Obesity in 4-year-old children more prevalent in girls and in municipalities with a low socioeconomic level

The effect of unhealthy dietary habits on the incidence of dental caries and overweight/obesity among Egyptian school children (A cross-sectional study)

Background

Obesity and dental caries are public health problems in Egypt. Factors such as unhealthy diet, poor oral hygiene, and physical inactivity can play a major role in both problems. This study was carried out to illuminate the mutual unhealthy dietary risk factors associated with the incidence of both health conditions.

Methods

Between 1 October 2020 and 1 July 2021, 369 Egyptian children (5-10 years) were examined. Dental status was assessed using decayed, missing/extracted, and filled tooth indices (dmft, deft, and DMFT) for deciduous, mixed, and permanent dentitions, respectively. Moreover, the lifestyle, food habits, and body mass index (BMI) were recorded.

Results

A total of 342 (93.7%) of the included subjects suffered from caries, and only 27(7.3%) were caries-free. Based on BMI percentiles, 247 (66.9%) of the youngsters were overweight/obese, while 122 (33.1%) had normal weight. The mean dmft was 6.9 (±4.6), deft 4.2 (±3.3), and DMFT 0.1 (±1.7). In the primary dentition, a significant positive correlation was detected between dmft and BMI, legumes, sweetened milk and juice, soft drinks, and desserts, while a significant negative correlation was detected between dmft/deft, meat/poultry/fish, fresh fruits, and vegetables. A significant positive correlation was detected between deft and BMI, sweetened milk and juice, ice cream, candies, and crackers. In the permanent dentition, a significant positive correlation was detected between age, soft drinks, sweetened juice, desserts, and DMFT, while a significant negative correlation was detected with fresh fruits and vegetables. BMI was significantly negatively correlated with a healthy lifestyle, meat/poultry/fish consumption, and fresh fruits and vegetables while positively correlated with legumes, ice cream, soft drinks, granulated sugars, desserts, fast food, and caffeinated drinks.

Conclusion

Overweight/obesity was positively correlated with primary dentition dental caries. Desserts (sweetened snacks) and soft drinks could be the common risk factors associated with high caries and overweight/obesity incidence among Egyptian school children; conversely, consumption of fruits and vegetables could hinder both health conditions. Moreover, sweetened juices were associated with primary and permanent dental caries.

Is There a Link between Balance and Body Mass Composition in Children and Adolescents?

School-age children are particularly prone to disturbances in body composition, because this is a period of intensive growth and a period in which correct habits are shaped, especially in relation to diet. This is why it is so important to diagnose emerging disorders early so as to implement therapeutic or educational activities. The aim of this study was to assess the relationship between the factors of body mass composition and body mass index (BMI), as well as the balance parameters in children and adolescents. The study group consisted of 1137 children aged 7 to 15. There were 559 girls and 578 boys among the subjects. The study used the Tanita 780 body mass composition analyser and the Zebris stabilometric platform. It was found that girls were characterized by a significantly higher content of adipose tissue (24.37% vs. 20.45%), while boys were characterized by a higher content of lean tissue (32.99% vs. 30.43%), muscle tissue (31.23% vs. 28.86%) and water (24.15% vs. 22.28%). Interestingly, the girls had better balance than their peers in all analyzed parameters (COF TTL.-616.72 vs. 661.50; CEArea-73.63 vs. 112.24; COF HD-3.44 vs. 4.23; COF VD-4.52 vs. 5.12). It turned out that among children in adolescence, a higher adipose tissue content and a higher BMI correlated with a smaller surface area (p < 0.05) defined by the center of gravity and smaller deviations of the center of gravity in the horizontal plane (p < 0.05). Sex and adolescence play an important role in differentiating both body composition and body balance. The results of this study allow us to conclude that children with higher BMI values have better balance. Due to the fact that these conclusions are inconsistent with those of other researchers, it will be worth continuing the research (e.g., on a different population group) in order to confirm the results and to draw far-reaching conclusions.

Health counselling in dental care for expectant parents: A qualitative study

Objectives

Interventions during pregnancy and early childhood have been shown to impact dental health. Thus, Antenatal Care and Dental Care collaborated in an intervention called Health Counselling in Dental Care (HCDC). HCDC was offered free of charge to first‐time expectant parents and was aimed at reducing the frequency of dental caries in children and their parents. However, the intervention reached less than 50% of the parents. The aim of this study was to explore facilitators of, barriers to, and suggestions for increased participation in HCDC.

Methods

Data were collected through semi‐structured, face‐to‐face interviews with expectant parents. Participants were purposively sampled based on having been invited to HCDC and to achieve a variation in socio‐demographics. Interviews were audio recorded, transcribed verbatim and analysed using conventional qualitative content analysis.

Results

In total, 16 interviews were conducted (10 women, 6 men). Six categories representing three facilitators and three barriers for participation emerged. The facilitators were the midwife’s crucial role for disseminating information about HCDC and motivating participation, that the parents perceived HCDC as valuable for themselves and their offspring, and a desire for new or more knowledge. The barriers included a shortage of information regarding the counselling, a perceived lack of value for the parents and offspring, and the timing of the counselling during pregnancy.

Conclusions

The midwives were crucial in providing information and motivation for HCDC participation. To increase attendance, sufficient information regarding the benefits of counselling is required, and the timing needs to be flexible and family‐centred.

Predicting the development of overweight and obesity in children between 2.5 and 8 years of age: The prospective ABIS study

BACKGROUND

A relationship between overweight and obesity early in life and adolescence has been reported. The aim of this study was to track changes in overweight/obesity in children and to assess risk factors related to the persistence of overweight/obesity between 2.5 and 8 years.

STUDY DESIGN

Children who participated in all three follow-ups at 2.5, 5 and 8 years in the prospective cohort All Children in Southeast Sweden (ABIS) (N = 2245, 52.1% boys and 47.9% girls) were classified as underweight, normal, overweight or with obesity, and changes within categories with age were related to risk factors for development of obesity in a multivariate analysis.

