A social epidemiologic study of obesity among preschool children in Thailand

Cultural and Western Influences on the Nutrition Transition in Thailand

The impact of economic development and urbanisation on nutrition and dietary changes in transitional countries has been well researched. It generally has been found that there is a positive correlation between economic development, urbanization, and negative nutrition transitions with the result of growing levels of obesity and diet related non-communicable diseases. However, the impact of Western influences and culture on specific eating styles associated with the nutrition transition has been less studied. There is limited information about cultural and Western influences on eating styles in Thailand. Recent findings suggest that Thailand may have progressed further along the nutrition transition model, in terms of unhealthy eating styles, than would be expected based on economic development. This study was designed to determine the prevalence of current eating styles and eating motivations among Thai university students. University students were chosen for evaluation as they are thought to represent the forefront of dietary trends and nutrition changes in a population. Convenience samples from four different universities in south-central and northern Thailand were selected. The following scales were used to assess eating and dieting styles and attitudes among 662 Thai undergraduate and graduate students: Motivation For Eating Scale (MFES), Eating Attitudes Test-26 (EAT-26), and Cognitive Dieting Behavior Scale (CBDS). All scales have been shown to be reliable and valid in previous research. For this study, scales were translated into Thai, reverse translated, and pilot tested to ensure cultural relevancy and the conveyance of intended meanings. Basic demographic information was also obtained, including age, gender, year in school, marital status, height and weight, and income. Results indicated that Thai students exhibit significant levels of dieting behaviour and extrinsic eating based on CBDS and MFES scores (with the exception of environmental eating). For most negative eating styles, females scored higher than males. It was also found that high levels of dieting and extrinsic eating were positively correlated with body mass index, suggesting the possible risk of future weight gain and obesity. While the occurrence of eating disordered attitudes based on EAT-26 scores was low (13%), analysis of EAT-26 scores indicated that the occurrence of eating disordered attitudes was strongly correlated with dieting behaviour among this population. The results support the need for a programme to educate Thai students, especially females, regarding healthy patterns of dieting and eating attitudes in order to prevent future weight gains and eating disorders predicted by the nutrition transition model.

Overweight and obesity in Indonesia: prevalence and risk factors-a literature review

OBJECTIVES

Overweight/obesity is a problem faced by both high- and low- and middle-income countries. This review aimed to report published data on the prevalence of overweight and obesity in Indonesian children, adolescents, and adults, along with the associated risk factors.

STUDY DESIGN

Literature review.

METHODS

We conducted a literature search for articles published in English (through Medline via OvidSP, Scopus, Global Health via OvidSP and Web of Science electronic databases) and Indonesian languages (several websites, direct contact with Indonesian public health researchers, practitioners and Ministry of Health staff) from earliest to March 2016. We screened the results and ensured the quality of included studies with Loney's tools for critically appraising prevalence or incidence studies.

RESULTS

We included 17 papers on the topic which were available in full text and passed the critical appraisal process. The prevalence of overweight/obesity has increased over the past two decades in Indonesian children, adolescents and adults. Prevalence rates are higher in boys than girls among children, but higher in females in the adolescent and adult age groups. The prevalence of overweight/obesity is also higher in those living in urban areas and with higher income or education.

CONCLUSIONS

Overweight/obesity is a serious public health problem in Indonesia with a continuing increase in its prevalence. Interventions at the household level and beyond are needed to successfully lower the prevalence of overweight/obesity in the country.

Self-Perception of Body Weight among Secondary Students in Chiang Mai, Thailand

Self-perception of body weight and other weight-related factors were assessed among 2,519 Chiang Mai Province, Thailand high school students. A high percentage of the girls (57.6%) and boys (29.0%) reported that they were too fat and these percentages were higher than those reported by U.S. students in a recent Youth Risk Behavior Survey. Yet, in comparison to U.S. students, the Thai students were less likely than their U.S. counterparts to engage in weight management practices (e.g., dieting, eating less food, using diet pills). Thai students with a self-perception of being too fat were more likely than those with perceptions of being just right or too thin to engage in weight management practices, to be dissatisfied with their weight, feel that they were unattractive, estimate that their same-sex peers were trying to lose weight, and have a higher body mass index. The findings showed a relationship between self-perception of body size and engaging in weight control behaviors consistent with other research. It suggested that self-perception of body weight, more so than objective weight status, was predictive of weight loss behavior and also negative psychological outcomes associated with poor body weight image. As a result, self-perception of weight may be an important point of focus for the design and implementation of clinical and public health initiatives and health education interventions targeted at this adolescent population.

Preschool overweight and obesity in urban and rural Vietnam: differences in prevalence and associated factors

BACKGROUND

Childhood obesity may soon be an equally important health threat as undernutrition and infectious diseases. Accurate information about prevalence and risk factors of obesity in children is important for the design of prevention.

OBJECTIVE

The aim of this study was to estimate prevalence of overweight and obesity for preschool children in two Vietnamese areas, one urban and one rural, and to identify risk factors.

