Prevalence of overweight and obesity in Irish school children, using four different definitions

Gender differences and climate zones in overweight and obesity prevalence in European elementary school children from 2000 to 2020: a systematic review and meta-analysis

Introduction

After 2000, there are more obese than underweight people in the world. We face a rapid increase in average global warming of 1.5°C, reported as a syndemic problem of three interconnected epidemics: obesity, global warming, and undernutrition. We aimed to analyze the impact and association between global warming and obesity in children and differences by gender across Europe after 2000.

Methods

We searched PubMed, MEDLINE, Google Scholar, ScienceDirect, and Embase databases. The considered population were children aged 6-14. Only cross-sectional studies that defined obesity by the IOTF cutoffs and the subjects' place of residence, used to determine precise climate zones, were included. We assessed the prevalence of obesity and overweight using a random-effects and the Mantel-Haenszel fixed-effect method when heterogeneity was greater/lower than 50%. We did a subgroup analysis for prevalence across gender, obesity, and overweight, two decades, regions, countries, and the Köppen-Geiger climate zones. Random effects of the meta-regression were used to study the global warming impact and differences in trends across European countries by gender for both conditions separately.

Results

We identified 114 studies that included 985,971 children from 39 European countries. A significant difference between genders was in favor of obese girls 4.78 (95% CI: 3.85-5.93) versus boys 5.76% (95% CI: 5.11-6.48, p = 0.03), respectively, but not for overweight children. Most of the obese girls were in South Europe 7.51% (95% CI: 6.61-8.51) versus East Europe 2.86% (95% CI: 23-3.12), versus boys in South Europe 8.66% (95% CI: 7.68-9.74) and North Europe 3.49% (95% CI: 2.90-4.19), respectively. The "cold" Köppen-Geiger climate zone, with lowest temperatures, has the largest trend rise between two decades of 2.8% and 1.53% for obese girls and boys, and 5.31% and 1.81% for overweight girls and boys, respectively, followed by the smallest number of obese girls 3.28% (95% CI: 2.17-4.92) and boys 3.58% (95% CI: 2.39-5.33), versus the zone with the highest temperatures "hot" for girls 7.02% (95% CI: 6.30-7.82) and for boys 8.23% (95% CI: 7.55-8.96), respectively. The meta-regression proved global warming has a significant impact on the distribution of obesity and overweight across climate zones, R2 = 0.52 and R2 = 0.22. No significant gender differences, or significant interaction, was noted.

Conclusion

Our meta-analysis provides a comprehensive overview of the association between and impact of global warming on obesity. This impact increases obesity among children in Europe throughout all climate zones, and emphasizes an urgent call for further preventive methods in schools, since obesity differences continue their trend of disappearing into the future.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021282127, identifier: CRD42021282127.

Prevalence of early childhood obesity in Ireland: Differences over time, between sexes and across child growth criteria

BACKGROUND

Various child growth criteria exist for monitoring overweight and obesity prevalence in young children.

OBJECTIVES

To estimate early overweight and obesity prevalence in Ireland and compare the differences in prevalence across ages, growth criteria and sexes.

METHODS

Longitudinal body mass index data from the nationally representative Growing Up in Ireland infant cohort (n = 11 134) were categorized ('under-/normal weight', 'risk of overweight', 'overweight', 'obesity') using the sex- and age-specific International Obesity Task Force growth reference, World Health Organization growth standard and World Health Organization growth reference criteria. Differences in prevalences between criteria and sexes, and changes in each weight category and criterion across ages (9 months, 3 years, 5 years), were investigated.

RESULTS

Across criteria, 11%-40% of children had overweight or obesity at 9 months, 14%-46% at 3 years and 8%-32% at 5 years of age. Prevalence estimates were highest using the World Health Organization growth reference, followed by International Obesity Task Force estimates. Within each criterion, prevalence decreased significantly over time (p < 0.05). However, when combining both World Health Organization criteria, as recommended for population studies, prevalence increased, due to differences in definitions between them. Significantly more boys than girls had overweight/obesity using either World Health Organization criterion, which was reversed using the International Obesity Task Force growth reference.

CONCLUSIONS

To increase transparency and comparability, studies of childhood obesity need to consider differences in prevalence estimates across growth criteria. Effective prevention, intervention and policy-making are needed to control Ireland's high overweight and obesity prevalence.

What is a "high" prevalence of obesity? Two rapid reviews and a proposed set of thresholds for classifying prevalence levels

Categories such as "low" and "high" have been used for several decades to describe the prevalence of stunting and wasting in populations of children aged under 5 years. They provide support for public health risk assessment and policy-making, including alerting health departments and aid agencies to national trends and local needs. In the light of the need for monitoring progress to meet globally agreed targets for overweight and obesity, the classification of their prevalence will be a valuable to aid in policy development, to target resources, and to promote public health interventions. This paper reviews the current use of categories to describe obesity prevalence in policy, advocacy, and research literature. Where prevalence categories have been formally proposed, this paper compares their application on large-scale datasets. The paper then develops a set of recommended threshold values to classify prevalence levels for overweight and obesity among children under age 5 years, children aged 5-19 years, and adults.

The prevalence of overweight and obesity in Irish children between 1990 and 2019

OBJECTIVE

The present study aimed to examine the temporal prevalence of overweight and obesity in Irish children through different methodologies and evaluate the change in rates between 1990 and 2019.

DESIGN

Anthropometric data from three Irish national food consumption surveys were used to examine the change in the prevalence of BMI and waist circumference-derived overweight and obesity levels.

SETTING

Three cross-sectional food consumption surveys from the Republic of Ireland: the Irish National Nutrition Survey (1990), the National Children's Food Survey (2005) and The Second National Children's Food Survey (2019).

PARTICIPANTS

A demographically representative sample of Irish children aged 5-12 years: 1990 (n 148), 2005 (n 594) and 2019 (n 596).

RESULTS

Twelve percentage of children had overweight/obesity in 1990, which was significantly higher in 2005 at 25 % and significantly lower in 2019 at 16 % (P = 0·003). In 2019, more girls had overweight/obesity in comparison with boys (19 v. 14 %), whilst children from the lowest social class group had the highest levels of overweight/obesity (P = 0·019). Overall, the proportion of children with abdominal overweight/obesity was significantly lower in 2019 in comparison with 2005 (P ≤ 0·001).

CONCLUSIONS

Evidence from the most recent national survey suggests that overweight and obesity levels are plateauing and in some cases reducing in children in Ireland. Despite this, rates remain high, with the highest prevalence in 2019 observed in girls and in those from the lowest social class group. Thus, overweight/obesity prevention and intervention policies are necessary and should be continued.

