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Koliaki C, Dalamaga M, Liatis S. Update on the Obesity Epidemic: After the Sudden Rise, Is the Upward Trajectory Beginning to Flatten? Curr Obes Rep 2023; 12:514-527. [PMID: 37779155 DOI: 10.1007/s13679-023-00527-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE OF REVIEW To provide an update on current obesity prevalence trends and summarize the available evidence suggesting a possible plateau or stabilization in obesity rates after the previous sudden global rise. RECENT FINDINGS The escalating global obesity epidemic represents one of the most serious public health challenges. There have been some indications that in high-income populations, the rate of obesity increase in adults has been stabilized after the decade 2000-2010, suggesting a possible plateau. Current evidence also suggests that obesity rates have been stabilized in children and adolescents of most economically advanced countries since 2000, which is possibly related to healthier dietary habits and increased levels of physical activity. On the other hand, there is a steady uninterrupted rise in low-income nations, and the universal trend is obesity escalation rather than slowdown, mainly driven by sharp increases in the obesity prevalence of low-income populations. Furthermore, an increasing number of high- and middle-income countries are currently experiencing an epidemic of severe obesity. In high-income populations, severe obesity is expected to double its prevalence from 10 to 20% between 2020 and 2035, posing an enormous threat for healthcare systems. Even if transiently stabilized, the obesity prevalence remains globally at unacceptably high levels, and there is no guarantee that the current stability (if any) will be maintained for long. In this review, we explore the underlying drivers of the global obesity epidemic; we provide possible explanations for the reported slowdown of the obesity rates in some countries; and we overall take a critical perspective on the obesity plateau hypothesis, emphasizing the urgent need for immediate effective actions at population and regional level in order to halt the alarming obesity escalation and its serious health risks.
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Affiliation(s)
- Chrysi Koliaki
- First Propaedeutic Department of Internal Medicine and Diabetes Center, Laiko General Hospital, Medical School, National Kapodistrian University of Athens, Agiou Thoma 17 Street, 11527, Athens, Greece.
| | - Maria Dalamaga
- Department of Biologic Chemistry, Medical School, National Kapodistrian University of Athens, Mikras Asias 75 Street, 11527, Athens, Greece
| | - Stavros Liatis
- First Propaedeutic Department of Internal Medicine and Diabetes Center, Laiko General Hospital, Medical School, National Kapodistrian University of Athens, Agiou Thoma 17 Street, 11527, Athens, Greece
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2
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Maessen SE, Swinburn BA, Taylor RW, Gerritsen S, Nichols M, Körner A, Kiess W, Hancock C, Cutfield WS. Slim Evidence to Suggest Preschoolers Are Emerging from the Obesity Epidemic. J Pediatr 2021; 236:292-296. [PMID: 33865860 DOI: 10.1016/j.jpeds.2021.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/22/2021] [Accepted: 04/09/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Sarah E Maessen
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Boyd A Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Rachael W Taylor
- A Better Start-National Science Challenge, University of Auckland, Auckland, New Zealand; Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Sarah Gerritsen
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Melanie Nichols
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Antje Körner
- Center for Pediatric Research Leipzig (CPL), University Hospital for Children and Adolescents, Leipzig, Germany
| | - Wieland Kiess
- Center for Pediatric Research Leipzig (CPL), University Hospital for Children and Adolescents, Leipzig, Germany
| | | | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand; A Better Start-National Science Challenge, University of Auckland, Auckland, New Zealand.
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Nichols M, Allender S, Swinburn B, Orellana L. Inequalities in early childhood body-mass index Z scores in Victoria, Australia: a 15-year observational study. LANCET PUBLIC HEALTH 2021; 6:e462-e471. [PMID: 34175000 DOI: 10.1016/s2468-2667(21)00079-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Early childhood overweight and obesity increased substantially in high-income countries throughout the 1980s and 1990s. The flattening or reversal of this trend since the early 2000s might conceal widening inequalities. This study aimed to identify trends in body-mass index Z score (BMIz) among children aged 1-3·5 years in Victoria (Australia), by socioeconomic status and geographical location. METHODS This repeated, cross-sectional study used deidentified records of height, weight, and demographic information from electronic databases in the Victorian Maternal and Child Health system. Data from the consultations for children aged 1, 2, and 3·5 years were included in this analysis. We removed duplicate records; records with missing data for sex, age, weight, height, or postcode; and records with postcodes that were outside of Victoria. The coprimary outcomes were trends in mean BMIz (continuous linear models) and prevalence of high BMIz (>+1; generalised linear models), estimated for six independent age-sex groups. Secondary analysis was done for the prevalence of BMIz greater than 2. Effect modification by socioeconomic status and remoteness was evaluated. FINDINGS Electronic data were available for 48 local government areas collected between Jan 1, 2003, and Dec 31, 2017, representing approximately 63% of the Victorian population. Overall, 1 329 520 measurements from 675 991 children were included in the analysis. There were small, significantly decreasing trends in mean BMIz across all six age-sex groups, overall and in major cities. Similar patterns were observed for some subgroups in prevalence of high BMIz. These decreasing trends appear to be partly explained by migration. Conversely, in regional areas the trends in BMIz were consistently increasing in all age-sex groups and across socioeconomic strata, although not all groups were statistically significant. Inequalities in BMIz according to socioeconomic status persisted throughout the study period, such that the children from more advantaged areas had lower mean BMIz. INTERPRETATION This study showed that at a state level, mean BMIz and prevalence of high BMIz decreased in children aged 1, 2, and 3·5 years in Victoria between 2003 and 2017. We found metropolitan-regional differences to be key source of inequality in early childhood BMIz trends, alongside area-level socioeconomic status. These findings highlight the risk that analysis of overall trends in childhood BMIz might obscure important inequalities according to, for example, remoteness, socioeconomic status, and ethnicity. Future research requires monitoring data with large population samples to adequately examine differences in prevalence and trends between population subgroups. FUNDING None.
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Affiliation(s)
- Melanie Nichols
- Global Obesity Centre, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia.
| | - Steven Allender
- Global Obesity Centre, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, VIC, Australia
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Millar SR, Harding M, McCarthy LE, Kelleher V, Harrington JM, James P, Whelton H, Perry IJ. Exploring 12-Year trends in childhood obesity prevalence for the Republic of Ireland – a national study using survey data from 2002 and 2014. HRB Open Res 2021; 4:3. [PMID: 35949452 PMCID: PMC9334843 DOI: 10.12688/hrbopenres.12988.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The prevalence of overweight and obesity among children may have reached a plateau in some developed countries, including Ireland. The aim of this study was to examine 12-year trends in the prevalence of overweight and obesity among primary-school-aged children in the Republic of Ireland between 2002 and 2014. Methods: Two large-scale oral health cross-sectional surveys of primary-school-aged children aged 4–13 years were conducted 12 years apart in 2002 (n=14,055; response rate=68%) and 2014 (n=5,223; response rate=67%). Both surveys included standardised and calibrated height and weight measures. Ownership of a means-tested medical card determined economic status. Standard International Obesity Task Force criteria were applied to determine the prevalence of overweight and obesity. Results: The overall prevalence of overweight/obesity among 4–13-year-olds significantly decreased from 26% (95% CI: 25.1%–26.5%) in 2002 to 24% (95% CI: 22.4%–24.7%) in 2014. Among boys and girls aged 4–13 years, the significant decrease was from 23% (95% CI: 22.1%–24.1%) to 20% (95% CI: 18.9%–22.0 and 28% (95% CI: 27.4%–29.5%) to 27% (95% CI: 25.0%–28.4%), respectively. Among 5-year-old children, the overall prevalence of overweight and obesity significantly decreased from 25% (95% CI: 23.7%–26.2%) to 22% (95% CI: 19.9%–23.4%). In 2002, the estimated prevalence of overweight/obesity was similar in children with and without medical cards, whereas in 2014, overall prevalence was higher in those with medical cards. Conclusions: Results suggest a fall in the prevalence of overweight/obesity between 2002 and 2014, and may suggest a favourable cohort effect. Despite this fall, the overall prevalence remains high and socioeconomic disparities have increased.
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Affiliation(s)
- Seán R. Millar
- School of Public Health, University College Cork, Cork, Co Cork, Ireland
| | - Mairead Harding
- Oral Health Services Research Centre, University College Cork, Cork, Co Cork, Ireland
- Cork University Dental School and Hospital, University College Cork, Cork, Co Cork, Ireland
- Cork Kerry Community Healthcare, Health Service Executive, Cork, Co Cork, Ireland
| | - Laura E. McCarthy
- School of Public Health, University College Cork, Cork, Co Cork, Ireland
| | - Virginia Kelleher
- Oral Health Services Research Centre, University College Cork, Cork, Co Cork, Ireland
| | | | - Patrice James
- Oral Health Services Research Centre, University College Cork, Cork, Co Cork, Ireland
| | - Helen Whelton
- Oral Health Services Research Centre, University College Cork, Cork, Co Cork, Ireland
- College of Medicine and Health, University College Cork, Cork, Co Cork, Ireland
| | - Ivan J. Perry
- School of Public Health, University College Cork, Cork, Co Cork, Ireland
- Oral Health Services Research Centre, University College Cork, Cork, Co Cork, Ireland
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Thorén A, Janson A, Englund E, Silfverdal SA. Development, implementation and early results of a 12-week web-based intervention targeting 51 children age 5-13 years and their families. Obes Sci Pract 2020; 6:516-523. [PMID: 33082993 PMCID: PMC7556424 DOI: 10.1002/osp4.440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/17/2020] [Accepted: 06/21/2020] [Indexed: 12/16/2022] Open
Abstract
Background Internet-based treatments have proven effective for various health issues. There is a need to scale up interventions targeting children with obesity, also in less densely populated areas where the prevalence in many countries is higher than in urban areas. The aim of this study was to design and implement an internet-based program as an add-on to standard treatment for childhood obesity. Methods Web-Childhood Obesity Prevention (Web-COP) was a prospective feasibility study with a pre- post- design. The intervention consisted of four group-based education sessions at the clinic, physical activity on prescription, and a new 12-week internet-based program. Web-COP was offered to children with obesity (International Obesity Task Force Body Mass Index (IOTF-BMI) ≥ 30 kg/m2) and their parents in two counties in Northern Sweden from August 2018 to June 2019. The primary outcome was change in BMI standard deviation score (BMI-SDS). Results The study included 55 children 5-13 years of age. The internet-based component was well received, and retention rate was 51/55 (92.7%). Data was analysed for 51 children. Mean BMI-SDS was 3.3 at start and decreased by 0.2, 0.3, and 0.4 at two, four, and six months from baseline. Using a continuous algorithm, 42/51 (81%), children lowered their BMI-SDS and 33/51 (65%) lowered their BMI. Conclusion Adding group sessions and an internet-based program to standard care was feasible and two thirds of included children with obesity reduced their BMI.
