Factors associated with childhood obesity in Spain. The OBICE study: a case–control study based on sentinel networks

Sociocultural differences in the development of obesity in adolescents in Murcia

BACKGROUND

Childhood obesity presents alarming numbers in our country, being even higher in the population of immigrant origin. The main objective was to analyse the excess weight numbers both in native adolescents and in those children of immigrants and to determine the ethnic influence on lifestyle habits that could condition these differences in weight overload.

METHODS

Adolescents from 1st year of Obligatory Secondary Education (E.S.O.) participated; somatometry was determined and classified according to BMI (with WHO references) and parental origin. Parents completed the survey on healthy habits (ENHASA). An analysis of variance was performed for each of the 4 dimensions of the questionnaire.

RESULTS

A total of 416 adolescents participated (12.8±0.62 years). Excess weight was detected in 41.2% of the participants, with significant differences between groups (p 0.018): 36.7% in Spanish, 42.9% in North Africa and 58.2% in South America. The ANOVA analysis showed differences in the section "physical activity" (p 0.003), highlighting the maximum disparity in the performance of extracurricular sports activities, with a lower score in both non-native groups.

CONCLUSION

We found significant differences according to ethnic origin in the number of overweight children and the amount of physical activity they do; South American adolescents are the most sedentary. We must design interventions that guarantee the access of all adolescents to sports activities to prevent the development of obesity.

School Menu Review Programme (PReME): evaluation of compliance with dietary recommendations during the period 2006-2020 in Catalonia

BACKGROUND

The School Menu Review Programme (PReME) has been offering complimentary revisions of meal plans to all schools in Catalonia since 2006. This study aims to assess the evolution of compliance with PReME's recommendations in the meals provided by school cafeterias in Catalonia during the period 2006-2020.

METHODS

Pre-post study with a sample of 6,387 meal plans from 2221 schools assessed during the period. The information was collected mainly by public health specialists within the annual technical and sanitary inspection of school kitchens and cafeterias. Meal plans were evaluated by Dietitian-Nutritionists team according to the criteria of the National Health System's "Consensus document on nutrition in schools" and the Public Health Agency of Catalonia's current guide "Healthy eating at school". Reports were sent to each participating school. A few months later, a new meal plan and another questionnaire were collected and evaluated in comparison with the first meal plan. Compliance with the recommendations was analysed based on the type of canteen management and the school category.

RESULTS

Compliance improved during the study period. The percentage of schools that complied with dietary recommendations in relation to the five PReME indicators (fresh fruit, pulses, daily vegetables, fresh food and olive oil for dressing) has steadily increased since PReME began, (over 70% in all indictors; p =  < 0.001), with variations depending on school category and cafeteria management. Furthermore, an improvement in the levels of compliance with de recommended food frequencies was observed. with statistically significant differences for all items (p < 0.001), except for pulses whose compliance had been high since the beginning of the study (p = 0.216).

CONCLUSIONS

The positive evolution in compliance with PReME's recommendations provides evidence of the programme's effectiveness, with an improvement in the quality of school meals delivered in Catalonia.

Genetic, environmental and life-style factors associated with longevity. Protocol and response of the LONGECYL Study

OBJECTIVE

To describe the objectives, the methodological approach, the response rate of the Genetic, Environmental and Life-style Factors Study in Castilla y León (Spain).

METHOD

The Health Sentinel Network studied a sample of long-lived individuals aged 95 or more (LLI). The study included biological samples processed with the Global Screening Array v3.0 that contains a total of 730,059 markers. Written consent was obtained before the examination.

CONCLUSIONS

The LLI contacted were 944, and 760 were completed studied. The 87.4% of LLI were born in Castile and Leon and only 1% were non-native of Spain. Severe cognitive impairment was declared in 8.1% of men and 19.2% of women. Genotyping was performed in 739 LLI, the 78.3% of the contacted sample. Family doctors and nurses achieve high participation in population-based studies. DNA samples were taken from 94% of fully studied LLI, and 100% of these samples where successfully genotyped.

