Trends in growth and obesity in ethnic groups in Britain

Variation in the Socioeconomic Gradient of Obesity by Ethnicity - England's National Child Measurement Programme

OBJECTIVE

This study examined the prevalence and risk of overweight/obesity among expanded ethnicity categories within boys and girls in England and the differential influence of socioeconomic position using the 2015/2016 and the 2016/2017 cycles of the National Child Measurement Programme.

METHODS

This cross-sectional and descriptive study examined surveillance data of weight status among primary school children in England. Data were pooled across data collection years, representing 1.25 million children in Reception (aged 4-5 years) and 1.1 million children in Year 6 (aged 10-11 years). Ethnicity was classified according to National Health Service definitions, and child residence was used to calculate quintiles of Income Deprivation Affecting Children Index. Measured weight status was classified using the International Obesity Task Force's definition. Logistic regression models were run for each sex and year group.

RESULTS

Within each sex, ethnicity- and socioeconomic-specific differentials in overweight/obesity prevalence were evident. For example, among the five most populous ethnic groups in the most deprived quintile, 26.8% of White British girls in Reception had overweight/obesity compared with 20.7% of girls with Pakistani, 31.2% with Black African, 17.1% with Indian, and 22.2% with any Any Other White (e.g., White European) background.

CONCLUSIONS

Ethnicity had an independent influence on overweight/obesity risk after adjustment for socioeconomic position.

Prevalence of obesity in children aged 6-12 years in Greece: nutritional behaviour and physical activity

INTRODUCTION

During the last two decades, obesity has proved to be one of the most important problems of public health, and it is considerably more frequent in developed countries, not only in adults, but in children, too. The aim of the current study is to evaluate the prevalence of overweight and obesity in children.

MATERIAL AND METHODS

Two thousand three hundred and seventy-four pupils in primary education were considered for the study (1206 boys and 1168 girls).

RESULTS

In the population-based study, the proportion of overweight children was 23.9%, of obese children 7.3%, and of those with central obesity 35.5%. The boys were obese in a higher percentage than the girls (9.2% vs. 5.3%, p < 0.05). The obesity rates were gradually reduced as the children were growing older. The nutritional habits which were identified to have a positive association with obesity were the following: skipping breakfast, not consuming fruits and vegetables, and consuming bread and soft drinks. Children's healthy nutrition in school was related to lower rates of generalised and central obesity, while the hours spent watching TV were positively associated with all types of obesity.

CONCLUSIONS

Results from the study suggest that a high proportion of children are overweight or obese. Therefore, it is important to adhere to a healthy lifestyle which emphasizes healthy food choices and habits, regular physical activity, and limiting screen time.

Unevenly distributed: a systematic review of the health literature about socioeconomic inequalities in adult obesity in the United Kingdom

BACKGROUND

There is a growing literature documenting socioeconomic inequalities in obesity risk among adults in the UK, with poorer groups suffering higher risk.

METHODS

In this systematic review, we summarize and appraise the extant peer-reviewed literature about socioeconomic inequalities in adult obesity risk in the UK published between 1980 and 2010. Only studies featuring empirical assessments of relations between socioeconomic indicators and measures of obesity among adults in the UK were included.

RESULTS

A total of 35 articles met inclusion criteria, and were reviewed here.

CONCLUSION

Socioeconomic indicators of low socioeconomic position (SEP), including occupational social class of the head-of-household at birth and during childhood, earlier adulthood occupational social class, contemporaneous occupational social class, educational attainment, and area-level deprivation were generally inversely associated with adult obesity risk in the UK. Measures of SEP were more predictive of obesity among women than among men. We outline important methodological limitations to the literature and recommend avenues for future research.