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Affiliation(s)
- Annelie Thorén
- Department of Clinical Sciences, Pediatrics Umeå University Umeå Sweden.,Department of Pediatrics Sollefteå Hospital Sollefteå Sweden
| | - Annika Janson
- National Childhood Obesity Centre Karolinska University Hospital Stockholm Sweden.,Division of Pediatric Endocrinology, Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Erling Englund
- Department of Research and Development Västernorrland County Council Sundsvall Sweden
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Duchen K, Jones M, Faresjö ÅO, Faresjö T, Ludvigsson J. Predicting the development of overweight and obesity in children between 2.5 and 8 years of age: The prospective ABIS study. Obes Sci Pract 2020; 6:401-408. [PMID: 32874675 PMCID: PMC7448170 DOI: 10.1002/osp4.418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 12/27/2022] Open
Abstract
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.
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Affiliation(s)
- Karel Duchen
- Division of Children's and Women's Health, Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Mike Jones
- Department of Psychology, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyAustralia
| | - Åshild Olsen Faresjö
- Division of Society and Health, Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Tomas Faresjö
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Johnny Ludvigsson
- Division of Children's and Women's Health, Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
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7
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Öhlund I, Lind T, Hernell O, Silfverdal SA, Liv P, Karlsland Åkeson P. Vitamin D status and cardiometabolic risk markers in young Swedish children: a double-blind randomized clinical trial comparing different doses of vitamin D supplements. Am J Clin Nutr 2020; 111:779-786. [PMID: 32140704 PMCID: PMC7138658 DOI: 10.1093/ajcn/nqaa031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 02/03/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Observational studies have linked low vitamin D status to unfavorable cardiometabolic risk markers, but double-blinded vitamin D intervention studies in children are scarce. OBJECTIVES The aim was to evaluate the effect of different doses of a vitamin D supplement on cardiometabolic risk markers in young healthy Swedish children with fair and dark skin. METHODS Cardiometabolic risk markers were analyzed as secondary outcomes of a double-blind, randomized, milk-based vitamin D intervention trial conducted during late fall and winter in 2 areas of Sweden (latitude 63°N and 55°N, respectively) in both fair- and dark-skinned 5- to 7-y-old children. During the 3-mo intervention, 206 children were randomly assigned to a daily milk-based vitamin D3 supplement of either 10 or 25 µg or placebo (2 µg; only at 55°N). Anthropometric measures, blood pressure, serum 25-hydroxyvitamin D [25(OH)D], total cholesterol, HDL cholesterol, apoA-I, apoB, and C-reactive protein (CRP) were analyzed and non-HDL cholesterol calculated at baseline and after the intervention. RESULTS At baseline, serum 25(OH)D was negatively associated with systolic and diastolic blood pressure (β = -0.194; 95% CI: -0.153, -0.013; and β = -0.187; 95% CI: -0.150, -0.011, respectively). At follow-up, there was no statistically significant difference in any of the cardiometabolic markers between groups. CONCLUSIONS We could not confirm any effect of vitamin D supplementation on serum lipids, blood pressure, or CRP in healthy 5- to 7-y-old children. The study was registered at clinicaltrials.gov (NCT01741324).
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Affiliation(s)
- Inger Öhlund
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden,Address correspondence to IO (e-mail: )
| | - Torbjörn Lind
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Olle Hernell
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | | | - Per Liv
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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8
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Duchen K, Faresjö ÅO, Klingberg S, Faresjö T, Ludvigsson J. 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. Obes Sci Pract 2020; 6:57-69. [PMID: 32128243 PMCID: PMC7042022 DOI: 10.1002/osp4.377] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/17/2019] [Accepted: 10/07/2019] [Indexed: 11/09/2022] Open
Abstract
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.
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Affiliation(s)
- Karel Duchen
- Crown Princess Victoria Children's Hospital, Region ÖstergötlandLinköpingSweden
- Division of Pediatrics, Department of Clinical and Experimental MedicineLinköping UniversityLinköpingSweden
| | - Åshild Olsen Faresjö
- Department of Medicine and Health, Division of Community MedicineLinköping UniversityLinköpingSweden
| | - Sofia Klingberg
- Department of Public Health and Community Medicine, Section of Epidemiology and Social MedicineSahlgrenska Academy at University of GothenburgGothenburgSweden
| | - Tomas Faresjö
- Department of Medicine and Health, Division of Community MedicineLinköping UniversityLinköpingSweden
| | - Johnny Ludvigsson
- Crown Princess Victoria Children's Hospital, Region ÖstergötlandLinköpingSweden
- Division of Pediatrics, Department of Clinical and Experimental MedicineLinköping UniversityLinköpingSweden
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Sayon-Orea C, Moreno-Iribas C, Delfrade J, Sanchez-Echenique M, Amiano P, Ardanaz E, Gorricho J, Basterra G, Nuin M, Guevara M. Inverse-probability weighting and multiple imputation for evaluating selection bias in the estimation of childhood obesity prevalence using data from electronic health records. BMC Med Inform Decis Mak 2020; 20:9. [PMID: 31959164 PMCID: PMC6971988 DOI: 10.1186/s12911-020-1020-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 01/13/2020] [Indexed: 11/21/2022] Open
Abstract
Background and objectives Height and weight data from electronic health records are increasingly being used to estimate the prevalence of childhood obesity. Here, we aim to assess the selection bias due to missing weight and height data from electronic health records in children older than five. Methods Cohort study of 10,811 children born in Navarra (Spain) between 2002 and 2003, who were still living in this region by December 2016. We examined the differences between measured and non-measured children older than 5 years considering weight-associated variables (sex, rural or urban residence, family income and weight status at 2–5 yrs). These variables were used to calculate stabilized weights for inverse-probability weighting and to conduct multiple imputation for the missing data. We calculated complete data prevalence and adjusted prevalence considering the missing data using inverse-probability weighting and multiple imputation for ages 6 to 14 and group ages 6 to 9 and 10 to 14. Results For 6–9 years, complete data, inverse-probability weighting and multiple imputation obesity age-adjusted prevalence were 13.18% (95% CI: 12.54–13.85), 13.22% (95% CI: 12.57–13.89) and 13.02% (95% CI: 12.38–13.66) and for 10–14 years 8.61% (95% CI: 8.06–9.18), 8.62% (95% CI: 8.06–9.20) and 8.24% (95% CI: 7.70–8.78), respectively. Conclusions Ages at which well-child visits are scheduled and for the 6 to 9 and 10 to 14 age groups, weight status estimations are similar using complete data, multiple imputation and inverse-probability weighting. Readily available electronic health record data may be a tool to monitor the weight status in children.
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Affiliation(s)
- Carmen Sayon-Orea
- Servicio Navarro de Salud, Pamplona, Spain.,Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
| | - Conchi Moreno-Iribas
- Public Health Institute of Navarra, IdiSNA, Leyre 15, 31003, Pamplona, Spain. .,Research Network for Health Services in Chronic Diseases (REDISSEC), Pamplona, Spain.
| | - Josu Delfrade
- Public Health Institute of Navarra, IdiSNA, Leyre 15, 31003, Pamplona, Spain.,Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Pilar Amiano
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Public Health Division of Gipuzkoa, Department of Health of the Basque Government, Donostia-San Sebastian, Gipuzkoa, Spain
| | - Eva Ardanaz
- Public Health Institute of Navarra, IdiSNA, Leyre 15, 31003, Pamplona, Spain.,Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Javier Gorricho
- Research Network for Health Services in Chronic Diseases (REDISSEC), Pamplona, Spain.,Department of Health, Navarra Regional Government, Pamplona, Spain
| | - Garbiñe Basterra
- Department of Health, Navarra Regional Government, Pamplona, Spain
| | - Marian Nuin
- Primary Healthcare, Navarra Health Service, Pamplona, Spain
| | - Marcela Guevara
- Public Health Institute of Navarra, IdiSNA, Leyre 15, 31003, Pamplona, Spain.,Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
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10
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Sidra S, Tariq MH, Farrukh MJ, Mohsin M. Evaluation of clinical manifestations, health risks, and quality of life among women with polycystic ovary syndrome. PLoS One 2019; 14:e0223329. [PMID: 31603907 PMCID: PMC6788722 DOI: 10.1371/journal.pone.0223329] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/18/2019] [Indexed: 11/18/2022] Open
Abstract
This study aimed to evaluate the clinical manifestations and health risks associated with polycystic ovary syndrome (PCOS) and its impact on quality of life (QOL) in Pakistan. A detailed cross-sectional study was conducted on PCOS among women of reproductive age visiting the gynecology and obstetrics and endocrinology departments at primary and tertiary care hospitals located in Abbottabad, Kohat, and Islamabad. In total, 440 patients meeting the inclusion criteria were included. A checklist was specifically designed to identify symptoms and health risks, including adverse drug reactions, complications, irrational prescription or underprescription, and drug-drug interactions. The Short Form-12 questionnaire was used to evaluate the QOL of patients with PCOS. Data collected were analyzed for descriptive and inferential statistics using chi-square test, analysis of variance, and post hoc analysis. All patients exhibited the cardinal symptoms of PCOS, including obesity (n = 352, 80%), acne (n = 296, 67.3), hirsutism (n = 299, 68%), hyperglycemia (n = 278, 63.2%), and irregular menstruation (n = 316, 71.8%). Ultrasonography confirmed that 268 (61%) patients had multiple cysts of >10 mm in diameter. Patients with untreated PCOS exhibited a high prevalence of health risks including hypertension (n = 87, 19.8%), diabetes (n = 268, 60.9%), sleep apnea (n = 11, 2.5%), infertility (n = 146, 33.2%), increased endometrial thickness (n = 21, 4.8%), miscarriages (n = 68, 15.5%), high cholesterol level (n = 85, 19.3%), and hyperandrogenism (n = 342, 77.7%). Most patients exhibited low QOL scores (n = 374, 85%), with depression being the largest contributor to low QOL. Apart from novel results, this study found an association between depression and low QOL in patients with PCOS, suggesting the need for reviewing the management guidelines and psychological health assessment of women with PCOS.