RESULTS

The prevalence of overweight and obesity between 2.5 and 8 years was 11%-12% and 2%-3%, respectively. Children with normal weight remained in the same category over the years, 86% between 2.5 to 5 years and 87% between 5 and 8 years. Overweight and obesity at 5 and 8 years were positively related to each other (p < 0.0001 for both). High level of TV watching at 8 years and high maternal body mass index (BMI) when the child was 5 years were related to lower probability to a normalized ISO-BMI between 5 and 8 years of age (p < 0.05 for both).

CONCLUSION

Children with ISO-BMI 18.5 to 24.9 remain in that range during the first 8 years of life. Children with overweight early in life gain weight and develop obesity, and children with obesity tend to remain with obesity up to 8 years of age. TV watching and high maternal BMI were related to lower probability to weight normalization between 5 and 8 years of age. A multidisciplinary approach to promote dietary and physical activity changes in the entire family should be used for the treatment and prevention of overweight and obesity in early childhood.

Fatty fish intake in mothers during pregnancy and in their children in relation to the development of obesity and overweight in childhood: The prospective ABIS study

BACKGROUND

Although controversial, lower maternal intake of n-3 polyunsaturated fatty acid (PUFA) during pregnancy and lower levels of omega-3 PUFA in serum phospholipids during childhood have been related to obesity. The main source of omega-3 PUFA is fatty fish in the diet.

OBJECTIVES

To assess the relationship between overweight/obesity and the intake of fatty fish in maternal diet during pregnancy and in children up to 8 years of age.

METHODS

The prospective cohort All Children in South-East Sweden (ABIS) followed babies from birth to 8 years of age. A total of 6749 children at 5 years of age (boys 52.6%) and 3017 children at 8 years (boys 52.3%) participated. A "fatty-fish index" was constructed on the basis of self-reports of nutritional habits.

RESULTS

The prevalence of overweight and obesity in children at 5 years were 12.9% and 4.2%, respectively. At 8 years, 12.2% of the children presented overweight and 2.3% obesity. Girls were more affected than boys by overweight/obesity. A higher fish index during pregnancy was not related to overweight/obesity in the children, whereas a higher fish index in the children during the first years of life was related to obesity at 5 and 8 years of age. This relationship disappeared in a multivariable analysis. Maternal body mass index (BMI), maternal education, maternal smoking during pregnancy, birth weight, and physical activity all remained related to overweight/obesity at both 5 and 8 years of age.

CONCLUSION

No relationships were found between a lower intake of fatty fish in the diet, neither in mothers during pregnancy nor in early childhood, and increased risk of overweight/obesity.

Association between Dental Caries and Obesity in Children and Young People: A Narrative Review

OBJECTIVES

To explore the association between obesity and dental caries in children and adolescents. Furthermore, to consider the possible reasons behind this relationship.

METHODS

A database search for papers published between January 2015 and May 2018, inclusive, addressing the association between obesity and dental caries was conducted. A review and critical appraisal of all included studies was performed.

RESULTS

Twenty-six studies were included in this review from different populations worldwide. Eight studies assessed the primary dentition, nine studies were conducted on permanent dentition, and remaining nine studies on both dentitions. The results regarding the association between obesity and dental caries were conflicting and inconsistent. Nine studies concluded that there was no relationship between obesity and dental caries. A positive association was reported in five studies, while the inverse association was reported in eleven studies. Studies included in this review had significant variations in methodology and the investigated cofactors. Possible explanations of the controversial association between obesity and dental caries are discussed in this review.

CONCLUSION

Both obesity and dental caries are multifactorial diseases, and their association is far more complex that can be explained by a single common risk factor, presenting evidence for the complexity of this association.

Longitudinal assessment of body composition in healthy Swedish children from 1 week until 4 years of age

BACKGROUND/OBJECTIVES

Knowledge of longitudinal body composition development is required to identify the mechanisms behind childhood overweight and obesity and to prevent these conditions. However, accurate data on this development in early childhood are lacking. Our aim was to describe the longitudinal body composition development in healthy young Swedish children.

SUBJECTS/METHODS

Body size and composition were assessed in 26 children using air-displacement plethysmography (1 and 12 weeks and 4.4 years of age) and isotope dilution (1.5 and 3 years of age) and compared with available reference data.

RESULTS

Body fat (%) for boys (n=16) was 12.8±3.9 (1 week), 25.6±4.8 (12 weeks), 28.2±3.8 (1.5 years), 27.3±5.1 (3 years) and 26.1±3.5 (4.4 years). For girls (n=10) these values were 15.3±2.9, 25.7±3.9, 27.9±3.3, 26.3±7.2 and 26.0±5.3, respectively. These values were above the Fomon reference values at 1.5 years of age and later and higher than the Butte reference (P<0.05) for boys at 1.5 years of age. At all ages the coefficients of variation were higher for body fat (%) (12-30%) than for BMI (4-11%).

CONCLUSIONS

At 4 years of age our children had more body fat than indicated by reference data. This high level may have already been established at 1.5 years of age but our small sample and the lack of appropriate reference data limit the possibility of drawing firm conclusions. Our results demonstrate the limitations of BMI when investigating overweight and obesity in early life and highlight the need for appropriate reference body composition data in infants and young children.European Journal of Clinical Nutrition advance online publication, 23 August 2017; doi:10.1038/ejcn.2017.125.

Influence of masticatory function, dental caries and socioeconomic status on the body mass index of preschool children

OBJECTIVE

The objective of this study was to determine the influence of masticatory function, dental caries and socioeconomic status on the body mass index (BMI) of preschool children.

METHODS

A cross-sectional study was conducted with a sample of 285 children aged three to five years allocated to three groups based on the BMI: underweight, ideal weight and overweight/obesity. Socioeconomic status was determined based on the responses of parents/caregivers to a specific form. Cavitated lesions were diagnosed using the criteria of the International Caries Detection and Assessment System. Masticatory function was assessed based on masticatory performance (MP) and the swallowing threshold (ST), which were evaluated based on the results of a test food. Data analysis involved the employment of the Kruskal-Wallis, Mann-Whitney and chi-square tests as well as simple and multiple linear regression analyses.

