Child overweight in France and its relationship with physical activity, sedentary behaviour and socioeconomic status

Active video games and weight management in overweight children and adolescents-systematic review and meta-analysis

BACKGROUND

The prevalence of childhood obesity has been increasing for several decades. Active video games (AVG) may be an effective intervention to help manage this rising health crisis. The aim of this review is to evaluate whether AVG are effective at reducing weight or improving body composition in overweight youths.

METHOD

Medline, Embase, SportDiscus, ASSIA, CINAHL Plus, CENTRAL, CDSR and PsychINFO databases were searched for studies assessing quantitative or qualitative impact of AVG in overweight adolescents published in English. Three authors screened the results using inclusion/exclusion criteria.

RESULTS

A total of 12 studies met the inclusion criteria; 11 reported a significant decrease in at least one weight outcome. Results from seven randomized controlled trials were pooled by meta-analysis, which compared with controls subjects in AVG groups demonstrated greater body mass index (BMI) Z-score reduction (mean difference: -0.09 (-0.12, -0.05) I2 = 34%, P < 0.0001). The mean weight reduction (-2.66 Kg (-5.67, +0.35) I2 = 0%, P = 0.08) and BMI (-2.29 (-4.81, +0.22) I2 = 49%, P = 0.07) were greater in AVG groups but results did not reach statistical significance.

CONCLUSIONS

BMI Z-score was significantly reduced in the AVG group and the majority of included studies reported significant results in at least one weight outcome, suggesting AVG can be used to reduce weight or improve body composition in overweight youths. Further studies investigating the long-term sustainability of this change in body composition are needed.

The nutritional quality and contents of heavy elements due to thermal processing and storage in canned Thunnus tonggol fish change compared to fresh fish

The purpose of this study was to evaluate the nutritional quality and concentration of heavy and toxic metals in the fresh and canned tuna Thunnus tonggol at different storage periods. The content of iron, zinc, copper, mercury, and also macronutrient compounds in the Iranian fresh and canned tuna fish and the effects of thermal processing and subsequent storage on metal contents were evaluated using atomic absorption spectroscopy. The results showed that the levels of iron, zinc, copper, and mercury after the 6th, 9th, and 11th months of storage were 26.52, 10.83, 6.22, and 0.04 mg/kg, respectively. The concentrations of iron, zinc, copper, and mercury in the fresh fish were 11.03, 7.11, 1.71, and 0.03 mg/kg, respectively. The results of the statistical analysis of the samples showed that canning process and sterilization by autoclave increased the contents of elements except mercury to a significant level (p < .05). The results showed that the amount of fat significantly increased in all samples after storage (p < .05), but the ash and protein content significantly decreased (p < .05). The moisture content significantly increased (p < .05) except for the 9th month of storage. The obtained results showed that the energy value after 6 months of storage was the highest (297.53 kcal/100 g). The results showed that the bioaccumulation of copper, iron, zinc, and mercury in the fresh and canned muscles was lower than the standard concentration recommended by the FAO and WHO. This type of fish was a high-quality food source and it was safe after 11 months of storage and was suitable for human consumption. Therefore, the consumption of Iranian canned tuna can be safe for human health despite the possible contamination with heavy metals.

Prevalence of overweight, obesity, and early adiposity rebound in nursery school children in southeastern France

BACKGROUND

The aim of the present study was to assess the prevalence of overweight, obesity, and early adiposity rebound in nursery school children aged 3.5-4.5 years and to evaluate associations with deprivation.

METHODS

A cross-sectional study was conducted in the Bouches-du-Rhône department in southeastern France. Data for all nursery school children aged 3.5-4.5 years were collected during systematic medical examinations. The prevalence of overweight and obesity was determined using French, International Obesity Task Force (IOTF), and World Health Organization reference values. A French ecological deprivation index was used to assess associations with deprivation.

RESULTS

Among 19,295 children included in the study, the prevalence of overweight (IOTF-25 < BMI < IOTF-30) was 9.1% and the prevalence of obesity (BMI > IOTF-30) was 2.6%. Children attending nursery schools in the most disadvantaged areas were 4.3 times more likely to be affected by obesity than those from schools in the most advantaged areas (OR: 4.32; 95% CI: 2.98-6.25, p < 0.001), after adjusting for gender, age group, and school status. Early adiposity rebound was observed in 2131 of 9872 children (21.6%).

CONCLUSION

Programs to prevent childhood overweight and obesity in France should be intensified and take account of major persistent social inequalities. Medical practitioners should learn to systematically assess BMI curve dynamics and early adiposity rebound.

Physical activity level (PAL) and risk factors of cardiovascular disease in the MASHAD study cohort

BACKGROUND AND AIM

The relationship between physical activity levels (PAL) and the presence of cardiovascular disease (CVD) risk factors such as anthropometric and biochemical indices and heat shock proteins 27 antibody (anti-HSP-27) concentration, and serum inflammatory markers, was investigated in the MASHAD cohort study.

METHODS

The overall study population consisted of 9,684 subjects (3,858 men, 5,826 women) with a mean age of 47.73 ± 8.08 to 48.87 ± 9.26 years respectively. They were divided into four categories based on their PAL. Biochemical parameters were determined for all participants. Also, serum anti-HSP-27 levels were measured using an in-house enzyme-linked immune sorbent assay method. Multiple regression analysis was used to explore the association between the anti-HSP antibody titers and physical activity after adjusting for confounding factors. The level of statistical significance was set at p < 0.05.

RESULTS

Several CVD risk factors were associated with the level of PAL including: body mass index, waist hip ratio, systolic and diastolic blood pressure, serum HDL-C and TG (p < 0.001) and also fasting blood glucose (0.004). Also, serum anti-HSP-27 titers were significantly higher in inactive subjects (P > 0.05).

CONCLUSION

We found that PAL was significantly associated with several established CVD risk factors. Also, the level of anti-HSP-27 was lower in individuals with moderate and high PAL.

Associations Between Household Socioeconomic Status, Car Ownership, Physical Activity, and Cardiorespiratory Fitness in South African Primary Schoolchildren Living in Marginalized Communities

BACKGROUND

Little is known whether physical activity (PA)-promoting environments are equally accessible to children with divergent socioeconomic status (SES) in low-/middle-income countries. The authors, therefore, examined whether South African children from poorer versus wealthier families living in marginalized communities differed in moderate to vigorous PA and cardiorespiratory fitness. We also tested associations between family car ownership and PA/cardiorespiratory fitness.

METHODS

Parents/guardians of 908 children (49% girls, mean age = 8.3 [1.4] y) completed a survey on household SES. PA was assessed via 7-day accelerometry, parental and child self-reports, and cardiorespiratory fitness with the 20-m shuttle run test.

RESULTS

Based on accelerometry, most children met current moderate to vigorous PA recommendations (≥60 min/d). About 73% of the children did not engage in structured physical education lessons. Whereas children of the lowest SES quintile accumulated higher levels of device-based moderate to vigorous PA, peers from the highest SES quintile engaged in more sedentary behaviors, but self-reported higher engagement in sports, dance, and moving games after school. Families' car ownership was associated with higher parent/self-reported leisure-time PA.

CONCLUSIONS

A deeper understanding is needed about why wealthier children are more sedentary, but simultaneously engage in more leisure-time PA. The fact that access to structural physical education is denied to most children is critical and needs to be addressed.