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Affiliation(s)
- Syeda Sidra
- Faculty of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
| | - Muhammad Haseeb Tariq
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | | | - Muhammad Mohsin
- Faculty of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
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11
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Lindholm A, Bergman S, Alm B, Almquist‐Tangen G, Dahlgren J, Roswall J. Infant body mass index growth patterns predicted overweight at five years, waist-to-height ratio did not add to this predictivity. Acta Paediatr 2019; 108:945-953. [PMID: 30192410 DOI: 10.1111/apa.14572] [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: 04/03/2018] [Revised: 08/12/2018] [Accepted: 09/05/2018] [Indexed: 11/29/2022]
Abstract
AIM The aim of the present study was to examine body mass index (BMI) and waist-to-height ratio (WHtR) growth patterns from birth until five years regarding their ability to predict overweight or obesity in children at five years of age. METHODS Population-based longitudinal birth cohort study of 1540 children from the south-west region of Sweden, recruited at the first visit to the child health care centres in 2007-2008. The children were followed for five years and classified into two weight groups according to the 2012 International Obesity Task Force criteria. BMI and WHtR standard deviation scores (SDS) were analysed with Student's t-tests and multiple logistic regression models. RESULTS BMI-SDS and WHtR-SDS growth patterns were from an early age different in children with overweight or obesity, compared to in children with normal weight or underweight. Overweight or obesity was significantly predicted by BMI-SDS at 0-1 month (p < 0.001), ΔBMI-SDS between 0-1 and 12 months (p < 0.001) and between 18 and 48 months (p < 0.001), but not by WHtR-SDS, except for a negative association between 18 and 48 months in the boys (p = 0.040). CONCLUSION Overweight or obesity at five years could be predicted by early BMI-SDS growth patterns, and WHtR-SDS did not add to the predictivity with regard to BMI-SDS.
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Affiliation(s)
- Annelie Lindholm
- School of Health and Welfare Halmstad University Halmstad Sweden
- Research and Development Center Spenshult Halmstad Sweden
| | - Stefan Bergman
- School of Health and Welfare Halmstad University Halmstad Sweden
- Research and Development Center Spenshult Halmstad Sweden
- Department of Public Health and Community Medicine The Primary Health Care Unit at the Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Bernt Alm
- Department of Pediatrics The Institute of Clinical Sciences at the Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Gerd Almquist‐Tangen
- Department of Pediatrics The Institute of Clinical Sciences at the Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Child Health Care Unit, Region Halland Kungsbacka Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics The Institute of Clinical Sciences at the Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Josefine Roswall
- Department of Pediatrics The Institute of Clinical Sciences at the Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Pediatrics County Hospital Halmstad Sweden
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12
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Baby Fat or a Fat Baby? Clin Ther 2018; 40:1621-1625. [DOI: 10.1016/j.clinthera.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 11/17/2022]
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13
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van Hooft J, Patterson C, Löf M, Alexandrou C, Hilton S, Nimegeer A. Media framing and construction of childhood obesity: a content analysis of Swedish newspapers. Obes Sci Pract 2018; 4:4-13. [PMID: 29479459 PMCID: PMC5818738 DOI: 10.1002/osp4.150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 12/05/2017] [Accepted: 12/16/2017] [Indexed: 11/10/2022] Open
Abstract
Objective Despite lower prevalence than most European countries, childhood obesity is a Swedish public health priority due to its lasting health impacts and socioeconomic patterning. Mass media content influences public and political perceptions of health issues, and media framing of childhood obesity may influence perceptions of its solutions. This study examines framing of childhood obesity in Swedish morning and evening newspapers from 1996 to 2014. Methods Content analysis of 726 articles about childhood obesity published in the five most-circulated Swedish newspapers. Article content coded quantitatively and subjected to statistical analysis, describing relationships between themes and trends over time. Results Childhood obesity was consistently problematised, primarily in health terms, and linked to socio-economic and geographical factors. The yearly frequency of articles peaked in 2004, followed by a decline, corresponding with evidence about prevalence. Childhood obesity was framed as being driven by individual behaviours more frequently than structural or environmental factors. Structural framings increased over time, but constructions of the problem as driven by individual behaviours, particularly parenting, remained prominent. Conclusions A relative growth in structural framings of causes and solutions over time, combined with prominent coverage of socio-economic inequalities, might be indicative of public and political amenability towards societal-level solutions, but individual behaviours remain prominent in framing of the issue. Health advocates might incorporate these insights into media engagement.
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Affiliation(s)
- J. van Hooft
- Department of biosciences and nutritionKarolinska InstitutetHuddingeSweden
| | - C. Patterson
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - M. Löf
- Department of biosciences and nutritionKarolinska InstitutetHuddingeSweden
| | - C. Alexandrou
- Department of biosciences and nutritionKarolinska InstitutetHuddingeSweden
| | - S. Hilton
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - A. Nimegeer
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
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14
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Henriksson H, Eriksson B, Forsum E, Flinke E, Henriksson P, Löf M. Longitudinal assessment of body composition in healthy Swedish children from 1 week until 4 years of age. Eur J Clin Nutr 2017; 71:ejcn2017125. [PMID: 28832576 DOI: 10.1038/ejcn.2017.125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/21/2017] [Accepted: 07/17/2017] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- H Henriksson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
- PROFITH 'PROmoting FITness and Health through physical activity' Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - B Eriksson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - E Forsum
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - E Flinke
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - P Henriksson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- PROFITH 'PROmoting FITness and Health through physical activity' Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - M Löf
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
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15
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Nyström CD, Sandin S, Henriksson P, Henriksson H, Trolle-Lagerros Y, Larsson C, Maddison R, Ortega FB, Pomeroy J, Ruiz JR, Silfvernagel K, Timpka T, Löf M. Mobile-based intervention intended to stop obesity in preschool-aged children: the MINISTOP randomized controlled trial. Am J Clin Nutr 2017; 105:1327-1335. [PMID: 28446496 DOI: 10.3945/ajcn.116.150995] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 03/23/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Traditional obesity prevention programs are time- and cost-intensive. Mobile phone technology has been successful in changing behaviors and managing weight; however, to our knowledge, its potential in young children has yet to be examined.Objective: We assessed the effectiveness of a mobile health (mHealth) obesity prevention program on body fat, dietary habits, and physical activity in healthy Swedish children aged 4.5 y.Design: From 2014 to 2015, 315 children were randomly assigned to an intervention or control group. Parents in the intervention group received a 6-mo mHealth program. The primary outcome was fat mass index (FMI), whereas the secondary outcomes were intakes of fruits, vegetables, candy, and sweetened beverages and time spent sedentary and in moderate-to-vigorous physical activity. Composite scores for the primary and secondary outcomes were computed.Results: No statistically significant intervention effect was observed for FMI between the intervention and control group (mean ± SD: -0.23 ± 0.56 compared with -0.20 ± 0.49 kg/m2). However, the intervention group increased their mean composite score from baseline to follow-up, whereas the control group did not (+0.36 ± 1.47 compared with -0.06 ± 1.33 units; P = 0.021). This improvement was more pronounced among the children with an FMI above the median (4.11 kg/m2) (P = 0.019). The odds of increasing the composite score for the 6 dietary and physical activity behaviors were 99% higher for the intervention group than the control group (P = 0.008).Conclusions: This mHealth obesity prevention study in preschool-aged children found no difference between the intervention and control group for FMI. However, the intervention group showed a considerably higher postintervention composite score (a secondary outcome) than the control group, especially in children with a higher FMI. Further studies targeting specific obesity classes within preschool-aged children are warranted. This trial was registered at clinicaltrials.gov as NCT02021786.
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Affiliation(s)
| | - Sven Sandin
- Medical Epidemiology and Biostatistics, and.,Department of Psychiatry, and.,Seaver Autism Center for Research and Treatment, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Pontus Henriksson
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Hanna Henriksson
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Ylva Trolle-Lagerros
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden.,Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Christel Larsson
- Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Victoria, Australia
| | - Francisco B Ortega
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Jeremy Pomeroy
- Marshfield Clinic Research Foundation, Marshfield, WI; and Departments of
| | - Jonatan R Ruiz
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | | | - Toomas Timpka
- Medical and Health Sciences, Faculty of the Health Sciences, Linköping University, Linköping, Sweden
| | - Marie Löf
- Departments of Biosciences and Nutrition
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Liston A, Todd JA, Lagou V. Beta-Cell Fragility As a Common Underlying Risk Factor in Type 1 and Type 2 Diabetes. Trends Mol Med 2017; 23:181-194. [DOI: 10.1016/j.molmed.2016.12.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/07/2016] [Accepted: 12/11/2016] [Indexed: 12/13/2022]
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17
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Feldman I, Eurenius E, Häggström J, Sampaio F, Lindkvist M, Pulkki-Brännström AM, Ivarsson A. 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. BMJ Open 2016; 6:e011202. [PMID: 27491668 PMCID: PMC4985974 DOI: 10.1136/bmjopen-2016-011202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/10/2016] [Accepted: 07/14/2016] [Indexed: 11/07/2022] Open
Abstract
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.
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Affiliation(s)
- Inna Feldman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Eva Eurenius
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Jenny Häggström
- Department of Statistics, USBE, Umeå University, Umeå, Sweden
| | - Filipa Sampaio
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Marie Lindkvist
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Statistics, USBE, Umeå University, Umeå, Sweden
| | - Anni-Maria Pulkki-Brännström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
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18
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Döring N, Ghaderi A, Bohman B, Heitmann BL, Larsson C, Berglind D, Hansson L, Sundblom E, Magnusson M, Blennow M, Tynelius P, Forsberg L, Rasmussen F. Motivational Interviewing to Prevent Childhood Obesity: A Cluster RCT. Pediatrics 2016; 137:peds.2015-3104. [PMID: 27244793 DOI: 10.1542/peds.2015-3104] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2016] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Nora Döring
- Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, and
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Benjamin Bohman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Centre for Psychiatric Research, Health Care Services, Stockholm, Sweden
| | - Berit L Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Denmark; The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia; National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Christel Larsson
- Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Daniel Berglind
- Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, and
| | - Lena Hansson
- Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, and
| | - Elinor Sundblom
- Centre for Epidemiology and Community Medicine, Health Care Services, Stockholm County Council, Solna, Sweden
| | - Margaretha Magnusson
- Department of Women's and Children's Health, Uppsala University and Central Child Healthcare Unit, Uppsala University Hospital, Uppsala, Sweden; and
| | - Margareta Blennow
- Department of Clinical Science and Education, Child Health Services, Södersjukhuset, Stockholm, Sweden
| | - Per Tynelius
- Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, and Centre for Epidemiology and Community Medicine, Health Care Services, Stockholm County Council, Solna, Sweden
| | - Lars Forsberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Finn Rasmussen
- Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, and Centre for Epidemiology and Community Medicine, Health Care Services, Stockholm County Council, Solna, Sweden;
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19
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Kleanthous K, Dermitzaki E, Papadimitriou DT, Papaevangelou V, Papadimitriou A. Overweight and obesity decreased in Greek schoolchildren from 2009 to 2012 during the early phase of the economic crisis. Acta Paediatr 2016; 105:200-5. [PMID: 26280808 DOI: 10.1111/apa.13143] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/30/2015] [Accepted: 07/22/2015] [Indexed: 11/30/2022]
Abstract
AIM We examined the weight status of Greek schoolchildren from November 2009 to May 2012, shortly before, and during the early years, of the Greek economic crisis. METHODS This was a mixed longitudinal study that formed part of the West Attica Growth Study and followed children at the ages of 6-7, 9-10, 12-13 and 15-16 years every six months for 2.5 years. Each child's height and weight were measured and their body mass index calculated. We were able to determine the weight status of 1327 children (53% boys) based on their first and last measurements. Overweight, obesity and underweight were defined using the International Obesity Task Force criteria. RESULTS During the 2.5-year study period, there was a decrease in the total prevalence of overweight and obesity, which reached a statistical significance for both sexes. It decreased from 43% to 37.3% (p = 0.02) in boys and from 33.4% to 26.9% (p = 0.0056) in girls. There was also a statistically significant increase in normal weight children and a slight but insignificant increase in underweight children of both sexes. CONCLUSION During the initial years of the Greek economic crisis, there was a statistically significant reduction in overweight and obesity in children from six to 16 years of age.