RESULTS

In the final multiple regression model, BMI was influenced by monthly household income (β=0.234; 95%CI: 1.014 to 1.647), number of cavitated teeth (β=-0.180; 95%CI: -0.293 to -0.054) and X50 of the ST (β=0.304; 95%CI: 0.213-0.498).

CONCLUSION

Children whose food test resulted in large particles and those from families with a higher monthly income had a higher BMI. Children with a greater number of teeth with cavitated dental caries had a lower BMI.

Child Health Systems in Sweden

On a national level, several factors are responsible for Sweden's leading position in achieving the excellent health of children because Sweden has experienced a long history of peace and success in establishing a parliamentary democracy throughout the 20th century. Among the different sectors of society, Sweden has been able to focus on prevention and health promotion. The Swedish health care system is publicly financed based on local taxation. Pediatricians working in secondary and tertiary care are employed by the public sector, whereas family physicians are employed by both the private and public sectors. The pediatric departments at county and university levels provide a high quality of inpatient care for neonates and children. The county hospital pediatric departments typically include one neonatal ward and one ward for older children. Subspecialization exists even at the county level, and there is close cooperation between the county level and subspecialist units at the university level. Within the primary care sector, most children receive care from family physicians. The majority of family physicians have completed 3 months of pediatrics in their basic training program. In the more densely populated areas there are also pediatric ambulatory care centers working mostly with referrals from the family physicians. Preventive care is carried out at midwife-led maternity health centers, nurse-led Child Health Centers, and nurse-led school health care settings and reach almost everyone (99%). All health care for children and adolescents is free of charge up to 18 years of age.

A Cross-sectional Study of the Prevalence of Dental Caries among 12- to 15-year-old Overweight Schoolchildren

INTRODUCTION

Overweight and obesity are growing health-related problems worldwide, and it is currently the most prevalent nutritional disorder among children and adolescents. The objective of this study was to assess the association between overweight and dental caries among 12- to 15-year-old schoolchildren in Mangaluru district, Karnataka, India.

MATERIALS AND METHODS

Data were obtained from 2000 school-going children aged 12 to 15 years. The children were categorized as overweight and normal-weight group by assessing the body mass index (BMI). Body mass index was categorized using the classification system given by the International Obesity Task Force (IOTF) and obtained in units of kg/m². The dental caries was assessed by detection and was performed according to decayed, missing, and filled teeth (DMFT) index.

RESULTS

Of the 2000 children examined, the mean BMI recorded was 26.87 ± 2.26 for the overweight children and 20.82 ± 1.48 for the normal-weight children. Even though the DMFT (3.90 ± 2.95) in the overweight children was slightly higher than the control group (3.36 ± 2.73), it was not statistically significant.

CONCLUSION

Within the confines of the present study, it can be concluded that there is no significant association between overweight and dental caries among the schoolchildren of Mangaluru district in Karnataka. Longitudinal studies are necessary to substantiate the possible relationships between dental caries and overweight in children. Knowledge of these relationships could lead to preventive health measures designed to reduce the prevalence of both obesity and dental caries.

Effectiveness and cost-effectiveness of the Salut Programme: a universal health promotion intervention for parents and children-protocol of a register-based retrospective observational study

INTRODUCTION

There is inadequate evidence for the effectiveness and cost-effectiveness of health promotion interventions. The Salut Programme aims to reach all parents and children in the Västerbotten County of Sweden with a combination of health promotion interventions initiated during pregnancy and continued over the childhood period. This study protocol describes an effectiveness study and an economic evaluation study, where the ongoing Salut Programme is compared to care-as-usual over the periods of pregnancy, delivery and the child's first 2 years of life.

METHODS

A register-based retrospective observational study design will be used with existing data sources with respect to exposures and outcomes. Outcomes of interest are clustered at 3 points: around the child's birth, 1 month after the child's birth and 2 years after the child's birth. We will simulate an experiment by retrospectively identifying and comparing children and their parents in the geographical areas where the Salut Programme was implemented since 2006 and onwards, and the areas where the Programme was not implemented before 2009. Outcomes will be analysed and compared for the premeasure period, and the postmeasure period for both groups. Our analysis combines difference-in-difference estimation with matching. A complementary analysis will be carried out on the longitudinal subsample of mothers who gave birth at least once during each of the time periods. The economic evaluation aims to capture the wider societal costs and benefits of the Salut Programme for the first 2 years of the children's lives. Incremental costs will be compared with incremental health gains and the results will be presented as a cost-consequence analysis.

ETHICS AND DISSEMINATION

The Regional Ethical Review Board in Umeå has given clearance for the Salut Programme research (2010-63-31M). No individual's identity will be revealed when presenting results. This study will provide information that can guide decision-makers to allocate resources optimally.

Motivational Interviewing to Prevent Childhood Obesity: A Cluster RCT

OBJECTIVE

The objective was to evaluate a manualized theory-driven primary preventive intervention aimed at early childhood obesity. The intervention was embedded in Swedish child health services, starting when eligible children were 9 to 10 months of age and continuing until the children reached age 4.

METHODS

Child health care centers in 8 Swedish counties were randomized into intervention and control units and included 1355 families with 1369 infants. Over ∼39 months, families in the intervention group participated in 1 group session and 8 individual sessions with a nurse trained in motivational interviewing, focusing on healthy food habits and physical activity. Families in the control group received care as usual. Primary outcomes were children's BMI, overweight prevalence, and waist circumference at age 4. Secondary outcomes were children's and mothers' food and physical activity habits and mothers' anthropometrics. Effects were assessed in linear and log-binominal regression models using generalized estimating equations.

RESULTS

There were no statistically significant differences in children's BMI (β = -0.11, 95% confidence interval [CI]: -0.31 to 0.08), waist circumference (β = -0.48, 95% CI: -0.99 to 0.04), and prevalence of overweight (relative risk = 0.95, 95% CI: 0.69 to 1.32). No significant intervention effects were observed in mothers' anthropometric data or regarding mothers' and children's physical activity habits. There was a small intervention effect in terms of healthier food habits among children and mothers.

