Relationships between physical activity, obesity and meal frequency in adolescents

Exercise habits and health behaviors on adolescent obesity

BACKGROUND AND PURPOSE

Obesity among children and adolescents continues to increase globally, and it is important to determine the factors associated with obesity among adolescents for the prevention and reduction of obesity. The purpose of this study is to understand the factors associated with the increase in the obesity rate among adolescents, providing a reference basis for the development of projects aimed at promoting adolescent health.

METHODS

Using the raw data of 2021 adolescent health behavior online survey, this study analyzed demographic sociological factors, mental health, exercise habits, health behaviors and other categorical variables, and conducted the frequency, χ2 test for the difference in the proportion of obese and non-obese. According to the hierarchy model of obesity-related variables, binary logistics regression is used for multivariate analysis. This study used the original data of the 2021 Youth Health Behavior Online Survey, and performed frequency, χ2 tests on the differences in the proportion of obese and non-obese for categorical variables such as demographic sociological factors, mental health, exercise habits, and health behaviors. Multivariate analysis was performed using binary logistic regression based on hierarchical models of obesity-related variables.

RESULTS

The obesity rate among Korean adolescents was 18.25 %. The obesity risk for females was reduced by 0.344 times compared to males (95 % CI = 0.327-0.361, p < 0.001); high school students had a 1.4 times higher obesity risk than middle school students (95 % CI = 1.379-1.511, p < 0.001); students with "Subjective household economic status" rated as "Medium" and 'Low' had their obesity risk increased by 1.07 times (95 % CI = 1.020-1.124, p < 0.01) and 1.254 times (95 % CI = 1.165-1.350, p < 0.001), respectively, compared to students with 'Subjective household economic status' rated as 'High'; students with 'Moderate' and 'Low' levels of 'Perceived stress' had their obesity risk reduced by 0.78 times (95 % CI = 0.74-0.823, P < 0.001) and 0.75 times (95 % CI = 0.70-0.803, P < 0.001), respectively, compared to students with 'High' levels of 'Perceived stress'; students engaging in 'Muscle strengthening exercise' '1-2 times/week' and "≥ 3 times/week" had their obesity risk reduced by 0.844 times (95% CI = 0.797-0.895, P < 0.001) and 0.575 times (95% CI = 0.537-0.616, P < 0.001), respectively, compared to students not participating in "Muscle strengthening exercise".

CONCLUSION

The obesity rate of boys is higher than that of girls and high school students is higher than that of middle school students, and obesity is inversely proportional to family economic status. Mental health factors, exercise habits and eating habits are all important factors affecting adolescent obesity. It is suggested that gender differences, psychological factors, health habits, obesity education and healthy eating habits suitable for different age groups should be considered in the formulation of adolescent obesity policy.

Association of main meal frequency and skipping with metabolic syndrome in Korean adults: a cross-sectional study

BACKGROUND

Reduced meal frequency can increase the risk of metabolic syndrome (MetS). However, limited studies have examined the association between meal frequency and skipping meals with MetS. This study aims to analyze the association between main meal frequency and meal skipping with MetS in Korean adults aged ≥ 19 years.

METHODS

In this study, we included data from 22,699 Korean adult participants from the 2016-2020 Korea National Health and Nutrition Examination Survey (KNHANES). The 24-h dietary recall method was used to classify the participants into three groups based on main meal frequency (one, two, or three meals per day) and seven groups based on the type of main meal they skipped. Multivariable logistic regression analysis was conducted to determine the association between main meal frequency and the types of main meals skipped with the odds of MetS and its associated components. Appropriate estimates were accounted for using sampling weights, stratification, and clustering.

RESULTS

The prevalence of MetS in the study population was 33.8%. The average age of the participants was 47.2 years with 42.6% being men, and 57.4% being women. Men who consumed two meals per day had higher odds of MetS than those who consumed three meals per day (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.01-1.33). Women who consumed two meals per day, and skipped breakfast had increased odds of having elevated fasting blood glucose levels (OR 1.18, 95% CI 1.02-1.35), and elevated triglycerides (OR 1.19, 95% CI 1.02-1.39). However, women who skipped dinner had reduced odds of having elevated fasting blood glucose levels (OR 0.74, 95% CI 0.58-0.94).

CONCLUSIONS

Our findings suggest that meal frequency and the type of main meal skipped may be associated with MetS and emphasize the importance of consuming breakfast to prevent MetS.

How disability severity is associated with changes in physical activity and inactivity from adolescence to young adulthood

BACKGROUND

Disabilities may play a different role in determining people's physical activity (PA) and physical inactivity (PI) levels when they go through multiple lifetime transitions (e.g., graduation, marriage) between adolescence and young adulthood. This study investigates how disability severity is associated with changes in PA and PI engagement levels, focusing on adolescence and young adulthood, when the patterns of PA and PI are usually formed.

METHODS

The study employed data from Waves 1 (adolescence) and 4 (young adulthood) of the National Longitudinal Study of Adolescent Health, which covers a total of 15,701 subjects. We first categorized subjects into 4 disability groups: no, minimal, mild, or moderate/severe disability and/or limitation. We then calculated the differences in PA and PI engagement levels between Waves 1 and 4 at the individual level to measure how much the PA and PI levels of individuals changed between adolescence and young adulthood. Finally, we used two separate multinomial logistic regression models for PA and PI to investigate the relationships between disability severity and the changes in PA and PI engagement levels between the two periods after controlling for multiple demographic (age, race, sex) and socioeconomic (household income level, education level) variables.

RESULTS

We showed that individuals with minimal disabilities were more likely to decrease their PA levels during transitions from adolescence to young adulthood than those without disabilities. Our findings also revealed that individuals with moderate to severe disabilities tended to have higher PI levels than individuals without disabilities when they were young adults. Furthermore, we found that people above the poverty level were more likely to increase their PA levels to a certain degree compared to people in the group below or near the poverty level.

CONCLUSIONS

Our study partially indicates that individuals with disabilities are more vulnerable to unhealthy lifestyles due to a lack of PA engagement and increased PI time compared to people without disabilities. We recommend that health agencies at the state and federal levels allocate more resources for individuals with disabilities to mitigate health disparities between those with and without disabilities.

Association between meal frequency with anthropometric measures and blood pressure in Iranian children and adolescents

BACKGROUND

This study aimed to assess the association of meal frequency with anthropometric measures and blood pressure in Iranian children and adolescents.

METHODS

In this national survey, 14,880 students with 6-18 years of age were selected by stratified multistage sampling method from urban and rural regions of 30 provinces of Iran. Meal frequency was assessed by a questionnaire prepared based on global school-based student health survey. Physical measurements included height, weight, waist circumference, systolic blood pressure (SBP), and diastolic blood pressure (DBP).

RESULTS

The participation rate was 90.6% including 49.24% girls and 75.5% urban residents. Skipping breakfast and dinner were more frequent in girls than in boys (71.6% vs. 64.1%, 91.2% vs. 86.9%, respectively, P<0.05). Overweight, obesity, and abdominal obesity were more prevalent in those who had two meals, one meal, or very low intake (P<0.001) than those had three meals. There were no significant differences in SBP, DBP, and blood pressure across to different meal frequency groups (P>0.05). Students who had very low intake and one meal per week had a higher risk of abdominal obesity compared with those who had three meals (OR 1.7, 95% CI: 1.3-2.3, and OR 1.6, 95% CI: 1.4-2.0, respectively).

CONCLUSIONS

An inverse significant association between higher meal frequency and anthropometric indices was observed. Therefore, encouraging children and adolescents for regular meal intake should be considered as a health priority in the pediatric population.

Deriving neighborhood-level diet and physical activity measurements from anonymized mobile phone location data for enhancing obesity estimation

BACKGROUND

Obesity is a serious public health problem. Existing research has shown a strong association between obesity and an individual's diet and physical activity. If we extend such an association to the neighborhood level, information about the diet and physical activity of the residents of a neighborhood may improve the estimate of neighborhood-level obesity prevalence and help identify the neighborhoods that are more likely to suffer from obesity. However, it is challenging to measure neighborhood-level diet and physical activity through surveys and interviews, especially for a large geographic area.

METHODS

We propose a method for deriving neighborhood-level diet and physical activity measurements from anonymized mobile phone location data, and examine the extent to which the derived measurements can enhance obesity estimation, in addition to the socioeconomic and demographic variables typically used in the literature. We conduct case studies in three different U.S. cities, which are New York City, Los Angeles, and Buffalo, using anonymized mobile phone location data from the company SafeGraph. We employ five different statistical and machine learning models to test the potential enhancement brought by the derived measurements for obesity estimation.

RESULTS

We find that it is feasible to derive neighborhood-level diet and physical activity measurements from anonymized mobile phone location data. The derived measurements provide only a small enhancement for obesity estimation, compared with using a comprehensive set of socioeconomic and demographic variables. However, using these derived measurements alone can achieve a moderate accuracy for obesity estimation, and they may provide a stronger enhancement when comprehensive socioeconomic and demographic data are not available (e.g., in some developing countries). From a methodological perspective, spatially explicit models overall perform better than non-spatial models for neighborhood-level obesity estimation.