Socioeconomic inequalities in childhood obesity in the United Kingdom: a systematic review of the literature

Childhood obesity is a major public health challenge worldwide. There is a growing literature documenting socioeconomic inequalities in childhood obesity risk. Here we draw inference from the literature about inequalities in childhood obesity risk in the UK. We summarize and appraise the extant peer-reviewed literature about socioeconomic inequalities in childhood obesity in the UK. Common area-level indices of socioeconomic position, including the Carstairs Deprivation Index, the Index of Multiple Deprivation and the Townsend Deprivation Index, as well as common household and individual-level metrics of childhood socioeconomic position, including head-of-household social class and maternal education, were generally inversely associated with childhood obesity in the UK. We summarize key methodological limitations to the extant literature and suggest avenues for future research.

Ethnic inequalities in obesity among children and adults in the UK: a systematic review of the literature

Ethnic minority groups are growing as a proportion of the British population. Although disparate, literature suggests inequalities in obesity risk within and among ethnic minority groups relative to Caucasians in the UK. We summarize and appraise the existing peer-reviewed literature about the prevalence and determinants of obesity among ethnic minority groups relative to Caucasians among children and adults in the UK. There was no consensus about obesity prevalence relative to Caucasians among South Asian or Black children or among South Asian adults relative to Caucasians. Black adults generally had higher risk for obesity than Caucasians. Both Chinese children and adults had lower risk for obesity than Caucasians. Few studies have considered differences in the aetiology of obesity by ethnicity. The lack of consensus regarding obesity risk among large ethnic minority groups relative to Caucasians in the UK, and the paucity of studies concerned with differences in obesity aetiology by ethnicity warrant further research in this area. Certain obesity metrics may bias obesity prevalence among particular ethnic groups relative to Caucasians. We summarize key methodological limitations to the current literature and suggest avenues for future research.

The relationship between obesity and blood pressure differs by ethnicity in Sydney school children

BACKGROUND

The objective of this study was to investigate the relationship between obesity and high systolic blood pressure (SBP) in Southeast Asian (SEAsian) and Australian children living in Australia.

METHODS

SBP, country of birth, and obesity indices (body mass index (BMI), waist circumference (WC), and percent body fat (%TBF)) were recorded in 1,232 9-year-old children from Sydney schools and remeasured 3 years later (n = 628). The relationship between SBP and obesity (both at baseline and longitudinally) was investigated by regression analyses.

RESULTS

Children of SEAsian origin had a significantly higher risk of high SBP with increases in obesity indices compared to those of Australian origin. At 9 years old, SBP increased 1.51 mm Hg for each of BMI increase for SEAsian children compared to 1.05 mm Hg for Australian children (P(interaction) = 0.03). These same significant analysis of variance (ANOVA) interactions were seen with WC (P(interaction) = 0.02) and %TBF (P(interaction) = 0.04) as predictors of SBP. These differences by ethnic background were also reflected in the 3-year longitudinal analysis where SEAsian children showed higher risk of increasing SBP with BMI increase (SBP increased 1.70 mm Hg for each unit of BMI increase for SEAsian children compared to 0.80 mm Hg for Australian children (P(interaction) = 0.02)) or with WC increase (P(interaction) = 0.01), whereas these increases were small and nonsignificant in Australian children.

CONCLUSION

These findings suggest that SEAsian children living in Australia are at higher risk of increasing SBP than their Australian counterparts when they become overweight or obese.

Ethnic differences in adolescent lung function: anthropometric, socioeconomic, and psychosocial factors

RATIONALE

The relative contribution of body proportion and social exposures to ethnic differences in lung function has not previously been reported in the United Kingdom.

OBJECTIVES

To examine ethnic differences in lung function in relation to anthropometry and social and psychosocial factors in early adolescence.

METHODS

The subjects of this study were 3,924 pupils aged 11 to 13 years, of whom 80% were ethnic minorities with satisfactory lung function measures. Data were collected on economic disadvantage, psychological well-being, tobacco exposure, height, FEV(1), and FVC.

