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Li K, Chen L, Wang K, Jiang X, Ji Y, Fang S, Wei H. Emotional problems mediate the association between attention deficit/hyperactivity disorder and obesity in adolescents. BMC Psychiatry 2023; 23:381. [PMID: 37259044 DOI: 10.1186/s12888-023-04882-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Attention deficit/hyperactivity disorder (ADHD) has been identified as a risk factor for obesity in both children and adolescents. However, the mechanisms underlying the relationship between ADHD and obesity are still unclear. This study aimed to test a theoretical model of whether anxiety/depression is an intermediary factor in the ADHD-obesity relationship. METHODS Data were derived from the National Health Interview Survey (NHIS), a principal source of information on the health of the civilian noninstitutionalized population of the United States. A total of 35,108 adolescents aged 12-17 years old from 2010-2015 NHIS and 2016-2018 NHIS representing 46,550,729 individuals in the weighted population, had a parent-reported previous ADHD diagnosis, emotional problems, and height and weight data. Mediation analyses were used to explore whether anxiety/depression is an intermediary factor in the relationship between ever having ADHD and obesity. Mediation analyses were performed using multiple logistic regressions. RESULTS The findings showed that ADHD was a predictor of obesity. This relationship was partially mediated by depression(2010-2015: β=0.28, 95%CI:0.13-0.43; 2016-2018: β=0.26, 95%CI:0.03-0.49), as well as anxiety (2010-2015: β=0.28, 95%CI:0.18-0.38). CONCLUSIONS Our study suggests the hypothetical role of depression and anxiety as underlying mechanisms in the association between ever having ADHD and obesity in adolescents. When treating children with ADHD, clinicians need to be particularly attentive to whether they show emotional problems and use interventions to eliminate anxiety/depression to protect against obesity.
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Affiliation(s)
- Ke Li
- Department of Child Health Care, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Liangliang Chen
- Department of Developmental and Behavioral Pediatrics, (Fujian Branch of Shanghai Children's Medical Center), Fujian Children's Hospital, Fuzhou, China
| | - Kai Wang
- Department of Pediatrics, 1st Affiliated Hospital to Zhengzhou University, Zhengzhou, China
| | - Xiaodong Jiang
- Rehabilitation Medicine Department, Wuhan Children's Hospital(Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yiting Ji
- Department of Child and Adolescent Healthcare, Children's Hospital of Soochow University, Suzhou, China
| | - Shuanfeng Fang
- Department of Child Health Care, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China.
| | - Haiyan Wei
- Department of Endocrinology and Genetic Metabolism, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China.
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Oken E, Thompson JW, Rifas-Shiman SL, Vilchuk K, Bogdanovich N, Hameza M, Yang S, Patel R, Kramer MS, Martin RM. Analysis of Maternal Prenatal Weight and Offspring Cognition and Behavior: Results From the Promotion of Breastfeeding Intervention Trial (PROBIT) Cohort. JAMA Netw Open 2021; 4:e2121429. [PMID: 34410396 PMCID: PMC8377565 DOI: 10.1001/jamanetworkopen.2021.21429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Prenatal experiences can influence fetal brain development. OBJECTIVE To examine associations of maternal prenatal body mass index (BMI) with cognition and behavior of offspring born full-term. DESIGN, SETTING, AND PARTICIPANTS This cohort study examined follow-up data from a breastfeeding promotion intervention at 31 hospitals and affiliated polyclinics in the Republic of Belarus. Participants included 11 276 children who were evaluated from birth (1996-1997) to adolescence (2017-2019), with maternal BMI information available in prenatal medical records. EXPOSURES Maternal BMI, calculated as weight in kilograms divided by height in meters squared, after 35 weeks gestation; secondary analyses examined maternal BMI at other time points and paternal BMI. MAIN OUTCOMES AND MEASURES Trained pediatricians assessed child cognition with the Wechsler Abbreviated Scales of Intelligence (WASI) at 6.5 years and the computerized self-administered NeuroTrax battery at 16 years, both with an approximate mean (SD) of 100 (15). Parents and teachers rated behaviors at 6.5 years using the Strengths and Difficulties Questionnaire (SDQ, range 0-40). Mixed-effects linear regression analyses corrected for clustering, adjusted for the randomized intervention group and baseline parental sociodemographic characteristics, and