CONCLUSIONS

Our proposed method can be used for deriving neighborhood-level diet and physical activity measurements from anonymized mobile phone data. The derived measurements can enhance obesity estimation, and can be especially useful when comprehensive socioeconomic and demographic data are not available. In addition, these derived measurements can be used to study obesity-related health behaviors, such as visit frequency of neighborhood residents to fast-food restaurants, and to identify primary places contributing to obesity-related issues.

Factors associated with overweight and obesity among Bangladeshi university students: a case-control study

Objectives: Overweight and obesity has an adverse effect on public health, and emerging adulthood (18-25 years) is recognized as a potential period for the onset of obesity, thus, this study aimed to explore risk factors associated with overweight and obesity in Bangladeshi university students. Participants: Bangladeshi university students (n = 280). Methods: A case-control study of 140 students with overweight and obesity and 140 students with normal weight. Results: Multiple logistic regression revealed having at least one overweight or obese parent (AOR = 4.2; 95% CI: 2.2-8.4) and participating in no physical activity (AOR = 3.2; 95% CI: 1.0-9.9) were potential risk factors. Reported consumption ≥4 meals in a day, junk food/fast food, and soft drinks for ≥3 days a week were potential determinants of overweight and obesity in this population. Conclusion: Increased awareness on the importance of regular physical activity and a healthy diet may reduce the risk of overweight and obesity among Bangladeshi university students.

Young people and adolescents have more irregular meals during the COVID-19 pandemic: A nested case-control study on chrono-nutrition before and during the COVID-19 pandemic

Chrono-nutrition is an emerging field of research that includes three aspects of time: (1) regularity, (2) frequency, and (3) clock time. Due to the COVID-19 pandemic and the implemented lockdown, daily routines were disrupted, which presented a unique opportunity to investigate chrono-nutrition, in particular in adolescents. A nested case-control study was conducted and information on chrono-nutrition was collected via an anonymous online questionnaire including 99 participants aged 13 to 20 years (N = 43 before the COVID-19 pandemic and N = 56 during the COVID-19 pandemic). Differences in chrono-nutrition were tested with chi-square and Mann-Whitney U. During the COVID-19 pandemic, participants consumed their breakfast less regularly (34%) compared with participants before the COVID-19 pandemic (65%) (P = .003). Additionally, during the COVID-19 pandemic, participants consumed snacks in the morning (26% vs. 60%, P = .001), afternoon (19% vs. 81%, P < .000), and evening (22% vs. 84%, P < .001) less regularly. However, the frequency in afternoon (4.9 ± 2.2 times per week vs. 3.8 ± 1.9 times per week, P = .002) and evening snacks (4.4 ± 2.4 times per week vs. 3.4 ± 2.0 times per week, P = .02) was higher for participants during the COVID-19 pandemic. We also observed that participants reported more sleeping problems during the COVID-19 pandemic (34% vs. 14%; P = .07). This study in 99 young people and adolescents suggests that meal regularity declined during the COVID-19 pandemic, while meal frequency, especially snack consumption, increased. This highlights the importance of maintaining a regular daily structure to avoid excessive energy intake via snacks.

Joint association of meal frequency and diet quality with metabolic syndrome in Iranian adults

BACKGROUND

Metabolic syndrome (MetS) is a common complication that has been shown in various studies to be related to the frequency and timing of eating. We aimed to evaluate the relationship between meal timing and frequency with diet quality and prevalence of MetS.

STUDY DESIGN

Cross-sectional.

METHODS

We analyzed data from 850 adults (20 to 59 years) and divided the participants into different categories in terms of frequency of eating occasions (EO) (5 ≥ , 6-7 and 7 <), meal (2 ≥ and 3) and snack (2 ≥ , 3 and 4 ≤) in a day. Daily food consumption was assessed using the structured three 24-h recalls. The quality of diet we calculated using the food quality score (FQS). Metabolic syndrome was defined based on the guidelines of the national cholesterol education program adult treatment panel III (ATP III). The covariates-adjusted relationships between exposures and outcomes were investigated using a logistic regression test and two-way ANOVA.

RESULTS

The overall prevalence of MetS in participants was 34.2%. The average FQS was 28.0. Increased frequency of EOs and snacks was related to the higher prevalence of MetS ((OR, 1.72; 95% CI, 1.24, 2.37; P < 0.01) and (OR, 1.34; 95% CI, 1.07, 1.68; P, 0.01), respectively). The adjusted mean of FQS was not significantly different between the EO as well as meals and snack categories. The joint association of EO frequency and snack frequency with diet quality showed a higher chance of having MetS ( (OR, 2.36; 95% CI, 1.19, 4.66; P, 0.01 and (OR, 1.68; 95% CI, 1.06, 2.68; P,0.02), respectively). Also, we observed a higher mean of high density level cholesterol in people with the highest FQS and lowest EO frequency (P,0.02).

CONCLUSION

Our findings suggest that the EO and snack frequency may be associated with the higher chance of MetS. We also found when the frequency of EO increases, the beneficial associations of the diet quality were overshadowed. To confirm our findings, well designed randomised clinical trials are needed.

Breakfast skipping and cardiometabolic risk factors in adolescents: Systematic review

OBJECTIVE

To systematically review the results of the association between breakfast skipping and cardiometabolic risk factors in adolescents.

METHODS

The articles were searched in May 2020 from PubMed, Virtual Health Library, Scopus, Web of Science and Scientific Electronic Library Online (SciELO). The review included observational studies conducted with adolescents (10-19 years old), which estimated the association of breakfast skipping with at least one outcome (markers of body adiposity, blood pressure, serum lipid and glucose levels). Regarding the risk of bias, the articles were evaluated using the Research Triangle Institute (RTI) Item Bank on bias risk and accuracy of observational studies. The quality of the evidence was assessed by the Grade rating.

RESULTS

A total of 43 articles involving 192,262 participants met the inclusion criteria and were considered in this review. The prevalence of breakfast skipping ranged from 0.7% to 94% and 60.5% of studies were classified with low risk of bias. The significant association between breakfast skipping and cardiometabolic risk factors was found in twenty-nine cross-sectional articles (n = 106,031) and four longitudinal articles (n = 5,162) for excess adiposity, in three articles (n = 8,511) for high total cholesterol levels, low-density lipoprotein and triglycerides, and in three studies (n = 6,303) for high blood pressure levels. However, there was no significant association between breakfast skipping and glycemic profile. According to the Grade rating, all the associations had low quality of evidence.

CONCLUSION

The results of this review suggest that breakfast skipping is associated with cardiometabolic risk factors in adolescents aged 10 to 19 years. However, considering the low quality of the evidence, the present results should be interpreted carefully. In addition, our findings highlight the importance of standardizing the definition of breakfast skipping and that more prospective studies are needed to determine how skipping breakfast can affect cardiometabolic risk factors in the long time.

Short- and Medium-Term Impact of a Structured Medical Intervention in Adolescents with Overweight, Obesity, or Increased Waist Circumference

INTRODUCTION AND OBJECTIVES

This study aimed to assess the impact of a structured medical intervention in adolescents with overweight or obesity at medical discharge and after 5 years and identify the factors responsible for the reappearance of anthropometric alterations.

METHODS

A total of 42 adolescents with overweight, obesity, and/or increased waist circumference (WC) participated in a survey on eating habits, physical exercise, and sedentary habits. Body mass index (BMI), fat mass (FM), and WC were evaluated quarterly during a structured medical intervention, with a maximum duration of 3 years (2007-2010) and 5 years after its conclusion (2015-2016). SPSS 19.0®was used for statistical analysis.

RESULTS

Initially, 23.8% adolescents were overweight, 28.6% were obese, 83.3% had increased FM, and 95.2% had high WC. A significant improvement was noted until medical discharge with respect to BMI, FM, and WC (p < 0.001) owing to an increased number of meals; reduction in the consumption of hypercaloric foods/drinks (p < 0.001); increase in the consumption of fruits, vegetables, and soup (p < 0.001); increase in physical exercise and daily walks (p < 0.001); and reduction in sedentary habits (p < 0.001). At reassessment, after 5 years, the majority had normal BMI, FM, and WC (p < 0.001), although 45.2% had abandoned sports (p < 0.001).

CONCLUSIONS

A relation exists between the improvement or normalization of BMI, FM, and WC and the number of meals, healthy eating habits, physical exercise, and less sedentary habits. The intervention was associated with an improvement in the parameters during the short and medium terms.

Association between obesity, common chronic diseases and health promoting lifestyle profiles in Hong Kong adults: a cross-sectional study

Background

Recent surveys revealed that the health status of many people from Hong Kong is far from ideal. Although non-communicable diseases are largely preventable, few relevant health promotion and disease prevention programs are available. Thus, we assessed the health indicators of Chinese adults in Hong Kong to investigate the relationship between obesity, common chronic diseases, and health-promoting lifestyle profiles to provide inspirations for decision makers in formulating targeted disease prevention and health management programs.

Methods

This is a secondary analysis of a data set of 270 community-dwelling Hong Kong adults who were within the eligible age range between 18 and 80 years without eye diseases that affect retinal photographs. The study exposure variable, health-promoting lifestyle profiles, was measured using the Health-Promoting Lifestyle Profile II (HPLP-II) questionnaire. The primary outcome variable, obesity, was defined using body mass index and waist-hip ratio. The secondary study outcome, estimated chronic diseases, including of anemia, chronic kidney disease, and cardiovascular disease, were estimated using automatic retinal image analysis from the retinal images. Data were analyzed using tests of proportion, the independent sample t-tests, Welch’s t-test, and binary logistic regression models.