The school playground environment as a driver of primary school children's physical activity behaviour: A direct observation case study

The school playground can promote PA for large numbers of children. This study identifies areas of the playground that children visited at break-times, the decisions according to gender and the influence of contextual and environmental variables on PA levels. The playground of a culturally diverse primary school was observed during morning break-times and lunchtimes. Counts of sedentary, LPA, and MVPA episodes, and the contexts in which they occurred were recorded using the system for observing play and leisure in youth (SOPLAY). Ball sports areas had higher counts of boys (mean ± SD; 9.9 ± 4.8) compared to girls (2.0 ± 3.5); areas promoting climbing and social interaction had higher counts of girls (7.9 ± 7.2) compared to boys (3.5 ± 2.9). The proportion of MVPA episodes during break-times was 34% ± 26%. Areas of the playground with organised activities had 2.70 (95%CI: 1.87 to 3.91) times higher MVPA counts than areas "not organised". Areas with "supervision" were associated with higher MVPA counts (1.34; 1.18 to 1.53) compared with "not supervised" areas. Organisation and supervision might influence PA choices and PA levels of children in the primary school playground. Further investigation is required to explore different playgrounds settings, and context and gender preferences.

SOCIOECONOMIC STATUS AND PHYSICAL ACTIVITY DURING ELEMENTARY SCHOOL STUDENT RECESS

ABSTRACT Introduction The association between socioeconomic status (SES) and the level of physical activity (PA) at school has not been studied at length. Objective To describe the association between SES and the intensity of physical activity during recess in elementary school children as well as the space dedicated to physical activity. Methods A total of 212 children (110 boys and 102 girls) who were enrolled in the fourth, fifth and sixth grade of elementary school at the time participated in this study. The subjects were divided into 4 levels according to the marginalization index (MI). The geographical location of the schools and the available area were calculated using Google Maps Pro (GMP) software.1 Physical activity level was measured using accelerometry.2 Comparisons of different levels of PA with respect to marginalization indices and sex were investigated using one-way analysis of variance. The association between health variables and PA was determined through the Pearson correlation coefficient. Results Results indicated that the level and intensity of PA during recess are associated with socioeconomic status and the social marginalization index, as well as sex, age, and infrastructure. Conclusion The higher the level of social marginalization, the lower the level of PA and the smaller the space dedicated to PA. Level of Evidence III; Comparative retrospective study.

Analysis of the Relationship between Sleep Duration and Body Mass Index among Korean Adolescents Using Data from the 2013-2015 Korea National Health and Nutrition Examination Survey

BACKGROUND

Obesity in adolescence can continue up to adulthood and lead to various complications. There has been a continuous increase in the obesity incidence among adolescents, which is an emerging social issue. Studies have reported that decreased sleep duration in adolescents can have negative effects on health, leading to obesity. Therefore, in the present study, we aimed to investigate the relationship between sleep duration and body mass index among South Korean middle and high school students aged 12-18 years.

METHODS

The participants of the Sixth National Health and Nutrition Survey conducted during 2013-2015 were screened. We selected 1,177 adolescents aged between 12 and 18 years who were enrolled in middle and high school or on leave of absence and had available data for sleep duration and body mass index (BMI) in the survey. Analyses of variance and covariance were performed after adjusting for confounding variables, including age, gender, waist circumference, and drinking experience, that showed significant correlations in univariate logistic regression.

RESULTS

The analysis of covariance revealed that an increase in sleep duration led to a corresponding decrease in the mean BMI among all students and middle school students.

CONCLUSION

Significant negative correlations were confirmed between sleep duration and BMI in all students and middle school students.

Socioeconomic Correlates of Sedentary Behavior in Adolescents: Systematic Review and Meta-Analysis

Background

The body of evidence on associations between socioeconomic status (SES) and sedentary behaviors in adolescents is growing.

Objectives

The overall aims of our study were to conduct a systematic review and meta-analysis of this evidence and to assess whether (1) the associations between SES and sedentary behavior are consistent in adolescents from low-middle-income and from high-income countries, (2) the associations vary by domain of sedentary behavior, and (3) the associations vary by SES measure.

Methods

We performed a systematic literature search to identify population-based studies that investigated the association between SES and sedentary behavior in adolescents (aged 10–19 years). Only studies that presented risk estimates were included. We conducted meta-analyses using random effects and univariate meta-regression and calculated pooled effect sizes (ES).

Results

Data from 39 studies were included; this provided 106 independent estimates for meta-analyses. Overall, there was an inverse association between SES and sedentary behavior (ES 0.89; 95 % confidence interval [CI] 0.81–0.98). However, the direction of the association varied: in high-income countries, SES was inversely associated with sedentary behavior (ES 0.67; 95 % CI 0.62–0.73), whereas in low-middle-income countries, there was a positive association between SES and sedentary behavior (ES 1.18; 95 % CI 1.04–1.34). In high-income countries, the associations were strongest for screen time (ES 0.68; 95 % CI 0.62–0.74) and television (TV) time (ES 0.58; 95 % CI 0.49–0.69), whereas in low-middle-income countries, the associations were strongest for ‘other’ screen time (i.e., computer, video, study time, but not including TV time) (ES 1.38; 95 % CI 1.07–1.79). All indicators of SES were negatively associated with sedentary behavior in high-income countries, but only resources (income and assets indexes) showed a significant positive association in low-middle-income countries.

Conclusion

The associations between SES and sedentary behavior are different in high- and low-middle-income countries, and vary by domain of sedentary behavior. These findings suggest that different approaches may be required when developing intervention strategies for reducing sedentary behavior in adolescents in different parts of the world.

Electronic supplementary material

The online version of this article (doi:10.1007/s40279-016-0555-4) contains supplementary material, which is available to authorized users.

Impact of Dietary, Socioeconomic, and Physical Factors on Obese and Overweight Schoolchildren Living in Sidi-Bel-Abbes (West of Algeria) and Ain Defla (Centre)

Background and aims: The aim of the current study was to assess the impact of environmental factors; food, socio-economic, and physical activity, on a group of obese children living in Ain-Defla (Center Algeria) and Sidi-Bel-Abbes (West Algeria).

Material and methods: The protocol was carried out on a cohort of 125 school children aged of 5 to 11 years, including 64 boys and 61 girls, and 139 school children, including 93 boys and 46 girls in Ain Defla and Sidi-Bel-Abbes respectively. Concerning the classification of obesity and overweight, we referred to the International Obesity Task Force and the French References' curves.

Results: Regarding dietary intake our results showed that 34% of students from both regions took their breakfast, compared to 66% who did not take. Furthermore, 73% of students skipped at least one meal, however 23% respected meals frequency i.e. 4 meals a day. Regarding socio-economic factors and physical activity, our findings showed that obesity rates were high (36%) among children whose fathers are workers. However, for mothers who are housewives, obesity increases among their children (88%). The relationship was reversed between the parents' education level and the Body Mass Index. We found an opposite relationship between Body Mass Index and physical activity, and investigated children use screen devices for long time periods.

Conclusions: Our study showed a positive relationship between obesity and overweight and environmental factors.

