readiness scores. The municipalities achieved an average readiness of 3.84, corresponding to the 'Vague Awareness' stage. A lack of prioritization and leadership support, insufficient low-threshold efforts, a lack of knowledge and problem awareness as well as a lack of structures and resources were identified as factors that can determine municipal readiness to prevent childhood obesity. This study not only extends the application of the CRM to childhood obesity in German municipalities but also offers practical implications for professionals in assessing readiness.

Changes of anthropometric indicators of lithuanian first-graders in 2008-2019 according to International Obesity Task Force (IOTF) and World Health Organization (WHO) definitions

INTRODUCTION

The monitoring of children's growth plays a crucial role in assessing their growth patterns and indicating their weight status. Overweight and obesity, determined by cut-offs of body mass index (BMI), are most commonly associated with unhealthy nutrition, non-communicable diseases, and other health disorders. The World Health Organization (WHO) initiated the WHO European Childhood Obesity Surveillance Initiative (COSI) to measure routinely trends in children's anthropometric changes, which allow intercountry comparisons within the European Region. Lithuania joined the COSI initiative. Our study aims to evaluate and compare underweight, normal and elevated weight (overweight and obesity) changes of Lithuanian first-graders during eleven years period.

METHODS

This study was composed according to the COSI study protocol, and it compares the five rounds of anthropometric measurements of Lithuanian first-graders (7-8-year-old) from 2008 to 2019. The main analysed variables were weight and height; calculated BMI, weight-for-age (W/A), height-for-age (H/A) and body mass index-for-age (BMI/A) z-scores. Changes of the indicators were evaluated according to the International Obesity Task Force (IOTF) cut-offs and WHO child growth standards, grouped by 4 estimates: underweight (thinness), normal weight, overweight and obesity. All comparisons were performed between age groups, gender and COSI round year.

RESULTS

The mean values for weight, height, W/A and H/A Z-scores were significantly higher for both age and gender groups when comparing later COSI round years (2016 or 2019) to earlier years (2008-2013, in some cases 2016 is included in this range). Time trends of the WHO growth standards and IOTF cut-offs indicate significant decrease among 7-year-old overweight group for boys and girls. Also, a significant decrease was indicated among boys aged 8 years in the overweight group according to the WHO definitions. The only significant increase in trend were expressed in girl's group with obesity aged 8 years according to IOTF cut-offs.

CONCLUSION

The prevalence of overweight and obesity of first-grade children in Lithuania indicates positive changes, that is the proportion of children with elevated body weight decreased, during eleven-year period. However, it is important to continue the monitoring of children's growth tendencies.

Anthropometric status of preschoolers and elementary school children with ADHD: preliminary results from the EPINED study

BACKGROUND

A current area of research interest is the association between ADHD and weight status. This paper aimed to describe the anthropometric status of school children with ADHD, considering age and clinical presentation (inattentive, hyperactive-impulsive, or combined), compared with control children.

METHODS

Participants came from the "Epidemiological Research Project on Neurodevelopmental Disorders" and consisted of 198 preschoolers (41 with ADHD) and 389 elementary school children (163 with ADHD). ADHD was diagnosed using DSM-5 criteria. Anthropometric measurements were taken at various anatomical points, and height, weight, and body composition were also measured.

RESULTS

In preschoolers, an association was found between hyperactive-impulsive ADHD and greater height and lower waist-to-height ratio. In elementary school children, regardless of the medication, combined ADHD was associated with smaller head, hip, arm, and thigh circumferences and lower weight, height, and BMI. A total of 19.7% of them were underweight. In contrast, children with inattentive and hyperactive/impulsive presentations presented the highest percentage of overweight/obesity (56%).

CONCLUSION

The anthropometric status of the school children with ADHD showed differences in terms of age and presentation. Preschoolers with hyperactive-impulsive ADHD are taller, and elementary school children with combined ADHD are shorter and smaller than their age-matched control peers.