DESIGN

A cross-sectional study was conducted in urban Dong Da and rural Ba Vi districts, Hanoi, Vietnam. Totally, 2,677 children, 1,364 urban and 1,313 rural, were weighed and measured. Caregivers were interviewed. Background information about children and families was obtained from regular household surveys.

RESULTS

The prevalence of overweight and obesity combined were 21.1% (95% CI 18.9-23.3) in the urban area and 7.6% (95% CI 6.2-9.2) in the rural. Multiple logistic regression revealed that at the individual level, in both sites, the risk increased with increased child age. The identified urban risk factors were being a boy, consuming large amounts of food, eating fast, and indoor activity less than 2 hours per day. The rural risk factors were frequent consumption of fatty food. At the family level, significant association was found in rural areas with frequent watching of food advertisements on television.

CONCLUSIONS

Overweight and obesity are emerging problems in Vietnam, particularly in the urban context. Prevention programs should focus on education about healthy eating habits at early preschool age and need to be tailored separately for urban and rural areas since the risk factors differ. Non-healthy food advertisement needs to be restricted.

The efficacy of topical 0.1% adapalene gel for use in the treatment of childhood acanthosis nigricans: a pilot study

AIMS

To assess the degree of improvement of neck hyperpigmentation in childhood acanthosis nigricans (AN) after treatment with topical 0.1% adapalene gel and the assessment of localized tissue tolerance to the gel.

SUBJECTS AND METHODS

A split comparison study of the hyperpigmentation on the neck was conducted in patients diagnosed with childhood AN. Patients were treated with topical 0.1% adapalene gel for a period of 4 weeks. The skin color of their neck was evaluated at baseline, 2 weeks and 4 weeks using a skin color chart. Skin color ratio (the skin on their necks compared with the skin on their backs) was calculated for all subjects. The investigator's global evaluation (IGE) scale and the parent's global evaluation (PGE) scale were used to assess the efficacy of the patients' treatment at the end of the 4(th) week.

RESULTS

The mean skin color ratio of therapeutic side was significantly decreased from the baseline scores, at weeks 2 and 4, respectively (30.1%, 18.3%, and 12.9%, P < 0.001), with marked skin improvement at 60.7% ± 28.5%. The percentage of changes of skin color ratio was consistent with the efficacy evaluations as performed by the IGE and PGE scales. Treatment-related cutaneous irritation was minimal, predominantly in the first 2 weeks of treatment and was shown to be well-tolerated at week 4 following a modification of the treatment regimen.

CONCLUSIONS

The study has shown the efficacy of topical 0.1% adapalene gel in the treatment of AN, specifically, in regards to the skin darkening with minimal cutaneous irritation.

Urban environments and obesity in southeast Asia: a systematic review, meta-analysis and meta-regression

Many environmental factors contribute to the rise in prevalence of obesity in populations but one key driver is urbanization. Countries in Southeast (SE) Asia have undergone rapid changes in urbanization in recent decades. The aim of this study is to provide a systematic review of studies exploring the relationship between living in an urban or rural environment (urbanicity) and obesity in Southeast Asia. In particular, the review will investigate whether the associations are uniform across countries and ages, and by sex. The literature search was conducted up to June 2014 using five databases: EMBASE, PubMed, GlobalHealth, DigitalJournal and Open Grey. Forty-five articles representing eight of the eleven countries in SE Asia were included in the review. The review found a consistent positive association between urbanicity and obesity in countries of Southeast Asia, in all age groups and both genders. Regional differences between the associations are partly explained by gross national income (GNI). In countries with lower GNI per capita, the association between urbanicity and obesity was greater. Such findings have implications for policy makers. They imply that population level interventions need to be country or region specific, tailored to suit the current stage of economic development. In addition, less developed countries might be more vulnerable to the negative health impact of urbanization than more developed countries.

Obesity and overweight in Bangladeshi children and adolescents: a scoping review

BACKGROUND

Obesity and overweight in children and adolescents is an emerging public health concern alongside under-nutrition in low and middle income countries. Our aim was to conduct a scoping review of literature to ascertain what is known about childhood and adolescent overweight and/or obesity in Bangladesh.

METHOD

Using the scoping review based on York methodology, a comprehensive search of published academic articles, conference proceedings and grey literature was carried out through PubMed, BanglaJOL, Google and Google scholar limited to English-written papers. We summarized prevalence, risk factors and health outcomes of obesity/overweight in young children and adolescents aged between 0 to 19 years old in Bangladesh and highlighted use of different reference standards to measure childhood obesity.

RESULTS

In total 21 studies met the inclusion criteria. Nearly all of the reviewed articles used data from cross sectional studies, while only two used case-control design. Overall thirteen studies (62%) were primary research and eight (38%) included secondary data. Studies indicated an increasing trend in childhood obesity over time. Prevalence ranged from less than 1% to 17.9% based on different reference standards, with higher percentage amongst urban children across different age groups and sexes.