The frequency of overweight and obesity occurrence among Polish children (age 6–7 years) in relation to the place of residence, the education level of parents and the number children in the family

This study sought to evaluate the number of those overweight and the rate of obesity among 6- and 7-year-olds living in Poland with regard to their place of residence, the parental level of education and the number of children in the family. The analysis was based on a survey of 64 544 children (33 051 boys and 31 493 girls) living in Poland. Overweight and obesity were defined based on body mass index (BMI) using the IOTF cut-off points. To evaluate the rates of overweight and obesity occurrence in children with regard to family socio-economic status, parental level of education, the number of children in the family, and the place of residence (divided into city and village) was used. ‘Only children’ were the most likely group to be overweight or obese. These children were twice as likely to be obese as their peers living in families with four or more children. Overweight and obesity occurred more often amongst children living in cities rather than those living in rural areas. Moreover, these conditions were more frequent among children whose parents had higher levels of education. The most significant predictors of childhood overweight and obesity were the number of children in the family and the educational level of the mother

Systematic review of the relationships between sedentary behaviour and health indicators in the early years (0-4 years)

Background

The purpose of this systematic review was to examine the relationships between sedentary behaviour (SB) and health indicators in children aged 0 to 4 years, and to determine what doses of SB (i.e., duration, patterns [frequency, interruptions], and type) were associated with health indicators.

Methods

Online databases were searched for peer-reviewed studies that met the a priori inclusion criteria: population (apparently healthy, 1 month to 4.99 years), intervention/exposure and comparator (durations, patterns, and types of SB), and outcome/health indicator (critical: adiposity, motor development, psychosocial health, cognitive development; important: bone and skeletal health, cardiometabolic health, fitness, risks/harm). The quality of the evidence was assessed by study design and outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Results

Due to heterogeneity, meta-analyses were not possible; instead, narrative syntheses were conducted, structured around the health indicator and type of SB. A total of 96 studies were included (195,430 participants from 33 countries). Study designs were: randomized controlled trial (n = 1), case-control (n = 3), longitudinal (n = 25), longitudinal with additional cross-sectional analyses (n = 5), and cross-sectional (n = 62). Evidence quality ranged from “very low” to “moderate”. Associations between objectively measured total sedentary time and indicators of adiposity and motor development were predominantly null. Associations between screen time and indicators of adiposity, motor or cognitive development, and psychosocial health were primarily unfavourable or null. Associations between reading/storytelling and indicators of cognitive development were favourable or null. Associations between time spent seated (e.g., in car seats or strollers) or in the supine position, and indicators of adiposity and motor development, were primarily unfavourable or null. Data were scarce for other outcomes.

Conclusions

These findings continue to support the importance of minimizing screen time for disease prevention and health promotion in the early years, but also highlight the potential cognitive benefits of interactive non-screen-based sedentary behaviours such as reading and storytelling. Additional high-quality research using valid and reliable measures is needed to more definitively establish the relationships between durations, patterns, and types of SB and health indicators, and to provide insight into the appropriate dose of SB for optimal health in the early years.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4849-8) contains supplementary material, which is available to authorized users.

Systematic review of the relationships between physical activity and health indicators in the early years (0-4 years)

Background

Given the rapid development during the early years (0-4 years), an understanding of the health implications of physical activity is needed. The purpose of this systematic review was to examine the relationships between objectively and subjectively measured physical activity and health indicators in the early years.

Methods

Electronic databases were originally searched in April, 2016. Included studies needed to be peer-reviewed, written in English or French, and meet a priori study criteria. The population was apparently healthy children aged 1 month to 59.99 months/4.99 years. The intervention/exposure was objectively and subjectively measured physical activity. The comparator was various volumes, durations, frequencies, patterns, types, and intensities of physical activity. The outcomes were health indicators ranked as critical (adiposity, motor development, psychosocial health, cognitive development, fitness) and important (bone and skeletal health, cardiometabolic health, and risks/harm). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to assess the quality of evidence for each health indicator by each study design.

Results

Ninety-six studies representing 71,291 unique participants from 36 countries were included. Physical activity interventions were consistently (>60% of studies) associated with improved motor and cognitive development, and psychosocial and cardiometabolic health. Across observational studies, physical activity was consistently associated with favourable motor development, fitness, and bone and skeletal health. For intensity, light- and moderate-intensity physical activity were not consistently associated with any health indicators, whereas moderate- to vigorous-intensity, vigorous-intensity, and total physical activity were consistently favourably associated with multiple health indicators. Across study designs, consistent favourable associations with health indicators were observed for a variety of types of physical activity, including active play, aerobic, dance, prone position (infants; ≤1 year), and structured/organized. Apart from ≥30 min/day of the prone position for infants, the most favourable frequency and duration of physical activity was unclear. However, more physical activity appeared better for health. Evidence ranged from “very low” to “high” quality.

Conclusions

Specific types of physical activity, total physical activity, and physical activity of at least moderate- to vigorous-intensity were consistently favourably associated with multiple health indicators. The majority of evidence was in preschool-aged children (3-4 years). Findings will inform evidence-based guidelines.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4860-0) contains supplementary material, which is available to authorized users.

The Brain-Derived Neurotrophic Factor Val66Met Polymorphism, Delivery Method, Birth Weight, and Night Sleep Duration as Determinants of Obesity in Vietnamese Children of Primary School Age

BACKGROUND

Obesity is a complex disease that involves both environmental and genetic factors in its pathogenesis. Several studies have identified multiple obesity-associated loci in many populations. However, their contribution to obesity in the Vietnamese population is not fully described, especially in children. The study aimed to investigate the association of obesity with Val66Met polymorphism in brain-derived neurotrophic factor (BDNF) gene, delivery method, birth weight, and lifestyle factors in Vietnamese primary school children.

METHODS

A case-control study was conducted on 559 children aged 6-11 years (278 obese cases and 281 normal controls). The obesity of the children was classified using both criteria of International Obesity Task Force (IOTF, 2000) and World Health Organization (WHO, 2007). Lifestyle factors, birth delivery, and birth weight of the children were self-reported by parents. The BDNF genotype was analyzed using the polymerase chain reaction-restriction fragment length polymorphism method. Association was evaluated by multivariate logistic regression and cross-validated by the Bayesian model averaging method.

RESULTS

The most significantly independent factors for obesity were delivery method (cesarean section vs. vaginal delivery, β = 0.56, p = 0.007), birth weight (>3500 to <4000 g vs. 2500-3500 g, β = 0.52, p = 0.035; ≥4000 g vs. 2500-3500 g, β = 1.06, p = 0.015), night sleep duration (<8 h/day vs. ≥8 h/day, β = 0.99, p < 0.0001), and BDNF Val66Met polymorphism (AA and GG vs. AG, β = 0.38, p = 0.039).

CONCLUSIONS

The study suggested the significant association of delivery method, birth weight, night sleep duration, and BDNF Val66Met polymorphism, with obesity in Vietnamese primary school children.

Maternal Attitudes, Normative Beliefs, and Subjective Norms of Mothers of 2- and 3-Year-Old Children

INTRODUCTION

This exploratory study examined maternal attitudes, normative beliefs, subjective norms, and meal selection behaviors of mothers of 2- and 3-year-old children.

METHODS

Guided by the Theory of Reasoned Action, we had mothers complete three surveys, two interviews, and a feeding simulation exercise. Data were analyzed using descriptive and bivariate statistics and multivariate linear regression.

RESULTS

A total of 31 mothers (50% Latino, 34% Black, 46.9% ≤ high school education, 31.3% poor health literacy) of 32 children (37.5% overweight/obese) participated in this study. Maternal normative beliefs (knowledge of U.S. Department of Agriculture recommendations) did not reflect actual U.S. Department of Agriculture recommendations. Collectively, regression models explained 13% (dairy) to 51% (vegetables) of the variance in behavioral intent, with normative belief an independent predictor in all models except grain and dairy.

DISCUSSION

Meal selection behaviors, on average, were predicted by poor knowledge of U.S. Department of Agriculture recommendations. Dietary guidance appropriate to health literacy level should be incorporated into well-child visits.