How are frames generated? Insights from the industry lobby against the sugar tax in Ireland

There is a causal link between the consumption of ultra-processed foods and a range of non-communicable diseases (NCDs) such as obesity, type 2 diabetes and cancers. Despite this, no country in the world has reduced its obesity levels because the factors that drive obesity continue unchanged (Swinburn et al., 2019). One systemic driver is corporate influence on the public policy process. The world's largest food and beverage manufacturers engage public relations firms to create a narrative which speaks of corporate cooperation with public health policy, while simultaneously influencing policy making in ways that are favorable to industry. We sought to examine framing as a key strategy in the corporate political activity of food industry actors attempting to resist the introduction of a public health policy. Specifically, we analyzed industry submissions for an Irish government consultation for the proposed introduction of a sugar sweetened beverage (SSB) tax in 2018. We describe how a food product like sugar is framed positively by corporate actors who rely on it as their principal ingredient. Sugar is a good focus from a framing perspective because it is currently undergoing recalibration in the public's imagination - from a benign, nourishing treat in its heyday to a dangerous 'substance' that can contribute to premature mortality. Framing is already well established as a corporate political activity (CPA) to influence public policy (Shelton et al., 2017; Nixon et al., 2015; Darmon et al., 2008). Our research expands this understanding by uncovering four underlying mechanisms used to generate frames - dichotomizing, contesting, equating and cropping. Recognizing these mechanisms could help policy makers, public health professionals and business ethicists to deconstruct any given frame that becomes dominant in corporate discourse, such as 'personal responsibility', 'inadequate exercise', 'freedom' and so on. These mechanisms may also apply to other industries such as alcohol, fossil fuels and tobacco, where hazards from interference in public health strategies are a concern.

Effect of integrating a video intervention on parenting practices and related parental self-efficacy regarding health behaviours within the Feel4Diabetes-study in Belgian primary schoolchildren from vulnerable families: A cluster randomized trial

BACKGROUND

This study aimed to investigate the effect of integrating a video intervention "Movie Models" within the Feel4Diabetes-study on specific parenting practices and related parental self-efficacy regarding children's physical activity, screen-time and eating behaviour in vulnerable families (i.e. families living in low socioeconomic municipalities and at risk for developing type 2 diabetes). Additionally, there was examination of how the intervention was perceived by the parents.

METHODS

Within randomly selected low socioeconomic municipalities in Belgium, families were recruited through primary schools. Families at risk for developing type 2 diabetes were identified using the FINDRISC questionnaire (n = 457). Afterwards, the municipalities were randomly assigned to the intervention or control condition. At risk families assigned to the intervention group were invited to participate in six Feel4Diabetes counselling sessions in which families were encouraged to adopt a healthier lifestyle. The "Movie Models" videos were integrated within two sessions by using a face-to-face group discussion approach. Parenting-related factors were assessed before and after the integration of the videos, using a questionnaire. After integrating the videos, some extra evaluation questions were assessed. In total, 126 families were included in a per protocol evaluation and Repeated Measures ANOVAs were conducted to evaluate the potential intervention effects.

RESULTS

Some favourable intervention effects were found on parenting practices and related parental self-efficacy regarding children's eating behaviours, however almost no effects were found on parenting-related factors regarding children's physical activity and screen-time. In total, 60.0% of the participants indicated that they applied tips regarding parenting practices and 52.0% indicated that discussions with other participants regarding the videos were useful for them.

CONCLUSION

The integration of "Movie Models" within the Feel4Diabetes-study was effective in improving some parenting-related factors regarding children's health behaviours, however most parenting-related factors could not be improved. The implementation of "Movie Models" as a face-to-face group discussion approach was relatively well received and may be a promising way to improve parenting-related factors in vulnerable families.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02278809.

Perceived rather than actual overweight is associated with mental health problems in adolescence

BACKGROUND

Overweight and perceived overweight are common among adolescents. The nature of the relationship between overweight/perceived overweight and mental health problems is still unclear.

AIMS

The aim of this study was to examine whether actual overweight, perceived overweight or both are associated with internalizing and externalizing disorders among adolescents.

METHODS

Data were collected by two similar school surveys in all Finnish-speaking secondary schools in Tampere (population 200,000) in the academic years 2002-2003 and 2012-2013. A total of 2775 acceptable responses were received. All the analyses were carried out separately for girls and boys. Mean age of the respondents was 15.6 years.

RESULTS

In multivariate analyses perceived overweight, not actual weight, was significantly associated with higher risk of self-reported depression (OR: 4.3, 95% CI: 2.9-6.3, p < .001) and self-reported conduct disorder (OR: 2.3, 95% CI: 1.6-3.3, p < .001) in girls and with higher risk of self-reported depression (OR: 3.26, 95% CI: 1.65-6.4, p = .001) and self-reported social phobia (OR: 2.4, 95% CI: 1.0-5.6, p = .05) in boys.

CONCLUSION

Perceived overweight rather than actual weight status is associated with both internalizing and externalizing mental health problems in adolescents.

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

Prevalence and characteristics of paediatric Type 2 diabetes in the Republic of Ireland

OBJECTIVE

To establish the prevalence of paediatric Type 2 diabetes in the Republic of Ireland and describe patient demographics, initial presentation, management, outcomes, comorbidities and complications.

METHODS

Using a standardized proforma we conducted a cross-sectional survey of children and adolescents aged < 16 years with a diagnosis of Type 2 diabetes between October and December 2015 in each of the 19 centres in the Republic of Ireland responsible for the care of children with diabetes.

RESULTS

Twelve cases of Type 2 diabetes were identified, giving a prevalence in children aged <16 years of 1.2/100 000 (95% CI 0.6 to 2). Six of these children (50%) were white, two (33%) of whom were members of the travelling community. Four (33%) were of black ethnicity. The prevalence of Type 2 diabetes in traveller children was 16.1/100 000 (95% CI 1.9 to 58.1) and was similar to that in black children, a known high-risk group, which was 13.3/100 000 (95% CI 3.6 to 34.1). The median current HbA_1c value was 51 mmol/mol (6.8%) and four (33%) of the children achieved the International Society for Pediatric and Adolescent Diabetes target HbA_1c of ≤48 mmol/mol (6.5%). Seven (59%) children were managed on metformin monotherapy, three (25%) were managed on insulin and metformin in combination, and two (16%) were receiving dietary management.

CONCLUSION

This was the first national study to estimate the prevalence of childhood Type 2 diabetes in Ireland. Despite their white ethnicity, traveller children appear to be a high-risk group, but this finding requires further study.

The Use of Different International References to Assess Child Anthropometric Status in a Malaysian Population

OBJECTIVE

To assess the prevalence of child underweight, overweight, and obesity in a Malaysian population according to 3 international references because classification of anthropometric status may differ according to the reference used to express body mass index (BMI).

STUDY DESIGN

We assessed data from 6414 children aged 6-18 years, collected by the South East Asia Community Observatory. Child underweight, overweight, and obesity were expressed according to 3 internationally used BMI references: World Health Organization 2007, International Obesity Task Force 2012, and Centers for Disease Control and Prevention 2000. We assessed agreement in classification of anthropometric status among the references using Cohen's kappa statistic and estimated underweight, overweight, and obesity prevalence according to each reference using mixed effects Poisson regression.

RESULTS

There was poor to moderate agreement between references when classifying underweight, but generally good agreement when classifying overweight and obesity. Underweight, overweight, and obesity prevalence estimates generated using the 3 references were notably inconsistent. Overweight and obesity prevalence estimates were higher using the World Health Organization reference vs the other 2, and underweight prevalence was up to 8.5% higher and obesity prevalence was about 4% lower when using the International Obesity Task Force reference.