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Affiliation(s)
- Kleanthis Kleanthous
- Third Department of Pediatrics; University of Athens School of Medicine; ‘Attikon’ University Hospital; Athens Greece
| | - Eleni Dermitzaki
- Third Department of Pediatrics; University of Athens School of Medicine; ‘Attikon’ University Hospital; Athens Greece
| | - Dimitrios T. Papadimitriou
- Third Department of Pediatrics; University of Athens School of Medicine; ‘Attikon’ University Hospital; Athens Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics; University of Athens School of Medicine; ‘Attikon’ University Hospital; Athens Greece
| | - Anastasios Papadimitriou
- Third Department of Pediatrics; University of Athens School of Medicine; ‘Attikon’ University Hospital; Athens Greece
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20
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Lindkvist M, Ivarsson A, Silfverdal SA, Eurenius E. Associations between toddlers' and parents' BMI, in relation to family socio-demography: a cross-sectional study. BMC Public Health 2015; 15:1252. [PMID: 26679345 PMCID: PMC4683751 DOI: 10.1186/s12889-015-2602-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 12/11/2015] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Marie Lindkvist
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE, 901 87, Umeå, Sweden. .,Department of Statistics, USBE, Umeå University, SE, 901 87, Umeå, Sweden.
| | - Anneli Ivarsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE, 901 87, Umeå, Sweden.
| | - Sven Arne Silfverdal
- Department of Clinical Science, Paediatrics, Umeå University, SE, 901 87, Umeå, Sweden.
| | - Eva Eurenius
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE, 901 87, Umeå, Sweden.
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21
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Lindberg J, Norman M, Westrup B, Öhrman T, Domellöf M, Berglund SK. Overweight, Obesity, and Body Composition in 3.5- and 7-Year-Old Swedish Children Born with Marginally Low Birth Weight. J Pediatr 2015; 167:1246-52.e3. [PMID: 26394823 DOI: 10.1016/j.jpeds.2015.08.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/28/2015] [Accepted: 08/21/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess the prevalence of overweight/obese children and to explore body composition in a Swedish cohort of preschool children born with marginally low birth weight (MLBW, ie, 2000-2500 g). STUDY DESIGN We included 285 Swedish children with MLBW (44% small for gestational age), and 95 control children with normal birth weights. At 3.5 years and 7 years of age, we assessed anthropometrics, including the prevalence of overweight/obese children. At 7 years, dual-energy X-ray was used for body composition. RESULTS There were no significant differences between groups in the prevalence of overweight/obesity or in skinfold thickness; however, at 3.5 years, mean height, weight, and BMI in children with MLBW were 2.1 cm (95% CI 1.2-3.1), 1.2 kg (95% CI 0.7-1.6), and 0.47 kg/m(2) (95% CI 0.17-0.76) lower compared with controls. The corresponding mean differences also were lower in children with MLBW compared with control children at 7 years; 2.5 cm (95% CI 0.9-4.1), 1.6 kg (95% CI 0.6-2.8), and 0.48 kg/m(2) (95% CI 0.01-0.94). The differences were greater in those born small for gestational age. Dual-energy X-ray analyses showed lower fat-free mass index in MLBW infants and a similar trend in fat mass index. Within children with MLBW, BMI at 7 years correlated positively to growth velocity in infancy. CONCLUSION Children with MLBW had lower BMI and did not show increased risk of overweight or obesity up to 7 years. Nevertheless, the BMI in MLBW children was positively correlated to growth-velocity in infancy. TRIAL REGISTRATION Clinicaltrials.gov: NCT00558454.
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Affiliation(s)
- Josefine Lindberg
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Björn Westrup
- Division of Neonatology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Tove Öhrman
- Department of Medical Physics, Danderyd Hospital, Stockholm, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Staffan K Berglund
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
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Thorén A, Werner B, Lundholm C, Bråbäck L, Silfverdal SA. A rapid growth rate in early childhood is a risk factor for becoming overweight in late adolescence. Acta Paediatr 2015; 104:1138-43. [PMID: 26173008 DOI: 10.1111/apa.13106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 03/28/2015] [Accepted: 06/30/2015] [Indexed: 11/30/2022]
Abstract
AIM We evaluated whether body mass index (BMI) and rapid growth in early life were associated with an increased risk of becoming overweight at 16 and 18 years of age. METHODS The study population comprised all children born in Sweden on the 15th of each month in 1981. Individuals born on the 5th, 10th and 20th of every month were added for counties with low population densities. Information on weight and height was collected from birth up to 18 years of age for 98.6% of the 3537 children identified. RESULTS Weight at 12 months of age was associated with being overweight at both 16 and 18 years of age. Rapid weight gain from birth to 12 months was associated with higher odds for being overweight later in life, and the weight gain between 18 months and four years of age was the strongest risk factor for being overweight in late adolescence in both sexes. There was no association between a birthweight of <2500 g or >4500 g and being overweight at 16 or 18 years of age. CONCLUSION Fast growth during early childhood was associated with an increased risk of being overweight later in life, emphasising the importance of early prevention.
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Affiliation(s)
- Annelie Thorén
- Clinical Sciences, Pediatrics; Umeå University; Umeå Sweden
- Department of Pediatrics; Sollefteå hospital; Umeå Sweden
| | - Bo Werner
- Child Health Care Unit; Örebro County Council and Division of Social Medicine; Department of Public Health Sciences; Karolinska Institute; Stockholm Sweden
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics; Karolinska Institute; Stockholm Sweden
| | - Lennart Bråbäck
- Occupational and Environmental Medicine; Umeå University; Umeå Sweden
- Department of Research and Development; Västernorrland County Council; Umeå Sweden
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Parental poverty and occupation as risk factors for pediatric sleep-disordered breathing. Sleep Med 2015; 16:1169-75. [DOI: 10.1016/j.sleep.2015.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/19/2015] [Accepted: 05/21/2015] [Indexed: 11/22/2022]
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Rajput N, Tuohy P, Mishra S, Smith A, Taylor B. Overweight and obesity in 4-5-year-old children in New Zealand: results from the first 4 years (2009-2012) of the B4School Check programme. J Paediatr Child Health 2015; 51:334-43. [PMID: 25157848 DOI: 10.1111/jpc.12716] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 11/30/2022]
Abstract
AIM We describe the prevalence of overweight and obesity in four-year-old children in New Zealand, variations with ethnicity and socio-economic status, and changes over the study duration using body mass index (BMI) measurements collected as part of the B4School Check programme. METHODS Demographic and BMI data were extracted for all children measured between 2009 and 2012. Overweight and obesity rates were estimated using International Obesity Task Force (IOTF) 2012 standards and the 85th (overweight) and 95th (obese) percentiles for BMI-for-age of the World Health Organization (WHO) 2006, Centers for Disease Control and Prevention 2000 and UK 1990 reference standards. RESULTS A total of 168,744 BMI measurements were included in the analysis with a coverage rate of 66.5%. Mean BMI was 16.30 kg/m(2) in girls and 16.44 kg/m(2) in boys. Mean BMI z-score (WHO 2006 standards) was 0.601 in girls and 0.785 in boys. Using WHO 2006 standards, 16.9% of girls and 19.6% of boys were overweight and 13.8% of girls and 18.7% of boys were obese. Using IOTF standards, 18.3% of girls and 16.2% of boys were overweight and 5.7% of girls and 4.7% of boys were found obese. Prevalence of overweight and obesity was higher in Pacific and Maori children and those living in more socio-economically deprived areas than other children. No definite time-trends were observed over the study duration. CONCLUSIONS The study reaffirms the high prevalence of overweight and obesity in pre-school children in New Zealand, and demonstrates the variations in prevalence when using different reference standards.
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Keane E, Kearney PM, Perry IJ, Kelleher CC, Harrington JM. Trends and prevalence of overweight and obesity in primary school aged children in the Republic of Ireland from 2002-2012: a systematic review. BMC Public Health 2014; 14:974. [PMID: 25312652 PMCID: PMC4197331 DOI: 10.1186/1471-2458-14-974] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 09/11/2014] [Indexed: 11/28/2022] Open
Abstract
Background The prevalence of childhood overweight and obesity in developed countries appears to be levelling off. As trends in childhood obesity prevalence have not been examined over the past decade in the Republic of Ireland, this systematic review aims to compile and synthesise all available information on the prevalence of overweight and obesity in primary school aged children between 2002 and 2012. Methods Systematic review of published and grey literature containing data on objectively measured height and weight. Inclusion criteria included studies where data was collected between 2002 and 2012 from at least 200 primary school aged children in the Republic of Ireland. Database searching, Google searching, reference searching and contact with obesity experts was undertaken. Overweight, obesity and morbid obesity were defined using standard International Obesity Taskforce definitions. Study quality was assessed. Results Fourteen studies (16 prevalence estimates) met the inclusion criteria. The combined prevalence of overweight and obesity within the studies ranged from 20-34%. No significant trend in overweight prevalence over time was observed (p=0.6). However, there was evidence of a slight decrease in obesity prevalence over the period (p=0.01), with a similar though non-significant decline in the prevalence of morbid obesity (p=0.2). Conclusion The findings of this systematic review require cautious interpretation though the prevalence of childhood overweight and obesity in the Republic of Ireland has reached a plateau and may be falling. These findings provide some ground for optimism though the current plateau is at an unacceptably high level. Thus current population based preventive strategies need to be sustained and intensified. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-974) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eimear Keane
- Department of Epidemiology and Public Health, University College Cork, Fourth Floor, Western Gateway Building, Western Road, Cork, Republic of Ireland.