[Systematic review on the physical activity level and nutritional status of Brazilian children]

Objective To systematically review the literature on the prevalence and the factors associated with physical activity level and nutritional status of Brazilian children. Methods The electronic database MEDLINE (via PubMed), SciELO, SCOPUS and Web of Science were selected. The search strategy included the descriptors proposed in the Medical Subject Headings (MeSH): "Motor Activity", "Activities", "Nutritional Status", "Overweight", "Obesity", "Body Mass Index", "Child", "Brazil". Results The search allowed the identification of 141 articles, of which 16 studies were considered potentially relevant and were included in the review. Conclusions Studies about nutritional status and physical activity levels in Brazilian children are still scarce, but the work on this has increased in recent years, especially those that use cross designs, as well as questionnaires to measure physical activity; BMI for nutritional status is still widely used. Furthermore, studies that analyzed the amount of hours designated to sedentary behaviors such as watching TV, playing video-games and using the computer, found that these activities took more than two hours every day.

Overweight and Obesity in Children under 5 Years: Surveillance Opportunities and Challenges for the WHO European Region

Background

Many children who have overweight or obesity before puberty can develop obesity in early adulthood, which is associated with increased morbidity and mortality. The preschool years (ages 0–5) represents a point of opportunity for children to be active, develop healthy eating habits, and maintain healthy growth. Surveillance of childhood overweight and obesity in this age group can help inform future policies and interventions.

Objective

To review and report available prevalence data in WHO European Region Member States and determine how many countries can accurately report on rates of overweight and obesity in children under 5 years.

Methods

We conducted a rapid review of studies reporting on overweight and obesity prevalence in children ages 0–5 in the WHO European region member states from 1998 to 2015.

Results

Currently, 35 of the 53 member states have data providing prevalence rates for overweight and obesity for children under 5 years. There was little consistency in study methods, impacting comparability across countries. The prevalence of overweight and obesity in children under 5 years ranges from 1 to 28.6% across member states.

Conclusion

Although measuring overweight and obesity in this age group may be challenging, there is an opportunity to leverage existing surveillance resources in the WHO European Region.

Sedentary Behavior During School Recess in Southern Brazil

The aim of this study was to assess sedentary behavior during school recess in Brazilian boys and girls. The study included 455 students (233 boys and 222 girls), aged 8 to 17 years, enrolled in a public school in the city of Londrina, Brazil. All data was collected using questionnaires. Logistic regression with odds ratio and confidence interval (95%) was used to measure the relationship between sedentary behavior and sex, age, weight, screen time, and economic status. There was a high prevalence (40.7%) of sedentary behavior in this sample, with girls (aged 8 to 17 years) more likely than boys (54.5% vs. 27.5%, respectively) and older students (13-17 years) more likely than younger students (8-12 years) to engage in sedentary behavior (49.6% vs. 30.1%, respectively). These findings, and their broad implications for health and for interventions to increase physical activity, are discussed in light of past literature.

Investigating the Physiological and Psychosocial Responses of Single- and Dual-Player Exergaming in Young Adults

OBJECTIVE

This study investigated the effect of acute exergaming on the physiological and psychosocial responses of young adults and the modulatory effect of a single- or dual-player game play situation.

MATERIALS AND METHODS

Thirty-six participants (19 male; 21.7 ± 3.8 years; 23.65 ± 3.17 kg/m2) each completed two 30-minute exergame sessions in a randomized order (single and dual player) while wearing an Actiheart® to estimate energy expenditure. Positive and negative affect, subjective vitality, and indices of intrinsic motivation were assessed directly after each gaming bout.

RESULTS

There was no significant difference in energy expenditure or psychosocial outcomes between conditions. Although males expended more energy than females in both single- (z = -2.124, P = 0.033) and dual-player situations (z = -2.679, P = 0.007), females reported significantly greater vitality (z = -2.219, P = 0.026) and effort/importance than males (z = -2.001, P = 0.045). Conversely, males reported a greater negative affect (z = -2.872, P = 0.004) and pressure/tension (z = -3.295, P = 0.001). A linear mixed effects model revealed that energy expenditure during exergaming was a significant predictor of interest and enjoyment (P = 0.001) and effort and importance (P = 0.001). This relationship between energy expenditure and psychosocial variables was not modulated by sex or order of gameplay (single or dual player first).

CONCLUSION

The present results suggest that females have a more positive psychosocial response to exergaming relative to males, highlighting exergames such as Wii™ boxing as a potential avenue for future interventions seeking to address the low physical activity levels that characterize the young adult population.

Association between Obesity and Neighborhood Socioeconomic Status in Korean Adolescents Based on the 2013 Korea Youth Risk Behavior Web-Based Survey

Background

An increase in the obese adolescent population is being recognized as a serious medical and social problem. The present study aimed to examine the association between neighborhood socioeconomic status (SES) and obesity in Korean adolescents based on total available resources and local social inequality models.

Methods

The present study used data from the 2013 Korea Youth Risk Behavior Web-based Survey in analyzing 72,438 Korean adolescents aged 12–18. The analysis investigated obesity odds ratio (OR) according to neighborhood SES adjusted for age and individual SES indices, which included family affluence scale (FAS), education level of parents, cohabitation with parents, and weekly allowance. Obesity OR was investigated according to neighborhood SES by FAS, and according to FAS by neighborhood SES.

Results

After adjusting for age and individual SES variables, there was no significant association between neighborhood SES and adolescent obesity for either boys or girls. However, girls in the high FAS group showed a pattern of lower neighborhood SES being associated with a significant increase in risk of obesity; in the high neighborhood SES group, boys showed a pattern of higher FAS being associated with a significant increase in risk of obesity, whereas girls show a pattern of decrease.

Conclusion

Although limited, the present study demonstrated that some girl groups exhibited a pattern of lower neighborhood SES being associated with an increase in risk of obesity, as well as a gender-based difference in risk of obesity by individual SES. Therefore, measures to prevent adolescent obesity should be established with consideration for differences in risk according to individual and neighborhood SES.

Association between maternal education and objectively measured physical activity and sedentary time in adolescents

Background

Investigating socioeconomic variation in physical activity (PA) and sedentary time is important as it may represent a pathway by which socioeconomic position (SEP) leads to ill health. Findings on the association between children's SEP and objectively assessed PA and/or sedentary time are mixed, and few studies have included international samples.

Objective

Examine the associations between maternal education and adolescent's objectively assessed PA and sedentary time.

Methods

This is an observational study of 12 770 adolescents (10–18 years) pooled from 10 studies from Europe, Australia, Brazil and the USA. Original PA data were collected between 1997 and 2009. The associations between maternal education and accelerometer variables were examined using robust multivariable regression, adjusted for a priori confounders (ie, body mass index, monitor wear time, season, age and sex) and regression coefficients combined across studies using random effects meta-analyses. Analyses were conducted in March 2014.

Results

Adolescents of university educated mothers spent more time sedentary (9.5 min/day, p=0.005) and less time in light activity (10 min/day, p<0.001) compared with adolescents of high school educated mothers. Pooled analysis across two studies from Brazil and Portugal (analysed separately because of the different coding of maternal education) showed that children of higher educated mothers (tertiary vs primary/secondary) spent less time in moderate to vigorous PA (MVPA) (6.6 min/day, p=0.001) and in light PA (39.2 min/day: p<0.001), and more time sedentary (45.9 min/day, p<0.001).

