Maternal employment and childhood overweight in low- and middle-income countries

Maternal long working hours and offspring's weight-related outcomes: A systematic review and meta-analysis

It is unclear whether maternal working time has an impact on offspring's weight-related outcomes especially obesity; the objective of this study is to conduct the first meta-analysis to focus on this topic. We searched PubMed, Ovid, and Web of Science databases through August 2021. A random-effect model was used to assess the pooled odds ratios (ORs) and regression coefficients (β) with their corresponding 95% confidence intervals (95% CIs). Subgroup analyses were conducted to explore sources of heterogeneity. Publication bias was evaluated by the Egger's tests. Twenty-two observational studies were included with a total of 191,420 participants. Compared with children whose mothers worked less than 35 h/week, we found that children whose mothers worked more than 35 to 40 h/week had a 2.24-fold increased risk of childhood overweight/obesity (OR = 2.24, 95% CI: 1.61-3.11). An increment of 10 h/week in maternal working was associated with an approximately 1.0 percentage points in the probability of childhood overweight/obesity (β = 0.008, 95% CI: 0.004-0.012). The pooled OR also indicated a similar result (OR = 1.09, 95% CI: 1.04-1.15). In addition, an increment of 10 h/week in maternal working was associated with 0.029 units increase in offspring's BMI z score (β = 0.029, 95% CI: 0.016-0.042). Maternal long working hours is a potential risk factor for offspring's weight-related outcomes. Measures should be taken to protect the work welfare of females, thus facilitating the positive interaction of individual-family-society.

Risk Factors for Overweight and Obesity within the Home Environment of Preschool Children in Sub-Saharan Africa: A Systematic Review

Sub-Saharan Africa (SSA) is experiencing an increasing prevalence of young children being overweight and obese. Many feeding and physical activity-related behaviours are established at home during preschool years, yet the precise factors that contribute to preschool overweight and obesity have not been fully elucidated. This review aims to identify factors in the home environment associated with overweight and or obesity in preschool children in SSA. Ovid MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, Africa Journals Online (AJOL) and the African Index Medicus databases were systematically searched for qualitative and quantitative studies published between 2000 and 2021. Eleven studies (ten quantitative, one qualitative) met the inclusion criteria. Overall, the results highlight the paucity of studies exploring factors in the home environment associated with overweight and obesity in preschool children in Sub-Saharan Africa. The home food environment and maternal BMI appear to be important factors associated with overweight and obesity in preschool children; however, the information for all other factors explored remains unclear due to the lack of evidence. For successful obesity prevention and treatment interventions to be developed, more research in this area is required to understand how different aspects of the home environment contribute to overweight and obesity in preschool Sub-Saharan African children.

Development and validation of a food frequency questionnaire for children aged 7 to 10 years

ABSTRACT Objective Food and nutritional evaluation of children can support public policies to combat early overweight and obesity. This study developed and validated a quantitative food frequency questionnaire for assessing the dietary intake of children. Methods This is a cross-sectional study of the development of a food frequency questionnaire for 130 children of both genders aged 7 to 10 years old. For the food frequency questionnaire list, 81 food items were selected. The validity of the food frequency questionnaire was evaluated by comparison with 24-hour recalls and reproducibility was performed by comparing two food frequency questionnaires. Results Most of the foods with 95% relative contribution were ultra-processed, such as packaged snacks and powdered juice. In validation, correlation coefficients were found between 0.45 (p<0.000) for lipids and 0.37 (p<0.000) for carbohydrates. An adjustment for energy reduced the correlations, but there was an increase in the correlation in calcium (r=0.75) and retinol (r=0.20). In terms of reproducibility, all macronutrients and calcium showed a satisfactory intraclass correlation coefficient (>0.400) and moderate correlations [proteins (0.54; p<0.000) and lipids (0.41; p<0.000)]. Conclusion The food frequency questionnaire developed was valid and able to assess the local food consumption by children from northeastern Brazil.

Preschoolers' and Mothers Dietary Practices and Compliance with the 24-h Movement Guidelines: Results of Oman's National Nutrition Survey

Introduction: Little is known on the nutritional and lifestyle variables of preschool children in Oman. This study analyzed data of the 2017 Oman National Nutrition Survey to assess the prevalence and interrelationships between dietary and movement variables among preschool children, aged 2–5 years. Methods: Household visits of a nationally representative sample evaluated mothers and children’s dietary, sleep and physical activity practices; media exposure; and anthropometric and sociodemographic variables. Results: Dyads of mothers and pre-school children aged 2–5 years (n = 1771) were assessed. Childhood overweight/obesity was prevalent in 2% of the sample. Over 54% of children consumed sweetened items and/or French fries or chips at least once daily. Over 65% of children had fruits and/or vegetables once daily or less. Mothers had healthier dietary and movement habits compared to their offspring. Compliance with media exposure was the lowest among mothers and children. Multivariate regression revealed children’s increased sweet intake was the only significant predictor of excess weight in children. Conclusion: This study revealed a low prevalence of overweight/obesity among preschool children in Oman. Children had an acceptable compliance with sleeping recommendations, yet limited adherence to media exposure, activity, added sugar and fruits and vegetables guidelines.