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Döring N, Hansson LM, Andersson ES, Bohman B, Westin M, Magnusson M, Larsson C, Sundblom E, Willmer M, Blennow M, Heitmann BL, Forsberg L, Wallin S, Tynelius P, Ghaderi A, Rasmussen F. Primary prevention of childhood obesity through counselling sessions at Swedish child health centres: design, methods and baseline sample characteristics of the PRIMROSE cluster-randomised trial. BMC Public Health 2014; 14:335. [PMID: 24717011 PMCID: PMC3995501 DOI: 10.1186/1471-2458-14-335] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 04/02/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Childhood obesity is a growing concern in Sweden. Children with overweight and obesity run a high risk of becoming obese as adults, and are likely to develop comorbidities. Despite the immense demand, there is still a lack of evidence-based comprehensive prevention programmes targeting pre-school children and their families in primary health care settings. The aims are to describe the design and methodology of the PRIMROSE cluster-randomised controlled trial, assess the relative validity of a food frequency questionnaire, and describe the baseline characteristics of the eligible young children and their mothers. METHODS/DESIGN The PRIMROSE trial targets first-time parents and their children at Swedish child health centres (CHC) in eight counties in Sweden. Randomisation is conducted at the CHC unit level. CHC nurses employed at the participating CHC received training in carrying out the intervention alongside their provision of regular services. The intervention programme, starting when the child is 8-9 months of age and ending at age 4, is based on social cognitive theory and employs motivational interviewing. Primary outcomes are children's body mass index and waist circumference at four years. Secondary outcomes are children's and mothers' eating habits (assessed by a food frequency questionnaire), and children's and mothers' physical activity (measured by accelerometer and a validated questionnaire), and mothers' body mass index and waist circumference. DISCUSSION The on-going population-based PRIMROSE trial, which targets childhood obesity, is embedded in the regular national (routine) preventive child health services that are available free-of-charge to all young families in Sweden. Of the participants (n = 1369), 489 intervention and 550 control mothers (75.9%) responded to the validated physical activity and food frequency questionnaire at baseline (i.e., before the first intervention session, or, for children in the control group, before they reached 10 months of age). The food frequency questionnaire showed acceptable relative validity when compared with an 8-day food diary. We are not aware of any previous RCT, concerned with the primary prevention of childhood obesity through sessions at CHC that addresses healthy eating habits and physical activity in the context of a routine child health services programme. TRIAL REGISTRATION ISRCTN16991919.
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Affiliation(s)
- Nora Döring
- Department of Public Health Sciences, Karolinska Institutet, Child and Adolescent Public Health Epidemiology, Tomtebodavägen 18A, Stockholm SE-171 77, Sweden
| | - Lena M Hansson
- Department of Public Health Sciences, Karolinska Institutet, Child and Adolescent Public Health Epidemiology, Tomtebodavägen 18A, Stockholm SE-171 77, Sweden
| | - Elina Scheers Andersson
- Department of Public Health Sciences, Karolinska Institutet, Child and Adolescent Public Health Epidemiology, Tomtebodavägen 18A, Stockholm SE-171 77, Sweden
| | - Benjamin Bohman
- Department of Clinical Neuroscience, Karolinska Institutet, Division of Psychology, Stockholm, Sweden
| | - Maria Westin
- Department of Public Health Sciences, Karolinska Institutet, Child and Adolescent Public Health Epidemiology, Tomtebodavägen 18A, Stockholm SE-171 77, Sweden
| | - Margaretha Magnusson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Christel Larsson
- Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden
- Department of Food and Nutrition, Umeå University, Umeå, Sweden
| | - Elinor Sundblom
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services, Stockholm, Sweden
| | - Mikaela Willmer
- Department of Public Health Sciences, Karolinska Institutet, Child and Adolescent Public Health Epidemiology, Tomtebodavägen 18A, Stockholm SE-171 77, Sweden
| | - Margareta Blennow
- Department of Clinical Science and Education, Child Health Services, Södersjukhuset, Stockholm, Sweden
| | - Berit L Heitmann
- Research Unit for Dietary Studies, Institute of Preventive Medicine, Copenhagen University Hospital, Copenhagen, Denmark
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorder, University of Sydney, Sydney, Australia
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lars Forsberg
- Department of Clinical Neuroscience, Karolinska Institutet, Centre of Psychiatry Research, Stockholm, Sweden
| | - Sanna Wallin
- Department of Public Health Sciences, Karolinska Institutet, Child and Adolescent Public Health Epidemiology, Tomtebodavägen 18A, Stockholm SE-171 77, Sweden
| | - Per Tynelius
- Department of Public Health Sciences, Karolinska Institutet, Child and Adolescent Public Health Epidemiology, Tomtebodavägen 18A, Stockholm SE-171 77, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services, Stockholm, Sweden
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Division of Psychology, Stockholm, Sweden
| | - Finn Rasmussen
- Department of Public Health Sciences, Karolinska Institutet, Child and Adolescent Public Health Epidemiology, Tomtebodavägen 18A, Stockholm SE-171 77, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services, Stockholm, Sweden
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Triunfo S, Lanzone A. Impact of overweight and obesity on obstetric outcomes. J Endocrinol Invest 2014; 37:323-9. [PMID: 24515300 DOI: 10.1007/s40618-014-0058-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 12/05/2013] [Indexed: 12/18/2022]
Abstract
Abnormal nutritional status is an increasingly common complication in developed countries and, as reproductive age women are a part of this trend, the effect of maternal obesity on the pregnancy and neonate must be investigated. Pregestational obesity or overweight condition or an excessive gestational weight gain can be an independent risk factor for feto-maternal complications and long-term risks in adult life for the fetus. The selected risks include infertility, miscarriage, congenital anomalies, hypertensive disorders, gestational diabetes, intrauterine fetal death, macrosomia, and delivery complications. From an etiological point of view, the causes of the adverse outcomes include maternal body habitus, proinflammatory state of obesity, and metabolic dysfunction. Actually, a weight management guidance for obese pregnant women is limited, recommending a gain between 5 and 9 kg during the pregnancy period, while weight loss is discouraged. Mainly, therapeutic approach is prevention using specific programs of reducing weight before pregnant status. In addition, mechanistic studies, in animal models especially, have identified potential areas for intervention which might limit adverse risk factors for obesity from mothers to infants during pregnancy. In this article, a review of the literature on selected obstetrical risks associated with maternal overweight and obesity has been performed and both the target prevention and management strategies have been assessed.
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Affiliation(s)
- S Triunfo
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Largo A. Vito, 8, 00168, Rome, Italy,
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Surgically induced interpregnancy weight loss and prevalence of overweight and obesity in offspring. PLoS One 2013; 8:e82247. [PMID: 24349234 PMCID: PMC3861408 DOI: 10.1371/journal.pone.0082247] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/22/2013] [Indexed: 01/14/2023] Open
Abstract
Introduction According to the fetal overnutrition hypothesis, obesity in pregnancy predisposes the offspring to obesity. Previous studies have suggested that after biliopancreatic surgery for obesity, the offspring is less likely to be obese. This study aims to further compare the BMI development of children born before and after maternal surgical weight loss. Method Women with at least one child born before and one child born after bariatric surgery were identified by record-linkage. Information about maternal BMI was extracted from medical records, as was information about the children's BMI from birth to 10 years of age. We retrieved BMI data at four years of age for 340 children, born to 223 women (164 children born before surgery (BS), 176 children born after surgery (AS)). We evaluated prevalence of overweight/obesity and mean BMI in children born BS and AS at the ages of four, six and ten using GEE regression models. For 71 families, where we had complete data on mother and both children, we used a fixed-effects regression model to explore the association between differences in maternal BMI in w10 of the pre- and post-operative pregnancies with siblings' BMI differences at age four. Results In no age group did we see a significantly reduced prevalence of overweight/obesity AS. For 10-year-old girls, the AS group had significantly higher rates of obesity. There was no association between differences in maternal BMI in early pregnancy and differences in siblings' BMI at four years of age (β = −0.01, CI 95% = −0.11; 0.09). Conclusions We have been unable to demonstrate any effect of bariatric surgery on weight development in offspring. It seems unlikely that restrictive bariatric surgery conveys a protective effect in offspring with regards to obesity.
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Savva SC, Kourides YA, Hadjigeorgiou C, Tornaritis MJ. Overweight and obesity prevalence and trends in children and adolescents in Cyprus 2000-2010. Obes Res Clin Pract 2013; 8:e426-34. [PMID: 25263832 DOI: 10.1016/j.orcp.2013.11.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 11/12/2013] [Accepted: 11/14/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To estimate the prevalence of overweight and obesity in 2010 and examine prevalence trends between 2000 and 2010 among school-aged children and adolescents in Cyprus. METHODS A representative cross-sectional study was undertaken in 2010. Anthropometric data were taken using standard methods from 3090 children. The IOTF cut-offs were used to define overweight and obese participants, and prevalence was compared with a previous representative study performed in 2000. Prevalences with 95% confidence intervals (95% CI) were calculated and logistic regression models were used to estimate 10-year trends. RESULTS The overall prevalence of obesity was higher in 2010 (8.1% [95%CI: 7.1, 9.1]) compared to 2000 (5.9% [95%CI: 5.0, 6.8]), p=0.002. The overall prevalence of overweight was also higher in 2010 (20.1% [95%CI: 18.7, 21.5]) compared to 2000 (16.5% [95%CI: 15.0, 18.0]), p<0.001. The prevalence of obesity increased at a greater rate in school-aged boys (p=0.017), and in rural areas (p=0.001). In rural areas, high maternal education background is associated with a decreased odds for obesity; odds ratio 0.35 (95% CI: 0.17, 0.69), p=0.003. CONCLUSIONS The prevalence of obesity and overweight in children and adolescents in Cyprus has increased substantially over a decade, mainly in rural areas and in school-aged boys.
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Affiliation(s)
- Savvas C Savva
- Research and Education Institute of Child Health, 138, Limassol Avenue, 2015 Strovolos, Cyprus.
| | - Yiannis A Kourides
- Research and Education Institute of Child Health, 138, Limassol Avenue, 2015 Strovolos, Cyprus
| | | | - Michael J Tornaritis
- Research and Education Institute of Child Health, 138, Limassol Avenue, 2015 Strovolos, Cyprus; Pedagogical Institute of Cyprus, 40, Macedonia Avenue, 2238 Latsia, Cyprus
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Regber S, Mårild S, Johansson Hanse J. Barriers to and facilitators of nurse-parent interaction intended to promote healthy weight gain and prevent childhood obesity at Swedish child health centers. BMC Nurs 2013; 12:27. [PMID: 24308289 PMCID: PMC4175109 DOI: 10.1186/1472-6955-12-27] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 11/29/2013] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Susann Regber
- Nordic School of Public Health NHV, Box 12 133, Gothenburg SE- 402 42, Sweden
- Department of Public Health and Community Medicine, Public Health Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Staffan Mårild
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Johansson Hanse
- Nordic School of Public Health NHV, Box 12 133, Gothenburg SE- 402 42, Sweden
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
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Berntsson LT, Ringsberg KC. Health and relationships with leisure time activities in Swedish children aged 2-17 years. Scand J Caring Sci 2013; 28:552-63. [PMID: 24117615 DOI: 10.1111/scs.12081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 08/20/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Three cross-sectional time series studies, randomised and stratified for age and gender, were performed on children aged 2-17, studying their health and well-being. The studies were performed in the Nordic countries in 1984, 1996 and 2011. Long-term illness (LTI) and psychosomatic complaints (PSC) increased during the period. Data were collected from mailed questionnaires. METHODS Data of 1461 Swedish children from 2011 were used and compared with data from 1984 and 1996. Relationships between the health indicators (the absence of LTI, 13 diagnoses, the absence of PSC, six symptoms, six items of well-being) and 12 activities were analysed. RESULTS A total of 83.2% of the children were healthy and 16.8% had at least one LTI, boys 19.1% and girls 14.5%. PSC increased from 18.6% in 1996 to 23.1% in 2011. The distribution was higher in girls. Girls were more active than boys during leisure time. 'Reading books', 'visiting friends', 'listening to music' and 'activity in organisations' were related to an absence of PSC, LTI and well-being. 'Surfing/blogging on the Internet' was negatively related to LTI, PSC and well-being. Multiple regression showed that that 'visits or is visited by friends' was related with a low probability for LTI and also with a high probability for well-being. In the logistic regression analyses, the following variables were seen as promoting health most: 'visits or is visited by friends' and 'is active in organizations' for children aged 2-17 years, especially for boys and well-being. CONCLUSIONS The health of Swedish children declined between 1984 and 2011. Positive relationships were found between some activities and health as well as other activities related to ill health. The results suggest an increased focus on the activities that have positive relationships with health in order to promote health among children.