CONCLUSIONS

There were no significant group differences in children's and mothers' anthropometric data and physical activity habits. There was, however, some evidence suggesting healthier food habits, but this should be interpreted with caution.

Associations between toddlers' and parents' BMI, in relation to family socio-demography: a cross-sectional study

BACKGROUND

It is well established that the pregnancy and the first years of life are important for future childhood health and body weight. Even though current evidence suggests that both parents are important for childhood health, the influence that parents' BMI and socio-demography has on toddlers' BMI has so far received little attention. This study aimed to increase our knowledge on the association between toddlers' and parents' BMI, in relation to family socio-demography. Further, the aim was to investigate the interaction between the mothers' and fathers' BMI in relation to their child's BMI.

METHODS

A total of 697 children with a median age of 18 months (range 16-24 months) participated in the study along with their mothers (n = 697) and fathers (n = 674). As regards representability, our parental sample had a lower proportion of immigrants and the parents were more gainfully employed compared to parents in the rest of Sweden (when the child was 18 months old). The parents completed a questionnaire on parental and child health. Data on parental weight, height, and socio-demographics were recorded along with the child's weight and height measured at an ordinary child health care visit. We used the thresholds for children's BMI that were recommended for surveillance by the Royal College of Paediatrics and Child Health in 2012 based on the WHO reference population.

RESULTS

Among the toddlers, 33 % had a BMI above the WHO 85(th) percentile and 14 % had a BMI above the WHO 95(th) percentile. The probability of a toddler having a BMI above the WHO 95(th) percentile was significantly increased if either the mother or father was overweight (BMI ≥ 25 kg/m(2)). Furthermore, we found a positive synergistic effect between the mother and father being overweight and their child having a BMI above the WHO 85(th) percentile. No associations were found between the toddlers' BMI and the family's socio-demographics, but there were associations between the parents' BMI and the family's socio-demographics.

CONCLUSION

High BMI is common even in toddlers in this population. The risk increases if one parent is overweight, and it increases even more if both parents are overweight. The results in this study confirm the importance of considering familial risk factors when examining child health and BMI at ordinary child health care visits already at an early age.

Overweight and dental caries: the association among German children

OBJECTIVES

The aim of this study was to determine the relationship between iso-body mass index (iso-BMI) and both dental caries status and caries increment among German school children.

METHODS

Six hundred and ninety-four students (age range 9-12 years, mean 10.34 ± 0.56, 48% females) were recruited from the fifth grade of 18 primary schools. Weight, height, and oral health data number of decayed, missing and filled teeth (DMFT) as well as parent/legal guardian questionnaire (measuring SES) were collected during school dental examination at baseline and after one and a half-year follow-up. The body mass index (BMI) was calculated using the international classification system for childhood overweight and obesity (iso-BMI). Statistical analyses were performed using Poisson regression models.

RESULTS

Iso-BMI was significantly associated with dental caries prevalence and severity in the permanent dentition (P = 0.039). Low-normal weight children had a lower mean DMFT (0.56) than did overweight/obese children (0.70). In addition, a border-line significant association was found between overweight/obese children and caries increment (P = 0.055).

CONCLUSION

Although iso-BMI was associated with dental caries prevalence and severity, the association between caries increment and iso-BMI did not reach a statistical significance. Overweight/obese children however acquired more additional carious lesions during the follow-up period than children with low-normal weight.

Correlates of adiposity in a Caribbean pre-school population

OBJECTIVE

To evaluate ethnic and anthropometric correlates of adiposity among a nationally representative, multi-ethnic, Trinidadian pre-school population.

DESIGN

Cross-sectional study conducted between June 2008 and July 2009.

SETTING

Government and privately owned Early Childhood Care and Education Centres in Trinidad.

SUBJECTS

A total of 596 pre-school children (aged 31-73 months) from thirty-four schools had their weight, height, mid-upper arm circumference, waist circumference, biceps and triceps skinfold thicknesses measured by a registered dietitian using standard procedures. Percentage body fat was estimated using a foot-to-foot bioelectric impedance analyser (Tanita 531, Tokyo, Japan). Date of birth, religion and ethnicity were extracted from school records and pre-schoolers' ethnicity was categorized as East Indian, African, Mixed (a combination of two or more ethnicities), Chinese or Caucasian.

RESULTS

Anthropometric variables explained significantly more of the variance in adiposity among girls (67·4-88·1 %) than boys (24·4-39·2 %; P < 0·0 0 1). Pre-schoolers of African descent were significantly taller, heavier and had higher abdominal fat and mid-upper arm circumference than their East Indian and Mixed counterparts (all P < 0·001). The overall prevalence of excess adiposity (≥25 % body fat) as determined by bioelectrical impedance was 14·6 %, while 2·9 % of the children were undernourished according to WHO weight-for-age criteria. Differences in anthropometry were non-existent between children attending government and private pre-schools.

CONCLUSIONS

Gender, ethnicity and anthropometry all explained excess adiposity in these pre-schoolers. These findings highlight the need to elucidate the mechanisms that may be involved in explaining these differences, particularly those of ethnic origin.

Overweight and obese children have lower cortisol levels than normal weight children

AIM

The stress hormone cortisol is vital to survival, and a disturbed circadian rhythm can be deleterious to health. However, little is known about cortisol levels in healthy children. The aim of this study was to examine cortisol levels in relation to body mass index (BMI), age and sex.

METHODS

Salivary samples were collected in early morning, late morning and evening, on four consecutive days, from 342 children aged 6-12 years using Salivette(®) tubes. Samples were analysed using a commercial enzyme immunoassay (EIA). School nurses measured the children's height and weight, and these measurements were used to calculate their BMI.

RESULTS

The children displayed a circadian rhythm in cortisol secretion, with morning zeniths and evening nadirs. Average cortisol levels in early morning, late morning and evening were significantly lower in overweight and obese children than in their normal weight counterparts. Cortisol levels did not vary significantly with age or sex.