Conclusions

Across a number of international samples, adolescents of mothers with lower education may not be at a disadvantage in terms of overall objectively measured PA.

Why are primary school children overweight and obese? A cross sectional study undertaken in Kinondoni district, Dar-es-salaam

Background

The world is experiencing an alarming increase in prevalence of childhood obesity. Despite this trend little is known about determinants of childhood obesity in Tanzania. A cross sectional study determined the prevalence and factors associated with overweight and obesity in 1722 children aged 7–14 years (10.9 ± 1.74) attending primary schools in Dar es Salaam.

Methods

Six public and four private schools were systemically selected from a total of 227 primary schools. Anthropometric measurements (weight and height) were collected using a standard protocol and Body Mass Index (BMI) was calculated. Interviews collected demographic characteristics and lifestyle factors. Multiple logistic regression test was used to assess the influence of independent variables on overweight and obesity while controlling for confounding factors. The level of significance was set at α = 5 %.

Results

Of 1, 722 children 10.2 % were overweight and 4.5 % were obese. Overweight and obesity was higher in boys (14.9 %) than girls (14.5 %), higher in children attending private schools (27.7 %) than public schools (5.9 %). Children who walked to and from school were less likely to be overweight or obese than those who used vehicles (AOR = 0.5; 95%CI: 0.3–0.6; p < 0.001). Those who used private cars or school buses were more likely to be overweight or obese than those who used public transport (AOR = 2.9; 95%CI: 0.2–0.7; p < 0.05). Computer/video game use were associated with increased risk of overweight and obesity (AOR = 1.6; 95%CI: 1.1–2.3; p = 0.03). Lunch provided by schools was associated with increased risk of overweight or obese (AOR = 6.4, 95 % CI = 4.2–9.6, p < 0.001).

Conclusions

The findings of this study identified a number of behavioural and dietary factors that are related to overweight and obesity. Parents and teachers should encourage children to be physically active by limiting screen time and promoting active transport to and from school to promote health and reduce obesity. Ministry of education needs to formulate/enforce policies that encourage physical activities for school children and regulate quality of foods provided to children at schools.

The Effect of Parents' Self-Efficacy Perception on Healthy Eating and Physical Activity Behaviors of Turkish Preschool Children

Preschool is an important period for the development of healthy lifestyle behaviors. Parents have a great influence upon a child developing healthy lifestyle behaviors. The purpose of this study was to determine the self-efficacy perceptions of parents related to their preschool children's healthy eating and physical activity behaviors. This study was conducted with a research population of 425 parents of 3- to 6-year-old children. The data collection tools included Demographic Information Form, and The Parental Self-efficacy Questionnaire (PSQ). Also, the weight and height of the children and their parents were measured. There was a positive correlation in parental self-efficacy score between parents' educational status and economic status and there was a significant negative correlation between children's body mass index and parental self-efficacy scores. The understanding of the effect of parental self-efficacy perception in the development of preschool children's healthy eating and physical activity behaviors is one of the first important steps in effective health promotion interventions.

Socioeconomic position and childhood-adolescent weight status in rich countries: a systematic review, 1990-2013

Background

Childhood obesity is a major problem in rich countries due to its high prevalence and its harmful health consequences. An exploratory analysis conducted in the PubMed database highlighted that the number of papers published on the relationship between socioeconomic position (SEP) and childhood-adolescent weight status had risen substantially with respect to an earlier review which had covered the period 1990–2005.

Methods

To describe the findings on the relationship between SEP and childhood-adolescent weight status in papers published in rich countries from 1990 through 2013, studies were identified in the following databases: PubMed; Web of Knowledge (WOK); PsycINFO; Global Health; and Embase. We included observational studies from the 27 richest OECD countries, which covered study populations aged 0 to 21 years, and used parental education, income and/or occupation as family SEP indicators. A total of 158 papers met the inclusion criteria and reported 134 bivariable and 90 multivariable analyses.

Results

Examination of the results yielded by the bivariable analyses showed that 60.4 % of studies found an inverse relationship, 18.7 % of studies did not found relationship, and 20.9 % of studies found a relationship that varied depending on another variable, such as age, sex or ethnic group; the corresponding percentages in the multivariable analyses were 51.1, 20.0 and 27.8 %, respectively. Furthermore, 1.1 % found a positive relationship.

Conclusion

The relationship between SEP and childhood-adolescent weight status in rich countries is predominantly inverse and the positive relationship almost has disappeared. The SEP indicator that yields the highest proportion of inverse relationships is parents’ education. The proportion of inverse relationships is higher when the weight status is reported by parents instead using objective measurements.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-015-0443-3) contains supplementary material, which is available to authorized users.

Associations between objectively assessed and questionnaire-based sedentary behaviour with BMI-defined obesity among general population children and adolescents living in England

OBJECTIVES

Sedentary behaviour (SB) is an emerging candidate risk factor for obesity in young people. Evidence to date is conflicting and it is unclear how different SB types are associated with obesity independently of physical activity. The objective of this study was to examine associations between a range of objectively measured and questionnaire-based SB indicators with obesity and body mass index (BMI) to assess whether these associations were independent of physical activity.

PARTICIPANTS

4469 (705 with accelerometer data) children aged 5-15 years from the 2008 Health Survey for England.

OUTCOMES

The outcome was adiposity, classified using age-specific and sex-specific BMI SD scores (continuous) and obesity cut-offs (binary). Questionnaire-based measures comprised TV time, non-TV sitting time (such as homework, drawing, time at a computer or playing video games), total sitting time (TV time+non-TV sitting time) and average daily MVPA time. Objective SB and moderate to vigorous physical activity (MVPA) time were measured using an Actigraph GT1M accelerometer, with cut-offs of 100 and 200 counts per minute for SB, and 2802 counts per minute for MVPA. Multiple logistic and multiple linear regression models examined associations between each indicator of sedentary time with obesity and BMI SD scores.

RESULTS

TV time (but not non-TV sitting or objectively-measured SB) was consistently associated with higher levels of obesity and BMI SD score, even after adjusting for MVPA and other potential confounders. Weaker associations were observed for total sitting time.

CONCLUSIONS

TV viewing (but not other forms of objectively-measured or questionnaire-based sedentary time) was associated with obesity in children and adolescents. Although a causal relationship cannot be established, TV time may be a reasonable target for obesity prevention in young populations.

Total fluid intake and its determinants: cross-sectional surveys among adults in 13 countries worldwide

Purpose

To evaluate the total fluid intake from drinking water and beverages in adult populations from different countries and assess the percentage of individuals complying with the European Food Safety Agency (EFSA) adequate intake (AI) of water from fluids.

Methods

A total of 16,276 adults (7580 men and 8696 women) aged between 18 and 70 years (mean age 39.8 years) were randomly recruited from 13 different countries from three continents. Information about the total daily fluid intake (sum of drinking water and beverages) was collected using a 24-h fluid-specific record over seven consecutive days.

Results

Important differences in total fluid intake between countries were found; however, few differences between men and women were reported in most of the countries. Less than 50 % of the women and approximately 60 % of the men do not comply with the EFSA AI of water from fluids. Women were more than twice as likely as men to meet these AI (OR 2.15; 95 % CI 2.02–2.29). The odds of meeting the AI of water from fluids were lower in individuals over 50 years (OR 0.88; 95 % CI 0.80–0.96). Nine percent of the total population consumed less than half of the AI, 40.5 % between 50 and 100 %, and 50.5 % more than the AI.