MEASUREMENTS AND MAIN RESULTS

The lowest FEV(1) was observed for Black Caribbean/African children after adjusting for standing height (SH) (white boys: 2.475 L; 95% confidence interval [CI], 2.442-2.509; white girls: 2.449 L; 95% CI, 2.464-2.535]; Black Caribbean boys: -14% [95% CI, -16 to -12]; Black Caribbean girls: -13% [95% CI, -16 to -11]; Black African boys: -15% [95% CI, -17 to -13]; Black African girls: -17% [95% CI, -19 to -14]; Indian boys: -13% [95% CI, -16 to -11]; Indian girls: -11% [95% CI, -14 to -8]; Pakistani/Bangladeshi boys: -7% [95% CI, -9 to -5]; Pakistani/Bangladeshi girls: -9% [95% CI, -11 to -6]). Adjustment for upper body segment instead of SH achieved a further reduction in ethnic differences of 41 to 51% for children of Black African origin and 26 to 39% for the other groups. Overcrowding (boys) and poor psychological well-being (boys and girls) were independent correlates of FEV(1), explaining up to a further 10% of ethnic differences. Similar patterns were observed for FVC. Social exposures were also related to height components.

CONCLUSIONS

Differences in upper body segment explained more of the ethnic differences in lung function than SH, particularly among Black Caribbeans/African subjects. Social correlates had a smaller but significant impact. Future research needs to consider how differential development of lung capacity is compromised by the social patterning of growth trajectories.

Obesity in asylum seekers' children in The Netherlands--the use of national reference charts

BACKGROUND

Growth assessment can be used to monitor health at individual and population level. For asylum seekers' children with different geographic backgrounds, growth reference values are frequently not available. We assessed nutritional condition and growth of asylum seekers' children upon arrival and follow-up in The Netherlands, using national growth charts, and related these parameters to geographic origin.

METHODS

Height and weight of 135 children originating from Africa (n=47), Central Asia (n=41), and Eastern Europe (n=47), were assessed longitudinally (median follow-up 3 years, range 1-8 years). Body-mass-index (BMI) was calculated, and overweight and obesity were defined according the international BMI cut-off values for age and gender.

RESULTS

Upon arrival at a median age of 4.5 years (range 0-11.5 years), 13% of the children were small for age (below -2 SD of the Dutch height for age reference), which decreased to 5% during follow-up (P<0.05). During follow-up, 90% of the height measurements in boys and 85% in girls were within the normal range (+/-2 SD) of the Dutch references. The proportion of children with overweight including obesity increased from 15% at arrival to 21% during follow-up (P<0.05). Irrespective of age, children originating from Africa were taller than children from Central Asia or Eastern Europe at follow up (P<0.05). Overweight and obesity was most prominent among children of Eastern Europe.

CONCLUSION

Dutch national reference values allow monitoring growth and the development of overweight or obesity in asylum seekers' children in The Netherlands. Prevention strategies to reduce the development of overweight and obesity among these children seem warranted.

Overweight hypothesis in asthma and eczema in young adolescents

BACKGROUND

A positive association between body mass index (BMI) and allergic diseases has recently been suggested; however the sex-dependence of this association remains controversial. The aim of the present study was to explore the relationship between BMI and asthma and eczema, as well as its sex-dependence in young adolescents.

METHODS

Self-reported data obtained through the standardized International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three written questionnaires of 2926 young adolescents aged 13-14 years old from randomly selected schools in Skopje (Republic of Macedonia) were used. The BMI for each individual was calculated and used-both unadjusted and adjusted for confounding factors-as a variable for analysis. The international cut-off points for BMI for overweight and obesity by sex and age were used. Because of the very low prevalence of obesity (1.5 %), obese respondents were included in the overweight group. The data were statistically analyzed by the chi-square test, the t-test for independent samples and odds ratios (OR, 95 % CI) in binary logistic regression.

RESULTS

Being overweight was significantly associated with an increased risk of having a dry night cough without a cold or chest infection (adjusted OR: 1.54; 95 % CI: 1.09-2.16; p = 0.01) and with having had self-reported asthma at some time (adjusted OR: 2.36; 95 % CI: 1.02-5.44; p = 0.04) in boys only. A significant association between overweight and other symptoms of asthma or atopic eczema was not established.