CONCLUSIONS

The choice of reference to express BMI may influence conclusions about child anthropometric status and malnutrition prevalence. This has implications regarding strategies for clinical management and public health interventions.

DIFFERENCES IN THE PREVALENCE OF OVERWEIGHT AND OBESITY IN 5- to 14-YEAR-OLD CHILDREN IN KRAKÓW, POLAND, USING THREE NATIONAL BMI CUT-OFFS

The problem of overweight and obesity in children and adolescents has been noted in many different countries. The aim of this study was to evaluate the differences in the percentage occurrence of overweight and obesity in Polish children depending on the criteria used, and to evaluate the usefulness of the Polish national database. The study sample comprised 3405 children aged 5-14 years (1674 girls and 1731 boys) from the city of Kraków, Poland, in 2009-2010. The BMI of each child was calculated and classified as overweight or obese according to three different reference BMI cut-offs: the International Obesity Task Force (IOTF), the Centers for Disease Control and Prevention (CDC) and the Polish 2010 standard. To assess the statistical significance of the differences between these three applied reference datasets, a comparison of two proportions was performed and Cohen's kappa coefficient calculated. The prevalences of overweight were 15%, 11.3% and 9.5% (IOTF, CDC, Polish 2010, respectively) among boys and 15.5%, 11.6% and 9.9% among girls. The prevalences of obesity were 3.3%, 6.1% and 5.5% (IOTF, CDC, Polish 2010, respectively) among boys and 3.4%, 6.3% and 5.7% among girls. The different methods used generally showed good agreement. Nevertheless the prevalence of overweight and obesity differed significantly depending on the criteria used. In conclusion, the creation and updating of national databases based on large, representative groups is justified and provides the best reference for regional data. However, in order to ensure the comparability of results with those from other countries, it seems advisable to use cut-offs based on international data as well.

Diagnostic comparison of Centers for Disease Control and Prevention and International Obesity Task Force criteria for obesity classification in South African children

Background

This study was designed to estimate overweight and obesity in school children by using contrasting definitions recommended by the Centers for Disease Control and Prevention (CDC) and the International Obesity Task Force (IOTF).

Method

The sample size consisted of 1361 learners (n = 678 boys; n = 683 girls) aged 9–13 years who were randomly selected from Mpumalanga and Limpopo provinces of South Africa. A cross-sectional and descriptive design was used to measure the children’s anthropometric characteristics. Based on height and weight measurements, the children’s body mass index (BMI) was calculated and used to classify them as underweight, overweight and obese. Percentage body fat was calculated from the sum of two skinfolds (i.e. triceps and subscapular). Age-specific BMI, percentage body fat and sum of skinfolds were examined for the boys and girls.

Results

A higher prevalence of overweight and obesity was found in boys and girls when the CDC BMI categories were used. In contrast, the IOTF BMI classifications indicated a strong prevalence of underweight among the children.

Conclusion

In contrast to the IOTF index that yielded a greater occurrence of underweight among South African children, the CDC criteria indicated a higher prevalence of obesity and overweight among the same children. Future large-scale surveillance studies are needed to determine the appropriateness of different definitions in order to establish a more reliable indicator for estimating overweight and obesity in South African children.

Trends and socioeconomic disparities in preadolescent's health in the UK: evidence from two birth cohorts 32 years apart

BACKGROUND

Compared to children and adults, little is known about changes in adolescent health over time. This study profiles the health of preadolescents in two distinct time periods, 1980 and 2012.

METHODS

Secondary analysis of the British Cohort Study and the Millennium Cohort Study for preadolescents mostly aged between 10 and 11.5 years (range 9.75-13 years). The prevalence/average of, and socioeconomic gradients in, the following were compared between 1980 and 2012; general health problems, anthropometrics, allergic conditions, infectious diseases, health service use, smoking and parental smoking behaviour and maternal adiposity. Socioeconomic status was measured by familial income (3 groups).

RESULTS

There were decreases in the proportion of hospital admissions (Δ=-0.10(-0.09:-0.11)) smoking (Δ=-0.12(-0.11:-0.13)), parental smoking (mother: (Δ=-0.19(-0.18:-0.21)) father: (Δ=-0.35(-0.34:-0.37), infectious diseases (measles: (Δ=-0.46(-0.45:-0.47)) whooping cough: (Δ=-0.07(-0.06:-0.07)) and hearing problems (Δ=-0.04(-0.03:-0.05)). There were no changes in limiting long-standing illness (Δ=0.00 (-0.00:0.00)), or the proportion of children having two or more accidents requiring medical attention (Δ=-0.02(-0.00:-0.02)). There were increases in the proportion overweight (Δ=0.18(0.17:0.19)), maternal overweight(Δ=0.22(0.21:0.23)) and obesity(Δ=0.12(0.11:0.13)), height for age(Δ=0.47(0.44:0.49)), weight for age (Δ=0.68(0.65:0.71)), proportion reporting chicken pox (Δ=0.28(0.27:0.29)), allergic conditions (eczema Δ=0.19(0.18:0.20)), asthma Δ=0.12(0.11:0.13), hay fever Δ=0.15(0.14:0.16)) and wearing glasses (Δ=0.08(0.07:0.09)). There were increases in socioeconomic gradients for limiting long-standing illness, smoking, overweight, weight for age, height for age, wearing glasses, asthma and the onset of puberty.

CONCLUSIONS

There have been reductions in infectious diseases and tobacco exposure among British preadolescents, but overweight and allergic conditions have risen dramatically. Children from deprived families have benefitted least from improvements in health status, and have experienced the largest increases in health risks.

Food for thought: analysing the internal and external school food environment

Purpose

– Availability and access to food is a determinant of obesity. The purpose of this paper is to examine food availability within and outside of post-primary schools in Ireland.

Design/methodology/approach

– Data on the internal school food environment were collected from 63 post-primary schools using questionnaires. The external school food environment for these 63 schools was assessed by mapping food businesses within 1 km of schools, using a Geographic Information System (GIS). Food businesses were categorised based on type of food sold.

Findings

– A total of 68.3 per cent of schools had a canteen, 52.5 per cent had a small food shop and 37.1 per cent had a vending machine. A total of 32.7 per cent of schools reported selling chips (French fries) in their canteen while 44.2 per cent of schools reported selling energy-dense nutrient-poor foods in their school shop. Of the schools surveyed, there was an average of 3.89 coffee shops and sandwich bars, 3.65 full service restaurants, 2.60 Asian and other “ethnic” restaurants, 4.03 fast food restaurants, 1.95 supermarkets, 6.71 local shops and 0.73 fruit and vegetable retailers within a 1 km radius of the post-primary schools. Findings are presented by geography (urban/rural), disadvantage (Delivering Equality of Opportunity in School (DEIS)/non DEIS), gender (girls/boys/mixed) and food policy in place at the school (yes/no).

Practical implications

– These data will facilitate schools working on the framework for Health Promoting Schools in Ireland.

Social implications

– This work can contribute to current discussions on restricting accessibility to certain foods and food premises for school children.

Originality/value

– The study explores the internal and external school food environment. GIS have been used to link the external food environment to specific schools thus allowing a comprehensive analysis of the schools’ food environment. To the authors knowledge, this is the first time that both environments are explored simultaneously.