were considered mediation by child BMI. RESULTS Among 11 276 participants, 9355 women (83%) were aged 20 to 34 years, 10 128 (89.8%) were married, and 11 050 (98.0%) did not smoke during pregnancy. Each 5-unit increase in of maternal late-pregnancy BMI (mean [SD], 27.2 [3.8]) was associated with lower offspring WASI performance intelligence quotient (IQ) (-0.52 points; 95% CI, -0.87 to -0.17 points) at 6.5 years and lower scores on 5 of 7 NeuroTrax subscales and the global cognitive score at 16 years (-0.67 points; 95% CI, -1.06 to -0.29 points). Results were similar after adjustment for sociodemographic characteristics, pregnancy complications, and paternal BMI and were not mediated by child weight. Higher late pregnancy maternal BMI was also associated with more behavioral problems reported on the SDQ by teachers but not associated with parent-reported behaviors (externalizing behaviors: 0.13 points; 95% CI, 0.02 to 0.24 points; and total difficulties: 0.14 points, 95% CI, -0.02 to 0.30 points). Results were similar for maternal BMI measured in the first trimester or postpartum. In contrast, higher 6.5-year paternal BMI was associated with slightly better child cognition (WASI verbal IQ: 0.42 points; 95% CI, 0.02 to 0.82 points; NeuroTrax executive function score: 0.68 points; 95% CI, 0.24 to 1.12 points) and fewer teacher-reported behavioral problems (total difficulties: -0.29 points; 95% CI, -0.46 to -0.11 points). CONCLUSIONS AND RELEVANCE This cohort study supports findings from animal experiments and human observational studies in settings with higher maternal BMI and obesity rates. Higher maternal prenatal BMI may be associated with poorer offspring brain development, although residual confounding cannot be excluded.
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Affiliation(s)
- Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Jennifer W. Thompson
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sheryl L. Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Konstantin Vilchuk
- The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Natalia Bogdanovich
- The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Mikhail Hameza
- The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Rita Patel
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Michael S. Kramer
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Richard M. Martin
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol and Weston National Health Service Foundation Trust, University of Bristol, Bristol, United Kingdom
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
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The impact of lifestyle and socioeconomic parameters on body fat level in early childhood. J Biosoc Sci 2021; 54:643-650. [PMID: 34238397 DOI: 10.1017/s002193202100033x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of this study was to examine the differences between selected lifestyle and socioeconomic parameters among preschool (3-7 years of age) children of differing adiposity status. The study was conducted from February to June 2018 in 20 randomly selected kindergartens in Kraków, Poland. Triceps, biceps, subscapular, suprailiac, abdominal and calf skinfold thicknesses were measured. The sum of all six skinfolds was calculated and the children were subsequently characterized by low (≤-1 SD [standard deviation]), normal (-1 to 1 SD) or high body fat (≥1 SD). Socioeconomic and lifestyle characteristics were obtained using a questionnaire filled out by the children's parents or legal guardians. Preschool children in the high adiposity category had, on average, fewer siblings and longer screen time; additionally, their parents had lower education and more often worked in manual jobs, in comparison to the children in the low and average adiposity categories. In conclusion, it was observed that children in different adiposity categories varied in terms of some socioeconomic as well as lifestyle characteristics. Knowledge regarding the influence that those factors can have on the metabolic health of children is essential for children's present as well as future well-being. Moreover, it can help health care professionals and parents decide what intervention and/ or preventive measures should be undertaken to ensure the best possible outcomes, as the development of successful obesity prevention strategies should rely on evidence-based information. Nonetheless, future research examining the issue of factors influencing the metabolic health of children, as well as these outcomes later in life, is crucial. Well-planned studies including a large number of individuals, as well as longitudinal research, will be particularly beneficial in this regard.