CONCLUSION

This review demonstrated paucity of comprehensive literature on childhood obesity in Bangladesh, which might be explored through population-based prospective studies based on strong methodology and uniform reference standards. Sustainable and scalable preventative measures targeting high risk groups are required to avoid further rise.

SEANUTS: the nutritional status and dietary intakes of 0.5–12-year-old Thai children

In the present study, we investigated nutritional status and health-related factors in a multistage cluster sample of 3119 Thai urban and rural children aged 0·5–12·9 years. In a subsample, blood samples were collected for the measurement of Hb, transferrin receptor, vitamin A and vitamin D concentrations. The prevalence of stunting and underweight was higher in rural children than in urban children, whereas the wasting rate was similar in both rural and urban areas. Among children aged 3·0–5·9 years, the prevalence of overweight was significantly higher in urban areas than in rural areas and so was the obesity rate in children aged 6·0–12·9 years. Protein intakes of all age groups were relatively high in both the areas. Intakes of Ca, Fe, Zn and vitamin C were significantly higher in urban areas than in rural areas. The prevalence of anaemia in rural areas was twice as high as that in urban areas, particularly in infants and young children. However, the prevalence of Fe-deficiency anaemia was similar in both urban and rural areas. While the prevalence of vitamin A deficiency (by serum retinol cut-off < 0·7 μmol/l) seemed to be very low, vitamin A insufficiency (by serum retinol cut-off < 1·05 μmol/l) was more prevalent (29·4–31·7 %) in both the areas. The prevalence of vitamin D insufficiency ranged between 27·7 and 45·6 % among the children. The present study indicates that the double burden of malnutrition is still a major public health problem in Thailand. Further studies need to explore the associated risk factors for these nutrient deficiencies. Effective strategies and actions are needed to tackle the nutritional problems in Thai children.

Changes in Prevalence of Overweight and in Body Image among Fijian Women between 1989 and 1998**

OBJECTIVE

To investigate changes in prevalence of overweight and obesity and in body image among ethnic Fijian women in Fiji during a period of rapid social change and the relationship between changes in body image and BMI.

RESEARCH METHODS AND PROCEDURES

The study design was a multiwave cohort study of BMI in a traditional Fijian village over a 9.5-year period from 1989 to 1998. Cohorts were identified in 1989 (n=53) and in 1998 (n=50). Selection criteria included Fijian ethnicity, female gender, age of at least 18 years, and residence in a specific coastal Fijian village in 1989 and 1998, respectively. Assessments consisted of measurement of height and weight, collection of demographic data by written survey, and administration of the Nadroga Language Body Image Questionnaire.

RESULTS

The prevalence of overweight and obesity was significantly different between the cohorts, increasing from 60% in 1989 to 84% in 1998 (p=0.014). In addition, the age-adjusted mean BMI was significantly higher in 1998 compared with 1989 (p=0.011). Finally, there were significant between-cohort differences in multiple measures of body image, which were mostly independent of BMI.

DISCUSSION

At 84%, the prevalence of overweight and obesity in this community sample of Fijian women is among the highest in the world. The dramatically increased prevalence over the 9.5-year period studied corresponds with rapid social change in Fiji and significant shifts in prevailing traditional attitudes toward body shape.

Participatory action project in reducing childhood obesity in Thai primary schools

The project aimed to improve nutrition and activity among primary schoolchildren via targeted activities. A preliminary nutritional survey was carried out involving 5126 children in 4 Bangkok public schools. Participatory action research involving students, teachers, and parents was conducted. After a 2-day training course, teachers integrated project concepts into their course curriculum. Seminars on weight management were given separately to parents and students. After 8 months, postnutritional survey was conducted. Preprogram and postprogram evaluation of obese and normal groups was done using questionnaires on dietary intake and exercise.

RESULTS

showed that high caloric dietary intake significantly decreased for the obese group (P < .001). Aerobic exercise activity also increased in both groups (P < .001) and prevalence of obesity declined from 19.3% to 16.8%. Thus, a long-term, participatory effort to promote healthy diets and physical exercise could be effective with primary school students and may establish habits that last to later life.

PREVALENCE AND TREND OF OVERWEIGHT AND OBESITY AMONG SARDINIAN CONSCRIPTS (ITALY) OF 1969 AND 1998

This study evaluated the prevalence of overweight and obesity in the male Sardinian population (Italy), and verifies that it has increased over the last 30 years. Data were collected during 2003–2004 from military registers in the Archive of the Military District of Cagliari for the years 1969 and 1998. A total of 22,345 forms were analysed from all Sardinia. The conscripts were classified on the basis of their place of residence and socioeconomic status. The overall prevalence of overweight and obesity in Sardinia were 4.33% and 0.55%, respectively, for the conscripts of 1969 and 9.8% and 3% for 1998. Olbia-Tempio (northern Sardinia) was the province with the highest incidence of overweight and obesity in 1969, and Nuoro (central Sardinia) had the highest incidence in 1998. Distribution of body mass index, overweight and obesity across the island showed a statistically significant heterogeneity that strongly decreased from 1969 to 1998. Among the conscripts of 1969, the incidence of overweight and obesity were higher in rural than in urban regions. An opposite trend was observed for the 1998 prevalence, it being more frequent in urban than rural regions. Comparison with other Italian regions was made. The percentages of overweight and obese individuals in Sardinia have markedly increased during the last 30 years, but their low incidence with respect to other Italian populations could be explained by the genetic peculiarity of the island. The change in the internal distribution of obesity clearly reflects socioeconomic changes.