CONCLUSION

These findings suggest a male-specific positive association between overweight and a current dry night cough and having received a diagnosis of asthma at some time. No association was found with other asthma symptoms or atopic eczema in young adolescents.

Anthropometry and blood pressure differences in black Caribbean, African, South Asian and white adolescents: the MRC DASH study

OBJECTIVES

In this first large-scale study of ethnic differences in blood pressure (BP) among British adolescents, we examine the differences in BP levels in adolescence and the extent to which age, sex, body size and stage of maturation affect any observed differences.

METHOD

A total of 6365 11-13 year olds (including 1189 white, 907 black Caribbeans and 1056 black Africans, 473 Indians, 605 Pakistanis and Bangladeshis, and 548 of mixed ethnicity) had systolic blood pressure (SBP) and diastolic blood pressure (DBP), anthropometry and pubertal stage measured in 2003.

RESULTS

Compared with their white UK counterparts, black Caribbean and African boys were taller, and black Caribbean and African girls were taller, larger and matured earlier. Except for DBP among Indian girls, BP in minority groups was generally lower than in white UK children. Adjusted for age, height and body mass index, mean SBP was 109.1 mmHg (95% confidence interval 108.4, 109.8) and DBP 65.7 mmHg (65.2, 66.3) among white UK boys. Black Caribbean boys had lower SBP (-2.0; -3.2, -0.9 mmHg) and DBP (-1.5; -2.3, -0.6), and black African (-2.3; -3.4, -1.2) and mixed ethnicity (-1.6; -2.9, -0.3) boys had lower SBP. Adjusted SBP was 108.5 (107.8, 109.3) and DBP was 67.5 mmHg (66.9, 68.1) among white UK girls. Pakistani (-1.8; -3.2, -0.4) and black African (-1.1; -1.9, -0.3) girls had lower SBP and Indian girls (1.2; 0.1, 2.4) had higher DBP. Unlike African American girls, late puberty was not associated with higher BP in minority groups.

CONCLUSION

At these ages, the ethnic-specific patterns in BP in adulthood were not observed. Apart from higher DBP for Indian girls, BP in minority groups was generally lower than their white UK counterparts. Targeting intervention in adolescence may be a critical opportunity for preventing ethnic differences in BP in later life.

Major differences in prevalence of overweight according to nationality in preschool children living in Germany: determinants and public health implications

AIMS

To investigate the prevalence of overweight according to nationality in preschool children living in Germany, and to establish the determinants responsible for differences in body mass index.

METHODS

The study was performed within the context of the 2001/2002 obligatory health examination before school entry in the city of Aachen, Germany. Of 2020 eligible children 1979 children were recruited (participation rate: 98%). Children's height and weight were measured using a standardised protocol. The parents completed a standardised questionnaire on sociodemographic factors and possible determinants of nutritional status. Being overweight was defined according to age and sex specific reference values for German children as well as according to international reference values.

RESULTS

The study population included 452 (22.9%) children with other than German nationality. Among these children the prevalence of overweight was twice as high than among German children (14.8% v 7.2%). Prevalence of most known risk factors for overweight, such as low physical activity, high consumption of soft drinks, and frequent visits to fast-food restaurants was higher in the children with other nationalities than in the German children. Multivariate analyses revealed that most of the difference in prevalence of obesity by nationality is explained by known risk factors of overweight, especially education of mother and watching TV.

CONCLUSIONS

The apparent ethnic differences could be explained by two non-ethnic but socioeconomic factors. In preventing overweight in children, there is the need to identify and deal with high risk environments rather than high risk ethnic groups.