Gender differences in the development of childhood obesity in young teenagers in Murcia, Spain

BACKGROUND

The number of overweight children is increasing at an alarming rate. This issue requires effective action plans, as childhood obesity has become a problem in which addressing environmental factors is decisive. Significant differences have also been shown in lifestyle habits that determine overweight based on sex. This study therefore aimed to examine these risk factors according to sex.

METHODS

The sample included first-year high school students from Murcia, Spain. Information was collected through the "Questionnaire on Healthy Habits in Adolescents," validated for this age range, and the weight, height, and waist circumference of the participants were obtained. Data were analyzed through partial least squares structural equation modeling to determine which modifiable risk factors promoted the appearance of excess weight and in what magnitude.

RESULTS

A total of 421 students participated in the study, and 40.6% of overweight patients were detected according to their body mass index. No differences were found between the sexes and weights. The environment and the use of new technologies that do not involve sitting were significant only in girls (P < 0.05). Conversely, physical activity was significantly higher in boys (P < 0.05). Dietary factors and sedentary activities did not differ according to sex.

CONCLUSIONS

The social and school environment, the use of new technologies (for girls), and physical activity (for boys) condition nutritional status. Identifying gender disparities in behaviors that involve health should be a priority for new prevention programs. Targeting young people's health from a gender perspective has considerable potential to reduce overweight problems in adulthood.

Role of Dietary Factors, Food Habits, and Lifestyle in Childhood Obesity Development: A Position Paper From the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition

ABSTRACT

Childhood obesity has high societal and economic impact but current treatment approaches are sub-optimal. In the last decade, important studies have been conducted aiming to identify strategies to prevent obesity during critical periods of life. Updated recommendations for childhood obesity prevention are needed. We present data from systematic reviews and meta- analysis, randomised controlled trials (RCTs) and large observational studies, published from 2011 onwards that consider the possible role of the following factors in obesity development: breast-feeding; macronutrient composition and method of complementary feeding; parenting style; dietary patterns; sugar-sweetened beverage consumption; eating behaviour (eg, skipping breakfast, family dinners. etc); meal frequency and composition (fast foods, snacking), portion size; dietary modulators of gut microbiota (including pre-, pro-, and synbiotics); physical activity and sedentary behaviour. We used the Medline database and the Cochrane Library to search for relevant publications. Important research gaps were also identified. This position paper provides recommendations on dietary factors, food habits, and lifestyle to prevent childhood obesity development, based on the available literature and expert opinion. Clinical research and high-quality trials are urgently needed to resolve numerous areas of uncertainty.

Frequent use of selected sugary products associates with thinness, but not overweight during preadolescence: a cross-sectional study

Convincing evidence suggests that diets laden with added sugar, specifically sugar-sweetened beverages, associate with excess weight in children. The relationships between sugar consumption frequency and BMI remain less well studied. We, therefore, evaluated children's consumption frequency of selected sugary products (n 8461; mean age 11·1 (sd 0·9) years) selected from the Finnish Health in Teens cohort study. Using a sixteen-item FFQ including six sugary products (chocolate/sweets, biscuits/cookies, ice cream, sweet pastry, sugary juice drinks and sugary soft drinks), we calculated a Sweet Treat Index (STI) for the frequency of weekly sugary product consumption and categorised children based on quartiles (Q) into low (Q1, cut-off < 4·0), medium (Q2 + Q3, range 4·0-10·5) and high STI (Q4, cut-off > 10·5), and as thin, normal and overweight/obese based on the measured BMI. Through multinomial logistic regression analyses, we found that subjects with a high STI exhibited a higher risk of being thin (OR 1·20, 95 % CI 1·02, 1·41) and lower risk of being overweight (OR 0·79, 95 % CI 0·67, 0·92), while subjects with a low STI were at higher risk of being overweight (OR 1·32, 95 % CI 1·14, 1·53). High consumption frequencies of salty snacks, pizza and hamburgers most closely were associated with a high STI. Our findings suggest that consuming sugary products at a high frequency does not associate with being overweight. The relationship between a low consumption frequency and being overweight suggests that overweight children's consumption frequency of sugary products may be controlled, restricted or underreported.