Traditional Societal Practices Can Avert Poor Dietary Habits and Reduce Obesity Risk in Preschool Children of Mothers with Low Socioeconomic Status and Unemployment

Healthy nutritional habits are of vital importance for good health and quality of life for all individuals in all life stages. Nutritional habits shaped in early childhood set the foundation for future dietary practices applied through lifespan, hence informing risk towards chronic diseases. A key contributor to child health is maternal impact. A healthy childhood status translates into increased lifespan, health, and life-quality, as well as better family and social interactions and improved academic performance. These conditions can contribute to a healthier and more vibrant workforce, and thus extend positive impact on the economic and overall development of a country. Evidence related to maternal impact on childhood dietary habits is limited in Turkey, an emerging economy with notable disparities and a significant segment (approximately one third) of its 83 million population under the age of 30. Hence, the aim of this study was to investigate the relationship between the socioeconomic status (SES) of mothers on the dietary habits of their preschool children. A pilot cross-sectional observational study was conducted involving the mothers of 109 preschool children aged 4-6 years. Data on the nutritional status of children were collected through a food frequency questionnaire and a 24-h recall interview, while sociodemographic information was also collected, and statistical analyses conducted. An unexpected finding regarding the lack of association between the socioeconomic and employment status of mothers and the nutritional intakes of their children was observed. Interestingly, it appears that more traditional societal and nutritional practices typically undertaken in the case of lower SES, especially in more traditional settings like the case of Turkey, appear to extend a protective effect as per the nutritional habits and ensuing obesity risk in the case of children of women with lower SES. Another way to interpret our finding is that the difference in education and SES is not adequate to produce a significant effect in terms of children dietary intake. This is an interesting finding that warrants further study. Additionally, such studies serve to increase awareness about the importance of healthy nutritional practices in preschool children and the critical role of the mother on their nutritional status, particularly in the Turkish idiosyncratic setting.

Social vulnerabilities as risk factor of childhood obesity development and their role in prevention programs

INTRODUCTION

Large socioeconomic, gender, and ethnic inequalities exist in terms of childhood obesity worldwide. Children from low socioeconomic status families are more likely to have overweight/obesity and related cardiometabolic problems and future cancer risk. A wider concept are social vulnerabilities defined as social or economic characteristics or experiences negatively affecting children through behavioral, biological factors, or mental health. Social vulnerabilities include also therefore low subjective perceptions of social position.

OBJECTIVE

This study aims to identify social vulnerabilities and to summarize their impact as obesity development risk factor. Preventive programs implemented targeting these vulnerable groups and their effectiveness are also discussed.

METHODS

Literature review based on the experience of the authors social vulnerabilities identified as risk factors for childhood obesity were children whose parents lack of a social network, low support from formal and informal sources, parental unemployment, belonging to a minority group or having migrant background, adverse childhood experiences including household dysfunction, violence and childhood maltreatment and other traumatic experiences, gender inequalities and being part of nontraditional families.

RESULTS

The impact of social vulnerabilities on childhood obesity is independent of SES; however, SES exacerbates or buffer the effect social vulnerabilities have on different lifestyles and stress. Behavioral, biological, and mental health mechanisms may explain the association between social vulnerabilities and childhood obesity.

CONCLUSIONS

Behaviors such as dietary intake, physical activity, sedentary behaviors, and sleep are negatively affected by the stress and low levels of mental health derived from social vulnerabilities. It seems that high energy intakes rather than low physical activity levels might be the main driving force behind the obesity epidemic in vulnerable groups. Most of the prevention programs identified did not take into account social vulnerabilities and inequalities making them ineffective in most vulnerable groups. Interventions conducted in children from socially vulnerable group suggest modest but promising effects.

Factors associated with dropout in a lifestyle modification program for weight management in children and adolescents

BACKGROUND

Significant dropout rates remain a serious concern in pediatric weight control program, but few studies have identified predictors of dropout.

AIMS

The objective of the study is to identify factors associated with dropout from a pediatric lifestyle modification weight control program at different phases.

METHODS

Data on overweight and obese participants (n = 242) aged 11-18 years in the Intervention for Childhood and Adolescent Obesity via Activity and Nutrition (ICAAN) study were collected at baseline, 6-months, and 24-months through self-report and a laboratory test. Logistic regression analysis was performed for those who dropped out during the first 6-months, and multivariate generalized estimating equation analysis identified longitudinal factors associated with those who dropped out after 24 months.

RESULTS

Lower family functioning (OR = 2.30, 95% CI [1.18-4.46]), exercise group (OR = 0.36, 95% CI [0.15-0.86]), lower initial attendance rate (OR = 6.09, 95% CI [2.94-12.6]), and non-self -referral pathways (OR = 2.35, 95% CI [1.05-5.27]) were significantly associated with 6-month dropouts. For late dropout, lower family functioning (OR = 1.71, 95% CI [1.06-2.77]) and lower initial attendance rates (OR = 2.06, 95% CI [1.12-3.81]) remained significant.