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Isma GE, Bramhagen AC, Ahlstrom G, Östman M, Dykes AK. Obstacles to the prevention of overweight and obesity in the context of child health care in Sweden. BMC FAMILY PRACTICE 2013; 14:143. [PMID: 24079391 PMCID: PMC3852529 DOI: 10.1186/1471-2296-14-143] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 09/19/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Overweight and obesity in younger children could better be brought in focus through a deeper understanding of how Child Health Care nurses (CHC-nurses) perceive their work with the problems of overweight at the CHC Centers. The aim of this study was to elucidate the CHC-nurses conceptions of their preventive work with childhood overweight and obesity in Child Health Care. METHOD A qualitative study, based on open-ended interviews, involving 18 CHC-nurses strategically selected from 17 CHC Centres in the southern part of Sweden using a phenomenographic approach. RESULTS Two categories of description emerged from the data: (i) Internal obstacles to the CHC- nurses' work with overweight in children and (ii) External obstacles to the management of overweight in children. The CHC-nurses conceived their work with overweight in Child Health Care to be complicated and constrained by several obstacles depending on the nurses' personal priorities, knowledge, responsibility and the absence of resources and cooperation, as well as the lack of uniform guidelines for preventing and managing childhood overweight and further a deficient management organisation. CONCLUSION Nurses' attention to monitoring overweight in children, and their initiative for prevention, is based on their conceptions of the obstacles that hinder them in their efforts. An increased awareness of the CHC-nurses conceptions of the priorities, their sense of responsibility and prevention practices is warranted. If measures in this direction are not taken there is a growing risk that overweight children will pass through the CHC without any formal recognition of their situation. There is an indication that the present level of the CHC-nurses' preventive work with childhood overweight has room for improvement in several areas. It is suggested that the specialist education of these health care professionals should be supplemented and that organisation of the management of childhood overweight should be also revised at the primary health care level.
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Affiliation(s)
- Gabriella E Isma
- Department of Care Sciences, Malmö University, Faculty of Health and Society, Malmö, Sweden
- Lund University, Faculty of Medicine, The Vårdal Institute (The Swedish Institute for Health Sciences), Lund, Sweden
| | - Ann-Cathrine Bramhagen
- Department of Care Sciences, Malmö University, Faculty of Health and Society, Malmö, Sweden
- Skånes University Hospital, Malmö, Sweden
| | - Gerd Ahlstrom
- Lund University, Faculty of Medicine, The Vårdal Institute (The Swedish Institute for Health Sciences), Lund, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Margareta Östman
- Department of Care Sciences, Malmö University, Faculty of Health and Society, Malmö, Sweden
| | - Anna-Karin Dykes
- Department of Care Sciences, Malmö University, Faculty of Health and Society, Malmö, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Health Sciences, Health Sciences Centre (HSC), Baravägen 3, Box 157, SE-221 00 Lund, Sweden
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Khanolkar AR, Sovio U, Bartlett JW, Wallby T, Koupil I. Socioeconomic and early-life factors and risk of being overweight or obese in children of Swedish- and foreign-born parents. Pediatr Res 2013; 74:356-63. [PMID: 23799533 DOI: 10.1038/pr.2013.108] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 02/28/2013] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- Amal R Khanolkar
- Centre for Health Equity Studies, Karolinska Institutet/Stockholm University, Stockholm, Sweden.
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Ekberg J, Timpka T, Angbratt M, Frank L, Norén AM, Hedin L, Andersen E, Gursky EA, Gäre BA. Design of an online health-promoting community: negotiating user community needs with public health goals and service capabilities. BMC Health Serv Res 2013; 13:258. [PMID: 23826944 PMCID: PMC3708753 DOI: 10.1186/1472-6963-13-258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 06/28/2013] [Indexed: 11/10/2022] Open
Abstract
Background An online health-promoting community (OHPC) has the potential to promote health and advance new means of dialogue between public health representatives and the general public. The aim of this study was to examine what aspects of an OHPC that are critical for satisfying the needs of the user community and public health goals and service capabilities. Methods Community-based participatory research methods were used for data collection and analysis, and participatory design principles to develop a case study OHPC for adolescents. Qualitative data from adolescents on health appraisals and perspectives on health information were collected in a Swedish health service region and classified into categories of user health information exchange needs. A composite design rationale for the OHPC was completed by linking the identified user needs, user-derived requirements, and technical and organizational systems solutions. Conflicts between end-user requirements and organizational goals and resources were identified. Results The most prominent health information needs were associated to food, exercise, and well-being. The assessment of the design rationale document and prototype in light of the regional public health goals and service capabilities showed that compromises were needed to resolve conflicts involving the management of organizational resources and responsibilities. The users wanted to discuss health issues with health experts having little time to set aside to the OHPC and it was unclear who should set the norms for the online discussions. Conclusions OHPCs can be designed to satisfy both the needs of user communities and public health goals and service capabilities. Compromises are needed to resolve conflicts between users’ needs to discuss health issues with domain experts and the management of resources and responsibilities in public health organizations.
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Affiliation(s)
- Joakim Ekberg
- Department of Medical and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden.
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Bohman B, Eriksson M, Lind M, Ghaderi A, Forsberg L, Rasmussen F. Infrequent attention to dietary and physical activity behaviours in conversations in Swedish child health services. Acta Paediatr 2013; 102:520-4. [PMID: 23356388 DOI: 10.1111/apa.12176] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 01/22/2013] [Accepted: 01/24/2013] [Indexed: 01/08/2023]
Abstract
AIM To investigate conversations between nurses and parents in Swedish child health services and to assess to what extent attention is directed towards dietary and physical activity behaviours in children. METHODS Twenty-three nurses audio-recorded one session each. Recordings were assessed and topics were classified according to predetermined categories. RESULTS The three most frequent topics of conversation concerned physical examinations of the child (30% of session time), talking to the child to establish or maintain contact and interest (15%), and development of language skills (12%). Dietary habits came on fourth place (10%), and physical activity ranked 14 (4%). CONCLUSION Attention to dietary and physical activity behaviours in children is infrequent in Swedish child health services. Concern is raised about the efficacy of prevention efforts against childhood obesity.
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Affiliation(s)
- B Bohman
- Department of Public Health Sciences; Karolinska Institutet; Stockholm; Sweden
| | | | - M Lind
- Child Health Services; Örebro County Council; Örebro; Sweden
| | | | - L Forsberg
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm; Sweden
| | - F Rasmussen
- Department of Public Health Sciences; Karolinska Institutet; Stockholm; Sweden
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Rosati P, Triunfo S, Scambia G. Child nutritional status: a representative survey in a metropolitan school. J Obes 2013; 2013:395671. [PMID: 23431424 PMCID: PMC3568893 DOI: 10.1155/2013/395671] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 01/05/2013] [Accepted: 01/05/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the prevalence of obesity, overweight, and thinness among children in an Italian school. METHODS Five hundred ninety-five children (289 males and 306 females) were enrolled, aged between 6 and 19 years old, in Italian school in Rome. Body mass index (BMI) was calculated according to International Obesity Task Force (IOFT) cut-off points. By age criterion all participants have been classified in age classes. RESULTS A normal BMI was recorded in 73.6% of all cases. Obesity, overweight, and thinness prevalence was 5.9%, 9.6%, and 10.9%, respectively, without statistical differences in both genders, except the prevalence of overweight that resulted statistically significant (13.1% males versus 6.2% females, P < 0.05). Differences in the age groups have been found. About 23.4% of children between 7 to 11 years were defined obese and about 42.3% between 6 to 8 years thin grade 2, respectively. CONCLUSION The study reports the low prevalence of overweight and obesity, in contrast to the unexpected thinness prevalence. The identification of specific age groups with abnormal nutritional status could be the first step to address future epidemiological investigations in order to plan strategic approach in selected age periods.
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Affiliation(s)
- Paolo Rosati
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Stefania Triunfo
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
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García García E, Vázquez López MÁ, Galera Martínez R, Alias I, Martín González M, Bonillo Perales A, Cabrera Sevilla JE, García Escobar I, Gómez Bueno S, López Ruzafa E, Muñoz Vico FJ, Oliva Pérez P, Ortiz Pérez M, Poveda González J, Rodríguez Lucenilla M, Rodríguez Sánchez FI, Ruiz Sánchez A, Ruiz Tudela L, Sáez MI, Salvador J, Torrico S. Prevalence of overweight and obesity in children and adolescents aged 2-16 years. ACTA ACUST UNITED AC 2013; 60:121-6. [PMID: 23337103 DOI: 10.1016/j.endonu.2012.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 09/20/2012] [Accepted: 09/24/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To estimate the prevalence of obesity and overweight in children and adolescents in our city and to investigate the associated factors. SUBJECTS AND METHODS A cross-sectional study of 1317 children and adolescents aged 2-16 years. Multistage probability sampling was used to select three groups of subjects: 411 aged 12 to 16 years, 504 aged 6 to 12 years, and 402 aged 2 to 6 years. Body mass index was calculated, and obesity and overweight were diagnosed using the threshold levels of the International Obesity Task Force for children and adolescents. Parents were asked about eating habits, health, social, and demographic aspects. Results are given as percentages (95% confidence interval). The relationship between obesity and overweight and the different variables was studied using multiple logistic regression. The adjusted odds ratio (OR) was calculated. RESULTS Among children and adolescents aged 2-16 years, 9.5% (8.0%-11.0%) were obese and 22.4% (23.3%-24.6%) were overweight. Of subjects aged 12-16 years, 8.5% (5.9%-11.2%) were obese and 20.5% (16.7%-24.3%) were overweight. In the groups aged 6-12 years and 2-6 years, rates of obesity and overweight were 11.6% (8.9% -14.3%) and 31.0% (27.0-35.0) and 8.0% (5.4%-10.6%) and 13.6% (10.3%-16.9%) respectively. Obesity or overweight was associated to age (OR 1.21; P<0.001), maternal obesity (OR 10.99; P= 0.008), a birthweight higher than 4kg (OR 2.91; p 0.002), and formula feeding (OR 1.82; P= 0.005). CONCLUSION Obesity and overweight in children and adolescents are highly prevalent problems in our city.