Breakfast consumption and adiposity among children and adolescents: an updated review of the literature

BACKGROUND

Breakfast consumption has been associated with reduced risk of overweight and obesity among children, but previous evidence reviews fail to confirm a causal relationship.

OBJECTIVES

To review recent literature on breakfast consumption and adiposity among children and discuss potential underlying mechanisms.

METHODS

A comprehensive literature search of studies published since the 2010 US National Evidence Library review (January 2010-January 2015) was conducted.

RESULTS

Twelve studies met inclusion criteria. All were conducted in industrialized countries: six in Europe, four in the USA, one in China and one in Australia. Ten of the studies used observational longitudinal designs, with follow-up periods ranging from 1 to 27 years (median: 3, mean: 7.4); of these, eight reported inverse associations between breakfast consumption and excess adiposity, while two found no association. The other studies (1 case-control, 1 experimental) each reported a protective effect of breakfast consumption on overweight and obesity among children.

CONCLUSIONS

Findings corroborate results from previous reviews, adding support for a possible, protective role for breakfast consumption in preventing excess adiposity during childhood and adolescence. However, drawing a causal conclusion from the collective evidence is curtailed by methodological limitations and inconsistencies, including study design, follow-up duration and frequency, exposure and outcome assessment, as well as limited consideration of confounding, mediating and effect-modifying variables. More rigorous study designs employing valid and standardized measurement of relevant variables are needed.

Recent studies of the effects of sugars on brain systems involved in energy balance and reward: Relevance to low calorie sweeteners

The alarmingly high rates of overweight and obesity pose a serious global health threat. Numerous factors can result in weight gain, one of which is excess consumption of caloric sweeteners. In an effort to aid weight loss efforts, many people have switched from caloric sweeteners to low calorie sweeteners, which provide sweet taste without the accompanying calories. In this review, we present an overview of the animal literature produced in the last 5years highlighting the effects of sugar consumption on neural pathways involved in energy balance regulation and reward processing. We also examine the latest evidence that is beginning to elucidate the effects of low calorie sweeteners on these neural pathways, as well as how homeostatic and hedonic systems interact in response to, or to influence, sugar consumption.

Desire for Sweet Taste Unchanged After Eating: Evidence of a Dessert Mentality?

BACKGROUND/OBJECTIVES

Added sugars provide calories and desirability to foods and beverages. Our aim was to test whether desire for a sweet taste would be better maintained than a desire for other tastes for 3 hours after a test meal.

METHODS

Eighty-three young adults ate 2 slices of bread on 2 separate occasions after which they were asked to rate their desire for savory, sweet, fatty, or salty tastes and to specify the number of servings of white rice, pizza, cheese and crackers, sweet biscuits, and pasta they could consume. Desirability was assessed using 100-mm visual analog scales (VAS), with 0 mm representing no desire and 100 mm great desire.

RESULTS

When participants provided a quantitative assessment of the servings of foods that they wanted to eat following the bread meal, desire decreased on average for all foods measured, χ² (3) = 2.63, p = 0.452. Mean (95% confidence interval [CI]) change in VAS taste desirability 30 minutes after eating declined for salty (14.5 mm [10.5, 18.6]), fatty (11.2 mm [7.1, 15.2]), and savory (24.1 mm [19.7, 28.5]) tastes (p < 0.001). Desirability for sweet taste did not differ from baseline (2.4 mm [-2.3, 7.1]), and this level of desire was maintained throughout the 3-hour period.