Results

All HPLP-II subscales had positive responses (≥ 2.5). Significant differences were noted between men and women in the health responsibility and nutrition subscales (Health Responsibility: p = 0.059; Nutrition: p = 0.067). Regression models revealed that nutrition (adjusted odds ratio [AOR] = 0.41; p = 0.017), physical activity (AOR = 0.50; p = 0.015), interpersonal relations (AOR = 2.14; p = 0.016), and stress management (AOR = 2.07; p 0.038) were associated with obesity; while spiritual growth (AOR = 0.24; p = 0.077) and interpersonal relations (AOR = 5.06; p 0.069) were associated with estimated chronic kidney disease.

Conclusions

Improving health behaviors may control or alleviate the prevalence of obesity and chronic kidney disease. These findings could arouse concern about lifestyle behaviors and promote self-assessment of health-promoting lifestyles to the general public. The study also provided new insights into the relationship between the HPLP-II and other common chronic diseases that warrant further study.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09726-x.

Eating Habits of Children Born after Maternal Bariatric Surgery

Mothers who underwent bariatric surgery (BS) before pregnancy have worrisome eating habits, but little is known about the eating habits of their offspring. EFFECTOR is a cross-sectional, long-term follow-up study of 4-11-year-old children born from mothers that underwent bariatric surgery before pregnancy (n = 36), mothers with overweight/obesity (OW/OB) in a control group (n = 71), and mothers with a normal weight (NW) in a second control group (n = 35). Data on anthropometry and on eating habits obtained through a Food Frequency Questionnaire were collected prospectively. The children's body mass index (BMI) scores significantly correlated with maternal pre-pregnancy BMI. The prevalence of overweight and obesity was the highest in children of the BS group (38.9% vs. 15.5% for children of the OW/OB group and 5.7% for those of the NW group; p = 0.004). Meal-skipping behavior was comparable between the groups. There was no difference in fruit and vegetable consumption. The BS group consumed more low-calorie sweetened beverages compared to the NW group (p = 0.01) but less fruit juice compared to the NW and OW/OB groups (p = 0.01). Our results may indicate a sugar-avoiding behavior in children of the BS group, fitting dietary maternal habits in a strategy to prevent dumping syndrome. In conclusion, maternal pre-pregnancy bariatric surgery does not alter unhealthy eating behaviors and the risk of development of overweight during childhood in their children.

Longitudinal association between body mass index and physical activity among adolescents with different parental risk: a parallel latent growth curve modeling approach

Background

Data available on the association between physical activity (PA) and body mass index (BMI) in different periods of life is controversial. Using a parallel latent growth curve modeling (LGCM) approach, the current study aimed to investigate the influence of daily PA on adolescents’ BMI over a 12 year follow-up, taking into account their parental risk.

Method

Participants comprised 1323 adolescents (53.5% girls), aged 12–18 years who had participated in the baseline phase of Tehran Lipid and Glucose Study (TLGS) (2001–2003), and were followed for an average period of 12 years. Physical activity, including leisure time and occupational activities, was assessed using the reliable and validated Iranian version of the Modifiable Activity Questionnaire (MAQ). Weight and height were objectively measured in order to calculateBMI.Atwo-step cluster analysis was conducted to classify parents into two high- and low-risk clusters. Parallel LGCM was fitted to estimate cross-sectional, prospective and parallel associations, which assessed the longitudinal association between simultaneous changes in PA and BMI during the study period. Analyses were stratified by gender and parental clusters.

Results

A rising trend of BMI per 3 years was observed in boys 1.39 kg.m²(95% CI; 1.32, 1.48) and girls 0.9 kg.m²(95% CI; 0.82, 0.98), as well as in the low risk 1.11 kg.m²(95% CI; 1.03, 1.18) and high-risk 1.12 kg.m²(95% CI; 1.03, 1.22) clusters. Moreover, a positive prospective association between PA at baseline and BMI change over the 12 year follow-up, was observed in adolescents in the low-risk parental cluster 0.27(95% CI; 0.14, 0.41) indicating that higher levels of PA at baseline may lead to greater BMI in adolescents over time. However, examining longitudinal parallel association between simultaneous changes of PA and BMI per 3 years revealed adverse associations for adolescents in the low-risk parental cluster − 0.07 (95% CI; − 0.13, − 0.01) and in boys − 0.06 (95% CI; − 0.11, − 0.01).

Conclusion

Despite a positive prospective association between BMI and PA at baseline, there was a weak inverse parallel association between these variables over time, particularly in boys and adolescents with low parental risk. These findings imply the potential role of other influential factors indetermining adolescents’ weight status which need to be considered in the future plannings.

Chrono-Nutrition and Diet Quality in Adolescents with Delayed Sleep-Wake Phase Disorder

Background: Delayed sleep-wake phase disorder (DSPD), characterized by delayed sleep-onset and problems with awakening in the morning, is mostly prevalent in adolescents. Several studies have suggested chrono-nutrition could present a possible modifiable risk factor for DSPD. Objective: To describe differences in chrono-nutrition and diet quality in adolescents with DSPD compared to age-related controls. Methods: Chrono-nutrition and diet quality of 46 adolescents with DSPD, aged 13–20 years, and 43 controls were assessed via questionnaires. Diet quality included the Dutch Healthy Diet index (DHD-index) and Eating Choices Index (ECI). Results were analysed using logistic regression and Spearman’s partial correlation. Results: Compared with controls, DSPD patients consumed their first food of the day significantly later on weekdays (+32 ± 12 min, p = 0.010) and weekends (+25 ± 8 min, p = 0.005). They consumed their dinner more regularly (80.4% vs. 48.8%, p = 0.002) and consumed morning-snacks less frequently (3.0 ± 2.1 days vs. 4.2 ± 1.7 days, p = 0.006). No differences in clock times of breakfast, lunch, or dinner were found. Moreover, no significant differences in overall diet quality were observed. Conclusion: This descriptive study showed chrono-nutritional differences between adolescents with and without DPSD. Further studies are needed to explore features of chrono-nutrition as a possible treatment of DPSD.

Decreased eating frequency linked to increased visceral adipose tissue, body fat, and BMI in Hispanic college freshmen

Background

To investigate the relationship between eating frequency and specific adiposity markers in a potentially high-risk and understudied population of Hispanic college freshmen.

Methods

This study included 92 Hispanic college freshmen (18–19 y). The following cross-sectional data were collected: height, weight, waist circumference, body mass index (BMI), dietary intake, body composition, physical activity, hepatic fat, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT).

Results

Infrequent eaters ate 44% less often (2.5 ± 0.2 vs. 4.5 ± 0.8, p ≤ 0.01) and consumed 27% more calories per EO (p ≤ 0.01), while consuming 21% less kcals per day (p ≤ 0.01) compared to frequent eaters. Infrequent eaters had 8% higher BMIs (24.8 ± 4.4 vs. 22.9 ± 3.2 kg/m²) (p = 0.02), 60% higher BMI z-scores (0.5 ± 1.0 vs. 0.2 ± 1.0, p = 0.03), 21% higher VAT (298.3 ± 153.8 vs. 236.8 ± 78.2 ml, p = 0.03), 26% higher SAT (1150.1 ± 765.4 vs. 855.6 ± 494.6 ml, p = 0.03), and 8% higher total body fat (27.6 ± 10.8 vs. 25.3 ± 8.8%, p = 0.04) compared to frequent eaters while showing no significant difference in physical activity. These findings seem to be driven by females more than males.

Conclusions

These findings suggest that infrequent eating is related to increased adiposity in Hispanic college freshmen, despite a decreased daily energy intake and no significant differences in physical activity. Yet, more research is needed to understand the underlying mechanisms of these findings, as well as investigate any potential causal relationship between eating frequency and adiposity in Hispanic youth.

Obesity in adolescents and the risk factors

OBJECTIVES

This study aims to investigate the frequency of obesity and to identify possible risk factors affecting obesity in adolescents.

MATERIALS AND METHODS

This cross-sectional study included a total of 1,357 adolescents between March 2011 and May 2012 in Beyoglu district of Istanbul province of Turkey. The questionnaire including 38 questions which was developed based on the Youth Risk Behavior Survey, which is used by the Center for Disease Control and Prevention (CDC), was used for the data collection. The weight and height of the participants were measured and their body mass index (BMI) values were calculated.

RESULTS

Of all participants, 54.8% were females, 5% of them were underweight, 12.6% were overweight, and 2.6% were obese. Among the male participants, the BMI values were higher (21.06±3.32 kg/m2) than females (20.26±2.88 kg/m2) (p<0.0001). The obesity ratio was higher in males (p<0.0001) and in children of highly educated parents (p<0.05). Of the participants, 23.5% were physically active. Physical activity level was higher in males, compared to females (p<0.0001). The rate of breakfast habit was higher in males than females (p=0.002). Healthy diets and losing weight in a healthy way were more commonly accepted by the students in the public schools, compared to those in private schools (p<0.0001).

CONCLUSION

Obesity is an important public health problem and proper eating habits and regular physical activity should be encouraged. High-income families should also encourage their children to become more aware of the importance of physical activity. The right time for this is childhood and adolescence, in which permanent habits can be easily acquired.