CONCLUSION

Our findings may suggest cortisol suppression in overweight and obese children. We found no evidence that sex or age influences cortisol levels. These findings highlight the need for further research on the relationship between stress and obesity in children.

Barriers to and facilitators of nurse-parent interaction intended to promote healthy weight gain and prevent childhood obesity at Swedish child health centers

BACKGROUND

Overweight and obesity in preschool children have increased worldwide in the past two to three decades. Child Health Centers provide a key setting for monitoring growth in preschool children and preventing childhood obesity.

METHODS

We conducted semi-structured interviews with 15 nurses working at Child Health Centers in southwest Sweden in 2011 and 2012. All interviews were tape recorded and transcribed verbatim and imported to QSR N'Vivo 9 software. Data were analyzed deductively according to predefined themes using content analysis.

RESULTS

Findings resulted in 332 codes, 16 subthemes and six main themes. The subthemes identified and described barriers and facilitators for the prevention of childhood obesity at Child Health Centers. Main themes included assessment of child's weight status, the initiative, a sensitive topic, parental responses, actions and lifestyle patterns. Although a body mass index (BMI) chart facilitated greater recognition of a child's deviant weight status than the traditional weight-for-height chart, nurses used it inconsistently. Obesity was a sensitive topic. For the most part, nurses initiated discussions of a child's overweight or obesity.

CONCLUSION

CHCs in Sweden provide a favorable opportunity to prevent childhood obesity because of a systematic organization, which by default conducts growth measurements at all health visits. The BMI chart yields greater recognition of overweight and obesity in children and facilitates prevention of obesity. In addition, visualization and explanation of the BMI chart helps nurses as they communicate with parents about a child's weight status. On the other hand, inconsistent use and lack of quality assurance regarding the recommended BMI chart was a barrier to prevention, possibly delaying identification of overweight or obesity. Other barriers included emotional difficulties in raising the issue of obesity because it was perceived as a sensitive topic. Some parents deliberately wanted overweight children, which was another specific barrier. Concerned parents who took the initiative or responded positively to the information about obesity facilitated prevention activities.

Socioeconomic and early-life factors and risk of being overweight or obese in children of Swedish- and foreign-born parents

BACKGROUND

Ethnic minorities/immigrants have differential health as compared with natives. The epidemic in child overweight/obesity (OW/OB) in Sweden is leveling off, but lower socioeconomic groups and immigrants/ethnic minorities may not have benefited equally from this trend. We investigated whether nonethnic Swedish children are at increased risk for being OW/OB and whether these associations are mediated by parental socioeconomic position (SEP) and/or early-life factors such as birth weight, maternal smoking, BMI, and breastfeeding.

METHODS

Data on 10,628 singleton children (51% boys, mean age: 4.8 y, born during the period 2000-2004) residing in Uppsala were analyzed. OW/OB was computed using the International Obesity Task Force's sex- and age-specific cutoffs. The mother's nativity was used as proxy for ethnicity. Logistic regression was used to analyze ethnicity-OW/OB associations.

RESULTS

Children of North African, Iranian, South American, and Turkish ethnicity had increased odds for being overweight/obese as compared with children of Swedish ethnicity (adjusted odds ratio (OR): 2.60 (95% confidence interval (CI): 1.57-4.27), 1.67 (1.03-2.72), 3.00 (1.86-4.80), and 2.90 (1.73-4.88), respectively). Finnish children had decreased odds for being overweight/obese (adjusted OR: 0.53 (0.32-0.90)).

CONCLUSION

Ethnic differences in a child's risk for OW/OB exist in Sweden that cannot be explained by SEP or maternal or birth factors. As OW/OB often tracks into adulthood, more effective public health policies that intervene at an early age are needed.

Neighborhood built and social environment characteristics: a multilevel analysis of associations with obesity among children and their parents

OBJECTIVE

To examine associations between characteristics of neighborhood built and social environments and likelihood of obesity among family triads living at the same residential address and to explore whether these associations differ between family members.

METHODS

Data were from the baseline wave of QUALITY (Quebec Adipose and Lifestyle Investigation in Youth), an ongoing study on the natural history of obesity in 630 Quebec youth aged 8-10 years with a parental history of obesity. Weight and height were measured in children and both biological parents and body mass index was computed. Residential neighborhood environments were characterized using a Geographic Information System and in-person neighborhood audits. Principal components analysis allowed for identification of overarching neighborhood indicators including poverty, prestige, level of urbanicity, traffic, physical disorder and deterioration, and pedestrian friendliness. Multilevel logistic regressions were used to examine associations between neighborhood indicators and obesity within multiple family members residing at the same address while controlling for household-level sociodemographic variables.

RESULTS

A total of 417 families were included in the analysis. Families residing in lower and average prestige neighborhoods were more likely to be obese (odds ratio (OR)=1.69, 95% confidence interval (CI): 1.16, 2.44, and OR=1.51, 95% CI: 1.09, 2.11, respectively) than those residing in higher prestige neighborhoods. Residing in lower traffic neighborhoods was associated with less obesity (OR=0.69, 95% CI: 0.50, 0.95). Other neighborhood indicators may have differential effects across family members. For example, as neighborhood poverty increased, obesity was more likely among children but less likely among fathers and no different for mothers.

CONCLUSION

Findings indicate that some shared neighborhood exposures are associated with greater risk of obesity for entire families whereas other exposures may heighten obesity risk in some but not all family members. Patterns may reflect differences in the way in which family members use residential neighborhood environments.

Assessment of selection bias in a health survey of children and families - the IDEFICS Sweden-study

Background

A health survey was performed in 2007–2008 in the IDEFICS/Sweden study (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) in children aged 2–9 years. We hypothesized that families with disadvantageous socioeconomic and -demographic backgrounds and children with overweight and obesity were underrepresented.