CONCLUSIONS

The data indicate a partial disconnection between appetite and desirability for sweet taste. Physiological and psychosocial reward systems may make it difficult for people to resist sweet tasting foods and beverages. Targeting familial and cultural practices that discourage the consumption of added sugar foods might be useful to combat desire-driven food intake.

Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update

This systematic review is an update examining the relationships between objectively and subjectively measured sedentary behaviour and health indicators in children and youth aged 5–17 years. EMBASE, PsycINFO, and Medline were searched in December 2014, and date limits were imposed (≥February 2010). Included studies were peer-reviewed and met the a priori-determined population (apparently healthy children and youth, mean age: 5–17 years), intervention (durations, patterns, and types of sedentary behaviours), comparator (various durations, patterns, and types of sedentary behaviours), and outcome (critical: body composition, metabolic syndrome/cardiovascular disease risk factors, behavioural conduct/pro-social behaviour, academic achievement; important: fitness, self-esteem) study criteria. Quality of evidence by outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework. Due to heterogeneity, a narrative analysis was conducted. A total of 235 studies (194 unique samples) were included representing 1 657 064 unique participants from 71 different countries. Higher durations/frequencies of screen time and television (TV) viewing were associated with unfavourable body composition. Higher duration/frequency of TV viewing was also associated with higher clustered cardiometabolic risk scores. Higher durations of TV viewing and video game use were associated with unfavourable behavioural conduct/pro-social behaviour. Higher durations of reading and doing homework were associated with higher academic achievement. Higher duration of screen time was associated with lower fitness. Higher durations of screen time and computer use were associated with lower self-esteem. Evidence ranged from “very low” to “moderate” quality. Higher quality studies using reliable and valid sedentary behaviour measures should confirm this largely observational evidence.

Dietary intake and meal frequency of Brazilian girls attending a school-based randomized controlled trial

Purpose

– This paper aims to evaluate the effects of a school-based obesity prevention program targeting Brazilian adolescent girls on dietary intake and meal frequency.

Design/methodology/approach

– It was a six-month school-based group randomized controlled trial with female adolescents. The intervention was based on the Social Cognitive Theory and focused on ten nutrition and physical activity key messages. Diet intake was measured using a validated food frequency questionnaire, and the food items were aggregate into the eight food groups of the Brazilian Food Guide Pyramid. The meals frequency assessed were breakfast, lunch, dinner and snack-in-between-meals, the frequency ranged from never to everyday. Linear mixed models were used to examine the dietary effects and chi-squared test to identify proportional differences among groups in meal frequency. All analyses followed intention-to-treat principles and alpha levels of p ≤ 0.05 were set.

Findings

– After six months from baseline, changes in the fruits (mean [SE] 12.48 kcal [7.86], p = 0.005), vegetables (8.80 kcal [7.11], p = 0.006) and sugar (−55.98 kcal [50.70], p = 0.036) groups were demonstrated. Proportional difference was shown for snack-in-between-meals (p = 0.001), and the frequency most cited was for “five to six days” per week.

Originality/value

– The “Healthy Habits, Healthy Girls-Brazil” showed promise in the adolescents’ dietary intake and could be used as framework for future interventions. Also, the methods used for dietary intake can be enhanced and implemented for future studies.

Social, dietary and lifestyle factors associated with obesity among Bahraini adolescents