IMPACT

The anthropometric status of the school children with ADHD showed differences in terms of age and presentation. Preschoolers with hyperactive-impulsive ADHD are taller than their control peers. Elementary school children with combined ADHD, regardless of the pharmacological treatment, are shorter and smaller than their control peers. Medication may anthropometrically affect the height of children with inattentive presentation. Anthropometric and dietary monitoring should be recommended to parents of children with ADHD, with and without medication.

Inequalities in Childhood Nutrition, Physical Activity, Sedentary Behaviour and Obesity in Italy

Unhealthy diets, physical inactivity and high body mass index (BMI) are preventable risk factors for non-communicable diseases throughout a person's lifespan. The higher prevalence of these risk factors in children from lower socio-economic groups has been generally observed. The aim of this study is to explore the effect of parents' socio-economic conditions on children's consumption of fruit, vegetables and sugar-sweetened drinks, and inactivity, sedentary behaviour, overweight and obesity. This study used data from the sixth cross-sectional survey of the surveillance "OKkio alla Salute" (Italian COSI), involving 2467 schools and 53,275 children in 2019. All the information was collected through four questionnaires addressed to parents, children, teachers and head teachers. The weights and heights of the children were measured with standard techniques and equipment to classify overweight/obesity according to the WOF-IOTF cut-offs. The results showed a high percentage of children who do not adhere to health recommendations and a high prevalence of overweight and obesity. In particular, "less healthy" behaviours and higher BMI were more frequent in children from families with a lower socio-economic status and those residing in Southern Italy. These findings highlight the need for effective interventions that address the differences in these health-related behaviours.

Overweight and Obesity in Finnish Children by Parents' Socioeconomic Position-A Registry-Based Study

Objectives: To examine associations between parents' socioeconomic position (SEP) and child overweight and obesity, using registry data. Methods: Data (final n = 194,423) on children's height, weight and parents' SEP were drawn from the national Register of Primary Health Care Visits (Avohilmo) and Statistics Finland. Risk ratios for bernoulli-distributed overweight (RROW) and obesity (RROB) according to SEP were estimated using generalized linear models and using a log -link. Results: The risk for obesity was lower in boys from high-income families (RROB 0.76), for overweight and obesity was lower in boys (RROW 0.72, RROB 0.58) and girls (RROW 0.72, RROB 0.54) with highly educated fathers, in boys (RROW 0.79, RROB 0.58) and girls (RROW 0.78, RROB 0.56) with high-educated mothers and in boys (RROW 0.85, RROB 0.77) and girls (RROW 0.80, RROB 0.69) living in urban areas, as compared to low-income families, low-educated parents, and rural residence, respectively. Conclusion: The risk of overweight and obesity was increased in children with low SEP or rural residence. Administrative registers are a valid approach to monitor childhood obesity by parents' SEP.

Independent and Joined Association between Socioeconomic Indicators and Pediatric Obesity in Spain: The PASOS Study

Childhood obesity is a public health problem worldwide. An important determinant of child and adolescent obesity is socioeconomic status (SES). However, the magnitude of the impact of different SES indicators on pediatric obesity on the Spanish population scale is unclear. The aim of this study was to assess the association between three SES indicators and obesity in a nationwide, representative sample of Spanish children and adolescents. A total of 2791 boys and girls aged 8 to 16 years old were included. Their weight, height, and waist circumference were measured. SES was assessed using two parent/legal guardian self-reported indicators (educational level -University/non-University- and labor market status -Employed/Unemployed-). As a third SES indicator, the annual mean income per person was obtained from the census section where the participating schools were located (≥12.731€/<12.731€). The prevalence of obesity, severe obesity, and abdominal obesity was 11.5%, 1.4%, and 22.3%, respectively. Logistic regression models showed an inverse association of both education and labor market status with obesity, severe obesity, and abdominal obesity (all p < 0.001). Income was also inversely associated with obesity (p < 0.01) and abdominal obesity (p < 0.001). Finally, the highest composite SES category (University/Employed/≥12.731€ n = 517) showed a robust and inverse association with obesity (OR = 0.28; 95% CI: 0.16-0.48), severe obesity (OR = 0.20; 95% CI: 0.05-0.81), and abdominal obesity (OR = 0.36; 95% CI: 0.23-0.54) in comparison with the lowest composite SES category (Less than University/Unemployed/<12.731€; n = 164). No significant interaction between composite SES categories and age and gender was found. SES is strongly associated with pediatric obesity in Spain.