Methods

In a cross-sectional study, we compared Swedish IDEFICS participants (N=1,825) with referent children (N=1,825) using data from Statistics Sweden population registers. IDEFICS participants were matched for age and gender with a referent child living in the same municipality. Longitudinal weight and height data from birth to 8 years was collected for both populations (n=3,650) from the children’s local health services. Outcome measures included the family’s socioeconomic and demographic characteristics, maternal body mass index (BMI) and smoking habits before pregnancy, the children’s BMI standard deviation score (SDS) at the age of inclusion in the IDEFICS study (BMISDS-index), and the children’s BMI-categories during the age-span. Comparisons between groups were done and a multiple logistic regression analysis for the study of determinants of participation in the IDEFICS study was performed.

Results

Compared with IDEFICS participants, referent families were more likely to have lower education and income, foreign backgrounds, be single parents, and have mothers who smoked before pregnancy. Maternal BMI before pregnancy and child’s BMISDS-index did not differ between groups. Comparing the longitudinal data-set, the prevalence of obesity was significantly different at age 8 years n= 45 (4.5%) versus n= 31 (2.9%) in the referent and IDEFICS populations, respectively. In the multivariable adjusted model, the strongest significant association with IDEFICS study participation was parental Swedish background (odds ratio (OR) = 1.91, 95% confidence interval (CI) (1.48–2.47) followed by parents having high education OR 1.80, 95% CI (1.02-3.16) and being married or co-habiting OR 1.75 95% CI (1.38-2.23).

Conclusion

Families with single parenthood, foreign background, low education and income were underrepresented in the IDEFICS Sweden study. BMI at inclusion had no selection effect, but developing obesity was significantly greater among referents.

Evolution of overweight prevalence among 5-6-year-old children according to socio-economic status

AIM

To assess time trends in overweight and obesity prevalence among 5-6-year-old children of Bordeaux city (France) over seven school years from 2004-2005 to 2010-2011.

METHODS

For each year, all 5-6-year-old children from 63 of the 69 schools of Bordeaux were included: 2005, 2100, 2010, 1952, 2040, 2017 and 2111 subjects, respectively. Weight and height were collected by school doctors, and weight status was defined according to the age- and sex-specific body mass index cut-off points of the International Obesity Task Force (IOTF) for obesity and to the French age- and gender-specific child cut-off (close to the IOTF cut-off) for overweight including obesity.

RESULTS

From 2004-2005 to 2010-2011, an overall decrease was observed in overweight including obesity (from 8.9% to 5.2%, p < 0.001) and obesity prevalences (from 2.8% to 1.4%, p = 0.046). Similar results were observed in non-low socio-economic status (SES) areas (p < 0.001), whereas the prevalence did not vary significantly in low-SES areas (p > 0.05).

CONCLUSION

Overweight prevalence has decreased between 2004 and 2011 in 5-6-year-old children from Bordeaux. However, the gap between low and non-low-SES areas has persisted during these years.

Higher maternal education is associated with favourable growth of young children in different countries

BACKGROUND

Childhood growth affects long-term health and could contribute to health inequalities that persist throughout life.

METHODS

We compared growth data of 4-year-old to 6-year-old children born 1997-2002 in UK (n=15,168), Sweden (n=6749) and rural China (n=10,327). SD scores (SDS) were calculated against the WHO Growth Standard. Obesity and overweight were defined by the International Obesity Taskforce cut-offs, and stunting, underweight and thinness by height, weight or body mass index (BMI)<-2 SDS. Associations with maternal education were standardised by calculating the Slope Index of Inequality (SII).

RESULTS

Mean SDS height, weight and BMI in the UK (-0.01, 0.42, 0.62, respectively) and Sweden (0.45, 0.59, 0.45) were higher than in China (-0.98, -0.82, -0.29). Higher maternal education was consistently associated with taller offspring height SDS (SII: UK 0.25; Sweden 0.17; China 1.06). Underweight and stunting were less common in the UK (prevalence: 0.6% and 2.2%, respectively) and Sweden (0.3% and 0.6%) than in China (9.5% and 16.4%), where these outcomes were inversely associated with maternal education (SII: -25.8% and -12.7%). Obesity prevalence in the UK, Sweden and China was 4.8%, 3.7% and 0.4%, respectively. Maternal education was inversely associated with offspring obesity in the UK (SII: -3.3%) and Sweden (-2.8%), but not in China (+0.3%).

CONCLUSIONS

Higher maternal education was associated with more favourable growth in young children: lower obesity and overweight in the UK and Sweden, and lower stunting and underweight in rural China. Public health strategies to optimise growth in early childhood need to acknowledge socioeconomic factors, but possibly with a different emphasis in different settings.

High prevalence of overweight and obesity among 6-year-old children in Finnmark County, North Norway

AIM

The aim was to determine the prevalence of overweight and obesity among 6-year-old children in Finnmark, the northernmost county of Norway.

METHODS

This is a survey of 1774 children born during 1999 and 2000 from 18 of 19 child healthcare centres in Finnmark. Body mass index data extracted retrospectively in 2007 from health records at the age of 6 years were compared with international definitions of over- and underweight. The prevalence figures were further compared with socio-demographic figures on municipality level.

RESULTS

Overall, 19% of the children were classified as overweight or obese; 5% were classified as obese. The prevalence of overweight and obesity was higher among girls (22%) than among boys (16%) (p < 0.01). The prevalence of underweight was 8% among both girls and boys. Despite large variations in the prevalence of overweight and obesity between municipalities (9-35%), no association was found with municipality figures on socio-demographic factors.

CONCLUSION

In the northernmost county Finnmark, the prevalence of overweight including obesity among 6-year-old children was somewhat higher than in previous surveys from Norway, especially among girls.

Body mass index (BMI) and dental caries in 5-year-old children from southern Sweden

OBJECTIVES

The aim of the present survey was to study the association between dental caries and body mass index (BMI) in Swedish preschool children (born in 1999).

METHODS

A population-based and cross-sectional study design was used comprising all 920 5-year-old children in a defined area in and around the city of Lund. Anthropometric measures for the calculation of BMI were retrieved for each child from recordings at Child Health Care Centers (CHC). The occurrence of caries and fillings in the primary dentition, defined as deft (decayed, extracted, or filled primary teeth) and dt (decayed primary teeth), was collected from the children's dental records.