Trends and prevalence of overweight and obesity in primary school aged children in the Republic of Ireland from 2002-2012: a systematic review

Background

The prevalence of childhood overweight and obesity in developed countries appears to be levelling off. As trends in childhood obesity prevalence have not been examined over the past decade in the Republic of Ireland, this systematic review aims to compile and synthesise all available information on the prevalence of overweight and obesity in primary school aged children between 2002 and 2012.

Methods

Systematic review of published and grey literature containing data on objectively measured height and weight. Inclusion criteria included studies where data was collected between 2002 and 2012 from at least 200 primary school aged children in the Republic of Ireland. Database searching, Google searching, reference searching and contact with obesity experts was undertaken. Overweight, obesity and morbid obesity were defined using standard International Obesity Taskforce definitions. Study quality was assessed.

Results

Fourteen studies (16 prevalence estimates) met the inclusion criteria. The combined prevalence of overweight and obesity within the studies ranged from 20-34%. No significant trend in overweight prevalence over time was observed (p=0.6). However, there was evidence of a slight decrease in obesity prevalence over the period (p=0.01), with a similar though non-significant decline in the prevalence of morbid obesity (p=0.2).

Conclusion

The findings of this systematic review require cautious interpretation though the prevalence of childhood overweight and obesity in the Republic of Ireland has reached a plateau and may be falling. These findings provide some ground for optimism though the current plateau is at an unacceptably high level. Thus current population based preventive strategies need to be sustained and intensified.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2458-14-974) contains supplementary material, which is available to authorized users.

Diet, lifestyle and body weight in Irish children: findings from Irish Universities Nutrition Alliance national surveys

Childhood obesity is an issue of public health concern globally. This review reports on levels of overweight and obesity in Irish children and examines some aspects of their diet and lifestyle proposed to promote or protect against increasing body fatness in children. While there is still some debate with regard to the most appropriate cut-off points to use when assessing body fatness in children, approximately one in five Irish children (aged 2-17 years) have been classified as overweight (including obese) according to two generally accepted approaches. Furthermore, comparison with previous data has shown an increase in mean body weight and BMI over time. On examining dietary patterns for Irish children, there was a noticeable transition from a less energy dense diet in pre-school children to a more energy dense diet in older children and teenagers, associated with a change to less favourable dietary intakes for fibre, fat, fruit and vegetables, confectionery and snacks and sugar-sweetened beverages as children got older. A significant proportion of school-aged children and teenagers reported watching more than 2 h television per day (35% on school-days and 65% on week-ends) compared with 13% of pre-school children. For children aged 5-12 years, eating out of the home contributed just 9% of energy intake but food eaten from outside the home was shown to contribute a higher proportion of energy from fat and to be less fibre-dense than food prepared at home. Improvements in dietary lifestyle are needed to control increasing levels of overweight and obesity in children in Ireland.

Nutritional quality of the school-day diet in Irish children (5-12 years)

BACKGROUND

The European Commission has identified schools as a priority setting for health promotion, including nutrition education and intervention. The present study examined the school-day diet of Irish primary-school children with the aim of identifying opportunities for dietary improvement.

METHODS

Data from The National Children's Food Survey (2003-2004) were used to establish a dataset of school-days. Dietary intake data were collected from 594 children (5-12 years) using a 7-day weighed food-record. The nutritional quality of the diet was examined for the total school-day and for food eaten 'before school', 'at school' and 'after school'.

RESULTS

Examination of dietary intake on school-days has highlighted nutritional imbalances for intakes of fat, saturated fat, added sugars, sodium and dietary fibre (DF). Mean energy (E) intake for the overall school-day was 7.1 MJ, with 16% of energy provided from food eaten 'before school', 33%E from food eaten 'at school' and 53% of energy from food eaten 'after school'. Relative to the overall school-day, food eaten 'before school' was lower in saturated fat and sodium, and higher in DF and many micronutrients. Food eaten 'at school' was relatively high in added sugars and sodium; lower in DF and micronutrients; and similar in saturated fat compared to the overall school-day. Food eaten 'after school' was relatively high in DF and vitamin A; similar in saturated fat, magnesium and sodium; and lower in added sugars and other micronutrients compared to the overall school-day.

CONCLUSIONS

To improve the overall nutritional quality of the school-day diet, food eaten at school should be targeted.

Trends in adiposity in Brazilian 7-10-year-old schoolchildren: evidence for increasing overweight but not obesity between 2002 and 2007

BACKGROUND

The negative health consequences of childhood overweight/obesity (OW/OB) are well known. Therefore, an accurate monitoring of the OW/OB prevalence is essential. Anthropometry is the most practical and cost-effective method for nutritional status evaluation.

AIM

To describe trends in the nutritional status among 7-10-year-old children by investigating changes in the prevalence of stunting, thinness, overweight, obesity, risk and excess abdominal adiposity, and to study changes in height-for-age, body mass index (BMI) and waist circumference (WC).

SUBJECTS AND METHODS

A school-based sample of 7-10-year-old children participated in two cross-sectional studies in 2002 (n = 2936) and 2007 (n = 1232) in Florianopolis, southern Brazil. Prevalence of stunting, risk and excess abdominal adiposity and changes in the distribution of height-for-age, BMI-for-age, WC-for-age z-scores were evaluated. Three BMI-based references were used to define the prevalence of thinness, overweight and obesity.

RESULTS

Between 2002-2007, the prevalence of stunting, thinness, obesity and excess abdominal adiposity remained stable, whereas overweight (including obesity) increased 10-23% in boys and 18-21% in girls, depending on the BMI reference used. The risk of abdominal adiposity increased in boys, but not in girls. No significant change was observed in mean height, BMI, WC-for-age z-scores.

CONCLUSIONS

This study identified a potential levelling off in the prevalence of obesity and excess abdominal adiposity, but a continuing increase in the prevalence of overweight.

Reviewing definitions of urinary continence in the contemporary spina bifida literature: a call for clarity

BACKGROUND

Urinary continence is a common goal for children with spina bifida and their physicians. However, definitions of urinary continence vary widely across published studies. We systematically assessed the utilization of common definitions of urinary continence in the spina bifida literature.

METHODS

We searched library databases for reports (2000-2012) describing urinary continence outcomes in children with spina bifida. We assessed various patient-level factors such as age, lesion level, surgical history, and use of additional therapies, as well as study-level factors such as study design, country of origin, continence definition(s), and method of data collection.

RESULTS

Of 473 identified articles, 105 met inclusion criteria, comprising a total of 3209 patients. Of these, 1791 patients (56%) were deemed continent by the study authors. Only 60 studies (57%) clearly defined what they considered to be "continent". The most common definition, used in 24% of all reports, was "always dry". There was no association between journal of publication (p = 0.13), publication year (p = 0.86), study size (p = 0.26), or study country (p = 0.43) and likelihood of a continence definition being included in the manuscript.

CONCLUSIONS

The most frequent definition of urinary continence in the spina bifida literature is "always dry". However, definitions were highly variable, and many authors did not define continence at all. Clinicians and researchers alike would be better able to apply research findings toward improving patient care if continence definitions were more explicitly reported and less variable.