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Patel R, Tilling K, Lawlor DA, Howe LD, Hughes RA, Bogdanovich N, Matush L, Nicoli E, Oken E, Kramer MS, Martin RM. Socioeconomic differences in childhood BMI trajectories in Belarus. Int J Obes (Lond) 2018; 42:1651-1660. [PMID: 29568106 PMCID: PMC6033313 DOI: 10.1038/s41366-018-0042-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 12/18/2017] [Accepted: 01/16/2018] [Indexed: 12/14/2022]
Abstract
Objective To examine associations of parental socioeconomic position with early-life offspring body mass index (BMI) trajectories in a middle-income country. Subjects Overall, 12,385 Belarusian children born 1996–97 and enrolled in a randomised breastfeeding promotion trial at birth, with 3–14 measurements of BMI from birth to 7 years. Methods Cohort analysis in which exposures were parental education (common secondary or less; advanced secondary or partial university; completed university) and occupation (manual; non-manual) at birth, and the outcome was BMI z-score trajectories estimated using multilevel linear spline models, controlling for trial arm, location, parental BMI, maternal smoking status and number of older siblings. Results Infants born to university-educated mothers were heavier at birth than those born to secondary school-educated mothers [by 0.13 BMI z-score units (95% confidence interval, CI: 0.07, 0.19) for girls and 0.11 (95% CI: 0.05, 0.17) for boys; equivalent for an infant of average birth length to 43 and 38 g, respectively]. Between the ages of 3–7 years children of the most educated mothers had larger BMI increases than children of the least educated mothers. At age 7 years, after controlling for trial arm and location, children of university-educated mothers had higher BMIs than those born to secondary school-educated mothers by 0.11 z-score (95% CI: 0.03, 0.19) among girls and 0.18 (95% CI: 0.1, 0.27) among boys, equivalent to differences in BMI for a child of average height of 0.19 and 0.26 kg/m2, respectively. After further controlling for parental BMI, these differences attenuated to 0.08 z-score (95% CI: 0, 0.16) and 0.16 z-score (95% CI: 0.07, 0.24), respectively, but changed very little after additional adjustment for number of older siblings and mother’s smoking status. Associations were similar when based on paternal educational attainment and highest household occupation. Conclusions In Belarus, consistent with some middle-income countries, higher socioeconomic position was associated with greater BMI trajectories from age 3 onwards.
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Affiliation(s)
- Rita Patel
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Kate Tilling
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Debbie A Lawlor
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Laura D Howe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Rachael A Hughes
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Natalia Bogdanovich
- The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Lidia Matush
- The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Emily Nicoli
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Michael S Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada
| | - Richard M Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Unit in Nutrition, Bristol, UK
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Wade KH, Kramer MS, Oken E, Timpson NJ, Skugarevsky O, Patel R, Bogdanovich N, Vilchuck K, Davey Smith G, Thompson J, Martin RM. Prospective associations between problematic eating attitudes in midchildhood and the future onset of adolescent obesity and high blood pressure. Am J Clin Nutr 2017; 105:306-312. [PMID: 27974308 PMCID: PMC5267301 DOI: 10.3945/ajcn.116.141697] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 11/15/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Clinically diagnosed eating disorders may have adverse cardiometabolic consequences, including overweight or obesity and high blood pressure. However, the link between problematic eating attitudes in early adolescence, which can lead to disordered eating behaviors, and future cardiometabolic health is, to our knowledge, unknown. OBJECTIVE We assessed whether variations in midchildhood eating attitudes influence the future development of overweight or obesity and high blood pressure. DESIGN Of 17,046 children who participated in the Promotion of Breastfeeding Intervention Trial (PROBIT), we included 13,557 participants (79.5% response rate) who completed the Children's Eating Attitudes Test (ChEAT) at age 11.5 y and in whom we measured adiposity and blood pressure at ages 6.5, 11.5, and 16 y. We assessed whether ChEAT scores ≥85th percentile (indicative of problematic eating attitudes) compared with scores <85th percentile at age 11.5 y were associated with new-onset overweight, obesity, high systolic blood pressure, or high diastolic blood pressure between midchildhood and early adolescence. RESULTS After controlling for baseline sociodemographic confounders, we observed positive associations of problematic eating attitudes at age 11.5 y with new-onset obesity (OR: 2.18; 95% CI: 1.58, 3.02), new-onset high systolic