A cross-sectional examination of growth indicators from Thai adolescent girls: evidence of obesity among Thai youth?

BACKGROUND

Few studies have examined growth data from adolescent girls in Southeast Asia and almost none have been carried out in Thailand. Thus this study examines growth data from Thai adolescent girls.

AIM

Cross-sectional growth data from a sample of Thai girls were compared to reference data from healthy well-nourished girls. It is hypothesized that the reference girls will be taller and heavier than the Thai girls; however, the growth indicators will also indicate that obesity is present among Thai girls.

SUBJECTS AND METHODS

Anthropometric and age at menarche data were collected from a sample of 319 adolescent girls ages 11-17 years living in suburban Thailand.

RESULTS

Thai girls are heavier than the reference girls at ages 11-13 years yet are shorter and lighter than the reference girls at ages 14-17 years. The data also reveal that 18.4% of the girls are overweight or obese as classified by the CDC BMI-for-age percentile growth curves.

CONCLUSION

The findings suggest the presence of overweight and obesity among this adolescent Thai population. These data may reflect the impact of the improved economic situation of Thailand as well as the impact of body image concerns among these young girls.

Bone mineral content and body composition in overweight children and adolescents

The aim of this study was to analyze the bone mineral content (BMC) of the skeleton and the body composition in lean and fat masses in a population of young overweight subjects, before diet or medical intervention. A total of 496 white youths (298 females, 198 males) were studied. Their body mass index (BMI) values were 29.2+/-5.5 kg/m2 in females and 28.3+/-5.1 kg/m2 in males, corresponding to relative weights (wts) [actual wt, W, divided by the mean wt normal for height (ht), Wi] of 1.55+/-0.24 and 1.53+/-0.24, respectively. Whole-body dual-energy x-ray absorptiometry (DXA) scans were performed (Norland XR36 DXA system) to obtain the total BMC (BMCt), lean tissue mass (LTMt) and fat mass (FMt), as well as the values of the corresponding parameters in arms (a), legs (l), and abdomen (ab). The measured data were compared with theoretical values calculated for Wi. The differences with reference values in LTMt and FMt were sex dependent, and the accretion in FMt, greater in males than in females, yielded a similar FMt/LTMt ratio in both sexes. The wt corresponding to the BMC of the bearing skeleton, lower than the actual wt by about 20%, seemed a reasonable first step to consider in the wt management of these youths.

Dieting among Thai adolescents: having friends who diet and pressure to diet

The purpose of this study was to assess dieting behavior, the number of friends who diet, and number of friends who pressure to go on a diet among a sample of 2,519 Thai adolescents. More than half of the girls (52.2%) and over one-fourth of boys (28.0%) reported going on a diet in the past 30 days. Dieting among friends was very common with only 14.2% of girls and 34.3% of boys saying none of their friends dieted. Results also showed significant associations between 1) number of friends who diet and 2) number of friends who pressure to diet with dieting behavior, body mass index (BMI), weight satisfaction, perceived body fatness, effort to look like people in the media, and frequency of thinking about wanting to be thinner in girls. In addition, several of these associations for boys were significant. The role of BMI in these relationships was also explored.

Prevalence of overweight and obesity in Sardinian adolescents

BACKGROUND

To estimate the prevalence of overweight and obesity among adolescents in Sardinia and to examine the association with several biological and geographic factors.

METHODOLOGY

A cross-sectional study was performed in 3,946 unselected adolescents (2,011 boys, 1,935 girls; aged 11-15 years) attending the public secondary schools in 33 Sardinian municipalities: 28 semi-rural, 5 urban, sub-grouped according to their geographic location (mountain, hillside and plain). Oversized children were measured and their BMI defined as being above normal values according to parameters provided by the International Obesity Task Force (IOFT) by Cole et al. (BMI for age > or = 95th percentile). Relative risk for overweight and obesity was calculated using Poisson regression analysis: risks associated to each covariate were reciprocally adjusted. The 95% confidence interval (CI) of the estimated risk was calculated using Wald's formula (RR, RR = log(n) beta +/- 1.96 se(beta)).

MAIN FINDINGS

The overall prevalence rate found for overweight and obesity was 14.9% (95% C.I.: 13.7-16.1%) and 3.7% (95% C.I. 3.1-4.3%), respectively. Overweight rate showed no association with gender, whereas belonging to the female sex constituted a significant protection against obesity. Increasing age in the range 12-14 years was protective against both overweight and obesity in the whole sample. A similar finding however was not observed for obesity in girls or overweight in boys, when considered separately. Boys, but not girls, living in urban areas displayed a modest though significant 20% increase in overweight and a 40% decrease in obesity risk. Living in a mountainous area conveyed a 30% decrease in risk of overweight and a 50% decrease in risk of obesity, when compared to living on the plains and hillside combined. However, the small sample size of study subjects living in mountainous areas generated extremely wide 95% confidence intervals, thereby preventing the drawing of any significant conclusions.