Conclusions

There were considerable differences in total fluid intake between countries but not between genders. Only 40 % of men and 60 % of women comply with the EFSA AI of water from fluids. Men and elderly individuals had an increased risk of not complying with this reference value.

Conceptual framework of a simplified multi-dimensional model presenting the environmental and personal determinants of cardiometabolic risk behaviors in childhood

Clinical manifestations of cardiometabolic risk (CMR) may be set early in childhood due to unfavorable behaviors or lifestyle patterns related to diet and physical activity. Several factors may determine the adoption of such lifestyle-related behaviors, which researchers have tried to cluster under certain frameworks or models. In this context, the framework developed and proposed by this review gathers all the present knowledge regarding these determining factors to date and groups them into three main categories related to personal characteristics and the social and physical environment. Based on the proposed framework, a large variety of personal, social and physical environmental factors can positively or negatively influence CMR-related behaviors (either directly or indirectly via their interrelations), thus leading to decreased or increased risk, respectively. This framework could be of great value to public health policy makers and legislators for designing and implementing interventional programs tailored to the needs of susceptible population groups who are most in need for such initiatives. Targeting the correlates as potential determinants of CMR-related behaviors, and not just on the behaviors themselves, has been shown previously to be the most effective approach for tackling health issues related to CMR starting from early life stages.

Habits and attitudes of first-year female students at Warmia and Mazury University: a call for implementing health education programme at universities

INTRODUCTION

Entering university frequently brings about considerable changes in the students' lifestyle, which often affect negatively their health. Therefore, it seems to be of great importance to promote pro-health habits and attitudes particularly among 1st-year-students and thus, it is necessary to accurately assess their lifestyles and needs in this regard.

AIM

The aim of the study was to assess the habits and attitudes towards healthy lifestyle of 762 first-year female students enrolled at the University of Warmia and Mazury in Olsztyn so as to detect health risks and ultimately present the need for remedial measures.

METHODS

Female students were randomly selected from all the groups attending obligatory physical education classes. The students filled in an anonymous questionnaire, which contained questions referring to their physical activity, nutrition, tobacco and alcohol use, and stress.

RESULTS

The research demonstrated a worrisome picture of the students' habits and attitudes with regard to health. It showed that the female students took keener interest in daily body care than in proper nutrition and an adequate level of physical activity. What is also alarming is the excessive amount of alcohol they consumed on a regular basis.

CONCLUSIONS

The research findings call for a specially designed pro-health programme to be implemented during the time of the studies in order to raise the female students' awareness of leading a health-conscious lifestyle.

Obesity status of middle school students in Xiangtan and its relationship with Internet addiction

OBJECTIVE

To investigate the state of middle school students' obesity in Xiangtan, China and to study the influence of Internet addiction on obesity.

SUBJECTS

1,150 junior and senior middle school students in Xiangtan, China.

DESIGN AND METHODS

The research subjects were select randomly for the study. The height and body weight of human body were measured and the obesity state was judged according to BMI value and the Working Group on Obesity in China (WGOC) standard. The questionnaire for the survey of middle school students' basic situation was designed and a survey of the respondents' personal information and the contributory factors to obesity was conducted. The Middle School Students' Internet Addiction Diagnosis Scale was adopted for measuring and judging the Internet addiction of the research subjects.

RESULTS

(1) The total detection rate of obesity was 23.57%. (2) The overall detection rate of Internet addiction was 21.23%. (3) The detection rate of obesity in middle school students with Internet addiction (32.92%) was significantly higher than that without Internet addiction (21.06%). Logistic regression showed that Internet addiction was an independent risk factor of obesity.

CONCLUSION

Internet addiction is related to obesity of middle school students.

Overweight in intellectually-disabled population: physical, behavioral and psychological characteristics

Intellectually disabled (ID) people are at high risk of overweight and obesity. Prevalence and risk factors were assessed in a French population of ID adults attending specialized institutions, using a questionnaire focusing on demographic characteristics, physical activities, food habits and self-awareness about body and health. Data analysis included descriptive statistics, univariate and multivariate regression. Overall, 570 participants were included in the analysis (59% male), aged 19-59 years. The mean body mass index (BMI) was 24.9 kg/m(2); 45.6% of participants were overweight (BMI ≥ 25), including 17.2% who were obese (BMI ≥ 30). Participants practiced sports for 5.7h/week on average and were sedentary for 21.8h/week (time spent in front of some kind of screen). Most participants had food and self-care habits usually regarded as healthy. Eighty percent of them felt unhappy with their body and their physical capacities, but otherwise expressed a rather good opinion of themselves. Bivariate and multivariate analyses showed that some behavioral habits were associated with a reduced incidence of overweight and/or obesity, such as regular sport practice outside the institution, good personal body care or alcohol avoidance. The strongest risk factor was gender. Women were much more at risk than men of being overweight (53.9% versus 39.9%) and obese (28.2% versus 9.5%). Results suggest numerous ways to improve the health of institutionalized ID adults, related to sports education, nutrition and self-care, with particular attention paid to women.

Children's and adolescents' sedentary behaviour in relation to socioeconomic position

BACKGROUND

Sedentary behaviour is an emerging cardiometabolic risk factor in young people. Little is known about how socioeconomic position (SEP) and sedentary behaviour are associated in children and adolescents. This study examines associations between SEP and sedentary behaviour in school-age children and adolescents.

METHODS

The core sample comprised 3822 Health Survey for England 2008 participants aged 5-15 years with complete information on SEP (household income, head of household occupational social class and area deprivation) and self-reported sedentary time (television viewing and other sitting during non-school times). Accelerometer-measured total sedentary time was measured in a subsample (N=587). We examined multivariable associations between SEP (including a composite SEP score) and sedentary time using generalised linear models, adjusting for age, sex, body mass index, physical activity, accelerometer wear time and mutually adjusting for the other SEP indicators.

RESULTS

Participants in the highest SEP category spent 16 min/day less (95% CI 6 to 25, p=0.003) watching TV than participants in the lowest SEP category; yet they spent 7 (2 to 16, p=0.010) and 17 (5 to 29, p<0.000) min/day more in non-TV sitting and total (accelerometry-measured) sedentary time, respectively. Associations across individual SEP components varied in strength. Area deprivation was not associated with sedentary time.

CONCLUSIONS

Low SEP is linked with higher television times but with lower total (accelerometer-measured) sedentary time, and non-TV sitting during non-school time in children and adolescents. Associations between sedentary time and SEP differ by type of sedentary behaviour. TV viewing is not a good proxy for total sedentary time in children.

Food reinforcement partially mediates the effect of socioeconomic status on body mass index

OBJECTIVE

Low socioeconomic status (low SES), as defined by income or educational attainment, has been associated with obesity in industrialized nations. Low SES persons have limited resources and may experience food insecurity that increases food reinforcement. Food reinforcement has been positively related to energy intake and weight status, and increased food reinforcement may explain the higher prevalence of obesity among low SES individuals who have restricted access to low-energy-dense foods and nonfood reinforcers.

DESIGN AND METHODS

Annual household income, highest education level completed and food reinforcement in 166 adults of varying body mass index (BMI, kg m(-2) ) was measured.

RESULTS

Multivariate linear regression analyses controlling for age, sex, minority status, session hunger, and the reinforcing value of nonfood alternatives showed that household income was related to food reinforcement (P = 0.048) and BMI (P = 0.019), and that food reinforcement was related to BMI (P = 0.0017). Path analyses revealed a significant indirect effect of household income on BMI through food reinforcement, suggesting that the relationship between lower household income and greater BMI was mediated in part by increased food reinforcement. A similar pattern of results was observed when education level was used as the proxy for SES.