Dietary Habits and Eating Practices and Their Association with Overweight and Obesity in Rural and Urban Black South African Adolescents

The aim of this study was to investigate differences/similarities in dietary habits and eating practices between younger and older, rural and urban South African adolescents in specific environments (home, community and school) and their associations with overweight and obesity. Dietary habits, eating practices, and anthropometric measurements were performed on rural (n = 392, mean age = 13 years) and urban (n = 3098, mean age = 14 years) adolescents. Logistic regression analysis was used to examine the associations between dietary habits and eating practices, with overweight and obesity risk. Differences in dietary habits and eating practices by gender and by site within the three environments were identified. After adjusting for gender, site, dietary habits, and eating practices within the home, community and school environment, eating the main meal with family some days (OR = 1.78, 95% CI = 1.114-2.835; p ≤ 0.02), eating the main meal with family almost every day (OR = 1.61, 95% CI = 1.106-2.343; p ≤ 0.01), and irregular frequency of consuming breakfast on weekdays (OR = 1.38, 95% CI = 1.007-1.896; p ≤ 0.05) were all associated with increased risk of overweight and obesity. For "Year 15" adolescents, irregular frequency of consuming breakfast on weekends within the home environment (OR = 1.53, 95% CI = 1.099-2.129, p ≤ 0.01), was associated with increased risk of overweight and obesity. For both early- and mid-adolescents, being male (OR = 0.401, 95% CI = 0.299-0.537; p ≤ 0.00; OR = 0.29, 95% CI = 0.218-0.397; p ≤ 0.00) was associated with reduced risk of overweight and obesity, while residing in a rural setting (OR = 0.55, 95% CI = 0.324-0.924; p ≤ 0.02) was associated with reduced risk of overweight and obesity only among early-adolescents. Only dietary habits and eating practices within the home environment were associated with increased risk of overweight and obesity.

Relationships between physical activity, food choices, gender and BMI in Southern Californian teenagers

Given the increased prevalence of pediatric obesity and risk of developing chronic disease, there has been great interest in preventing these conditions during childhood by focusing on healthy lifestyle habits, including nutritious eating and physical activity (PA). The purpose of this study was to determine the relationship between PA, body mass index (BMI) and food choices in adolescent males and females. This cross-sectional study, using a survey questionnaire, evaluated 1212 Southern Californian adolescents' self-reported PA, BMI and food frequency. Results revealed that even though males are more active than females, they have higher BMI percentile values (p < 0.05). Females consumed salad, vegetables and fruit more frequently than males (p < 0.05), where males consumed hamburgers, pizza, red meat, processed meat, eggs, fish, fruit juice, soda and whole milk more frequently than females (p < 0.05). Overweight/obese teens consumed red meat, processed meat and cheese more frequently than healthy weight teens (p < 0.05), yet there was no difference in PA between healthy and overweight/obese teens. These results demonstrate that higher levels of PA may not counteract an unhealthy diet. Even though PA provides numerous metabolic and health benefits, this study suggests that healthy food choices may have a protective effect against overweight and obesity. Healthy food choices, along with PA, should be advocated to improve adolescent health by encouraging maintenance of a healthy weight into adulthood.

Eating frequency predicts changes in regional body fat distribution in healthy adults

BACKGROUND

Eating frequency (EF) has been associated with generalized obesity.

AIM

We aimed to prospectively investigate potential associations of frequency of eating episodes with regional fat layers.

DESIGN

EF was evaluated at baseline in 115 subjects free of clinically overt cardiovascular disease (54 ± 9.1 years, 70 women) in a prospective, observational study.

METHODS

Metabolic parameters known to be associated with dietary factors and anthropometric markers including ultrasound assessment of subcutaneous (Smin) and pre-peritoneal (Pmax) fat and their ratio Smin/Pmax (AFI) were evaluated at baseline and at follow-up, 5 years later.

RESULTS

EF at baseline positively correlated with Pmax, even after adjustment for potential confounders. EF above median was also an independent predictor for Pmax (beta coefficient = -0.192, P = 0.037) and AFI (beta coefficient = 0.199, P = 0.049) at follow up. Multivariable linear mixed models analysis demonstrated that subjects with increased EF presented a lower progression rate of Pmax (beta = -0.452, P = 0.006) and a higher progression rate of AFI (beta = 0.563, P = 0.003) over time, independently of age, sex, progression of BMI, energy intake, smoking and changes in parameters of glucose metabolism.

CONCLUSIONS

High EF is associated with lower progression rate of pre-peritoneal fat accumulation. Future interventional studies should further investigate the clinical utility of these findings.

Exercise and eating habits among urban adolescents: a cross-sectional study in Kolkata, India

BACKGROUND

Unhealthy eating and lack of exercise during adolescence culminated into earlier onset and increasing burden of atherosclerotic cardiovascular diseases (CVDs) worldwide. Among urban Indian adolescents, prevalence of these risk factors of CVD seemed to be high, but data regarding their pattern and predictors was limited. To address this dearth of information, a survey was conducted among urban adolescent school-students in Kolkata, a highly populated metro city in eastern India.

METHODS

During January-June, 2014, 1755 students of 9th-grade were recruited through cluster (schools) random sampling. Informed consents from parents and assents from adolescents were collected. Information on socio-demographics, CVD-related knowledge and perception along with eating and exercise patterns were collected with an internally validated structured questionnaire. Descriptive and regression analyses were performed in SAS-9.3.2.

RESULTS

Among 1652 participants (response rate = 94.1%), about 44% had poor overall knowledge about CVD, 24% perceived themselves as overweight and 60% considered their general health as good. Only 18% perceived their future CVD-risk and 29% were engaged in regular moderate-to-vigorous exercise. While 55% skipped meals regularly, 90% frequently consumed street-foods and 54% demonstrated overall poor eating habits. Males were more likely to engage in moderate-to-vigorous exercise [adjusted odds ratio (AOR) = 3.40(95% confidence interval = 2.55-4.54)] while students of higher SES were less likely [AOR = 0.59(0.37-0.94)]. Males and those having good CVD-related knowledge were more likely to exercise at least 1 h/day [AOR = 7.77(4.61-13.07) and 2.90(1.46-5.78) respectively]. Those who perceived their future CVD-risk, skipped meals more [2.04(1.28-3.25)] while Males skipped them less [AOR = 0.62(0.42-0.93)]. Subjects from middle class ate street-foods less frequently [AOR = 0.45(0.24-0.85)]. Relatively older students and those belonging to higher SES were less likely to demonstrate good eating habits [AOR = 0.70(0.56-0.89) and 0.23(0.11-0.47) respectively]. A large knowledge-practice gap was evident as students with good CVD-related knowledge were less likely to have good eating habits [AOR = 0.55(0.32-0.94)].

CONCLUSIONS

CVD-related knowledge as well as eating and exercise habits were quite poor among adolescent school-students of Kolkata. Additionally, there was a large knowledge-practice gap. Multi-component educational interventions targeting behavioral betterment seemed necessary for these adolescents to improve their CVD-related knowledge, along with appropriate translation of knowledge into exercise and eating practices to minimize future risk of CVDs.

Eating frequency in relation to BMI in very young children: a longitudinal analysis

OBJECTIVE

Eating less frequently is associated with increased obesity risk in older children but data are potentially confounded by reverse causation, where bigger children eat less often in an effort to control their weight. Longitudinal data, particularly in younger children, are scarce. We aimed to determine whether eating frequency (meals and snacks) at 2 years of age is associated with past, current or subsequent BMI.

DESIGN

Cohort analysis of a randomised controlled trial. Eating frequency at 2 years of age was estimated using 48 h diaries that recorded when each child ate meals and snacks (parent-defined) in five-minute blocks. Body length/height and weight were measured at 1, 2 and 3·5 years of age. Linear regression assessed associations between the number of eating occasions and BMI Z-score, before and after adjustment for potential confounding variables.

SETTING

Prevention of Overweight in Infancy (POI) study, Dunedin, New Zealand.

SUBJECTS

Children (n 371) aged 1-3·5 years.

RESULTS

On average, children ate 5·5 (sd 1·2) times/d at 2 years of age, with most children (88-89 %) eating 4-7 times/d. Eating frequency at 2 years was not associated with current (difference in BMI Z-score per additional eating occasion; 95 % CI: -0·02; -0·10, 0·05) or subsequent change (0·02; -0·03, 0·06) in BMI. Similarly, BMI at age 1 year did not predict eating frequency at 2 years of age (difference in eating frequency per additional BMI Z-score unit; 95 % CI: -0·03; -0·19, 0·13).

CONCLUSIONS

Number of eating occasions per day was not associated with BMI in young children in the present study.

Regular family breakfast was associated with children's overweight and parental education: Results from the ENERGY cross-sectional study

INTRODUCTION

This study aims to assess (i) the prevalence of having regular family breakfast, lunch, dinner (i.e. 5-7days/week together with their family) among 10-12year olds in Europe, (ii) the association between family meals and child weight status, and (iii) potential differences in having family meals according to country of residence, gender, ethnicity and parental levels of education.

METHODS

7716 children (mean age: 11.5±0.7years, 52% girls) in eight European countries (Belgium, Greece, Hungary, The Netherlands, Norway, Slovenia, Spain, Switzerland) participated in a cross-sectional school-based survey in 2010. Data on family meals were self-reported by the parents and children's height and weight were objectively measured to determine overweight status. Binary regression analyses assessed the associations of having regular family meals (adjusted for potential confounders) with children's overweight/obesity and to assess potential differences in having family meals according to gender, ethnicity and parental education, in the total sample and for each country respectively.