Variation in definitions of urinary tract infections in spina bifida patients: a systematic review

OBJECTIVE

Urinary tract infections (UTIs) are a common source of morbidity among children with spina bifida (SB) and are a frequently reported outcome in studies of this patient population. However, the criteria for a diagnosis of UTI are often not stated. We evaluated the literature on SB patients for the criteria that authors use to define parameters in reporting UTI outcomes.

METHODS

Embase and Medline were queried with the medical subject heading terms “spinal dysraphism,” “myelomeningocele,” “infection,”and “urinary tract infection.” A second search with the exploded term“spina bifida” and “urinary tract infection” was performed. Original research studies reporting a UTI outcome in SB patients were included and evaluated by 2 independent reviewers for the presence of a UTI definition and diagnostic criteria.

RESULTS

We identified 872 publications, of which 124 met inclusion criteria. Forty-five of 124 (36.3%) studies reporting UTI as an outcome provided a definition of UTI. Of 124 studies, 28 (22.6%) were published in pediatric journals and 69 (55.6%) in urology journals. A definition of UTI was provided in 11 (39.3%) and 26 (37.7%) studies, respectively. “Fever,culture, and symptoms” defined a UTI in 17 of 45 studies. Journal category and presence of UTI definitions did not correlate (P = .71).

CONCLUSIONS

Explicit definitions for UTI are heterogeneous and infrequently applied in studies of SB patients, limiting study reliability and estimates of true UTI rates in this population. Future studies will benefit from the development and application of a standard definition for UTI in this population.

Appendicitis in obese children

During the past two decades, the incidence of childhood obesity has increased at alarming rates throughout the world. Obesity is associated with a variety of physiological changes that may impair a patient's response to surgery. With the rising rates of childhood obesity, pediatric surgeons must appreciate differences in the management and outcomes of these patients. Difficult physical examination, elevated inflammatory blood markers, and negative influence of obesity on the detection rate of the appendix on ultrasound have been reported causing diagnostic challenging of appendicitis in obese children. Moreover, obesity is associated with longer hospital stay and higher morbidity and minimal invasive techniques' superior outcomes over open technique in children undergoing appendectomy.

Parental weight (mis)perceptions: factors influencing parents' ability to correctly categorise their child's weight status

This study investigates parents' ability to correctly classify their child's weight status. The influence of parent and child socio-demographic and lifestyle factors on parental misclassification of their child's weight status is explored. A representative sample of Irish children (aged 5-12 (n = 596) years, aged 13-17 years (n = 441)) and their parents (n = 1885) were recruited to participate in a national dietary survey. Parental perceptions of their child's weight and their own weight were measured. Anthropometric measurements (weight and height) were objectively measured for parents and children. Body Mass Index (BMI) scores were derived and categorised as normal, overweight or obese using standard references. Over 80% of parents of overweight boys and 79.3% of parents of overweight girls reported their child's weight was fine for his/her height and age. Furthermore, 44.4% of parents of obese boys and 45.3% of parents of obese girls felt their child's weight was fine for their height and age. Parents were significantly less likely to be correct about their sons' weight status and more likely to be correct the older the child. Parents were over 86% less likely to be correct about their child's weight if their child was overweight and approximately 59% less likely to be correct if the child was obese, compared to parents of normal weight children. This research suggests that parents are failing to recognise overweight and obesity in their children with factors such as parental weight status, child's age and gender influencing this.

Risk factors for prediabetes in overweight and obese pre-teens and adolescents

We looked for easy-to-use and predictable tools for identifying early risk ofprediabetes (PD) and preventing the natural course to diabetes in overweight andobese pre-teens and adolescents. In 89 children (9-18 years) family history, bodymass index (BMI), waist circumference (WC), acanthosis nigricans, blood pressure(BP), lipids, HbA1c, fasting glucose and oral glucose tolerance test were determined.We found 69 (77.5%) obese (BMI≥95th percentile) and 20 (22.5%) overweightchildren (BMI 85th-95th percentiles); thirty-six (41.4%) had PD; two had type 2diabetes mellitus; two had metabolic syndrome. PD was associated with obesity (RR5.1), HbA1c>5.5% (RR 2.5), acanthosis nigricans (RR=1.9), malegender (RR = 1.9), total cholesterol ≥170 mg/dL (RR=1.8), high BP (RR=1.7), urbanarea (RR = 1.6). BMI, WC, HbA1c and acanthosis nigricans are the majorpredictors for PD in this population. All blood values are both easy to measure andto accept by children, using finger prick method.

Body mass index distribution affects discrepancies in weight classifications in children

BACKGROUND

The aim of the present study was to investigate the effect of body mass index (BMI) distribution, ethnicity and age at menarche on the consistency in the prevalence of underweight and overweight defined by the Centers for Disease Control and Prevention (CDC) and the International Obesity Task Force (IOTF) cut-off points in 2-17-year-old Chinese and US children.

METHODS

Data from the China Health and Nutrition Survey (CHNS) 1991 (n= 3895), CHNS 2004 (n= 1902), and the National Health and Nutrition Examination Survey (NHANES) 2003-2004 (n= 3344) were used to define the prevalence of underweight and overweight using the CDC and IOTF BMI cut-off points.

RESULTS

An upward shift in the BMI distribution was observed from the CHNS 1991 to CHNS 2004, and between the CHNS and NHANES 2004. The prevalence of underweight defined by the IOTF cut-off points was higher than that obtained using the CDC cut-off points; absolute differences between IOTF and CDC classifiers were 7%, 5%, and 2% in boys, and 12%, 11%, and 4% in girls in the CHNS 1991, CHNS 2004, and NHANES 2004, respectively. There was a greater consistency in the prevalence of overweight. The consistency of the two classification systems increased with the higher BMI distribution and was not affected significantly by ethnicity or age at menarche.

CONCLUSIONS

The BMI distribution of a population can affect the classification of childhood underweight and overweight differentially as defined by the CDC and IOTF cut-off points, and thus should be considered in the interpretation of results in clinical and population settings.

Is dieting behaviour decreasing in young adolescents?

Objective

To report trends in underweight, overweight and obesity in 12–15-year-old adolescents and examine changes in dieting behaviour, which have been less well documented.

Design

Comparison of two independent representative cross-sectional surveys.

Setting

Northern Ireland.

Subjects

Weight and height were objectively measured in 1324 boys and 1160 girls in 1996 and 1274 boys and 1374 girls in 2007. Participants reported whether they were following any particular diet including a self-proposed or prescribed weight-reduction diet.

Results

Overweight and obesity increased in girls from 15 % to 23 % and 2 % to 6 %, respectively. Increases were more modest in boys with overweight increasing from 13 % to 18 % and obesity from 3 % to 6 %. The proportion of underweight adolescents decreased from 9 % to 6 % in girls and 8 % to 5 % in boys. Evidence of social disparity was observed in girls from a manual socio-economic background, with overweight/obesity prevalence rates increasing from 21 % to 36 % compared with 15 % to 26 % in girls from a non-manual background. Despite these trends fewer adolescents, in particular girls, reported following weight-reduction diets (14 % of overweight/obese girls in 2007 v. 21 % in 1996; 8 % of boys in 2007 v. 13 % in 1996). Of these girls, the proportion from a manual background following weight-reduction diets decreased from 25 % to 11 %.