CONCLUSION

In comparison with other surveys performed by the IOFT, Sardinian adolescents show a low prevalence rate for oversize, emphasizing a marked discrepancy with the general north-south rising trend of oversize observed throughout Europe. Geographic location, aesthetic or other age related factors seem to exert a different gender-specific influence on overweight and obesity.

SIGNIFICANCE

The present report is cross sectional and the consequences of overweight and obesity on individuals over time are not traceable. However, the outcome of the study suggests the need to implement suitable policies and public health programs leading to increased awareness.

Factors affecting prevalence of overweight among 12- to 17-year-old urban adolescents in Hyderabad, India

OBJECTIVE

The problem of overweight and obesity is not confined only to developed countries but is also widely prevalent in developing countries. The objective of this study was to assess the prevalence of overweight and obesity as defined by the International Obesity Task Force (IOTF) among school-age children in Hyderabad, India, and identify its associated factors.

RESEARCH METHODS AND PROCEDURES

A cross-sectional and institutional study, adopting a multistage stratified cluster sampling procedure, was carried out during 2003 on adolescents 12 to 17 years of age of both sexes from Hyderabad, India.

RESULTS

The overall prevalence of overweight was 6.1% [95% confidence interval (CI): 4.2, 8.0] among boys and 8.2% among girls (CI: 6.0, 10.4); 1.6% and 1.0% were obese, respectively. The prevalence was significantly higher (p < 0.05) among adolescents who watched television > or =3 h/d (10.4%) or belonged to a high socioeconomic background (14.9%, p < 0.001), whereas it was significantly lower among those participating regularly in outdoor games > or =6 h/wk (3.1%, p < 0.004) and household activities > or =3 h/d (4.7%, p < 0.001). The logistic regression analysis revealed that the prevalence of overweight was 4 times higher among the adolescents of high socioeconomic status [odds ratio (OR): 4.1; CI: 2.25, 7.52], 3 times higher in those not participating in outdoor games (OR: 2.75; CI: 1.56, 4.72), and 1.92 times higher in those watching television > or =3 h/d (OR: 1.92; CI: 1.16, 3.18).

DISCUSSION

This study confirmed the findings of earlier studies carried out in Western countries and emphasizes that regular physical exercise, doing household activities, regulated television viewing, and healthy eating behaviors could contribute to controlling overweight and obesity.

Obesity and the metabolic syndrome in Korean adolescents

This study evaluated the prevalence of metabolic syndrome and investigated its association with being overweight in Korean adolescents. Data were obtained from 1,393 students between 12 and 13 yr of age in a cross-sectional survey. We defined the metabolic syndrome using criteria analogous to the Third Report of the Adult Treatment Panel (ATP III) as having at least three of the following: fasting triglycerides > or =100 mg/dL; HDL <50 mg/dL; fasting glucose > or =110 mg/dL; waist circumference >75th percentile for age and gender; and systolic blood pressure >90th percentile for age, gender, and height. Weight status was assessed using the age- and gender-specific body mass index (BMI), and a BMI > or =85th percentile was classified as overweight. Of the adolescents, 5.5% met the criteria for the metabolic syndrome, and the prevalence increased with weight status; it was 1.6% for normal weight and 22.3% in overweight (p<0.001). In multivariate logistic regression analyses among adolescents, overweight status was independently associated with the metabolic syndrome (odds ratio, 17.7; 95% confidence interval, 10.0-31.2). Since childhood metabolic syndrome and obesity likely persist into adulthood, early identification helps target interventions to improve future cardiovascular health.

Trends in overweight and obesity and changes in the distribution of body mass index in schoolchildren of Jena, East Germany

OBJECTIVE

Data of Jena children (Germany) show increases in the prevalence estimates of overweight and obesity between 1975 and 2001. Our objective was to determine if these increases contribute to changes in the distribution of body mass index (BMI) in the entire population of children. The decade 1985-1995, which includes the time of German reunification, is of particular interest because of the significant socio-economic changes in East Germany, in which Jena is located.

DESIGN AND SUBJECTS

The analyses were based on data from four cross-sectional growth studies in 7- to 14-year-old children performed in Jena, Germany, in 1975 (n=2013), 1985 (n=1534), 1995 (n=1906) and 2001 (n=1918). Overweight and obesity were estimated by German reference data and the reference of Cole et al. Mean difference plots were used to investigate the changes in the BMI distributions within sexes between the studies.