CONCLUSION

Family function and initial attendance rate were associated with lower dropout rates. Developing a supportive family environment and focusing on the early-stage factors at the intervention's outset may reduce overall dropout rates in obesity prevention intervention.

Rural-Urban Differences in Dietary Behavior and Obesity: Results of the Riskesdas Study in 10-18-Year-Old Indonesian Children and Adolescents

Obesity has become a significant problem for developing countries, including Indonesia. High duration of sedentary activity and high intake of unhealthy foods were associated with high risk of overweight and obesity. The objective of this study was to compare the distributions of sedentary activity and dietary behavior with overweight/obesity risks between urban and rural areas among children and adolescents aged 10-18 years in Indonesia. This is a cross-sectional study. Data from a national survey in 33 Indonesian provinces (Basic Health Research /Riskesdas 2013) were analyzed. Multiple logistic regression models were used to calculate the odds ratio (OR) adjusted with all variables, such as age, gender, residency, education level, physical activity, and food intake. An urban-rural residence difference was found in the factors related to obesity. Daily caffeinated soft drinks and energy drinks consumption (OR = 1.12, 95% CI: 1.01-1.23) were related to risk of overweight and obesity in urban areas. Daily grilled foods (OR = 1.32, 95% CI: 1.22-1.42) and salty food (OR = 1.09, 95% CI: 1.04-1.15) consumption were significantly associated with obesity in rural areas but not in urban areas. Furthermore, sedentary activity was correlated with overweight and obesity among those who lived in urban and rural areas. Our findings suggest that education, environmental, and policy interventions may need to specifically target urban settings, where access is high to a wide range of processed and traditional high-sugar, high-fat snack foods and beverages.

Socioeconomic status, perceptions and obesity among adolescents in Jordan

INTRODUCTION

Prevalence of obesity among adolescents constitutes a serious public health problem. We aimed to investigate the association between socioeconomic factors and obesity perceptions, and prevalence of overweight and obesity among school adolescents.

METHODS

A cross-sectional study that included students 12 to 17 years old participating from six schools that were randomly selected in Northern Jordan. Body mass index (BMI) measurements and interview questions were completed by trained researchers. A total of 701 were successfully involved in the analysis.

RESULTS

Students involved were 53.6% males and 46.4% females. Students with normal BMI had a mean BMI of 21.45 (+1.76). Those who were obese, or overweight were 202 (28.8%) students and had a BMI of 29.1 (+4.05). Family monthly income, mother's education and working status among other socioeconomic status factors were significantly associated with children's overweight or obesity. Perceptions about obesity including meal choices, interest in self body weight, considering someone in family as obese and instructions at school were statistically significant as well.

CONCLUSION

Family factors, adolescents' pocket money and perceptions about obesity were significant predictors of obesity among adolescents in Jordan. Effective intervention strategies should be implemented in schools and other primary care settings to reduce the relatively high prevalence of adolescent's obesity observed in this study.

Overweight in Indonesia: an observational study of trends and risk factors among adults and children

OBJECTIVE

To conduct a secondary data analysis detailing overweight prevalence and associations between key hypothesised determinants and overweight.

DESIGN

This observational study used publicly available data from the Indonesian Family Life Survey (IFLS) (1993-2014). The IFLS is a home-based survey of adults and children that collected data on household characteristics (size, physical infrastructure, assets, food expenditures), as well as on individual-level educational attainment, occupation type, smoking status and marital status. These analyses used data on the self-reported consumption of ultra-processed foods and physical activity. Anthropometrics were measured.

SETTING

Indonesia.

PRIMARY OUTCOME MEASURES

We described the distribution of overweight by gender among adults (body mass index (BMI) ≥25 kg/m2) and by age among children, over time. Overweight was defined as weight-for-height z-score >2 among children aged 0-5 years and as BMI-for-age z-score >1 among children aged 6-18 years. We also described individuals who were overweight by selected characteristics over time. Finally, we employed multivariable logistic regression models to investigate risk factors in relation to overweight in 2014.

RESULTS

One-third of adults were overweight in 2014. Between 1993 and 2014, the prevalence of overweight among adults doubled from 17.1% to 33.0%. The prevalence of overweight among children under 5 years increased from 4.2% to 9.4% between 1993 and 2007, but then remained relatively stagnant between 2007 and 2014. Among children aged 6-12 years and 13-18 years, the prevalence of overweight increased from 5.1% to 15.6% and from 7.1% to 14.1% between 1993 and 2014, respectively. Although overweight prevalence remains higher in urban areas, the increase in overweight prevalence was larger among rural (vs urban) residents, and by 2014, the proportions of overweight adults were evenly distributed in each wealth quintile. Data suggest that the consumption of ultra-processed foods was common and levels of physical activity have decreased over the last decade. In multivariable models, urban area residence, higher wealth, higher education and consumption of ultra-processed foods were associated with higher odds of overweight among most adults and children.

CONCLUSION

Urgent programme and policy action is needed to reduce and prevent overweight among all ages.