Conclusions

Overweight and obesity are continuing to increase in adolescents despite government and media awareness strategies. There also appears to be reduced dieting behaviour, despite increasing body weight, particularly in girls from manual socio-economic backgrounds.

Revision of food-based dietary guidelines for Ireland, Phase 2: recommendations for healthy eating and affordability

OBJECTIVE

To revise the food-based dietary guidelines for Ireland and assess the affordability of healthy eating.

DESIGN

An iterative process was used to develop 4 d food intake patterns (n 22) until average intakes met a range of nutrient and energy goals (at moderate and sedentary activity levels) that represented the variable nutritional requirements of all in the population aged 5 years and older. Dietary guidelines were formulated describing the amounts and types of foods that made up these intake patterns. Foods required for healthy eating by typical households in Ireland were priced and affordability assessed as a proportion of relevant weekly social welfare allowances.

SETTING

Government agency/community.

SUBJECTS

General population aged 5+ years.

RESULTS

Food patterns developed achieved energy and nutrient goals with the exception of dietary fibre (inadequate for adults with energy requirements <9·2 MJ) and vitamin D (inadequate for everyone). A new food group to guide on fats/oils intake was developed. Servings within the Bread, Cereal and Potato group were sub-categorized on the basis of energy content. Recommendations on numbers of servings from each food group were developed to guide on energy and nutrient requirements. Healthy eating is least affordable for families with children who are dependent on social welfare.

CONCLUSION

Daily supplementation with vitamin D is recommended. Wholemeal breads and cereals are recommended as the best source of energy and fibre. Low-fat dairy products and reduced-fat unsaturated spreads are prioritized to achieve saturated fat and energy goals. Interventions are required to ensure that healthy eating is affordable.

Revision of food-based dietary guidelines for Ireland, Phase 1: evaluation of Ireland's food guide

OBJECTIVE

To evaluate Ireland's food-based dietary guidelines and highlight priorities for revision.

DESIGN

Evaluation with stakeholder input. Energy and nutrient intake goals most appropriate for Ireland were determined. Advice from Ireland's food guide was translated into 4 d food intake patterns representing age and gender groups from 5 to 51+ years. Nutritional content of the food patterns was compared with identified goals and appropriateness of food advice was noted. Feedback from stakeholders was obtained on portion size of foods within the Bread, Cereal and Potato group and of portion descriptors for meat and cereal foods.

SETTING

Government agency/community.

SUBJECTS

General population aged 5+ years, dietitians/nutritionists (n 44) and 1011 consumers.

RESULTS

Goals were identified for energy, macronutrients, fibre, Fe, Ca and vitamin D. Goals not achieved by the food patterns included energy, total fat, saturated fat, fibre and vitamin D. Energy content of food portions within the Bread, Cereal and Potato group varied widely, yet advice indicated they were equivalent. Dietitians/nutritionists agreed with the majority of consumers surveyed (74 %, n 745) that larger portion sizes within the Bread, Cereal and Potato group were more meaningful. 'Palm of hand' as a descriptor for meat portions and a '200 ml disposable cup' for quantifying cereal foods were preferred.

CONCLUSIONS

Revision of the guidelines requires specific guidance on energy and vitamin D intakes, and comprehensive advice on how to reduce fat and saturated fat and increase fibre intakes. Advice should use portion descriptors favoured by consumers and enlarged portion sizes for breads, cereals and potatoes that are equivalent in terms of energy.

Laparoscopic appendectomy is associated with lower morbidity in extremely obese children

PURPOSE

In recent years there has been worldwide increase in childhood obesity. However, in the beginning laparoscopic appendectomy in obese children was contraindicated, now it is commonly used for the treatment of appendicitis. The purpose of this study was to compare open versus laparoscopic appendectomy in extremely obese children.

METHODS

The hospital records of 1,383 consecutive patients, who underwent appendectomy for acute appendicitis between 2000 and 2009 were analyzed. 238 children (17.2%) were extremely obese. Extremely obese was defined, as greater than 2 standard deviations above the standardized mean weight for age. 61 of 238 (25.6%) patients had open appendectomy and 177 (74.3%) underwent laparoscopic appendectomy. The length of hospital stay, operation time, complication rate and frequency of taking postoperative pain relief were compared between open and laparoscopic appendectomy in extremely obese children.

RESULTS

The incidence of complicated and non-complicated appendicitis was similar both in open and laparoscopic appendectomy group. Laparoscopic appendectomy for acute appendicitis in extremely obese children is associated with significantly shorter operating time (46.8 vs. 59.87 min, P < 0.05), lower overall complication rate (5 vs. 8.2%, P < 0.05) and lesser postoperative analgesia requirement (6.97× vs. 4.73×, P < 0.05).

CONCLUSION

Laparoscopic appendectomy should be the procedure of choice for the treatment of acute appendicitis in extremely obese children.

Changes in adiposity status from childhood to adolescence: a 6-year longitudinal study in Portuguese boys and girls

BACKGROUND

Cross-sectional data show high prevalence of overweight in Portuguese children, but there are few longitudinal studies describing the patterns of obesity development in the young.

AIM

To examine the trajectories of obesity from late childhood to adolescence.

SUBJECTS AND METHODS

Triceps and subscapular skinfold thickness measurements were carried out in 288 children at age 9 (baseline) and later at age 15 (follow-up). Percentage body fat (%BF) was estimated according to Slaughter equations and the health-related definition of obesity ( ≥ 25%BF in boys and ≥ 30%BF in girls) was used.

RESULTS

In boys, the prevalence of obesity decreased from 21.9% to 14.8% (p < 0.05) while in girls it increased from 14.3% to 19.5%. The incidence of obesity in the 6-year study period was 2.6% and 8.3% for boys and girls, respectively (p < 0.05). In comparison with girls, the percentage of boys that reversed obesity was more than 3-fold higher (3% vs 9.7%, p < 0.05). Obesity tracked moderately in both sexes (Kappa = 0.6, p < 0.001).

CONCLUSION

The results indicate a marked sex difference in the incidence and reversal of obesity from late childhood to adolescence that is unfavourable to girls. Consideration of this difference might be important when designing programmes for the prevention and treatment of obesity focusing on this period.

The nutrition transition in the Republic of Ireland: trends in energy and nutrient supply from 1961 to 2007 using Food and Agriculture Organization food balance sheets

Over the course of the last 50 years the Republic of Ireland has gone from being one of the poorest countries in Europe to one of the richest; however, it is now experiencing increasing rates of obesity and non-communicable chronic disease. Although several national nutrition surveys have been carried out in Ireland since 1990, there is little information on the Irish diet before then. We analysed the FAO food balance sheets for Ireland from 1961 to 2007 in order to characterise the changes in energy and nutrient supply that took place during that period. Food balance sheets were downloaded from the FAOSTAT database and per capita supply of commodities was analysed using dietary analysis software. Energy from carbohydrate as a percentage of total energy fell from 55 % in 1961 to 46 % in 2007, whereas energy from fat increased from 29 % to 34 %; these values are well outside WHO recommendations for the prevention of chronic disease. Energy from alcohol as a percentage of total energy has doubled within the last 20 years. On a nutrient-density basis, vitamins and minerals met or exceeded WHO recommendations, apart from vitamin D, folate, Ca and Fe. Although there are methodological limitations associated with the use of food balance sheets, the present results demonstrate that the current imbalances in the Irish diet were already evident several decades ago. Because they are so long established, they will be difficult to reverse unless major public health nutrition interventions are implemented.