RESULTS

Between 1985 and 1995, the prevalence of overweight and obesity increased significantly in both sexes, whereas nonsignificant changes were found between 1975 and 1985. Although there is a tendency towards increased overweight between 1995 and 2001, the differences were nonsignificant. Comparing data from 1975 and 1985, the mean difference plots showed virtually no changes in the BMI distribution. In the plots comparing the BMI distribution for 1985 data and 1995 data, the whole distribution tended to shift upwards with a greater shift in the upper BMI range. The entire population of children in Jena gained weight during this period of time. This increase may be linked to a transition towards a more Western lifestyle, that is, usually by lower energy expenditure and nutritional transitions, caused by the process of reunification of Germany in 1989.

CONCLUSIONS

Weight gain appears to be a characteristic feature of the entire population studied and does not seem to be a separate problem of the obese children. This suggests that reported changes in the prevalence may be underestimating the looming public health crisis.

Familial aggregation of the metabolic syndrome in Korean families with adolescents

We investigated the familial aggregation of the metabolic syndrome in Korean families with adolescents. In a cross-sectional observational study, the body mass index, waist circumference, blood pressure, fasting glucose, serum triglyceride, HDL-cholesterol, total cholesterol and fasting insulin concentrations, and homeostasis model assessment (HOMA) score, were examined in each individual in 132 Korean nuclear families. Most variables of the metabolic syndrome in offspring were significantly correlated with those of parents. Compared with sons, daughters had more significant difference for the metabolic parameters according to clustering of risk factors of their parents. Especially, daughters showed higher correlations with their parents for waist circumference, with their mothers for fasting glucose and HDL-cholesterol, and with their fathers for fasting insulin than sons. Compared with children whose parents did not have the metabolic syndrome, the odds ratios in children with at least one parent with the metabolic syndrome were 4.1 (1.6-10.6) for overweight, 3.6 (1.3-10.2) for abdominal obesity, 5.0 (2.0-12.3) for high triglycerides, and 4.8 (1.1-21.0) for the metabolic syndrome. We also observed significant correlations in variables of the metabolic syndrome between siblings and between spouses. In Korean families with adolescents, there is a familial aggregation of the metabolic syndrome, with daughters resembling their parents more than sons. These findings may have significant implications for clinical interventions directed at adolescents at high risk for the metabolic syndrome.

Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with 'best practice' recommendations

Childhood obesity is a global epidemic and rising trends in overweight and obesity are apparent in both developed and developing countries. Available estimates for the period between the 1980s and 1990s show the prevalence of overweight and obesity in children increased by a magnitude of two to five times in developed countries (e.g. from 11% to over 30% in boys in Canada), and up to almost four times in developing countries (e.g. from 4% to 14% in Brazil). The goal of this synthesis research study was to develop best practice recommendations based on a systematic approach to finding, selecting and critically appraising programmes addressing prevention and treatment of childhood obesity and related risk of chronic diseases. An international panel of experts in areas of relevance to obesity provided guidance for the study. This synthesis research encompassed a comprehensive search of medical/academic and grey literature and the Internet covering the years 1982-2003. The appraisal approach developed to identify best practice was unique, in that it considered not only methodological rigour, but also population health, immigrant health and programme development/evaluation perspectives in the assessment. Scores were generated based on pre-determined criteria with programmes scoring in the top tertile of the scoring range in any one of the four appraisal categories included for further examination. The synthesis process included identification of gaps and an analysis and summary of programme development and programme effectiveness to enable conclusions to be drawn and recommendations to be made. The results from the library database searches (13,158 hits), the Internet search and key informant surveys were reduced to a review of 982 reports of which 500 were selected for critical appraisal. In total 158 articles, representing 147 programmes, were included for further analysis. The majority of reports were included based on high appraisal scores in programme development and evaluation with limited numbers eligible based on scores in other categories of appraisal. While no single programme emerged as a model of best practice, synthesis of included programmes provided rich information on elements that represent innovative rather than best practice under particular circumstances that are dynamic (changing according to population subgroups, age, ethnicity, setting, leadership, etc.). Thus the findings of this synthesis review identifies areas for action, opportunities for programme development and research priorities to inform the development of best practice recommendations that will reduce obesity and chronic disease risk in children and youth. A lack of programming to address the particular needs of subgroups of children and youth emerged in this review. Although immigrants new to developed countries may be more vulnerable to the obesogenic environment, no programmes were identified that specifically targeted their potentially specialized needs (e.g. different food supply in a new country). Children 0-6 years of age and males represented other population subgroups where obesity prevention programmes and evidence of effectiveness were limited. These gaps are of concern because (i) the pre-school years may be a critical period for obesity prevention as indicated by the association of the adiposity rebound and obesity in later years; and (ii) although the growing prevalence of obesity affects males and females equally; males may be more vulnerable to associated health risks such as cardiovascular disease. Other gaps in knowledge identified during synthesis include a limited number of interventions in home and community settings and a lack of upstream population-based interventions. The shortage of programmes in community and home settings limits our understanding of the effectiveness of interventions in these environments, while the lack of upstream investment indicates an opportunity to develop more upstream and population-focused interventions to balance and extend the current emphasis on individual-based programmes. The evidence reviewed indicates that current programmes lead to short-term improvements in outcomes relating to obesity and chronic disease prevention with no adverse effects noted. This supports the continuation and further development of programmes currently directed at children and youth, as further evidence for best practice accumulates. In this synthesis, schools were found to be a critical setting for programming where health status indicators, such as body composition, chronic disease risk factors and fitness, can all be positively impacted. Engagement in physical activity emerged as a critical intervention in obesity prevention and reduction programmes. While many programmes in the review had the potential to integrate chronic disease prevention, few did; therefore efforts could be directed towards better integration of chronic disease prevention programmes to minimize duplication and optimize resources. Programmes require sustained long-term resources to facilitate comprehensive evaluation that will ascertain if long-term impact such as sustained normal weight is maintained. Furthermore, involving stakeholders in programme design, implementation and evaluation could be crucial to the success of interventions, helping to ensure that needs are met. A number of methodological issues related to the assessment of obesity intervention and prevention programmes were identified and offer insight into how research protocols can be enhanced to strengthen evidence for obesity interventions. Further research is required to understand the merits of the various forms in which interventions (singly and in combination) are delivered and in which circumstances they are effective. There is a critical need for the development of consistent indicators to ensure that comparisons of programme outcomes can be made to better inform best practice.