CONCLUSIONS

These findings support the hypothesis that deprivation and restricted food choice associated with low SES enhance food reinforcement, increasing the risk for obesity.

Associations between indicators of screen time and adiposity indices in Portuguese children

OBJECTIVES

To examine associations between three types of screen time (TV, electronic games (EG), and personal computer (PC)) and two proxies of adiposity (body mass index (BMI) and sum of skinfolds) in children.

DESIGN

The sample comprised 17,509 children aged 2-13 years who participated in the 2009/10 Portuguese Prevalence Study of Obesity in Childhood.

METHODS

Complex samples generalised linear models, using school as a cluster variable were ran separately for each combination of ST predictor and adiposity-related outcome, adjusting for covariates including age, sex, physical activity, diet, and parental factors. Missing values in predictors and covariates were imputed.

RESULTS

Watching TV for >2h/day compared to <1h/day was associated with higher age- and sex-specific BMI standard deviation score (coefficient: 0.06, 95% CI: 0.01 to 0.12, linear trend p=0.008) and sum of skinfolds (logged and back transformed 0.04, 0.02 to 0.07, p=<0.001). We also found weak evidence for an inverse association between PC and BMI.

CONCLUSIONS

Associations between ST and adiposity differ by both type of ST and type of adiposity marker. Only TV viewing was consistently associated with adiposity. Studies using a single adiposity marker looking at total screen time or total sedentary behaviour time may miss or confound type-specific associations.

Childhood physical activity, sports and exercise and noncommunicable disease: a special focus on India

Establishing the relationship between childhood physical inactivity and noncommunicable disease (NCD) is difficult, since chronic disease and mortality are not direct health outcomes of physical inactivity in children. Published literature explores the relationship of physical inactivity with appearance of early childhood disease risk markers, the adverse impact of which may take some time to appear. Promoting childhood physical activity has multiple benefits including delay in evolution of risk factors contributing to adult degenerative disease. It is clear from available literature that physical inactivity or its surrogates constitute an important independent risk factor for NCD. This is likely to be underestimated not only because of measurement issues, but also because physical inactivity may act through other risk factors for NCD. To recognize and intervene on the issue of physical inactivity in children is important not only for the benefit of the child but in the context of NCD in later life. Studies on physical inactivity and its functional correlates are limited in India and this would be an important area for future research.

Clustering of energy balance-related behaviors and parental education in European children: the ENERGY-project

Background

Recent research and literature reviews show that, among schoolchildren, some specific energy balance-related behaviors (EBRBs) are relevant for overweight and obesity prevention. It is also well known that the prevalence of overweight and obesity is considerably higher among schoolchildren from lower socio-economic backgrounds. This study examines whether sugared drinks intake, physical activity, screen time and usual sleep duration cluster in reliable and meaningful ways among European children, and whether the identified clusters could be characterized by parental education.

Methods

The cross-sectional study comprised a total of 5284 children (46% male), from seven European countries participating in the ENERGY-project (“EuropeaN Energy balance Research to prevent excessive weight Gain among Youth”). Information on sugared drinks intake, physical activity, screen time and usual sleep duration was obtained using validated self-report questionnaires. Based on these behaviors, gender-specific cluster analysis was performed. Associations with parental education were identified using chi-square tests and odds ratios.

Results

Five meaningful and stable clusters were found for both genders. The cluster with high physical activity level showed the highest proportion of participants with highly educated parents, while clusters with high sugared drinks consumption, high screen time and low sleep duration were more prevalent in the group with lower educated parents. Odds ratio showed that children with lower educated parents were less likely to be allocated in the active cluster and more likely to be allocated in the low activity/sedentary pattern cluster.

Conclusions

Children with lower educated parents seemed to be more likely to present unhealthier EBRBs clustering, mainly characterized by their self-reported time spent on physical activity and screen viewing. Therefore, special focus should be given to lower educated parents and their children in order to develop effective primary prevention strategies.

The key role of psychosocial risk on therapeutic outcome in obese children and adolescents. Results from a longitudinal multicenter study

OBJECTIVE

Childhood obesity is high on the global public health agenda. Although risk factors are well known, the influence of social risk on the therapeutic outcome of lifestyle intervention is poorly examined. This study aims to investigate the influence of migration background, low education, and parental unemployment.

METHODS

62,147 patients participated in multidimensional lifestyle intervention programs in 179 pediatric obesity centers. Data were collected using standardized software for longitudinal multicenter documentation. 12,305 (19.8%) attended care for 6-24 months, undergoing an intensive therapy period and subsequent follow-ups for up to 3 years. A cumulative social risk score was calculated based on different risk indicators.

RESULTS

Migration background, low education, and parental employment significantly influenced the outcome of lifestyle intervention. The observed BMI-SDS reduction was significantly higher in the subgroup with low social risks factors (Δ BMI-SDS -0.19) compared to those presenting moderate (Δ BMI-SDS -0.14) and high social risk (Δ BMI-SDS -0.11).

CONCLUSION

Our data underline the effect of children's social setting on the outcome of multidimensional lifestyle intervention. The presence of a high social risk burden is a negative predictor for successful weight loss. Specific therapeutic programs need to be developed for disadvantaged children and adolescents.

Prevalence and factors associated with overweight and obesity in French primary-school children

Objective

To determine the prevalence of, and identify associated factors with, overweight and obesity in two samples of French children.

Design

We conducted two cross-sectional studies among two samples of children. Weight status, eating behaviour, sedentary activity, physical activity and parents’ socio-economic status (SES) were collected using questionnaires filled by doctors during school health check-ups. Overweight and obesity were defined according to the age- and sex-specific BMI cut-off points of the International Obesity Taskforce. Multivariate analysis (logistic regression) was used to identify independent factors associated with overweight including obesity and obesity alone.

Setting

Aquitaine region (south-west France).

Subjects

Analyses were conducted among children aged 5–7 years (n 4048) and 7–11 years (n 3619).

Results

Overweight prevalence was 9·5 % including 2·2 % of obesity in 5–7-year-old children and 15·6 % including 2·9 % of obesity in 7–11-year-old children. In both samples, overweight and obesity prevalence were higher in children whose parents had low or medium SES (P < 0·05). Factors associated significantly (P < 0·05) and independently with higher overweight or obesity prevalence were female gender, low or medium parental SES, never or sometimes having breakfast, never eating at the school canteen, never having a morning snack, never or sometimes having a light afternoon meal and having high sedentary activity.

Conclusions

Our data confirm that low SES, absence of breakfast and high sedentary activity are associated with a higher risk of being overweight or obese, but also highlight original potential protective factors such as eating at the canteen and high meal frequency.

Socioeconomic status and the health of youth: a multilevel, multidomain approach to conceptualizing pathways

Previous research has clearly established associations between low socioeconomic status (SES) and poor youth physical health outcomes. This article provides an overview of the main pathways through which low SES environments come to influence youth health. We focus on 2 prevalent chronic health problems in youth today, asthma and obesity. We review and propose a model that encompasses (a) multiple levels of influence, including the neighborhood, family and person level; (b) both social and physical domains in the environment; and finally (c) dynamic relationships between these factors. A synthesis of existing research and our proposed model draw attention to the notion of adverse physical and social exposures in youth's neighborhood environments altering family characteristics and youth psychosocial and behavioral profiles, thereby increasing youth's risk for health problems. We also note the importance of acknowledging reciprocal influences across levels and domains (e.g., between family and child) that create self-perpetuating patterns of influence that further accentuate the impact of these factors on youth health. Finally, we document that factors across levels can interact (e.g., environmental pollution levels with child stress) to create unique, synergistic effects on youth health. Our model stresses the importance of evaluating influences on youth's physical health not in isolation but in the context of the broader social and physical environments in which youth live. Understanding the complex relationships between the factors that link low SES to youth's long-term health trajectories is necessary for the creation and implementation of successful interventions and policies to ultimately reduce health disparities.