Childhood obesity: are we all speaking the same language?

Terminology and measures used in studies of weight and adiposity in children can be complex and confusing. Differences arise in metrics, terminology, reference values, and reference levels. Most studies depend on body mass index (BMI) calculated from weight and height, rather than on more direct measures of body fatness. Definitions of overweight and obesity are generally statistical rather than risk-based and use a variety of different reference data sets for BMI. As a result, different definitions often do not give the same results. A basic problem is the lack of strong evidence for any one particular definition. Rather than formulate the question as being one of how to define obesity, it might be useful to consider what BMI cut-points best predict future health risks and how efficiently to screen for such risks. The answers may be different for different populations. In addition, rather than depending solely on BMI to make screening decisions, it is likely to be useful to also consider other factors, including not only race-ethnicity, sex and age, but also factors such as family history. Despite their limitations, BMI-based definitions of overweight and obesity provide working practical definitions that are valuable for general public health surveillance and screening.

Obesity prevalence estimates in a Canadian regional population of preschool children using variant growth references

BACKGROUND

Childhood obesity is a public health problem in Canada. Accurate measurement of a health problem is crucial in defining its burden. The objective of this study is to compare the prevalence estimates of overweight and obesity in preschool children using three growth references.

METHODS

Weights and heights were measured on 1026 preschool children born in Newfoundland and Labrador (NL), Canada, and body mass index calculated. The prevalence of overweight and obesity was determined and statistical comparisons conducted among the three growth references; the Centres for Disease Control (CDC), the International Obesity Task Force (IOTF) and the World Health Organization (WHO).

RESULTS

CDC and IOTF produced similar estimates of the prevalence of overweight, 19.1% versus 18.2% while the WHO reported a higher prevalence 26.7% (p < .001). The CDC classified twice as many children as obese compared to the IOTF 16.6% versus 8.3% (p < .001) and a third more than the WHO 16.6% versus 11.3% (p < .01). There was variable level of agreement between methods.

CONCLUSIONS

The CDC reported a much higher prevalence of obesity compared to the other references. The prevalence of childhood obesity is dependent on the growth reference used.

Availability of data assessing the prevalence and trends of overweight and obesity among European adolescents

OBJECTIVE

To review recent data on objectively measured overweight/obesity in national representative samples of European adolescents (aged 10-18 years), as well as availability of studies assessing trends in overweight/obesity in this target group. Attention was paid to the ability of the data to describe the obesity epidemic, especially in sociodemographic subgroups.

DESIGN/SETTING/SUBJECTS

Data on prevalence and trends in overweight/obesity among adolescents in the twenty-seven European Community member states, Iceland, Norway and Switzerland, available as scientific publications as well as reports or unpublished data by the end of 2009, were retrieved. Reports on the most recent objectively measured data from national representative samples were selected and described with regard to the years of data collection, sample sizes, response rates, age ranges included, trends by age, type of measures of overweight/obesity, sociodemographic variables and the sources of information.

RESULTS

Objectively measured data on national representative samples were identified for only half of the countries, and the trend studies were mainly conducted applying subnational samples. Most studies used the criteria from the International Obesity Task Force (IOTF) to define overweight/obesity, but the age ranges studied and the years of data collection varied, and information on sample sizes and response rates were often not presented. Data on trends of overweight/obesity over time are increasing, and the most recent studies indicate that the prevalence rate of overweight/obesity has stabilized. Few studies reported data by sociodemographic subgroups other than gender and age.

CONCLUSIONS

Objectively measured data on national representative samples of adolescents appear scattered, and there is a large heterogeneity with respect to the quality and comparability of available data. Increasing use of the IOTF criteria for overweight/obesity contributes to improved comparability across studies. Data by sociodemographic subgroups, and in particular by socio-economic status, are scarce.

Increased incidence of negative appendectomy in childhood obesity

BACKGROUND

In recent years, there has been worldwide increase in childhood obesity. The diagnosis of acute appendicitis in very obese children can sometimes be difficult and challenging. The purpose of this study was to determine the incidence of histologically normal appendix in very obese and non-obese children undergoing emergency appendectomy for the clinical diagnosis of acute appendicitis.

METHODS

The hospital records of 1,228 consecutive patients, who underwent appendectomy for acute appendicitis between 2000 and 2008, were analyzed. 207 children (16.9%) were very obese. Very obese was defined as greater than 2 standard deviations above the standardized mean weight for age. Histological data was compared between very obese and non-obese children. Seventy-seven (37%) of 207 very obese and 398 (39%) of 1,021 non-obese children had ultrasound preoperatively.

RESULTS

The incidence of normal appendectomy was significantly higher in very obese children compared to non-obese children (24.6 vs. 9.9%, P < 0.001). The false positive rate of ultrasound was significantly higher in very obese children group compared to non-obese (26 vs. 6%, P < 0.05). The specificity, sensitivity, positive and negative predictive values of ultrasound were significantly lower (P < 0.05) in very obese children group compared to non-obese children.

CONCLUSION

Suspected appendicitis in childhood obesity is associated with increased incidence of normal appendectomy. Active observation in hospital in very obese children may reduce the rate of normal appendectomy without increasing the incidence of complicated appendicitis.

Trends in obesity among Korean children using four different criteria

OBJECTIVE

This study examined the prevalence of and trends in childhood overweight and obesity among South Korean children using four different criteria.

METHODS

Data for 7 879 subjects, aged 2?19 (4 091 boys and 3 788 girls), were derived from four waves of the Korean National Health and Nutrition Examination Surveys conducted in 1998, 2001, 2005, and 2007. We examined the time trends in obesity measures based on criteria suggested by the International Obesity Taskforce (IOTF), the US Centers for Disease Control and Prevention (US CDC), the World Health Organization (WHO), and the Korea Centers for Disease Control and Prevention (KCDC).

RESULTS

Differences in the absolute prevalence of childhood obesity among the criteria were relatively great. There were no criteria that recorded consistently higher or lower prevalence of childhood overweight (including obesity) and obesity in both genders and age groups compared with other criteria. No differences in time trends of the prevalence between criteria were detected. Increases in the prevalence of overweight and obesity among boys aged 10?19 were found between 1998 and 2001 but, thereafter, trends toward stabilization were found. No significant increases in the prevalence of both overweight and obesity were detected among males and females aged 2?9 between 2001 and 2007 and among females aged 10?19 between 1998 and 2007.

CONCLUSIONS

The prevalence of childhood overweight and obesity in South Korea stabilized in the early 2000s; however, further policy efforts to lower the high prevalence of childhood obesity and overweight should be exercised.