Gender differences in familial aggregation of obesity-related phenotypes and dietary intake patterns in Korean families

PURPOSE

To investigate familial influences on obesity-related phenotypes and dietary intake patterns, and to examine gender differences in Korean families with adolescent children.

METHODS

A cross-sectional observational study was conducted on 134 biologically related families composed of 260 parents and 231 adolescent children aged 11 to 19 years. Anthropometric measurements, including total fatness and fat distribution, were measured. Dietary intake was assessed by the semi-quantitative food frequency questionnaire (FFQ).

RESULTS

The odds ratio and 95% confidence intervals for overweight were 6.6 (range, 1.5-29.7) in the sons and 13.7 (range, 2.5-76.4) in the daughters of overweight parents. Obesity and fat distribution in the adolescents were more significantly correlated with mothers than fathers. Daughters had more significant familial aggregations with their parents than did sons. The dietary intake patterns of both sons and daughters correlated more strongly with their mothers than their fathers. We observed significant correlations in anthropometric variables and dietary intake patterns between spouses and between siblings.

CONCLUSIONS

In the contemporary Korean nuclear family, maternal anthropometry and dietary behavior have a greater impact on children than do paternal contributions, and daughters resemble their parents more than sons. Genetics and environmental factors within the family infrastructure may provide strategies for the prevention and treatment of adolescent obesity.

[Childhood and adolescent obesity in Spain. Results of the enKid study (1998-2000)]

BACKGROUND AND OBJECTIVE

Obesity is a chronic disease with a complex multifactorial nature which typically begins during childhood and adolescence. It represents one of today's most critical and escalating public health concerns for this segment of the population. The lack of obesity prevalence data at national level prompted the enKid Study (1998-2000), which was designed to evaluate the food habits and nutritional status of Spanish children and youth.

SUBJECTS AND METHOD

Cross-sectional epidemiological study of a representative sample of the Spanish population aged 2 to 24 years (n=3534). Height and weight measurements were carried out using standard procedures and equipment. Obesity and overweight were defined according to BMI values for the 97th and 85th percentiles, respectively using Spanish reference data provided by Hernández et al (1998).

RESULTS

The prevalence of obesity in Spain is 13.9%, while the combination of overweight and obesity yields a prevalence of 26.3% (with a prevalence of overweight alone of 12.4%). Obesity is more common in males (15.6%) than in females (12%), which was also true for overweight. With regard to age, a higher prevalence is found among those aged 6 to 13 years. As for the geographic area, Canary Islands and Andalusia show the highest prevalence and the northeast region the lowest. Obesity is also more prevalent among those people with the lowest socio-economic and educational levels, and in those who omitted or consumed a poor breakfast.

CONCLUSIONS

Compared to other countries, Spain shows an intermediate level of obesity in children and youth. Over the past decades, there has been an increasing trend towards overweight and obesity, which are more prevalent in males and during prepuberal ages.

Change in body mass index from adolescence to young adulthood and increased carotid intima-media thickness at 28 years of age: The Atherosclerosis Risk in Young Adults study

Obesity has become a major health problem in Western societies by increasing the risk of atherosclerosis and cardiovascular disease. Although data on tracking of body mass index (BMI) are available, little is known about the impact of weight change over time on the development of vascular damage.

OBJECTIVE

To evaluate the relationship between adolescent BMI as well as change in BMI from adolescence into young adulthood and cardiovascular risk, as estimated by common carotid intima-media thickness (CIMT).

DESIGN

Cohort study.

SUBJECTS

A total of 750 healthy young adults, aged 27-30 y, who attended secondary school in Utrecht, the Netherlands.

MEASUREMENTS

Data on adolescent weight, height, blood pressure and puberty stage were available from the original school health records of the Municipal Health Service. At young adulthood, a questionnaire on cardiovascular risk factors was completed and fasting blood sample was drawn and common CIMT was measured.