RESULTS

The prevalence of regular family meals was 35%, 37% and 76% for breakfast, lunch and dinner respectively. Having regular family breakfast, but not lunch or dinner, was inversely associated with overweight (OR=0.78 (95% CI 0.67-0.91)). Children of higher educated parents were more likely to have regular family breakfast (1.63 (95% CI 1.42-1.86)) and less likely to have regular family lunch (0.72 (95% CI 0.63-0.82)) compared to children of lower educated parents.

CONCLUSION

This study showed that having regular family breakfast - but not other family meals- was inversely associated with children's weight status.

Associations between meal and snack frequency and overweight and abdominal obesity in US children and adolescents from National Health and Nutrition Examination Survey (NHANES) 2003–2012

The association between eating frequency (EF) and adiposity in young populations is inconsistent. This cross-sectional study examined associations of EF, meal frequency (MF) and snack frequency (SF) with adiposity measures in US children aged 6–11 years (n 4346) and adolescents aged 12–19 years (n 6338) participating in the National Health and Nutrition Examination Survey 2003–2012. Using data from two 24-h dietary recalls, all eating occasions providing ≥210 kJ of energy were divided into meals or snacks based on contribution to energy intake (≥15 or <15 %), self-report and time (06.00–09.00, 12.00–14.00 and 17.00–20.00 hours or others). When analysed without adjustment for the ratio of reported energy intake:estimated energy requirement (EI:EER), all measures of EF, MF and SF showed inverse or null associations with overweight (BMI≥85th percentile of BMI-for-age) and abdominal obesity (waist circumference≥90th percentile) in both children and adolescents. After adjustment for EI:EER, however, EF and SF, but not MF, showed positive associations in children, irrespective of the definition of meals and snacks. In adolescents, after adjustment for EI:EER, positive associations were observed for EF (abdominal obesity only), SF based on energy contribution and MF based on self-report, whereas there was an inverse association between MF based on energy contribution and overweight. In conclusion, higher SF and EF, but not MF, were associated with higher risks of overweight and abdominal obesity in children, whereas associations varied in adolescents, depending on the definition of meals and snacks. Prospective studies are needed to establish the associations observed here.

Higher Eating Frequency Does Not Decrease Appetite in Healthy Adults

BACKGROUND

Consumption of small, frequent meals is suggested as an effective approach to control appetite and food intake and might be a strategy for weight loss or healthy weight maintenance. Despite much speculation on the topic, scientific evidence is limited to support such a relation in the absence of changes to diet composition.

OBJECTIVE

We examined the effects of high compared with low eating frequency (EF) on self-reported appetite as a secondary outcome in a controlled trial.

METHODS

We conducted a randomized, crossover intervention trial in 12 participants (4 men, 8 women) who completed 2 isocaloric 3-wk intervention phases of low EF (3 eating occasions/d) compared with high EF (8 eating occasions/d). On the last morning of each study phase, participants completed a 4-h appetite testing session. During the appetite testing session, participants completing the low EF phase consumed a meal at 0800. Participants completing the high EF intervention consumed the same meal spread evenly over 2 eating occasions at 0800 and 1030. Standardized ratings of hunger, desire to eat, fullness, thirst, and nausea were completed every 30 min with the use of paper-and-pencil semianchored 100-mm visual analog scales. A composite appetite score was calculated as the mean of hunger, desire to eat, and the inverse of fullness (calculated as 100-fullness rating). Linear regression analysis compared ratings between low EF and high EF conditions.

RESULTS

The mean composite appetite score was higher in the high EF condition for the total testing period (baseline through 1200) (P < 0.05) and for the time period from baseline through 1030 (P < 0.001).

CONCLUSION

The results from this study in 12 healthy adults do not support the popularized notion that small, frequent meals help to decrease overall appetite. This trial was registered at clinicaltrials.gov as NCT02548026.

Dietary Carbohydrate and Nocturnal Sleep Duration in Relation to Children's BMI: Findings from the IDEFICS Study in Eight European Countries

Previous research has found an association between being overweight and short sleep duration. We hypothesized that this association could be modified by a high carbohydrate (HC) diet and that the timing and type (starch or sugar) of intake may be an important factor in this context. Participants in the prospective, eight-country European study IDEFICS were recruited from September 2007 to June 2008, when they were aged two to nine years. Data on lifestyle, dietary intake and anthropometry were collected on two occasions. This study included 5944 children at baseline and 4301 at two-year follow-up. For each meal occasion (morning, midday, and evening), starch in grams and sugar in grams were divided by total energy intake (EI), and quartiles calculated. HC-starch and HC-sugar intake categories were defined as the highest quartile for each meal occasion. In a mutually adjusted linear regression model, short sleep duration as well as HC-starch in the morning were positively associated with body mass index (BMI) z-scores at baseline. HC-starch at midday was positively associated with body mass index (BMI) z-scores in children with short sleep duration, and negatively associated with BMI z-scores in those with normal sleep. After adjustment for baseline BMI z-scores, associations between total HC from starch or sugar and high BMI z-scores at two-year follow-up did not persist. Our observations offer a perspective on optimal timing for macronutrient consumption, which is known to be influenced by circadian rhythms. Reduced carbohydrate intake, especially during morning and midday meals, and following nocturnal sleep duration recommendations are two modifiable factors that may protect children from being overweight in the future.

The role of eating frequency on relative weight in urban school-age children

BACKGROUND

The role of eating frequency on relative weight in childhood is not well understood.

OBJECTIVE

To clarify this relationship by assessing the cross-sectional and prospective relationships of weekday eating frequency with BMI z-score (BMIz) and change in BMIz in a sample of schoolchildren.

METHODS

Eating frequency, the average number of reported daily eating occasions, was assessed using two weekday 24-h diet recalls. BMIz was measured at baseline, 6 months and 1 year in 155 urban schoolchildren, ages 9-15 years. Multiple linear regression models were used.

RESULTS

Cross-sectional analyses at baseline suggest that BMIz was 0.23 units lower for each additional reported eating occasion (regression coefficient = -0.23; 95% confidence interval [CI]: -0.44, -0.07). From baseline to 6 months, BMIz increased by 0.03 units for each additional reported eating occasion (regression coefficient = 0.03; 95% CI: 0.01, 0.05). This relationship was no longer statistically significant at 1 year (regression coefficient = 0.01; 95% CI: -0.01, 0.03).

CONCLUSIONS

The findings suggest that the relationship of eating frequency with BMIz differs from that of change in BMIz. This difference may be due to methodological deficiencies of cross-sectional studies, challenges of dietary assessment or differences in eating patterns among normal and overweight youth. Controlled trials are needed to further clarify this relationship.

Decreasing the number of small eating occasions (<15 % of total energy intake) regardless of the time of day may be important to improve diet quality but not adiposity: a cross-sectional study in British children and adolescents

Evidence of associations between meal frequency (MF) and snack frequency (SF) and diet and obesity in young populations is limited. This cross-sectional study examined MF and SF in relation to dietary intake and adiposity measures in British children aged 4-10 years (n 818) and adolescents aged 11-18 years (n 818). Based on data from a 7-d weighed dietary record, all eating occasions were divided into meals or snacks on the basis of contribution to energy intake (≥15 or <15 %) or time (06.00-10.00, 12.00-15.00 and 18.00-21.00 hours or others). All measures of MF and SF showed positive associations with energy intake, except for MF based on energy contribution in children. Irrespective of the definition of snacks, SF was associated with higher intakes of soft drinks, confectionery and total sugar, lower intakes of cereals, fish, meat, protein, PUFA, starch and dietary fibre, and a lower diet quality (assessed by the Mediterranean diet score, except for SF based on energy contribution in adolescents). MF based on time, but not based on energy contribution, was associated with higher intakes of confectionery and total sugar, lower intakes of fish, protein, PUFA and starch, and, only in children, a lower diet quality. All measures of MF and SF showed no association with adiposity measures. In conclusion, this cross-sectional study in British children and adolescents suggests that decreasing the number of small eating occasions (<15 % of total energy intake) regardless of the time of day may be important to improve diet quality but not adiposity.

Sex differences in prevalence of overweight and obesity, and in extent of overweight index, in children and adolescents (3–18 years) from Kraków, Poland in 1983, 2000 and 2010

Objective

The increasing prevalence of overweight and obesity among children is now an important health problem. This fact, however, does not reflect the scale of the problem. The aim of the present study was to find how much the BMI threshold was exceeded in a population from Kraków.

Design

The study was based on three cross-sectional surveys conducted in 1983, 2000 and 2010. The prevalence of overweight and obesity was estimated based on the International Obesity Task Force cut-off points. In addition to these, an extent of overweight (EOW) index was calculated.

Setting

Poland.

Subjects

Children aged 3–18 years (n14 534) from Kraków.

Results

Between the populations examined in 1983 and 2010, the EOW index in boys rose by almost 10 %, and the prevalence of overweight and obesity by 39 %. In girls, however, the EOW index decreased by 45 %, while the prevalence of overweight and obesity remained at similar levels. Analyses in separate age groups showed that the EOW index increased only among early adolescents (150 % for boys, 94 % for girls) and late adolescents (390 % and 64 %, respectively).