Association of socioeconomic position and childhood obesity in Finland: a registry-based study

OBJECTIVE

To identify what dimensions of socioeconomic position (SEP) are most closely associated with childhood obesity in Finland, leveraging population-wide data among the whole child population aged 2-17 years in Finland.

DESIGN

Registry-based study.

SETTING

Data from several administrative registries linked on individual level covering the whole of Finland were used. Data on height and weight measurements in 2018 were obtained from the Register of Primary Health Care visits and data on sociodemographic and socioeconomic indicators (2014-2018) from Statistics Finland.

PARTICIPANTS

Children aged 2-17 years with valid height and weight measurements performed at the child health clinic or school healthcare in 2018 (final n=194 423).

MAIN OUTCOME MEASURES

Obesity was defined according to WHO Growth Reference curves. Sociodemographic and socioeconomic indicators were linked on individual level for adults (both parents) who lived in the same household (42 predictors). Boosted regression model was used to analyse the contribution of SEP to obesity.

RESULTS

From socioeconomic indicators, annual household income (12.6%) and mother and father's educational level (12.6% and 8.1%, respectively) had the highest relative influence on obesity risk. The relative influence of a child's sex was 7.7%.

CONCLUSIONS

The parents' SEP was inversely associated with obesity among the offspring. A remarkable number of objective SEP indicators were analysed with parents' education and household income finally being the indicators most strongly associated with obesity among children. In future research, more attention should be paid to reliable and objective ways of measuring educational status and income rather than on developing new SEP indicators. Administrative registries with information on both healthcare and socioeconomic indicators can in future provide better opportunities to assess the influence of SEP on various health risks.

Neighborhood Food Environment and Children's BMI: A New Framework with Structural Equation Modeling

The relationship between neighborhood food environment and childhood obesity is complex and not yet well defined by current research in China, especially when considering the integrated effects with other relative factors. The main purpose of this article is to introduce a framework of children's weight status, based on their neighborhood food environment, and to identify the impact of food environment on the children's BMI and potential pathways. The participants of this cross-sectional study were students aged 8-16.5 years old and their parents. Two conceptual frameworks were tested using the structural equation modeling method, and two models were extracted. Model B added the neighborhood food environment based on model A. By comparing the two models, the neighborhood environment was potentially correlated with the children's BMI directly and may have a positive impact on unhealthy-food eating behaviors, which were positively associated with the children's BMI. The results suggest that the focus should be placed on the integrated effects of the potential risk factors of childhood obesity, based on considering the neighborhood food environment, which may relate to children's unhealthy-food eating behaviors and weight status.

The Impact of Obesity on the Fitness Performance of School-Aged Children Living in Rural Areas-The West Attica Project

This study aimed to investigate the relationship of body mass index (BMI) with muscle and cardiorespiratory fitness in children living within rural areas (regional unit of West Attica) in Greece. Participants included 399 students (187 boys, 212 girls), ages 8-12 years old, and were evaluated in physical performance tests. The point prevalence of overweight and obesity was 21.39% and 26.20% in boys, and 19.90% and 23.79% in girls. Significant differences were observed in all physical performance tests (handgrip, long jump, shuttle run, trunk flexors, and extensors endurance) between normal weight and obese participants. BMI was positively correlated with handgrip (r = 0.442-0.462, p < 0.001). There was a negative association with long jump (r = -0.206, p < 0.001), 20 m shuttle run (r = -0.394, p < 0.001), trunk flexors (r = -0.403, p < 0.001) and trunk extensors endurance (r = -0.280, p < 0.001). The regression analysis showed that 20-30% of the overall variation for physical performance assessments could be accounted for by BMI, age, and sex. With the exception of the long jump and the endurance of the trunk extensors, BMI alone may explain more than 10% of the outcome of most tests. This study highlights the determinant of BMI on muscle and cardiorespiratory fitness. The management of obesity should begin early in childhood to prevent adult chronic cardiovascular and metabolic diseases.