RESULTS

One standard deviation (s.d.) increase in adolescent BMI was associated with 2.3 microm [95% confidence interval (CI): 1.3; 3.3] increase in mean common CIMT in young adults after adjustment for gender, adolescent age, adolescent blood pressure, puberty stage and lumen diameter. Further adjustment for adult cardiovascular risk factors did not change the relationship (linear regression coefficient=2.1 microm/s.d.; 95% CI: 1.0; 3.1). Adjustment for adult BMI attenuated the association (linear regression coefficient=0.9 microm/s.d.; 95% CI: -0.3; 2.2) as the majority of overweight and obese adolescents remained overweight or became obese young adults. Subjects who remained in the upper BMI distribution from adolescence into young adulthood had a significantly higher common CIMT compared to those who showed relative weight loss over time (mean difference 14.7 mum; P<0.001). These latter showed similar CIMT values as individuals with constant low BMI.

CONCLUSION

Adolescent BMI predicts cardiovascular risk, as estimated by common CIMT in young adulthood. Individuals who experience the largest increase in BMI and those who remain overweight over time have the thickest common CIMT.

Prevalência de sobrepeso e obesidade em crianças pré-escolares matriculadas em duas escolas particulares de Recife, Pernambuco

OBJETIVOS: determinar a prevalência de sobrepeso e obesidade entre pré-escolares de duas escolas particulares em Recife. MÉTODOS: realizou-se um estudo de corte transversal com 230 pré-escolares matriculados em duas escolas particulares de Recife, no ano de 2000. Foram classificadas como portadoras de sobrepeso as crianças com índice peso/estatura entre +1 a +2 escores z e, como obesas, aquelas com peso/estatura acima de +2 escores z. RESULTADOS: as prevalências de sobrepeso e obesidade foram de 22,6% e 11,3%, respectivamente. Entre as crianças do sexo feminino, a prevalência de sobrepeso foi de 27,0% e a de obesidade foi de 9,8%. No sexo masculino, a prevalência de sobrepeso foi de 17,6% e a de obesidade foi de 13,0%. CONCLUSÕES: as prevalências de sobrepeso e obesidade foram elevadas nesse grupo de pré-escolares, provenientes em sua maioria de famílias de classe socioeconômica média e alta. O pediatra deve estar atento para a crescente prevalência da obesidade infantil, a fim de atuar na prevenção, diagnóstico e tratamento dessa condição.

Child and adolescent obesity in the 21st century: an Australian perspective

The early 21st century has seen the development of a global epidemic of obesity in both developed and developing countries. In Australia at least one in five children and adolescents are overweight or obese, with rapid rises in prevalence apparently continuing. Similar trends are seen in other countries. Child and adolescent obesity is associated with both immediate and long-term medical and psychosocial problems, including a clustering of risk factors for the development of cardiovascular disease and diabetes. Thus, obesity poses a major health problem for the paediatric population. Major environmental and societal changes have led to a decrease in physical activity, a rise in sedentary behaviour and the consumption of high fat and high-energy foods, all in turn influencing the development of obesity. Effective management involves a multimodal approach with a developmentally aware approach, involvement of the family, a focus on healthy food choices, incorporation of physical activity and a decrease in sedentary behaviour all being important. Ultimately, however, the obesity epidemic requires a major focus on primary prevention. Australia has a national strategy for the prevention of overweight and obesity that depends upon intersectoral and intergovernmental cooperation, supported by adequate resourcing and significant community ownership.

Time trends of obesity in pre-school children in China from 1989 to 1997

OBJECTIVE

To examine predictors and time trends of obesity in pre-school children in China.

DESIGN

This study was based on data from China Health and Nutrition Survey, a longitudinal survey from 1989 to 1997.

SUBJECTS

For cross-sectional analysis, we included 944, 1058, 903 and 483 children aged 2-6 y in 1989, 1991, 1993 and 1997, respectively. For longitudinal analysis, we included 944 children and 3146 measurements during four time periods.

MEASURES

Overweight and obesity according to age- and sex-specific BMI cut-off points proposed by International Obesity Task Force.

RESULTS

The overall prevalence of obesity increased from 4.2% in 1989 to 6.4% in 1997 among children aged 2-6 y. The increase largely occurred in urban areas, where the prevalence of obesity increased from 1.5% in 1989 to 12.6% in 1997 and prevalence of overweight increased from 14.6 to 28.9% at the same period. Longitudinal analysis shows BMI increased by 0.2 kg/m2 per year in urban areas and 0.1 kg/m2 per year in rural areas. In multivariate analysis, overweight in early childhood (2-6 y), parental overweight, high income and urban areas independently predicted overweight at age 10-14 y.

CONCLUSION

A substantial increase in overweight and obesity among children aged 2-6 y was observed in urban areas in China from 1989 to 1997. Overweight in early childhood significantly predicted overweight during adolescence. Urgent public health strategies are needed to prevent childhood obesity in China.