Conclusions

The observed increased prevalence of overweight and obesity mainly concerned boys and was accompanied by an increase in the amount by which the BMI threshold values were exceeded.

Psychological well-being in adolescents with excess weight

BACKGROUND

Self-esteem, perceived health, weight satisfaction, eating habits, physical activity, friendships, intimate relationships, smoking and substance use habits can be regarded as important correlates of psychological well-being in adolescence.

AIM

The present study aimed to determine whether problems in the above-mentioned elements of psychological well-being were more prevalent among mid-adolescent pupils with excess weight than among their healthy-weight peers.

METHODS

The study participants comprised 178 adolescents with excess weight and 1087 healthy-weight peers with a mean age of 14.7 years attending the 8th grade at secondary school. The Rosenberg Self-Esteem Scale, the Eating Disorder Inventory and a questionnaire assessing health- and food-related attitudes and habits were used.

RESULTS

The adolescents with excess weight more often reported weight dissatisfaction, abnormal eating habits and signs of eating disorder pathology than those with healthy weight. No significant difference in self-esteem was observed between weight groups. The proportion of adolescents who were non-smokers, did not use alcohol and had one or more close friends did not differ between those with excess and healthy weight. However, a lower proportion of excess-weight adolescents had dating experience. Inadequate physical activity was highly prevalent among adolescents in both weight groups.

CONCLUSIONS

Despite the high prevalence of eating pathology and weight dissatisfaction, most mid-adolescent pupils with excess weight expressed good psychological health. Targeted psychological interventions should be offered to some adolescents with overweight problems.

Association between behavioural factors and BMI-for-age among early adolescents in Hulu Langat district, Selangor, Malaysia

OBJECTIVE

This paper investigates the association between behavioural factors and BMI-for-age among early adolescents (10-11 years old) in Hulu Langat district, Selangor.

METHODS

This cross-sectional study was conducted among 333 primary school students. Body weight and height of the students were measured and their BMI-for-age was calculated. Eating behaviours, energy intake, energy expenditure, physical activity, and screen time were assessed using the Eating Behaviours Questionnaire and a 2-day dietary and physical activity recall, respectively. Data were analysed using multiple linear regression analysis.

RESULTS

The prevalence of overweight and obesity (28.2%) was about twice the prevalence of thinness (11.1%). The mean energy intake and energy expenditure of the students was 1772±441kcal/day and 1705±331kcal/day, respectively. Three in five of the students (60.1%) skipped at least one meal and 98.2% snacked between meals daily. A majority of them (55.3%) were sedentary. Low energy intake (p<0.05) and low energy expenditure (p<0.05) were associated with high BMI-for-age. Energy expenditure (β=-0.033) and energy intake (β=-0.090) significantly explained 65.1% of the variances in BMI-for-age (F=119.170, p<0.05).

CONCLUSION

These findings suggested that promoting healthy eating and active lifestyle should be targeted in the prevention and management of obesity among early adolescents.

L-Carnitine intake prevents irregular feeding-induced obesity and lipid metabolism disorder

L-Carnitine supplementation has been used to reduce obesity caused by high-fat diet, which is beneficial for lowering blood and hepatic lipid levels, and for ameliorating fatty liver. However, whether l-carnitine may affect irregular feeding-induced obesity and lipid metabolism disorder is still largely unknown. In the present study, we developed a time-delayed pattern of eating, and investigated the effects of l-carnitine on the irregular eating induced adiposity in mice. After an experimental period of 8 weeks with l-carnitine supplementation, l-carnitine significantly inhibited body weight increase and epididymal fat weight gain induced by the time-delayed feeding. In addition, l-carnitine administration decreased levels of serum alanine aminotransferase (GPT), glutamic oxalacetic transaminase (GOT) and triglyceride (TG), which were significantly elevated by the irregular feeding. Moreover, mice supplemented with l-carnitine did not display glucose intolerance-associated hallmarks, which were found in the irregular feeding-induced obesity. Furthermore, quantitative real-time polymerase chain reaction (qRT-PCR) analysis indicated that l-carnitine counteracted the negative alterations of lipid metabolic gene expression (fatty acid synthase, 3-hydroxy-3-methyl-glutaryl coenzyme A reductase, cholesterol 7α-hydroxylase, carnitine/acylcarnitine translocase) in the liver and fat of mice caused by the irregular feeding. Therefore, our results suggest that the time-delayed pattern of eating can induce adiposity and lipid metabolic disorders, while l-carnitine supplementation might prevent these negative symptoms.

Increased eating frequency linked to decreased obesity and improved metabolic outcomes

BACKGROUND

We previously reported that more frequent eating in overweight minority youth was linked to lower visceral adiposity and circulating triglycerides. The aim of this study was to examine this issue in more detail by assessing the relationship between eating frequency and adiposity and metabolic disease risk in a cohort of exclusively overweight Hispanic youth.

METHODS

This analysis included 191 overweight (⩾ 85th percentile body mass index (BMI)) Hispanic youth (8-18 years) with the following cross-sectional measures: height, weight, BMI, dietary intake via multiple 24 h recalls, body composition via dual-energy X-ray absorptiometry, lipids and insulin action (insulin sensitivity, acute insulin response (AIR) and disposition index, a measure of β-cell function) via a frequently sampled intravenous glucose tolerance test. Each eating occasion (EO) was defined as ⩾ 50 calories and ⩾ 15 min from any prior EO. Infrequent eaters (IEs) were classified as any subject who ate <3 EOs on any dietary recall (n = 32), whereas frequent eaters (FEs) always consumed ⩾ 3 EOs (n = 159).

RESULTS

Using analyses of covariance, FEs compared with IEs consumed 23% more calories per day (P ⩽ 0.01), ate 40% more often and consumed 19% less calories per EO (P ⩽ 0.01). FEs also exhibited 9% lower BMI Z-scores (P ⩽ 0.01), 9% lower waist circumferences (P ⩽ 0.01), 29% lower fasting insulin (P = 0.02), 31% lower HOMA-IR (Homeostatic Model Assessment: Insulin Resistance) values (P = 0.02) and 19% lower triglycerides (P ⩽ 0.01), as well as an 11% higher AIR (P = 0.02) and 31% higher disposition index (P=0.01). The following a priori covariates were included: Tanner, sex, body fat and reported energy intake.

CONCLUSION

These findings suggest that increased eating frequency is related to decreased obesity and metabolic disease risk in overweight Hispanic youth, despite increases in energy intake.

Morning meal more efficient for fat loss in a 3-month lifestyle intervention

OBJECTIVE

To evaluate the effects of 2 low-calorie diets but with different distributions of calories throughout the day on weight loss and other major obesity-related metabolic parameters.

METHODS

We randomly assigned 42 nonsmoking homemakers (age = 46.3 ± 2.3 years, body mass index [BMI] = 35.7 ± 0.8 kg/m(2), mean ± SD) in 2 groups of 21 subjects (G1 and G2). The participants underwent a 3 month individualized Mediterranean-style diet (55% carbohydrate, 30% fat, 15% protein and fiber > 30 g), calorie (600 kcal daily deficit compared to the total energy expenditure measured by a metabolic Holter). Diets consisted of the same food and complied with cardiovascular disease prevention guidelines but differed in the distribution of calories throughout the day (G1: 70% breakfast, morning snack, lunch and 30% afternoon snack and dinner; G2: 55 breakfast, morning snack, lunch and 45% afternoon snack and dinner). Dual-energy X-ray absorptiometry was used for pre- and postintervention body composition assessment.

RESULTS

Thirty-six subjects completed the study (G1 = 18, G2 = 18). Both groups had significant improvements in body composition and metabolic parameters but G1 had enhanced results for weight loss (G1: -8.2 ± 3.0 kg; G2: -6.5 ± 3.4 kg; p = 0.028), waist circumference reduction (G1: -7 ± 0.6 cm; G2: -5 ± 0.3 cm; p = 0.033), and fat mass loss (G1: -6.8 ± 2.1 kg, G2: -4.5 ± 2.9 kg, p = 0.031; mean ± SD). Improvements were detected in both groups for blood pressure and blood and lipid parameters. G1 subjects showed a greater improvement in insulin sensitivity measured by homeostasis model assessment-estimated insulin resistance (G1: -1.37 ± 0.27, G2: -0.74 ± 0.12, p = 0.017).

CONCLUSIONS

These data suggest that a low-calorie Mediterranean diet with a higher amount of calories in the first part of the day could establish a greater reduction in fat mass and improved insulin sensitivity than a typical daily diet.

Prevalence of overweight and obesity among 6-to 9-year-old school children in Cuenca, Ecuador: relationship with physical activity, poverty, and eating habits

BACKGROUND

The high prevalence of childhood overweight and obesity is a health problem worldwide. In developing countries, we lack information on the extent of the problem and the risk factors involved.

OBJECTIVE

To determine the prevalence rates of overweight and obesity and of abdominal obesity, and their relationship with physical activity, poverty, and eating habits in schoolchildren in Cuenca, Ecuador.

METHODS

A cross-sectional survey in a representative sample (n = 743) schoolchildren aged 6 to 9 years was conducted. Overweight and obesity were detected using the International Obesity Task Force cutoffs according to body mass index (BMI), and abdominal obesity was detected according to waist circumference. Poverty, physical activity, and eating habits were assessed with validated questionnaires.