blood pressure (OR: 1.34; 95% CI: 1.05, 1.70), and new-onset high diastolic blood pressure (OR: 1.25; 95% CI: 0.99, 1.58) at age 16 y. After further controlling for body mass index at age 6.5 y, problematic eating attitudes remained positively associated with new-onset obesity (OR: 1.80; 95% CI: 1.28, 2.53); however, associations with new-onset high blood pressure were attenuated (OR: 1.14; 95% CI: 0.89, 1.45 and OR: 1.09; 95% CI: 0.86, 1.39 for new-onset systolic and diastolic blood pressure, respectively). CONCLUSIONS Problematic eating attitudes in midchildhood seem to be related to the development of obesity in adolescence, a relatively novel observation with potentially important public health implications for obesity control. PROBIT was registered at clinicaltrials.gov as NCT01561612 and isrctn.com as ISRCTN37687716.
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Affiliation(s)
- Kaitlin H Wade
- School of Social and Community Medicine, Faculty of Health Sciences, .,Medical Research Council Integrative Epidemiology Unit, and
| | - Michael S Kramer
- Departments of Pediatrics and.,Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Nicholas J Timpson
- School of Social and Community Medicine, Faculty of Health Sciences.,Medical Research Council Integrative Epidemiology Unit, and
| | - Oleg Skugarevsky
- Department of Psychiatry and Medical Psychology, Belarusian State Medical University, Minsk, Belarus; and
| | - Rita Patel
- School of Social and Community Medicine, Faculty of Health Sciences
| | - Natalia Bogdanovich
- National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Konstantin Vilchuck
- National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - George Davey Smith
- School of Social and Community Medicine, Faculty of Health Sciences.,Medical Research Council Integrative Epidemiology Unit, and
| | - Jennifer Thompson
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Richard M Martin
- School of Social and Community Medicine, Faculty of Health Sciences.,Medical Research Council Integrative Epidemiology Unit, and.,University Hospitals Bristol National Health Service Foundation Trust, National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, United Kingdom
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Dearden L, Ozanne SE. The road between early growth and obesity: new twists and turns. Am J Clin Nutr 2014; 100:6-7. [PMID: 24898232 DOI: 10.3945/ajcn.114.090449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Laura Dearden
- From the University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Susan E Ozanne
- From the University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, United Kingdom.
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Kramer MS, Martin RM, Bogdanovich N, Vilchuk K, Dahhou M, Oken E. Is restricted fetal growth associated with later adiposity? Observational analysis of a randomized trial. Am J Clin Nutr 2014; 100:176-81. [PMID: 24787489 PMCID: PMC4144097 DOI: 10.3945/ajcn.113.079590] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Several recent "developmental origins" studies have reported increased long-term risks of adiposity, especially truncal adiposity, among children born small for gestational age (SGA). OBJECTIVE We assessed the effects of SGA birth and weight gain in early infancy on adiposity at age 11.5 y. DESIGN From a cluster-randomized breastfeeding promotion trial in 17,046 Belarusian children, we measured height, weight, waist and hip circumferences, triceps and subscapular skinfold thicknesses, and bioimpedance measures of percentage body fat at age 11.5 y. Children born SGA (birth weight <10th percentile) and those born large for gestational age (LGA; >90th percentile for gestational age) were compared with those born appropriate for gestational age (AGA). Weight gain from birth to 6 mo was categorized as high (>0.67-SD increase in weight-for-age), low (>0.67-SD decrease in weight-for-age), or normal. Multilevel statistical models accounted for clustered measurement and controlled for maternal and paternal height and body mass index (BMI), maternal education, geographic region, urban compared with rural residence, and the child's exact age at follow-up. RESULTS Children born SGA had a significantly lower BMI, percentage body fat, and fat mass index than did those born AGA, with a dose-response effect across 2 subcategories of SGA (P < 0.001 for all comparisons). No difference was observed in waist-to-hip ratio, although the subscapular-to-triceps skinfold ratio was slightly but significantly (P < 0.001) higher in children born SGA. Differences among the study groups continued to increase since the previous follow-up at 6.5 y. SGA infants with catch-up growth in the first 3-6 mo had growth and adiposity measures intermediate between those born SGA without catch-up and those born AGA. Opposite effects of similar magnitude were observed in children born LGA. CONCLUSION The 11.5-y-old Belarusian children born SGA were shorter, were thinner, and had less body fat than their non-SGA peers, irrespective of postnatal weight gain. The Promotion of Breastfeeding Intervention Trial was registered at www.isrctn.org as ISRCTN-37687716.