RESULTS

The mean BMI was 16.1 (no differences between boys and girls). About 19.2% were overweight, of which 5.1% were obese. Overweight or obese children did not have higher deft or dt than others. However, children with low BMI (below -1 SD of national mean values for Swedish 5-year-olds) had statistically significantly higher deft and dt than children with normal BMI.

CONCLUSIONS

Children with low BMI may be at risk of caries development. Low BMI may be associated with eating habits endangering dental health.

Overweight among Four-Year-Old Children in Relation to Early Growth Characteristics and Socioeconomic Factors

Objectives. To assess early growth characteristics and socioeconomic factors of children in relation to body mass index (BMI) and presence of overweight among four-year-old children. Methods. Two Child Health Centres (CHC) participated in the study. They were selected to obtain two populations of children featuring divergent socio-economic characteristics. Growth data registered at the CHCs from birth to the 4-year check-up were recovered. Overweight was defined by the BMI cut-offs established by IOTF. BMI values expressed as BMI standard deviation score (BMISDS) were used for analysis. Results. At the 4-year check-up, the BMISDS and the proportion of children with overweight (including the obese) were significantly higher in the district with lower socio-economic status. High BMI at birth and low socio-economic status of the population in the CHC-district were shown to be independent determinants for overweight and BMISDS at four years of age. Conclusions. More research is needed to understand the mechanisms and how intervention programs should be designed in order to prevent the development of overweight and obesity in children.

Metabolic profiles of fat and glucose differ by gender in healthy 8-year-olds

OBJECTIVE

The aim was to investigate if metabolic markers were associated with anthropometry and weight increase in healthy 8-year-olds.

METHODS

Ninety-seven healthy children, 66 of whom had been examined at the age of 4 years, were investigated. Dual energy X-ray absorptiometry was performed to determine fat (FM) and lean body mass (LBM). Plasma glucose and serum levels of insulin, cholesterol, triglycerides, adiponectin and leptin were analysed and HOMA-indices were calculated.

RESULTS

Despite similar anthropometry, metabolic markers differed by gender. Sixteen % of the children were overweight or obese. Body mass index (BMI) was strongly correlated to FM. Anthropometric measures except LBM correlated to metabolic markers in the girls. Boys had higher concentrations of plasma glucose than girls. In overweight children, insulin was negatively associated with LBM. Leptin and the ratio between leptin and adiponectin, but not adiponectin, were significantly associated with HOMA-IR and body composition.

CONCLUSION

The metabolic profile of plasma glucose, serum leptin, fasting insulin and related HOMA indices differed by gender, despite no difference in BMI or FM. LBM, but not FM correlated to the insulin concentration in the overweight children. Leptin was the best marker of overweight.

Is the prevalence of overweight and obesity declining among 4-year-old Swedish children?

AIM

To investigate the trend in overweight and obesity prevalence among 4-year-old Swedish children.

METHODS

Height and weight data registered at the regular health check up at the child health centres in the county of Västerbotten during the years 2007/2008 (2225 boys and 2156 girls) were analysed and compared with data from 2002/2003 (2231 boys and 2176 girls). Overweight and obesity were estimated using the International Obesity Task Force cut-off values (ISO BMI).

RESULTS

In both boys and girls, overweight prevalence (ISO BMI > 25) decreased over the 5-year period, boys from 17.2% to 14.2% and girls from 22.3% to 19.0%. Among girls, there was also a decrease in obesity prevalence (ISO BMI > 30) from 5.7% to 3.1%.

CONCLUSION

The result of this study indicates that the overweight and obesity epidemic among Swedish pre-school children may be levelling off.

BMI at 4 years of age is associated with previous and current protein intake and with paternal BMI

OBJECTIVES

To evaluate possible associations between body mass index (BMI) at 4 years of age, current and previous dietary intakes and parental BMI.

METHODS

A follow-up of dietary intake and anthropometry in 127 4-year-old children corresponding to 54% of children who completed an initial intervention study at 18 months of age.

RESULTS

Fourteen percent of the girls and 13% of the boys were overweight (age-adjusted BMI> or =25) and 2% of the girls and 3% of the boys were obese (age-adjusted BMI> or =30). Thirty-four percent and 9% of the fathers and 19 and 7% of the mothers were overweight and obese, respectively. BMI at 6-18 months was a strong predictor of BMI at 4 years. Univariate regression analyses revealed that intake of protein in particular, and also of total energy and carbohydrates at 17/18 months and at 4 years, was positively associated with BMI at 4 years. Although BMI at 6-18 months was the strongest predictor of BMI at 4 years, in the final multivariate models of the child's BMI, protein intake at 17-18 months and at 4 years, energy intake at 4 years and the father's-but not the mother's-BMI were also independent contributing factors.

CONCLUSIONS

Among these healthy children, BMI at 4 years of age tracked from 6 to 18 months of age and were associated with previous and current protein intake as well as parental BMI, particularly that of the father.

Prevalence of overweight in kindergarten children in the centre of Israel - association with lifestyle habits

OBJECTIVES

(1) To determine the prevalence of overweight and at risk for overweight in a sample of 4- to 6-year-old Israeli children; and (2) to delineate factors which may be associated with excess of overweight such as food intake, food habits physical and sedentary activity, family and socio-economic factors.

METHODS

In a cross-sectional survey in six kindergartens in the centre of Israel, 204 children (104 boys), mean age 5.5 years were studied.

RESULTS

In total, 40% of the children were either at risk for overweight (25%) or overweight (15%). Parents of one-third of all children reported their children ate unbalanced meals; however, caloric intake was not different between the weight groups. Overweight children were reported to eat according to mood status and preferred eating candies. Knowledge of dietary requirements was fairly good and similar in all three weight groups. Screen viewing time was more than twofold greater than the recommended in all weight groups. The rate of parental obesity was not different in the weight groups.

CONCLUSIONS

A high rate of overweight was documented among pre-schoolers in the centre of Israel. Poor lifestyle habits were noted in about one-third of all children; however, no association was found between the poor lifestyle habits and overweight but more overweight children eat according to mood status and preferred eating candies as a snack.