RESULTS

The prevalence rates of overweight and obesity and of abdominal obesity were 26.0% and 10.6%, respectively. There were no differences between the sexes, but the prevalence of overweight and obesity was 1.5- to 2-fold higher in 9-year-old than in 6-year-old children (p < .05). Multivariate models demonstrated that higher BMI and waist circumference were significantly related to low physical activity and nonpoverty. Insufficient physical activity (in 75% of children) was associated with a 13% to 18% increased risk of overweight and obesity and abdominal obesity. Eating breakfast and eating more than three meals per day (in 96.7% and 85.9% of children, respectively) were not related to the prevalence of overweight and obesity. Eating fruits during school break was associated with a lower BMI.L CONCLUSIONS: The high prevalence of overweight and obesity observed in schoolchildren increased from the ages of 6 to 9 years and was associated with insufficient physical activity and nonpoverty. Promoting physical activity and fruit consumption in school snacks should be explored as intervention measures to prevent and reduce overweight and obesity in Cuenca schoolchildren.

Associations of eating frequency with adiposity measures, blood lipid profiles and blood pressure in British children and adolescents

Several epidemiological studies in adults have suggested a favourable effect of frequent eating on blood lipid profiles, but evidence in younger populations is lacking. In the present cross-sectional study, we examined the associations of eating frequency (EF) with metabolic risk factors in British children aged 4-10 years (n 818) and adolescents aged 11-18 years (n 818). Dietary intake was assessed using a 7 d weighed dietary record. EF was calculated based on all eating occasions, except for those providing < 210 kJ of energy. Metabolic risk factors examined were total, HDL-cholesterol and LDL-cholesterol concentrations, TAG concentration, BMI z-score, waist:height ratio (WHtR; only adolescents), and systolic and diastolic blood pressures. Adjustment was made for age, sex, social class, physical activity levels, intakes of protein, fat, total sugar and dietary fibre, ratio of reported energy intake to estimated energy requirement (EI:EER) and BMI z-score (except for BMI z-score and WHtR). In children, EF was inversely associated with total cholesterol and LDL-cholesterol concentrations (n 324, P= 0·01 and 0·04, respectively). Conversely, EF was positively associated with BMI z-score in adolescents (P= 0·004). There were no associations between EF and other metabolic risk factors. In analyses in which only plausible energy reporters (EI:EER: 0·72-1·28) were included, similar results were obtained, except for an inverse association between EF and diastolic blood pressure in children. In conclusion, a higher EF is associated with lower total cholesterol and LDL-cholesterol concentrations in children but with a higher BMI z-score in adolescents.

Meal pattern among Norwegian primary-school children and longitudinal associations between meal skipping and weight status

Objective

To investigate meal pattern longitudinally and explore whether meal skipping was associated with overweight among Norwegian children and adolescents.

Design

Longitudinal study. Children's meal frequencies were reported by their parents using a retrospective FFQ. Weight and height were measured by public health nurses. Descriptive data comparing 4th and 7th grade were analysed by paired-sample t tests for continuous variables and χ2 tests for categorical variables. Odds ratio estimates, including confidence intervals, with BMI category (normal/overweight) as the dependent variable, were determined through logistic regression analyses.

Setting

Primary schools, Telemark County, Norway.

Subjects

A cohort of 428 Norwegian boys and girls; 4th graders in 2007, 7th graders in 2010.

Results

The number of children eating four main meals per day (regular meal frequency) decreased from 4th grade (47 %) to 7th grade (38 %; P = 0·001). Those who ate regular meals in 4th grade but not in 7th grade had higher odds (OR = 3·1; 95 % CI 1·1, 9·0) of being overweight in 7th grade after adjusting for gender, maternal education and physical activity, but the odds ratio was not statistically significant after adjusting for overweight in 4th grade (OR = 2·8; 95 % CI 0·7, 11·6).

Conclusions

The present study showed significant increases in overall meal skipping among children between 4th and 7th grade. The results indicate an association between overweight and meal skipping, but additional prospective and longitudinal analyses and intervention trials are warranted to confirm this relationship.

Breakfast consumption and physical activity in adolescents: daily associations and hourly patterns

BACKGROUND

The association between breakfast consumption and physical activity (PA) is inconclusive.

OBJECTIVE

We aimed to investigate daily associations and hourly patterns of PA and breakfast consumption in British adolescents.

DESIGN

Daily PA [accelerometry-derived moderate and vigorous physical activity (MVPA)] and breakfast consumption (diet diary) were measured simultaneously over 4 d in 860 adolescents (boys: 43.4%; mean ± SD age: 14.5 ± 0.5 y). Associations between MVPA and breakfast consumption were assessed by using a multilevel mixed-effects logistic regression separately by sex and for weekends and weekdays. Hourly patterns of MVPA by breakfast consumption status were displayed graphically, and differences were tested by using ANOVA. Multilevel linear regression was used to investigate differences in log MVPA on days when 570 inconsistent breakfast consumers ate or skipped breakfast.

RESULTS

On weekends, boys and girls with higher MVPA were more likely to eat breakfast [OR (95% CI): boys, 1.78 (1.30, 2.45) (P < 0.001); girls, 2.30 (1.66, 3.08) (P < 0.001)] when adjusted for socioeconomic status, percentage of body fat, and total energy intake. Peak hourly MVPA differed for breakfast consumers compared with nonconsumers on weekends (P < 0.001). Inconsistent breakfast consumers did more MVPA on days when they ate breakfast [exponentiated β coefficients (95% CIs): 1.2 (1.0, 1.5) on weekdays and 1.4 (1.1, 1.8) on weekends for boys and 1.6 (1.3, 2.1) on weekends for girls; all P < 0.03].

CONCLUSIONS

Eating breakfast was associated with higher MVPA on weekends. The time of peak MVPA differed between breakfast consumers and nonconsumers on weekends. Breakfast consumption at weekends is worth additional investigation to potentially inform PA promotion in adolescents.

RISK FACTORS FOR ABDOMINAL OBESITY IN CHILDREN AND ADOLESCENTS FROM CRACOW, POLAND (1983–2000)

The aim of this study was to determine abdominal obesity risk factors in two successive cohorts of children and adolescents aged 4–18 from Cracow, Poland, examined during the years of political transformation. The influence of biological, socio-demographic and lifestyle factors on abdominal obesity was analysed by calculating odds ratios and 95% confidence intervals using logistic regression analysis. It was found that for girls obesity in both parents (OR=4.31; 95% CI 1.73–20.70) and high birth weight (OR=1.78; 95% CI 1.12–2.82) were significant risk factors for abdominal obesity in the 1983 cohort. In the 2000 cohort obesity in both parents for boys and girls (boys: OR=5.85; 95% CI 1.36–25.10; girls: OR=4.82; 95% CI 1.17–19.77), low level of parental education in girls (OR=2.06; 95% CI 1.15–3.69), having only one son (OR=1.96; 95% CI 1.36–3.40), parents' smoking habits in girls (OR=2.94; 95% CI 1.46–5.91) and lack of undertaking physical activity in sport clubs in boys (OR=6.11; 95% CI 1.46–25.47) were significant abdominal obesity risk factors. Higher number of hours of leisure time physical activity (OR=0.89; 95% CI 0.81–0.97) significantly lowered the risk of abdominal obesity in boys in the 2000 cohort. The greater differentiation of abdominal obesity risk factors in the 2000 cohort in comparison to the 1983 cohort may have resulted from the social and economic changes taking place in Poland at the end of the 20th century.

Associations between eating meals, watching TV while eating meals and weight status among children, ages 10-12 years in eight European countries: the ENERGY cross-sectional study

Background

To assess the association of eating meals, and never watching TV while eating meals, with weight status among children, ages 10–12 years across Europe.

Methods

7915 children (mean age: 11.5 years) in eight European countries (Belgium, Greece, Hungary, the Netherlands, Norway, Slovenia, Spain and Switzerland) completed a questionnaire at school. Data on meals eaten the day before questionnaire administration and the frequency of eating meals while watching TV were collected. Height and weight of the children were objectively assessed. Multinomial and binary regression analyses were conducted to test associations of eating meals (adjusted for gender and ethnicity) and never watching TV while eating meals (adjusted for gender, ethnicity and total TV time) with overweight/obesity, and to test for country- and socio-demographic differences.

Results

The proportions of children reporting eating breakfast, lunch and dinner were 85%, 96%, and 93% respectively, and 55%, 46% and 32% reported to never watch TV at breakfast, lunch and dinner respectively. The children who ate breakfast (OR = 0.6 (95% CI 0.5-0.7)) and dinner (OR = 0.4 (95% CI 0.3-0.5)), had lower odds of being overweight compared to those who did not. The children who never watched TV at lunch (OR = 0.7 (95% CI 0.7-0.8)) and dinner (OR = 0.8 (95% CI 0.7-0.9)) had lower odds of being overweight compared to those who watched TV at the respective meals.

Conclusions

The odds of being overweight was lower for children who ate breakfast and dinner compared to those who did not eat the respective meals. The odds of being overweight was lower for children who reported to never watch TV at lunch and dinner compared to those who did. A focus towards meal frequency and watching TV during meals in longitudinal and interventions studies in prevention of overweight and obesity, may contribute to a better understanding of causality.

Eating frequency and overweight and obesity in children and adolescents: a meta-analysis

OBJECTIVES

To determine the effect of eating frequency on body weight status in children and adolescents.