The main purpose of this study was to explore some of the social, dietary and lifestyle factors that could be related to the risk of obesity among adolescents in Bahrain. A multistage stratified method was used to select secondary school students (15-18years old) from governmental schools in Bahrain. The total sample selected was 735 (339 males and 396 females). A pre-validated self-report questionnaire was used to obtain information on socio-demographics, food and the lifestyle habits of adolescents. Weight and height were taken and percentiles of Body Mass Index for age and gender were used to classify the adolescents as non-obese and obese (overweight and obese), using NHANES-1 growth standard. In general, the prevalence of overweight and obesity was 29.5% and 36.8% among males and females, respectively. The risk of obesity was not consistent among male and female adolescents. Mothers' education was found to be a risk factor for obesity among both males and females (p=0.0167 and p=0.007, respectively). Bringing food from home to school (odds ratio (OR)=0.54, confidence interval (CI) 0.35-0.81) was protective factor for obesity among females but not among males. Fathers' education (p=0.0167), rank among siblings (p=0.009), place where breakfast is eaten (p=0.0398), eating between lunch and dinner (p=0.0152), fruit intake (p=0.042), sweet intake (p=0.0192), size of burger (p=0.002) and hours of watching television per day (p=0.004) were significantly associated with the risk of obesity among males, but not among females. Various social, dietary and lifestyle factors were found to contribute to obesity among adolescents in Bahrain. These factors should be considered in school health policy in the country.

Does low birth weight predict hypertension and obesity in schoolchildren?

BACKGROUND

Birth weight appears to play a role in determining high blood pressure (BP) and obesity during childhood. The purpose of this study is to investigate the association between birth weight and later obesity and hypertension among 10- to 13-year-old schoolchildren.

METHODS

A total of 1,184 primary school students were selected from 20 randomized schools between 2011 and 2012 in Iran. Height, weight, waist circumference and BP were measured using standard instruments. Data were analyzed using stepwise regression and logistic regression models.

RESULTS

13.5% of children had a history of low birth weight. First-degree family history of obesity, excessive gestational weight gain and birth weight were significantly correlated with overweight/obesity and abdominal obesity (p = 0.001), whereas only birth weight was associated with high BP (p = 0.001). An inverse correlation was found between waist circumference and systolic/diastolic BP. The duration of breastfeeding in children with low birth weight was inversely correlated with obesity/overweight, abdominal obesity and hypertension.

CONCLUSION

The results suggests that birth weight is inversely associated with BP and more so with obesity and abdominal obesity. The duration of having been breastfed could have an influence on later hypertension, obesity and abdominal obesity. Further results are needed to test these correlations as well as diagnosing early life factors to prevent young adult overweight/obesity or hypertension.

Diet–obesity associations in children: approaches to counteract attenuation caused by misreporting

Objective

Measurement errors in dietary data lead to attenuated estimates of associations between dietary exposures and health outcomes. The present study aimed to compare and evaluate different approaches of handling implausible reports by exemplary analysis of the association between dietary intakes (total energy, soft drinks, fruits/vegetables) and overweight/obesity in children.

Design

Cross-sectional multicentre study.

Setting

Kindergartens/schools from eight European countries participating in the IDEFICS Study.

Subjects

Children (n 5357) aged 2–9 years who provided one 24 h dietary recall and complete covariate information.

Results

The 24 h recalls were classified into three reporting groups according to adapted Goldberg cut-offs: under-report, plausible report or over-report. In the basic logistic multilevel model (adjusted for age and sex, including study centre as random effect), the dietary exposures showed no significant association with overweight/obesity (energy intake: OR=0·996 (95 % CI 0·983, 1·010); soft drinks: OR = 0·999 (95 % CI 0·986, 1·013)) and revealed even a positive association for fruits/vegetables (OR = 1·009 (95 % CI 1·001, 1·018)). When adding the reporting group (dummy variables) and a propensity score for misreporting as adjustment terms, associations became significant for energy intake as well as soft drinks (energy: OR = 1·074 (95 % CI 1·053, 1·096); soft drinks: OR = 1·015 (95 % CI 1·000, 1·031)) and the association between fruits/vegetables and overweight/obesity pointed to the reverse direction compared with the basic model (OR = 0·993 (95 % CI 0·984, 1·002)).

Conclusions

Associations between dietary exposures and health outcomes are strongly affected or even masked by measurement errors. In the present analysis consideration of the reporting group and inclusion of a propensity score for misreporting turned out to be useful tools to counteract attenuation of effect estimates.