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Affiliation(s)
- Michael S Kramer
- From the Departments of Pediatrics (MSK and MD) and Epidemiology, Biostatistics and Occupational Health (MSK), McGill University Faculty of Medicine, Montreal, Canada; the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (RMM); the National Institute for Health Research, Bristol Biomedical Research Unit in Nutrition, Bristol, United Kingdom (RMM); State Institution "the Republican Scientific and Practical Centre Mother and Child," Ministry of Health, Republic of Belarus (NB and KV); and the Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (EO)
| | - Richard M Martin
- From the Departments of Pediatrics (MSK and MD) and Epidemiology, Biostatistics and Occupational Health (MSK), McGill University Faculty of Medicine, Montreal, Canada; the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (RMM); the National Institute for Health Research, Bristol Biomedical Research Unit in Nutrition, Bristol, United Kingdom (RMM); State Institution "the Republican Scientific and Practical Centre Mother and Child," Ministry of Health, Republic of Belarus (NB and KV); and the Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (EO)
| | - Natalia Bogdanovich
- From the Departments of Pediatrics (MSK and MD) and Epidemiology, Biostatistics and Occupational Health (MSK), McGill University Faculty of Medicine, Montreal, Canada; the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (RMM); the National Institute for Health Research, Bristol Biomedical Research Unit in Nutrition, Bristol, United Kingdom (RMM); State Institution "the Republican Scientific and Practical Centre Mother and Child," Ministry of Health, Republic of Belarus (NB and KV); and the Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (EO)
| | - Konstantin Vilchuk
- From the Departments of Pediatrics (MSK and MD) and Epidemiology, Biostatistics and Occupational Health (MSK), McGill University Faculty of Medicine, Montreal, Canada; the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (RMM); the National Institute for Health Research, Bristol Biomedical Research Unit in Nutrition, Bristol, United Kingdom (RMM); State Institution "the Republican Scientific and Practical Centre Mother and Child," Ministry of Health, Republic of Belarus (NB and KV); and the Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (EO)
| | - Mourad Dahhou
- From the Departments of Pediatrics (MSK and MD) and Epidemiology, Biostatistics and Occupational Health (MSK), McGill University Faculty of Medicine, Montreal, Canada; the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (RMM); the National Institute for Health Research, Bristol Biomedical Research Unit in Nutrition, Bristol, United Kingdom (RMM); State Institution "the Republican Scientific and Practical Centre Mother and Child," Ministry of Health, Republic of Belarus (NB and KV); and the Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (EO)
| | - Emily Oken
- From the Departments of Pediatrics (MSK and MD) and Epidemiology, Biostatistics and Occupational Health (MSK), McGill University Faculty of Medicine, Montreal, Canada; the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (RMM); the National Institute for Health Research, Bristol Biomedical Research Unit in Nutrition, Bristol, United Kingdom (RMM); State Institution "the Republican Scientific and Practical Centre Mother and Child," Ministry of Health, Republic of Belarus (NB and KV); and the Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (EO)
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Lifestyle practices and obesity in Malaysian adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:5828-38. [PMID: 24886753 PMCID: PMC4078550 DOI: 10.3390/ijerph110605828] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 05/22/2014] [Accepted: 05/27/2014] [Indexed: 01/01/2023]
Abstract