METHODS

In this meta-analysis, original observational studies published to October 2011 were selected through a literature search in the PubMed database. The reference list of the retrieved articles was also used to identify relevant articles; researchers were contacted when needed. Selected studies were published in English, and they reported on the effect of eating frequency on overweight/obesity in children and adolescents. Pooled effect sizes were calculated using a random effects model.

RESULTS

Ten cross-sectional studies and 1 case-control study (21 substudies in total), comprising 18 849 participants (aged 2-19 years), were included in the analysis. Their combined effect revealed that the highest category of eating frequency, as compared with the lowest, was associated with a beneficial effect regarding body weight status in children and adolescents (odds ratio [OR] = 0.78, log OR = -0.24, 95% confidence interval [CI] -0.41 to -0.06). The observed beneficial effect remained significant in boys (OR = 0.76, log OR = -0.27, 95% CI -0.47 to -0.06), but not in girls (OR = 0.96, log OR = -0.04, 95% CI -0.40 to 0.32) (P for sex differences = 0.14).

CONCLUSIONS

Higher eating frequency was associated with lower body weight status in children and adolescents, mainly in boys. Clinical trials are warranted to confirm this inverse association, evaluate its clinical applicability, and support a public health recommendation; more studies are also needed to further investigate any sex-related differences, and most importantly, the biological mechanisms.

Adolescent dietary patterns in Fiji and their relationships with standardized body mass index

Background

Obesity has been increasing in adolescents in Fiji and obesogenic dietary patterns need to be assessed to inform health promotion. The objective of this study was to identify the dietary patterns of adolescents in peri-urban Fiji and determine their relationships with standardized body mass index (BMI-z).

Methods

This study analysed baseline measurements from the Pacific Obesity Prevention In Communities (OPIC) Project. The sample comprised 6,871 adolescents aged 13–18 years from 18 secondary schools on the main island of Viti Levu, Fiji. Adolescents completed a questionnaire that included diet-related variables; height and weight were measured. Descriptive statistics and regression analyses were conducted to examine the associations between dietary patterns and BMI-z, while controlling for confounders and cluster effect by school.

Results

Of the total sample, 24% of adolescents were overweight or obese, with a higher prevalence among Indigenous Fijians and females. Almost all adolescents reported frequent consumption of sugar sweetened beverages (SSB) (90%) and low intake of fruit and vegetables (74%). Over 25% of participants were frequent consumers of takeaways for dinner, and either high fat/salt snacks, or confectionery after school. Nearly one quarter reported irregular breakfast (24%) and lunch (24%) consumption on school days, while fewer adolescents (13%) ate fried foods after school. IndoFijians were more likely than Indigenous Fijians to regularly consume breakfast, but had a high unhealthy SSB and snack consumption.

Regular breakfast (p<0.05), morning snack (p<0.05) and lunch (p<0.05) consumption were significantly associated with lower BMI-z. Consumption of high fat/salt snacks, fried foods and confectionery was lower among participants with higher BMI-z.

Conclusions

This study provides important information about Fijian adolescents’ dietary patterns and associations with BMI-z. Health promotion should target reducing SSB, increasing fruit and vegetables consumption, and increasing regularity of meals among adolescents. Future research is needed to investigate moderator(s) of inverse associations found between BMI-z and consumption of snacks, fried foods and confectionery to assess for potential reverse causality.

Associations between sleep characteristics, seasonal depressive symptoms, lifestyle, and ADHD symptoms in adults

OBJECTIVE

The authors explored associations between ADHD symptoms, seasonal depressive symptoms, lifestyle, and health.

METHOD

Adult ADHD patients (n = 202) and controls (n = 189) completed the ASESA questionnaire involving lifestyle, eating pattern, and physical and psychological health, and validated measures on ADHD and sleep. ASESA is the Dutch acronym for inattention, sleep, eating pattern, mood, and general health questionnaire.

RESULTS

Indication for delayed sleep phase syndrome (DSPS) was 26% in patients and 2% in controls (p < .001). Patients reported shorter sleep, longer sleep-onset latency, and later midsleep. Shorter (R (2) = .21) and later (R (2) = .27) sleep were associated with hyperactivity, male gender, younger age, and seasonal depressive symptoms. Seasonal depressive symptoms were related to hyperactivity, female gender, unemployment, and late sleep (pseudo R (2) = .28). Higher body mass index (BMI) was associated with shorter sleep in patients (ρ = -.16; p = .04) and controls (ρ = -.17; p = .02). Longer sleep showed lower odds for indication of metabolic syndrome (OR = -0.17; p = .053).

CONCLUSION

DSPS is more prevalent in ADHD and needs further investigation to establish treatment to prevent chronic health issues.

Personal, behavioral and socio-environmental predictors of overweight incidence in young adults: 10-yr longitudinal findings

BACKGROUND

The objective of this study was to identify 10-year longitudinal predictors of overweight incidence during the transition from adolescence to young adulthood.

METHODS

Data were from Project EAT (Eating and Activity in Teens and Young Adults). A diverse, population-based cohort (N = 2,134) completed baseline surveys in 1998-1999 (mean age = 15.0±1.6, 'adolescence') and follow-up surveys in 2008-2009 (mean age = 25.4±1.7, 'young adulthood'). Surveys assessed personal, behavioral and socio-environmental factors hypothesized to be of relevance to obesity, in addition to height and weight. Multivariable logistic regression was used to estimate the adjusted odds for each personal, behavioral and socio-environmental factor at baseline, and 10-year changes for these factors, among non-overweight adolescents (n = 1,643) being predictive of the incidence of overweight (BMI ≥ 25) at 10-year follow-up.

RESULTS

At 10-year follow-up, 51% of young adults were overweight (26% increase from baseline). Among females and males, higher levels of body dissatisfaction, weight concerns, unhealthy weight control behaviors (e.g., fasting, purging), dieting, binge eating, weight-related teasing, and parental weight-related concerns and behaviors during adolescence and/or increases in these factors over the study period predicted the incidence of overweight at 10-year follow-up. Females with higher levels of whole grain intake and breakfast and dinner consumption frequency during adolescence were protected against becoming overweight. Among males, increases in vegetable intake protected against the incidence of overweight 10 years later.

CONCLUSIONS

Findings suggest that obesity prevention interventions for adolescents should address weight-specific factors from within the domains of personal, behavioral, and socio-environmental factors such as promoting positive body image, decreasing unhealthy weight control behaviors, and limiting negative weight talk.

Infrequent breakfast consumption is associated with higher body adiposity and abdominal obesity in Malaysian school-aged adolescents

Unhealthy dietary pattern increases the risk of obesity and metabolic disorders in growing children and adolescents. However, the way the habitual pattern of breakfast consumption influences body composition and risk of obesity in adolescents is not well defined. Thus, the aim of the present study was to assess any associations between breakfast consumption practices and body composition profiles in 236 apparently healthy adolescents aged 12 to 19 years. A self-administered questionnaire on dietary behaviour and lifestyle practices and a dietary food frequency questionnaire were used. Body composition and adiposity indices were determined using standard anthropometric measurement protocols and dual energy χ-ray absorptiometry (DXA). Mean age of the participants was 15.3±1.9 years. The majority of participants (71.2%) fell in the normal body mass index (BMI) ranges. Breakfast consumption patterns showed that only half of the participants (50%) were consuming breakfast daily. Gender-specific multivariate analyses (ANCOVA) showed that in both boys and girls, those eating breakfast at least 5 times a week had significantly lower body weight, body mass index (BMI), BMI z-scores, waist circumference, body fat mass and percent body fat (%BF) compared to infrequent breakfast eaters, after adjustment for age, household income, pubertal status, eating-out and snacking practices, daily energy intakes, and daily physical activity levels. The present findings indicate that infrequent breakfast consumption is associated with higher body adiposity and abdominal obesity. Therefore, daily breakfast consumption with healthy food choices should be encouraged in growing children and adolescents to prevent adiposity during these critical years of growth.

The impact of a 16-week dietary intervention with prescribed amounts of whole-grain foods on subsequent, elective whole grain consumption

Previous (mainly population-based) studies have suggested the health benefits of the elective, lifelong inclusion of whole-grain foods in the diet, forming the basis for public health recommendations to increase whole grain consumption. Currently, there is limited evidence to assess how public health recommendations can best result in longer-term improvements in dietary intake. The present study aimed to assess the impact of a previous 16-week whole-grain intervention on subsequent, elective whole grain consumption in free-living individuals. Participants completed a postal FFQ 1, 6 and 12 months after the end of the whole-grain intervention study period. This FFQ included inputs for whole-grain foods commonly consumed in the UK. Whole grain consumption was significantly higher (approximately doubled) in participants who had received whole-grain foods during the intervention (P< 0.001) compared with the control group who did not receive whole-grain foods during the intervention. This increased whole grain consumption was lower than whole grain intake levels required by participants during the intervention period between 60 and 120 g whole grains/d. Aside from a significant increase (P< 0.001) in NSP consumption compared with control participants (mean increase 2-3 g/d), there were no obvious improvements to the pattern of foods of the intervention group. The results of the present study suggest that a period of direct exposure to whole-grain foods in non-habitual whole-grain food consumers may benefit subsequent, elective dietary patterns of whole grain consumption. These findings may therefore aid the development of future strategies to increase whole grain consumption for public health and/or food industry professionals.