Increasing body weight predicts the earlier onset of insulin-dependant diabetes in childhood: testing the 'accelerator hypothesis' (2)

AIMS AND METHODS

It has recently been hypothesized that weight gain in childhood accelerates the onset of Type 1 diabetes, as well as increasing its risk, and that Type 1 diabetes and Type 2 diabetes may be one and the same disorder of insulin resistance. An explanation is needed for the rising incidence of childhood diabetes and, to test the Accelerator Hypothesis, we examined the anthropometric measurements recorded from birth in 168 young people presenting with Type 1 diabetes between 1980 and 2002. Pre-onset as well as peri- and post-onset measurements of height and weight were available, and waist circumference was recorded at various intervals after onset.

RESULTS

The mean birth weight of the children and their height, weight and body mass index (BMI) at diagnosis lay close to the population mean. However, pre-onset and post-onset BMI were both well above the population mean, were closely correlated with each other (r = 0.79, P < 0.001) and (inversely) with age at onset (r = -0.30, P < 0.001). A significant correlation was also found between BMI standard deviation scores (sds) and year of diagnosis (r = 0.27, P < 0.001) and, importantly, waist circumference sds in the children with Type 1 diabetes was found to be substantially greater than average for the population [boys: +0.96 (sd 1.04), girls: +1.30 (sd 0.89)].

CONCLUSIONS

The data suggest that children with Type 1 diabetes have become progressively heavier at diagnosis over the past 20 years, and that the heavier child develops it earlier. Waist circumference, a proxy for visceral fat mass and insulin resistance, is substantially greater in children with Type 1 diabetes. Weight centile crossing appears to be an important environmental accelerator which may contribute to or account for the striking increase in both Type 1 diabetes and Type 2 diabetes in childhood. A reduction of body weight and improved lifestyle might reverse this trend in both types of diabetes.

Ethnic group differences in overweight and obese children and young people in England: cross sectional survey

AIMS

To determine the percentage of children and young adults who are obese or overweight within different ethnic and socioeconomic groups.

METHODS

Secondary analysis of data on 5689 children and young adults aged 2-20 years from the 1999 Health Survey for England.

RESULTS

Twenty three per cent of children (n = 1311) were overweight, of whom 6% (n = 358) were obese. More girls than boys were overweight (24% v 22%). Afro-Caribbean girls were more likely to be overweight (odds ratio 1.73, 95% CI 1.29 to 2.33), and Afro-Caribbean and Pakistani girls were more likely to be obese than girls in the general population (odds ratios 2.74 (95% CI 1.74 to 4.31) and 1.71 (95% CI 1.06 to 2.76), respectively). Indian and Pakistani boys were more likely to be overweight (odds ratios 1.55 (95% CI 1.12 to 2.17) and 1.36 (95% CI 1.01 to 1.83), respectively). There were no significant differences in the prevalence of obese and overweight children from different social classes.

CONCLUSION

The percentage of children and young adults who are obese and overweight differs by ethnic group and sex, but not by social class. British Afro-Caribbean and Pakistani girls have an increased risk of being obese and Indian and Pakistani boys have an increased risk of being overweight than the general population. These individuals may be at greater combined cumulative risk of morbidity and mortality from cardiovascular disease and so may be a priority for initiatives to target groups of children at particular risk of obesity.

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

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

OBJECTIVE

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

DESIGN

Cohort study.

SUBJECTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

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

Type 2 and other forms of diabetes in 0-30 year olds: a hospital based study in Leeds, UK

BACKGROUND AND AIMS

Following recent reports of increased numbers of adolescents being diagnosed with the adult or type 2 form of diabetes we aimed to describe the prevalence of both type 2 and other forms of diabetes in an urban population of children and young people in northern England.

METHODS

A hospital based cross sectional study was performed in patients aged < or =30 years attending diabetic clinics in Leeds during the year 2000.