Aim: To determine the influence of physical activity (PA) and sedentary behavior (SB) on obesity profiles of 454 Malaysian adolescents aged 12 to 19. Methods: Validated PA and SB questionnaires were used and body composition assessed using anthropometry and dual-energy X-ray absorptiometry (DXA). Results: Gender-specific multivariate analyses showed boys with high levels of total PA and moderate-to-vigorous physical activity (MVPA) exhibited significantly lower levels of total body fat, percent body fat and android fat mass compared with low PA and MVPA groups, after adjusting for potential confounders. Girls with high SB levels showed significantly higher BMI, waist circumference and DXA-derived body fat indices than those at lower SB level. Multiple logistic analyses indicated that boys with low levels of total PA and MVPA had significantly greater obesity risk, 3.0 (OR 3.0; 95% CI, 1.1–8.1; p < 0.05) and 3.8-fold (OR 3.8; 95% CI, 1.4–10.1; p < 0.01), respectively, than more active boys. Only in girls with high SB level was there a significantly increased risk of obesity, 2.9 times higher than girls at low SP levels (OR 2.8; 95% CI, 1.0–7.5; p < 0.05). Conclusions: The present findings indicate that higher PA duration and intensity reduced body fat and obesity risk while high screen-based sedentary behaviors significantly adversely influenced body fat mass, particularly amongst girls when the PA level was low.
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Wade KH, Skugarevsky O, Kramer MS, Patel R, Bogdanovich N, Vilchuck K, Sergeichick N, Richmond R, Palmer T, Davey Smith G, Gillman M, Oken E, Martin RM. Prospective associations of parental smoking, alcohol use, marital status, maternal satisfaction, and parental and childhood body mass index at 6.5 years with later problematic eating attitudes. Nutr Diabetes 2014; 4:e100. [PMID: 24394456 PMCID: PMC3904081 DOI: 10.1038/nutd.2013.40] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 11/26/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Few studies have prospectively investigated whether early-life exposures are associated with pre-adolescent eating attitudes. OBJECTIVE The objective of this study is to prospectively investigate associations of parental smoking, alcohol use, marital status, measures of maternal satisfaction, self-reported parental body mass index (BMI) and clinically measured childhood BMI, assessed between birth and 6.5 years, with problematic eating attitudes at 11.5 years. METHODS Observational cohort analysis nested within the Promotion of Breastfeeding Intervention Trial, a cluster-randomised trial conducted in 31 maternity hospitals and affiliated polyclinics in Belarus. Our primary outcome was a Children's Eating Attitudes Test (ChEAT) score 22.5 (85th percentile), an indicator of problematic eating attitudes. We employed multivariable mixed logistic regression models, which allow inference at the individual level. We also performed instrumental variable (IV) analysis using parents' BMIs as instruments for the child's BMI, to assess whether associations could be explained by residual confounding or reverse causation. SUBJECTS Of the 17 046 infants enrolled between 1996 and 1997 across Belarus, 13 751 (80.7%) completed the ChEAT test at 11.5 years. RESULTS In fully adjusted models, overweight children at age 6.5 years had a 2.14-fold (95% confidence interval (CI): 1.82, 2.52) increased odds of having ChEAT scores 85th percentile at age 11.5 years, and those who were obese had a 3.89-fold (95% CI: 2.95, 5.14) increased odds compared with normal-weight children. Children of mothers or fathers who were themselves overweight or obese were more likely to score 85th percentile (P for trend 0.001). IV analysis was consistent with a child's BMI causally affecting future eating attitudes. There was little evidence that parental smoking, alcohol use, or marital status or maternal satisfaction were associated with eating attitudes. CONCLUSION In our large, prospective cohort in Belarus, both parental and childhood overweight and obesity at 6.5 years were associated with pre-adolescent problematic eating attitudes 5 years later.