Physical fitness and fatness in adolescents with intellectual disabilities

BACKGROUND

This study investigated health-related fitness in adolescents with intellectual disabilities and analysed the various performances in physical fitness tests according to degrees of obesity.

MATERIALS AND METHODS

Eighty-seven French intellectual disabilities adolescents (14.24 ± 1.48 years) performed the EUROFIT physical fitness test battery. Height, weight and waist circumference were assessed, and BMI and waist-to-height ratio were calculated. 'Bio-impedancemetry' evaluated body fat (BF) percentage.

RESULTS

Ninety-four per cent of the adolescents completed the aerobic running test, 52% of which had low VO(2max). Thirty-seven per cent were obese (%BF), and 32% had excess visceral adipose tissue. Adolescents with the lowest cardiorespiratory fitness had the highest BF percentages (P < 0.001).

CONCLUSIONS

Intellectual disabilities adolescents showed low physical fitness and high prevalence of obesity. Both could further worsen social participation and health status.

Prevalence and risk factors of obesity among school-aged children in Xi'an, China

The purpose of this study was to examine the prevalence and the risk factors associated with obesity among school-aged children in Xi'an city. The body mass index of 6,740 children aged 7-18 years was compared with the Working Group on Obesity in China cut-off value to estimate the prevalence of obesity. A case-control study of obese and non-obese children was carried out to study risk factors for obesity. A standardized questionnaire was used to collect information on possible risk factors causing obesity. Univariate analysis was performed first to compare the distribution of risk factors between cases and controls. Conditional logistic regression analysis was used to assess independent risk factors of obesity. The results showed that the overall prevalence of obesity among school-aged children was 4.11% (4.63% for males and 3.57% for females). A total of 516 subjects (258 pairs of cases and controls) were included in the final analysis. High maternal education and a longer sleeping time were shown to be protective factors against obesity (odds ratio [OR] 0.148, 95% confidence interval [CI] 0.074-0.296 and OR 0.472, 95% CI 0.342-0.652, respectively). Whereas family history of diabetes (OR 5.498, 95% CI 2.606-11.600), parental overweight (OR 3.720, 95% CI 2.068-6.689), and watching television, playing video games, and using computers (OR 1.564, 95% CI 1.133-2.159) were associated with a higher obesity risk.

CONCLUSION

The prevalence of childhood obesity in Xi'an has become a concern, and sleeping time, sedentary behavior, and family factors have pronounced effects on the prevalence of obesity.

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

Accumulating evidence suggests that, independent of physical activity levels, sedentary behaviours are associated with increased risk of cardio-metabolic disease, all-cause mortality, and a variety of physiological and psychological problems. Therefore, the purpose of this systematic review is to determine the relationship between sedentary behaviour and health indicators in school-aged children and youth aged 5-17 years. Online databases (MEDLINE, EMBASE and PsycINFO), personal libraries and government documents were searched for relevant studies examining time spent engaging in sedentary behaviours and six specific health indicators (body composition, fitness, metabolic syndrome and cardiovascular disease, self-esteem, pro-social behaviour and academic achievement). 232 studies including 983,840 participants met inclusion criteria and were included in the review. Television (TV) watching was the most common measure of sedentary behaviour and body composition was the most common outcome measure. Qualitative analysis of all studies revealed a dose-response relation between increased sedentary behaviour and unfavourable health outcomes. Watching TV for more than 2 hours per day was associated with unfavourable body composition, decreased fitness, lowered scores for self-esteem and pro-social behaviour and decreased academic achievement. Meta-analysis was completed for randomized controlled studies that aimed to reduce sedentary time and reported change in body mass index (BMI) as their primary outcome. In this regard, a meta-analysis revealed an overall significant effect of -0.81 (95% CI of -1.44 to -0.17, p = 0.01) indicating an overall decrease in mean BMI associated with the interventions. There is a large body of evidence from all study designs which suggests that decreasing any type of sedentary time is associated with lower health risk in youth aged 5-17 years. In particular, the evidence suggests that daily TV viewing in excess of 2 hours is associated with reduced physical and psychosocial health, and that lowering sedentary time leads to reductions in BMI.

Sociodemographic and home environment predictors of screen viewing among Spanish school children

BACKGROUND

Higher screen-viewing levels increase the risk of obesity. Understanding the correlates of screen viewing is an important first step in designing interventions but there is lack of information on the correlates among Spanish children. This study examined associations among environmental, sociocultural, age variables and screen viewing among Spanish children.

METHODS

Children completed a questionnaire about time spent in screen viewing. BMI was assessed and children were classified into obesity groups using International Obesity Task Force cut-off points. Parents completed a questionnaire about sociodemographic, environmental and sociocultural variables.

RESULTS

Participants were 247 primary and 256 secondary school-aged children and their parents. Time spent in screen viewing increased with age. Males spent more time than females in screen viewing. Greater access to bedroom media sources was associated with higher screen viewing. Younger children from single-parent households and older children having a younger parent, siblings and a father who was not working were higher screen-viewers on weekends and weekdays, respectively. For older children parental TV viewing time appeared to be a significant correlate, while parental rules was a determinant predictor for younger children on weekdays.

CONCLUSIONS

Environmental and sociocultural factors influence the time children spend in screen viewing. Parents play a central role in child's screen viewing; therefore, interventions that target environmental and family TV viewing practices are likely to be effective.

Physical activity and sedentary behaviours in Greek-Cypriot children and adolescents: a cross-sectional study

Background

There are no data on physical activity and sedentary behaviours of Greek-Cypriot children and adolescents, and no study to date examined the association between these two behaviours in this population. The purpose of this study was to document the prevalence of physical activity and sedentary behaviours among Greek-Cypriot adolescents and examine the association between physical activity and a range of sedentary behaviours. Logistic regression analyses were performed to examine the association between physical activity and sedentary behaviours.

Methods

A cross-sectional study among 1,966 Greek-Cypriot children and adolescents was conducted in 2008/2009. Data were collected by means of a questionnaire across primary, middle, high and technical/vocational schools.

Results

Overall 52.3% and 52.4% of the participants met physical activity and television viewing guidelines respectively. Boys and younger children were more likely to meet guidelines. Boys who attended sports clubs for two or more times per week were more likely to be physically active (OR = 3.4), and those who listened to music for one or less than one hour per day were less likely to be physically active (OR = 0.6). Girls who attended sports clubs for two or more times per week and who watched television for two or less than two hours per day were more likely to be physically active, (OR = 3.0 and OR = 1.5 respectively). Girls who reported travelling by car/bus/motorbike for one or less than one hour per day were more likely to actively travel to school (OR = 1.8).

Conclusions

Findings from this study provide limited support for the displacement hypothesis whereby sedentary behaviours displace physically active time. About 50.0% of Greek children and adolescents in Cyprus meet existing physical activity and television viewing guidelines. Encouraging children to attend sports clubs for at least two times per week may markedly improve their physical activity levels.