Prevalence of overweight and obesity in 5- and 12-year-old Finnish children in 1986 and 2006

OBJECTIVE

To investigate the prevalence and the trends of overweight and obesity in Finnish 5- and 12-year-old children in 1986 and 2006.

DESIGN

Retrospective cross-sectional study.

SUBJECTS AND METHODS

Anthropometric data were collected retrospectively from health examinations in Tampere and in three rural municipalities. The size of the 5- and 12-year-old cohorts were 2108 in 1986 and 4013 in 2006, respectively. The body mass index (BMI) was calculated. Overweight and obesity was estimated using the International Obesity Task Force cutoff values (ISO BMI).

RESULTS

The prevalence of overweight (ISO BMI >25) and obesity (ISO BMI >30) in 5-year-old boys in 2006 was 9.8% and 2.5% and in girls 17.7% and 4.3%, [corrected] respectively. At the age of 12 years, the corresponding figures in boys were 23.6% and 4.7% and in girls 19.1% and 3.2%. Between 1986 and 2006, the prevalence of overweight in 12-year-old children had increased 1.8 fold in boys (p < 0.001) and 1.5 fold in girls (p = 0.008). Overweight was significantly more common in rural than in urban areas.

CONCLUSION

During the last 20 years the prevalence of overweight has markedly increased in 12-year-old Finnish children, but remained nearly unchanged in 5-year-old children.

Exclusive breastfeeding of Swedish children and its possible influence on the development of obesity: a prospective cohort study

Background

Overweight and obesity are increasing among children all over the world. Socio-economic factors may influence the development of overweight and obesity in childhood, and it has been proposed that breastfeeding may protect against obesity. The aim of our study was to examine the relationship between exclusive breastfeeding and obesity when potential confounders, such as socioeconomic factors, are considered.

Methods

The data analyzed was from ABIS (All Babies in Southeast Sweden), a prospective cohort study. All parents with children born between October 1, 1997 and October 1, 1999 in Southeast Sweden (n = 21,700) were asked to participate. Parents were asked to answer periodic questionnaires from the time of the child's birth (n = 16,058) until he/she was five years of age (n = 7,356). Cutoffs for overweight and obesity were defined according to Cole et al, age and gender adjusted. Short-term exclusive breastfeeding was defined as < 4 months of exclusive breastfeeding. Multiple logistic regressions were used to identify variables that predict the child's BMI (Body Mass Index) at five years of age.

Results

At five years of age, 12.9% of the children in the study wereoverweight and 4.3% were obese. At the age of three months, 78.4% of the children were being breastfed exclusively. The median exclusive breastfeeding duration was four months. High maternal BMI > 30 (AOR = 1.07; CI = 1.05–1.09; P < 0.001), maternal smoking (AOR = 1.43; CI = 1.05–1.95; P = 0.023) and being a single parent (AOR = 2.10; CI = 1.43–3.09; P < 0.001) were associated with short-term exclusive breastfeeding (less than 4 months). Short-term exclusive breastfeeding was less common if one of the parents had a university degree (Mother: AOR = 0.74; CI = 0.61–0.90; P = 0.003 Father: AOR = 0.73; CI = 0.58–0.92; P = 0.008) or if the father was more than 37 years old (AOR = 0.74; CI = 0.55–0.99; P = 0.045). Short-term exclusive breastfeeding was associated with obesity in five-year-old children (simple logistic regression: OR = 1.44; CI = 1.00–2.07; P = 0.050), but when including other independent factors in the analysis, short-term exclusive breastfeeding did not attain statistical significance.

Conclusion

We cannot exclude the possibility that exclusive breastfeeding influences weight development, but it does not seem to protect against obesity at five years of age.

The association between neighborhood socioeconomic status and exposure to supermarkets and fast food outlets

This study examines whether exposure to supermarkets and fast food outlets varies with neighborhood-level socioeconomic status in Edmonton, Canada. Only market area and fast food proximity predicted supermarket exposure. For fast food outlets, the odds of exposure were greater in areas with more Aboriginals, renters, lone parents, low-income households, and public transportation commuters; and lower in those with higher median income and dwelling value. Low wealth, renter-occupied, and lone parent neighborhoods had greater exposure to fast food outlets, which was not offset by better supermarket access. The implications are troubling for fast food consumption among lone parent families in light of growing obesity rates among children.

Dietary fat in infancy should be more focused on quality than on quantity

OBJECTIVE

The primary aim was to assess, the association of the quantity and quality of dietary fat intake from 6 to 12 months of age and serum lipids at 12 months.

SUBJECTS/METHODS

Three hundred healthy term Swedish infants were recruited in a longitudinal prospective study at the age of 6 months; 276 remained in the study at 12 months. Food records and anthropometric data were collected monthly from 6 to 12 months; serum lipids were analysed at 6 and 12 months.

RESULTS

Swedish infants had a total fat intake within the Nordic recommendations, but intake of polyunsaturated fatty acids (PUFA) was low (5.6 percent of total energy (E%)) and intake of saturated fatty acids (SAFA) was high (15.1 E%). Higher PUFA intake was associated with lower total serum cholesterol (TC, B=-0.13, P=0.003), lower low-density-lipoprotein cholesterol (LDL-C, B=-0.12, P=0.004) and apolipoprotein B (B=-0.03) (P=0.034) in girls but not in boys. When data from the present study were compared to data from similar studies in Finland and Iceland, it appears that the quality of the dietary fat has greater impact on serum lipid levels than the quantity of fat in the diet.

CONCLUSIONS

Higher PUFA and lower SAFA intakes may reduce TC and LDL-C early in life, particularly in girls. Further, with respect to lowering serum lipid concentrations in early childhood it seems appropriate to set focus on fat quality rather than the quantity.

SPONSORSHIPS

Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (Formas), Swedish Research Council, Medicine, Stiftelsen Oskar Foundation, Sven Jerring Foundation, Samariten Foundation, Stiftelsen Goljes minne and Semper AB.