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Affiliation(s)
- K H Wade
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Medical Research Council (MRC)/University of Bristol Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - O Skugarevsky
- Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus
| | - M S Kramer
- Department of Pediatrics and Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - R Patel
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - N Bogdanovich
- The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - K Vilchuck
- The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - N Sergeichick
- The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - R Richmond
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Medical Research Council (MRC)/University of Bristol Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - T Palmer
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - G Davey Smith
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Medical Research Council (MRC)/University of Bristol Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - M Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - E Oken
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - R M Martin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Medical Research Council (MRC)/University of Bristol Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
- Bristol Biomedical Research Unit in Nutrition, National Institute for Health Research, Bristol, UK
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10
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Sun G, Jia G, Peng H, Dickerman B, Compher C, Liu J. Trends of childhood obesity in China and associated factors. Clin Nurs Res 2013; 24:156-71. [PMID: 23823460 DOI: 10.1177/1054773813493286] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Childhood obesity is worsening at dramatic rates and has become a public health crisis. This study investigated these trends in childhood obesity and examined parental factors that may contribute to overweight and obesity. Body mass index (BMI) was calculated from height and weight measurements taken annually from 2004 to 2007 in a subsample of 136 children (2-4 years old), from the Jintan Child Health Project in China. Parental factors were assessed through a self-administered questionnaire. Prevalence rates of overweight and obesity rose from 6.6% and 2.2% in 2004 to 15.4% and 6.6% in 2007 (p < .05). Overweight was significantly associated with maternal employment (p < .05), but not with parental education level, maternal age at birth, or breast-feeding. To counter this rapid increase of obesity and overweight prevalence, nurses should regularly monitor children's weight and advise parents, especially working mothers, on the nutritional benefits of home-cooked meals.
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Affiliation(s)
- Guiju Sun
- Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, China
| | - Genmei Jia
- Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, China
| | - Honglei Peng
- Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, China
| | - Barbra Dickerman
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Charlene Compher
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Jianghong Liu
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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11
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Patel R, Oken E, Bogdanovich N, Matush L, Sevkovskaya Z, Chalmers B, Hodnett ED, Vilchuck K, Kramer MS, Martin RM. Cohort profile: The promotion of breastfeeding intervention trial (PROBIT). Int J Epidemiol 2013; 43:679-90. [PMID: 23471837 DOI: 10.1093/ije/dyt003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The PROmotion of Breastfeeding Intervention Trial (PROBIT) is a multicentre, cluster-randomized controlled trial conducted in the Republic of Belarus, in which the experimental intervention was the promotion of increased breastfeeding duration and exclusivity, modelled on the Baby-friendly hospital initiative. Between June 1996 and December 1997, 17,046 mother-infant pairs were recruited during their postpartum hospital stay from 31 maternity hospitals, of which 16 hospitals and their affiliated polyclinics had been randomly assigned to the arm of PROBIT investigating the promotion of breastfeeding and 15 had been assigned to the control arm, in which breastfeeding practices and policies in effect at the time of randomization was continued. Of the mother-infant pairs originally recruited for the study, 16,492 (96.7%) were followed at regular intervals until the infants were 12 months of age (PROBIT I) for the outcomes of breastfeeding duration and exclusivity; gastrointestinal and respiratory infections; and atopic eczema. Subsequently, 13,889 (81.5%) of the children from these mother-infant pairs were followed-up at age 6.5 years (PROBIT II) for anthropometry, blood pressure (BP), behaviour, dental health, cognitive function, asthma and atopy outcomes, and 13,879 (81.4%) children were followed to the age of 11.5 years (PROBIT III) for anthropometry, body composition, BP, and the measurement of fasted glucose, insulin, adiponectin, insulin-like growth factor-I, and apolipoproteins. The trial registration number for Current Controlled Trials is ISRCTN37687716 and that for ClinicalTrials.gov is NCT01561612. Proposals for collaboration are welcome, and enquires about PROBIT should be made to an executive group of the study steering committee (M.S.K., R.M.M., and E.O.). More information, including information about how to access the trial data, data collection documents, and bibliography, is available at the trial website (http://www.bristol.ac.uk/social-community-medicine/projects/probit/).