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Bohman B, Ghaderi A, Rasmussen F. Psychometric Properties of a New Measure of Parental Self-Efficacy for Promoting Healthy Physical Activity and Dietary Behaviors in Children. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2013. [DOI: 10.1027/1015-5759/a000159] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
There is a lack of validated measures of parental self-efficacy (PSE) covering both physical activity and dietary behaviors in children which can be used to prevent childhood obesity. This study developed a new measure of PSE for promoting healthy physical activity and dietary behaviors in children and assessed its psychometric properties. Participants were mothers (n = 2,232) with 3-year-old first-born children living in Stockholm, Sweden. The mothers responded to questionnaires measuring PSE, locus of control, and self-esteem. Exploratory factor analysis yielded a three-factor structure, interpreted as PSE for promoting healthy dietary behaviors in children (Factor 1), PSE for limit-setting of unhealthy dietary or physical activity behaviors in children (Factor 2), and PSE for promoting healthy physical activity behaviors in children (Factor 3). The factor model was supported by confirmatory factor analysis. The internal consistency and test-retest reliability of the new PSE measure were high; discriminant validity was adequate. The Parental Self-Efficacy for Promoting Healthy Physical Activity and Dietary Behaviors in Children Scale (PSEPAD) shows promise as a valuable instrument in childhood obesity prevention.
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Affiliation(s)
- Benjamin Bohman
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Ata Ghaderi
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Finn Rasmussen
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Elinder LS, Heinemans N, Hagberg J, Quetel AK, Hagströmer M. A participatory and capacity-building approach to healthy eating and physical activity- SCIP-school: a 2-year controlled trial. Int J Behav Nutr Phys Act 2012; 9:145. [PMID: 23245473 PMCID: PMC3545832 DOI: 10.1186/1479-5868-9-145] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 12/11/2012] [Indexed: 11/10/2022] Open
Abstract
Background Schools can be effective settings for improving eating habits and physical activity, whereas it is more difficult to prevent obesity. A key challenge is the “implementation gap”. Trade-off must be made between expert-driven programmes on the one hand and contextual relevance, flexibility, participation and capacity building on the other. The aim of the Stockholm County Implementation Programme was to improve eating habits, physical activity, self-esteem, and promote a healthy body weight in children aged 6–16 years. We describe the programme, intervention fidelity, impacts and outcomes after two years of intervention. Methods Nine out of 18 schools in a middle-class municipality in Sweden agreed to participate whereas the other nine schools served as the comparison group (quasi-experimental study). Tailored action plans were developed by school health teams on the basis of a self-assessment questionnaire called KEY assessing strengths and weaknesses of each school’s health practices and environments. Process evaluation was carried out by the research staff. Impacts at school level were assessed yearly by the KEY. Outcome measures at student level were anthropometry (measured), and health behaviours assessed by a questionnaire, at baseline and after 2 years. All children in grade 2, 4 and 7 were invited to participate (n=1359) of which 59.8% consented. The effect of the intervention on health behaviours, self-esteem, weight status and BMIsds was evaluated by unilevel and multilevel regression analysis adjusted for gender and baseline values. Results Programme fidelity was high demonstrating feasibility, but fidelity to school action plans was only 48% after two years. Positive and significant (p<.05) impacts were noted in school health practices and environments after 2 years. At student level no significant intervention effects were seen for the main outcomes. Conclusions School staff has the capacity to create their own solutions and make changes at school level on the basis of self-assessment and facilitation by external agents. However these changes were challenging to sustain over time and had little impact on student behaviours or weight status. Better student outcomes could probably be attained by a more focused and evidence-based approach with stepwise implementation of action plans.
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Affiliation(s)
- Liselotte Schäfer Elinder
- Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, 171 76, Stockholm, Sweden.
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Isma GE, Bramhagen AC, Ahlstrom G, Östman M, Dykes AK. Swedish Child Health Care nurses conceptions of overweight in children: a qualitative study. BMC FAMILY PRACTICE 2012; 13:57. [PMID: 22697580 PMCID: PMC3426496 DOI: 10.1186/1471-2296-13-57] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 06/14/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Registered Sick Children's Nurses and District Nurses employed at Child Health Care centres are in a position to help prevent childhood overweight and obesity. Prevention of this challenging public health threat could be improved through having a better understanding of how this group of nurses perceives childhood obesity. The aim of this study was to elucidate the conceptions of childhood overweight, including obesity, among nurses working in Child Health Care. METHOD A qualitative study using a phenomenographic approach, based on open-ended interviews with 18 Child Health Care nurses (CHC-nurses) strategically selected from 17 Child Health Care Centres in the southern part of Sweden. RESULTS Four categories of description emerged from the data: Perception of childhood overweight changes, Overweight in younger children a neglected concern, Overweight a delicate issue and Importance of family lifestyle. The participating CHC-nurses conceived overweight in children, primarily obesity in children to be an extensive and serious problem which affects children, families and the surrounding society. Overweight in children was further perceived as a consequence of their parent's lifestyle and their awareness of the problem, which was considered by the CHC-nurses as a sensitive and a provoking issue. It was also perceived that overweight in children is not taken seriously during the pre-school period and that concerns regarding overweight in younger children were mainly about the appearance and not the health of the child. The CHC-nurses perceived that the proportion of overweight children has increased, which Swedish society and the CHC-nurses have adapted to. This adaptation makes it difficult for CHC-nurses to define those children who are overweight. CONCLUSION CHC-nurses provide a comprehensive and complex picture of childhood overweight, which includes several difficulties dealing with this issue. Attention to CHC-nurse's conceptions of overweight in children is important since it can affect the parent-nurse relationship and thereby the nurse's, as well as the parent's efforts to influence the children's weight. It is suggested that CHC- nurses should work with person centered counseling and empowerment concerning parent to child relations in cases involving overweight.
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Affiliation(s)
- Gabriella E Isma
- Department of Health Care Sciences, Faculty of Health and Society, Malmö University, Malmö, Sweden
- The Swedish Institute for Health Sciences (Vårdalinstitutet), Lund University, Lund, Sweden
| | - Ann-Cathrine Bramhagen
- Department of Health Care Sciences, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Gerd Ahlstrom
- The Swedish Institute for Health Sciences (Vårdalinstitutet), Lund University, Lund, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Margareta Östman
- Department of Health Care Sciences, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Anna-Karin Dykes
- Department of Health Care Sciences, Faculty of Health and Society, Malmö University, Malmö, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
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Fåhraeus C, Wendt LK, Nilsson M, Isaksson H, Alm A, Andersson-Gäre B. Overweight and obesity in twenty-year-old Swedes in relation to birthweight and weight development during childhood. Acta Paediatr 2012; 101:637-42. [PMID: 22320837 DOI: 10.1111/j.1651-2227.2012.02623.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To describe the frequency of overweight and obesity from birth to 20 years of age and analyse weight at 20 years of age in relation to weight and weight development during early childhood and adolescence. METHODS A longitudinal, population-based study, which followed 496 children from birth to 20 years of age. Information about weight and height was collected from health records at child health centres and school health care. At 20 years of age, weight and height measurements were taken by one of the authors. RESULTS At 20 years of age, 124 (25%) of the youth were obese or overweight. Of these youths, 60% had normal weight at 5.5 years. Of the teenagers who were overweight/obese at 15 years, 79% remained overweight/obese at 20 years of age. Out of the 124 overweight/obese at 20, 47% had normal weight at 15 years. [Corrections added after online publication on April 18, 2012: 'Out of the 124 obese at 20' has been changed to 'Out of the 124 overweight/obese at 20']. No relation was found between rapid weight gain during preschool age and overweight and obesity in 20-year-olds. CONCLUSIONS The majority of those who were overweight/obese at 20 years of age were recruited after 5.5 years of age, and half of them in their late teens. Thus, during the preschool period, the entire population should be the target of primary prevention from overweight/obesity and, in the case of teenagers, prevention strategies should be developed for the whole population as well as treatment strategies for teenagers with established overweight/obesity.
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Affiliation(s)
- Christina Fåhraeus
- Department of Oral Health Science, School of Health Sciences, Jönköping University, Sweden.
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Vaezghasemi M, Lindkvist M, Ivarsson A, Eurenius E. Overweight and lifestyle among 13–15 year olds: A cross-sectional study in northern Sweden. Scand J Public Health 2012; 40:221-8. [DOI: 10.1177/1403494812443603] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim: To increase knowledge of self-rated health and lifestyle in relation to overweight/obesity among 13–15 year olds in northern Sweden. Methods: All 6768 13–15 year olds in nine out of 15 municipalities in Västerbotten County were asked to complete a cross-sectional school-based on-line survey in 2007. Eighty-two per cent participated in the study. Responses were considered reliable for 74% of the participants (2517 boys/2470 girls). The survey addressed demography, self-rated health, self-reported weight, height, and lifestyle characteristics. Simple and multiple logistic regression analyses were used. Results: Overweight/obesity (ISO body mass index ≥25 kg/m2) was more prevalent among boys (20%) than girls (11%), but more girls (19%) than boys (9%) reported fair or bad health. Overweight/obese boys and girls were more often physically inactive. For the boys, overweight/obesity was also associated with skipping breakfast, insufficient tooth brushing, and using snuff. For the girls, overweight/obesity was also associated with living with one parent and more television watching. Boys reported healthier habits concerning sleep duration, physical activity, eating breakfast, and smoking compared to the girls. On the other hand, girls reported better dietary and tooth brushing habits. Conclusions: This study uncovered two alarming findings: a fifth of the boys were overweight/obese and a fifth of the girls reported fair or bad health. Girls living with a single parent and boys and girls with unhealthy lifestyles were more likely to be overweight. Our findings emphasise the need for developing and implementing effective health promotion strategies for school-aged children to prevent an overweight and obesity epidemic that could continue into adulthood.