Screening for body-weight disorders in Nigerian children using contrasting definitions

Several indices for body-weight disorders exist in scientific literature, but it is inconclusive whether or not they can yield comparable results when applied to Nigerian children. The prevalence of weight disorders in Nigerian children was examined using the Centre for Disease Control and Prevention (CDC) body mass index (BMI) for age charts and the International Obesity Task Force's (IOTF) age- and sex-specific BMI cut-off points. Participants were 2015 pupils (979 boys and 1036 girls) aged 9-12 years, attending 19 public primary schools in Makurdi, Nigeria. Stature and body mass were measured using standard techniques. Results were analysed using student t-test and Chi-squared statistics, with the probability level set at <or=0.05. CDC's BMI charts categorized 2.1%, 1.6% (boys) and 3.2%, 2.8% (girls) as overweight and obese respectively. Corresponding data for the IOTF's BMI charts were 1.7%, 0.9% (boys) and 2.6%, 2.0% (girls). CDC cut-off points indicated higher prevalence of overweight and obesity, thus suggesting the need for a single definition for evaluating measurements of body mass-for-stature in the children. However, more disconcerting is the fact that CDC charts showed a high prevalence of underweight for the boys (87.1%) and girls (79.7%). Prevalent underweight conditions in our sample need urgent intervention. The IOTF method is limited in its utility to identify children who are underweight and may be at risk of growth faltering.

Eleven-year prevalence trends of obesity in Greek children: first evidence that prevalence of obesity is leveling off

We examined 11-year (1997-2007) trends in underweight, overweight, and obesity in Greek children. Population data derived from a yearly, school-based health survey carried out between 1997 and 2007 in >80% of all Greek schools. Height and weight measurements from 651,582 children, aged 8-9 years (boys: 51.2%) were analyzed. The gender- and age-specific BMI cutoff points by the International Obesity Task Force (IOTF) were used in order to define underweight, normal weight, overweight, and obesity. Trend analysis showed an increase in the prevalence of obesity from 7.2 +/- 0.2% in 1997 to 11.3 +/- 0.2% in 2004 for girls (P < 0.001) and from 8.1 +/- 0.2% in 1997 to 12.3 +/- 0.2% in 2004 for boys (P < 0.001). An apparent leveling off in obesity rates was observed during 2004-2007 for both boys and girls. The prevalence of overweight rose between 1997 and 2007 from 20.2 +/- 0.2% to 26.7 +/- 0.2% for girls (P < 0.001) and from 19.6 +/- 0.2% to 26.5 +/- 0.2% for boys (P < 0.001). The overall prevalence of thinness in the same period remained constant in both sexes. The presented population-based data revealed that the prevalence of overweight and obesity among 8- to 9-year-old Greek children is alarmingly elevated, with the overweight rates rising continuously. However, an apparent leveling off in obesity rates for the past 4 consecutive years was documented for the first time in both genders.

Is C-reactive protein a reliable test for suspected appendicitis in extremely obese children?

PURPOSE

The diagnosis of acute appendicitis by physical examination can sometimes be difficult in extremely obese children. C-reactive protein (CRP) is commonly used to support the clinical diagnosis of appendicitis. However, obesity has been widely recognized as a chronic inflammatory condition and associated with elevated inflammatory indicators including CRP. The aim of this study was to examine the association between obesity and CRP levels in extremely obese children presenting with suspected appendicitis.

MATERIALS

The hospital records of 947 consecutive patients, who underwent appendectomy for acute appendicitis between 2002 and 2008 were retrospectively analyzed. 164 children (17.3%) were extremely obese. Extreme obesity was defined, as greater than two standard deviations above the standardized mean weight for age. The diagnostic value of CRP level was compared between extremely obese and non-obese children.

RESULTS

The incidence of histologically normal appendix was significantly higher in extremely obese children [42 out of 164 (25.6%)] compared to non-obese children [85 out of 783 (10.8%) (P < 0.001)]. The mean CRP levels were significantly higher in extremely obese children with histologically normal appendix compared to non-obese children with normal appendix (P < 0.001). The specificity and the positive predictive value were significantly lower in the extremely obese children group than in the non-obese group (P < 0.001).

CONCLUSION

CRP is not a reliable marker of inflammation in extremely obese children presenting with suspected appendicitis. Our data highlight the importance of obesity when interpreting the significance of an elevated CRP level in children with suspected diagnosis of appendicitis.

The prevalence and determinants of breast-feeding initiation and duration in a sample of women in Ireland

OBJECTIVE

To assess breast-feeding initiation and prevalence from birth to 6 months in a sample of mothers in Dublin, and to determine the factors associated with breast-feeding initiation and 'any' breast-feeding at 6 weeks in a sample of Irish-national mothers.

DESIGN

This prospective cross-sectional study involved the recruitment of women during the antenatal period, with subsequent follow-up of mothers who delivered healthy, term singleton infants, at 6 weeks and 6 months postpartum.

SETTING

Participants were recruited from antenatal clinics in the Coombe Women and Infants University Hospital, Dublin.

SUBJECTS

In all, 401 Irish-national and forty-nine non-Irish-national mothers met the criteria for inclusion in the present study.

RESULTS

Breast-feeding initiation rates of the Irish-national and non-Irish-nationals were 47% and 79.6%, respectively. Factors that were significantly (P = 0.000) associated with both breast-feeding initiation and 'any' breast-feeding at 6 weeks included mothers who were >or=35 years, educated to third level, reported positive postnatal encouragement to breast-feed from their partners and had a positive antenatal intention to breast-feed. The maternal negative perception that breast-feeding is an embarrassing way to feed an infant was demonstrated as a major barrier to initiation.

CONCLUSIONS

Breast-feeding initiation and prevalence rates of the Irish-national population remain low and lag considerably behind national and international targets. Inclusion of the partner in breast-feeding promotional initiatives during the antenatal period may be crucial to increase breast-feeding rates in Ireland. Public health campaigns that focus on increasing the social acceptability of breast-feeding may prove effective in addressing this cultural barrier.

Session 1: Public health nutrition Breast-feeding practices in Ireland

Breast-feeding is the superior infant feeding method from birth, with research consistently demonstrating its numerous short- and long-term health benefits for both mother and infant. As a global recommendation the WHO advises that mothers should exclusively breast-feed for the first 6-months of life, thus delaying the introduction of solids during this time. Historically, Irish breast-feeding initiation rates have remained strikingly low in comparison with international data and there has been little improvement in breast-feeding duration rates. There is wide geographical variation in terms of breast-feeding initiation both internationally and in Ireland. Some of these differences in breast-feeding rates may be associated with differing socio-economic characteristics. A recent cross-sectional prospective study of 561 pregnant women attending a Dublin hospital and followed from the antenatal period to 6 months post partum has found that 47% of the Irish-national mothers initiated breast-feeding, while only 24% were still offering ‘any’ breast milk to their infants at 6 weeks. Mothers' positive antenatal feeding intention to breast-feed is indicated as one of the most important independent determinants of initiation and ‘any’ breast-feeding at 6 weeks, suggesting that the antenatal period should be targeted as an effective time to influence and affect mothers' attitudes and beliefs pertaining to breast-feeding. These results suggest that the ‘cultural’ barrier towards breast-feeding appears to still prevail in Ireland and consequently an environment that enables women to breast-feed is far from being achieved. Undoubtedly, a shift towards a more positive and accepting breast-feeding culture is required if national breast-feeding rates are to improve.