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Affiliation(s)
- Rita Patel
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Emily Oken
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Natalia Bogdanovich
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Lidia Matush
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Zinaida Sevkovskaya
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Beverley Chalmers
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Ellen D Hodnett
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Konstantin Vilchuck
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Michael S Kramer
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Richard M Martin
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UKSchool of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UK
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12
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The mediating effect of parents' educational status on the association between adherence to the Mediterranean diet and childhood obesity: the PANACEA study. Int J Public Health 2012; 58:401-8. [PMID: 23128782 DOI: 10.1007/s00038-012-0424-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 08/31/2012] [Accepted: 10/17/2012] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To investigate the potential mediating effect of parental education on the association between adherence to the Mediterranean diet and obesity, in 10-12 years old children. METHODS A cross-sectional survey was performed among 1,125 (529 male) children in Greece. Children and their parents completed standardized questionnaires, which evaluated parents' educational level and dietary habits. Body mass index was calculated and children were classified as normal, overweight or obese (IOTF classification). Adherence to the Mediterranean diet was assessed using the KIDMED score. RESULTS 27.7% of the children were overweight and 6.3% were obese; 12.3% of children reported high adherence to the Mediterranean diet. Multi-adjusted analysis, stratified by parental education, revealed that adherence to the Mediterranean diet was inversely associated with children's obesity status only in families in which at least one parent was of higher educational level (stratum-specific adjusted odds ratio: 0.41; 95% CI 0.17-0.98), but not those in which both parents were of low educational level. CONCLUSIONS Parental education status seems to play a mediating role in the beneficial effect of Mediterranean diet on children's obesity status.
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13
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Martens PJ. What do Kramer's Baby-Friendly Hospital Initiative PROBIT studies tell us? A review of a decade of research. J Hum Lact 2012; 28:335-42. [PMID: 22584874 DOI: 10.1177/0890334412438264] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Kramer et al's PROBIT (Promotion of Breastfeeding Intervention Trial) research in Belarus studied effects of the Baby-Friendly Hospital Initiative (BFHI) training on breastfeeding duration, exclusivity, and health outcomes. AIMS To critique inclusion criteria, context, approaches to data analysis, and health outcome results. METHOD Twenty-two articles were retrieved from PubMed and the PROBIT Website for 2001-2010; 6 were excluded as not focusing on breastfeeding and health outcomes. RESULTS PROBIT data from the cluster randomized hospital comparisons included only breastfed babies since all non-breastfed babies were excluded from the research. Context may affect outcomes, knowing that Belarus has good basic health services, 3-year maternity leaves with little use of daycare, 95% breastfeeding initiation rate, and a well-educated population. PROBIT data were analyzed in 2 ways: (a) intent-to-treat analyses of breastfeeding and health differences by cluster randomized intervention and control site mother/baby pairs; and (b) as an observational cohort study of health outcomes for all mother/baby pairs, analyzed by various breastfeeding categorizations and controlling for biases. PROBIT demonstrated links between BFHI and longer breastfeeding duration (19.7% vs 11.4% at 12 months, P < .001) and exclusivity (43.3% vs 6.4% at 3 months, P < .001), reductions in gastrointestinal episodes and rashes, higher verbal IQ scores, and longer exclusive breastfeeding rates for subsequent children but no statistically significant differences in the child's body mass index, blood pressure, or dental health. CONCLUSION PROBIT provides foundational evidence for BFHI policy and follow-up care. Knowing that non-breastfed babies were excluded, caution must be exercised for health comparisons.
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Affiliation(s)
- Patricia J Martens
- Manitoba Centre for Health Policy, Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
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