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Affiliation(s)
- Masoud Vaezghasemi
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Marie Lindkvist
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Statistics, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Eva Eurenius
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Lundkvist K, Sundquist K, Li X, Friberg D. Familial risk of sleep-disordered breathing. Sleep Med 2012; 13:668-73. [PMID: 22538192 DOI: 10.1016/j.sleep.2012.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 01/20/2012] [Accepted: 01/22/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To estimate the incidence of hospitalization for paediatric obstructive sleep apnoea syndrome (OSAS) or sleep-disordered breathing (SDB) caused by adenotonsillar or tonsillar hypertrophy without infection in children with a parent affected by OSAS. PATIENTS AND METHODS Using the MigMed database at Lund University, hospital data on all children aged 0-18 years in Sweden between 1997 and 2007 (total of 3 million individuals) were used to identify all first hospital admissions for OSAS or either adenotonsillar or tonsillar hypertrophy. Next, individuals were categorized as either having or not having a parent affected by OSAS. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were estimated for boys and girls with a parent affected by OSAS. Children with OSAS or adenotonsillar or tonsillar hypertrophy without a parent affected by OSAS acted as the reference group (SIR=1). RESULTS After accounting for socio-economic status, age, and geographic region, the SIRs of OSAS in boys and girls with a parent affected by OSAS were 3.09 (95% CI 1.83-4.90) and 4.46 (95% CI 2.68-6.98), respectively. The SIRs of adenotonsillar or tonsillar hypertrophy in boys and girls with a parent affected by OSAS were 1.82 (95% CI 1.54-2.14) and 1.56 (95% CI 1.30-1.87), respectively. CONCLUSION This study indicates familial clustering of sleep-disordered breathing, which is important information for clinicians.
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Affiliation(s)
- Karin Lundkvist
- Department of Otorhinolaryngology, Karolinska Institutet, Stockholm, Sweden.
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Norberg C, Hallström Stalin U, Matsson L, Thorngren-Jerneck K, Klingberg G. Body mass index (BMI) and dental caries in 5-year-old children from southern Sweden. Community Dent Oral Epidemiol 2012; 40:315-22. [PMID: 22469188 DOI: 10.1111/j.1600-0528.2012.00686.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 02/12/2012] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Carina Norberg
- Department of Paediatric Dentistry, Faculty of Odontology, Malmö University, Malmö, Sweden
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Dreyhaupt J, Koch B, Wirt T, Schreiber A, Brandstetter S, Kesztyüs D, Wartha O, Kobel S, Kettner S, Prokopchuk D, Hundsdörfer V, Klepsch M, Wiedom M, Sufeida S, Fischbach N, Muche R, Seufert T, Steinacker JM. Evaluation of a health promotion program in children: Study protocol and design of the cluster-randomized Baden-Württemberg primary school study [DRKS-ID: DRKS00000494]. BMC Public Health 2012; 12:157. [PMID: 22394693 PMCID: PMC3351371 DOI: 10.1186/1471-2458-12-157] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 03/06/2012] [Indexed: 11/16/2022] Open
Abstract
Background Increasing prevalences of overweight and obesity in children are known problems in industrialized countries. Early prevention is important as overweight and obesity persist over time and are related with health problems later in adulthood. "Komm mit in das gesunde Boot - Grundschule" is a school-based program to promote a healthier lifestyle. Main goals of the intervention are to increase physical activity, decrease the consumption of sugar-sweetened beverages, and to decrease time spent sedentary by promoting active choices for healthy lifestyle. The program to date is distributed by 34 project delivery consultants in the state of Baden-Württemberg and is currently implemented in 427 primary schools. The efficacy of this large scale intervention is examined via the Baden-Württemberg Study. Methods/Design The Baden-Württemberg Study is a prospective, stratified, cluster-randomized, and longitudinal study with two groups (intervention group and control group). Measurements were taken at the beginning of the academic years 2010/2011 and 2011/2012. Efficacy of the intervention is being assessed using three main outcomes: changes in waist circumference, skinfold thickness and 6 minutes run. Stratified cluster-randomization (according to class grade level) was performed for primary schools; pupils, teachers/principals, and parents were investigated. An approximately balanced number of classes in intervention group and control group could be reached by stratified randomization and was maintained at follow-up. Discussion At present, "Komm mit in das Gesunde Boot - Grundschule" is the largest school-based health promotion program in Germany. Comparative objective main outcomes are used for the evaluation of efficacy. Simulations showed sufficient power with the existing sample size. Therefore, the results will show whether the promotion of a healthier lifestyle in primary school children is possible using a relatively low effort within a school-based program involving children, teachers and parents. The research team anticipates that not only efficacy will be proven in this study but also expects many other positive effects of the program. Trial registration German Clinical Trials Register (DRKS), DRKS-ID: DRKS00000494
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Affiliation(s)
- Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Ulm University, Schwabstr, 13, D-89075 Ulm, Germany.
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Stenhammar C, Wells M, Ahman A, Wettergren B, Edlund B, Sarkadi A. 'Children are exposed to temptation all the time'- parents' lifestyle-related discussions in focus groups. Acta Paediatr 2012; 101:208-15. [PMID: 21854450 DOI: 10.1111/j.1651-2227.2011.02446.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To explore parents' perspectives on providing their preschool child with a healthy lifestyle, including obstacles and resources. METHODS Five semi-structured focus group interviews were conducted, with 30 parents of 4-year-olds in Sweden. Interviews were transcribed verbatim and analysed using Systematic Text Condensation. RESULTS Four themes emerged from the qualitative analysis: Lifestyle -'The way you live is parents' responsibility', Challenges to promote children's healthy lifestyle, Support from professionals, and peers might facilitate, and Request for an overall responsibility from society. Parents felt that they were role models for their child's lifestyle, a concept including many factors. Attractive and tempting sedentary activities and unhealthy foods were perceived as obstacles, and parents were frustrated by the media's contradictory lifestyle messages. Child health services were expected to more actively invite parents to discuss their child's lifestyle issues. Parents desired some collective responsibility for children's lifestyles through agencies, services and media messages that support and promote healthy choices. CONCLUSION Parents struggled to give their children a healthy lifestyle and the 'temptations' of daily unhealthy choices causing hassles and conflicts. Parents desired professional support from preschool, Child Health Care and a collective responsibility from society with uniform guidelines. Parents groups were mentioned as peer support.
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Affiliation(s)
- C Stenhammar
- Department of Women's and Children's Health, Uppsala University, Sweden.
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Larsen LM, Hertel NT, Mølgaard C, Christensen RD, Husby S, Jarbøl DE. Prevalence of overweight and obesity in Danish preschool children over a 10-year period: a study of two birth cohorts in general practice. Acta Paediatr 2012; 101:201-7. [PMID: 22133108 DOI: 10.1111/j.1651-2227.2011.02551.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To determine change in the prevalence of overweight and obesity in preschool children, over a 10-year period and to identify possible predictors of overweight in 5-year-old children. METHODS Anthropometric data from birth and routine child health examinations at 3 and 5 years of age performed in general practice were collected in 5580 children from two Funen birth cohorts (1992 and 2001, respectively) representing 48% of the total population at similar age. The prevalence of overweight and obesity was classified using the International Obesity Task Force definitions. RESULTS In a Danish representative survey of preschool children, the average body mass index (BMI) and prevalence of overweight and obesity did not vary significantly during the 10-year period. No significant changes in mean birth weight were registered and mean BMI in the group of obese children did not increase. Overweight or obesity at 5 years was strongly associated with overweight and obesity at 3 years and with birth weight and gender. CONCLUSION The prevalence of overweight and obesity was observed to be stable over a decade in Danish preschool children without changes in mean BMI in the group of obese children. A strong association between overweight and obesity at 3 and at 5 years of age was detected.
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Affiliation(s)
- Lone Marie Larsen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark.
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Abstract
It is unclear whether the obesity epidemic has come to a halt. Perhaps the incidence is declining, at least in pre-school children. However, the obesity rate is higher than ever before. Prevention is a priority, especially in children, but has not been very successful to date. Treatment has basically offered the same tools for decades. The recent development of obesity pharmacotherapy has regressed with--in most countries--only one drug of modest effect available. Bariatric surgery has therefore been considered one of the few solutions in the adult setting and is gaining increasing attention as a treatment option, even in pediatric extreme obesity. In some countries, government action for prevention has been taken, but too often resources have not been set aside. This review addresses new and old strategies to manage obesity--from childhood and onwards.
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Affiliation(s)
- Ylva Trolle Lagerros
- Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden.
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Kunešová M, Vignerová J, Pařízková J, Procházka B, Braunerová R, Riedlová J, Zamrazilová H, Hill M, Bláha P, Steflová A. Long-term changes in prevalence of overweight and obesity in Czech 7-year-old children: evaluation of different cut-off criteria of childhood obesity. Obes Rev 2011; 12:483-91. [PMID: 21457181 DOI: 10.1111/j.1467-789x.2011.00870.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this paper was an evaluation of change in prevalence of overweight and obesity in Czech children, and a comparison of cut-off points for body mass index references from the Czech Republic (CzR), International Obesity Task Force and WHO. The authors conducted a survey in 7-year-old children, and compared data from 1951, 1981, 1991, 2001 and 2008 (WHO cut-offs). 2008 data were evaluated according to different cut-offs. Results showed that since 1951 in boys, overweight prevalence increased from 13.0% in 1951 to 26.8% in 2001, in girls from 10.9% to 22.9%. Obesity increased in boys from 1.7% to 8.3%, in girls from 1.7% to 6.9%. From 2001 to 2008 obesity in boys increased; obesity in girls and overweight in both genders decreased. In 2008 cohort the following values were found: overweight and obesity: CzR criteria, percentage was lowest (14.8% boys and 11.1% girls); WHO criteria, highest prevalence (23.5% boys and 19.5% girls); obesity: lowest ratio International Obesity Task Force criteria (4.4% boys, 3.3% girls), highest ratio boys WHO criteria (10.0%), girls CzR criteria (5.0%). Overweight and obesity prevalence increased in 7-year-old Czech children since 1951; since 2001 prevalence is plateauing with exception of boys. Using different body mass index references resulted in marked differences in overweight and obesity prevalence.
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Affiliation(s)
- M Kunešová
- Obesity Unit, Institute of Endocrinology, Prague, Czech Republic.
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Monasta L, Batty GD, Macaluso A, Ronfani L, Lutje V, Bavcar A, van Lenthe FJ, Brug J, Cattaneo A. Interventions for the prevention of overweight and obesity in preschool children: a systematic review of randomized controlled trials. Obes Rev 2011; 12:e107-18. [PMID: 20576004 DOI: 10.1111/j.1467-789x.2010.00774.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to analyse interventions for the prevention of overweight and obesity in children under 5 years of age. We carried out a systematic review focusing exclusively on randomized controlled trials (RCTs). Data sources include Medline, Cochrane Library, EMBASE, CINHAL, PsychInfo and Web of Science. Data were extracted from seventeen articles describing seven RCTs identified through electronic search, screening of references in systematic reviews, own files and contact with authors. RCTs were assessed with the Jadad scale. Four trials were carried out in preschool settings, one with an exclusive educational component, two with an exclusive physical activity component and one with both. Two trials were family-based, with education and counselling for parents and children. The remaining trial was carried out in maternity hospitals, with a training intervention on breastfeeding. None of the interventions had an effect in preventing overweight and obesity. The failure to show an effect may be due to the choice of outcomes, the quality of the RCTs, the suboptimal implementation of the interventions, the lack of focus on social and environmental determinants. More rigorous research is needed on interventions and on social and environmental factors that could impact on lifestyle.
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Affiliation(s)
- L Monasta
- Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Italy.
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