RESULTS

A total of 677 subjects were identified, of whom 621 (92%) and 37 (5%) had type 1 and type 2 diabetes respectively. Four patients had confirmed maturity onset diabetes of the young, while the cause was uncertain for four. Median age of all patients was 22 years, with 396 (58%) aged 20-30; 32/37 patients with type 2 diabetes were aged 20-30. The prevalence of type 2 diabetes was 0.13 per 1000 overall, compared to 2.2 per 1000 for patients with type 1 diabetes. Of all type 2 diabetes patients, 24% were south Asian compared to 5% of the background population; 87% were categorised into the two least affluent tertiles of the Townsend score. This link with deprivation was not explained by the proportion of Asian patients across tertiles (approximately 25%).

CONCLUSIONS

This study shows extremely low prevalence of type 2 diabetes in 10-19 year olds, but will provide a baseline for future comparisons. Overall, type 2 diabetes is seen more commonly in south Asians, and an association with deprivation is suggested.

[Immigration: indicators or growth and nutrition]

In the last few years, many immigrant and adopted children from poor countries have come to live in Spain and the number is increasing. In this article we indicate which standard references can help pediatricians to determine the nutritional status and growth of these children whose social, personal and familial histories are different from our own and sometimes unknown. In these cases application of the standard national growth charts of the receiving country is recommended.

Social inequalities and children's height in Trinidad and Tobago

OBJECTIVE

The aim of the study was to report the association of socio-economic factors with child's height.

DESIGN

Cross-sectional study based on a representative national sample of government schools.

SETTING

Trinidad and Tobago in 1999.

SUBJECTS

A total of 2608 boys and girls mean age 5.8 y, range 4.38-6.99 y and 3080 mean age 8.6 y, range 7.00-10.44 y olds.

OUTCOME

Measurement of height and a questionnaire completed by parents. In the analysis height was expressed as standard deviation scores (s.d.s.) based on the British height curves (1990) or height below -1.5 s.d.s.

RESULTS

Ethnicity, parental heights, birthweight, maternal age at child's birth and number of children in the family were the main factors associated with children's height. Lack of piped water supply in the home was the only socio-economic factor consistently associated with height (mean difference in s.d.s. adjusted only for age group, gender and ethnicity -0.192, 95% CI -0.257 to -0.127 and in addition adjusted for the variables listed above -0.080, 95% CI -0.141 to -0.019). Parental education, household overcrowding and employment status were weakly associated with height in the partially adjusted model only. Analysis of severe growth failure gave similar results.

CONCLUSION

The impact of socio-economic factors on height is marginal in Trinidad and Tobago. As socio-economic factors may have an impact on a broad range of health indicators, height and rates of undernutrition should not be used as sole criteria for assessing progress in decreasing health differentials caused by social inequalities.

Prevalence of overweight and obesity and trends in body mass index in German pre-school children, 1982-1997

OBJECTIVE

To examine the prevalence of overweight and obesity in the entire population of 5- and 6-y-old children entering school in Germany, Bavaria, and to assess time trends over the last 15 y and the impact of ethnicity.

DESIGN

Cross-sectional studies were based on the obligatory school entry health examinations: all health districts of Bavaria in 1997 (n=127 735); three health districts every 5 y from 1982 to 1997 (n=16 281).

MEASUREMENTS

Body mass index (BMI; kg/m(2)) was calculated and the prevalence of overweight and obesity was defined based on national and international agreed cut-off points. Ethnicity was measured as German and non-German nationality.

RESULTS

The prevalence of overweight and obese children as defined by international reference values was 9.4 and 3.1% for 5-y-old boys, 10.0 and 2.9% for 6-y-old boys, 12.2 and 3.3% for 5-y-old girls and 12.4 and 3.3% for 6-y-old girls. The whole BMI distribution in non-German children compared to German children was shifted to the right with median values in non-German children 0.3-0.5 kg/m(2) higher. In these the prevalence of overweight/obesity was 1.9/2.4 times higher for boys and 1.5/1.9 times higher for girls. The time trend between 1982 and 1997 shows an increase of the BMI distribution in the upper percentiles, whereas the lower percentiles did not change substantially. The increased prevalences of overweight/obesity for both sexes as defined by international references increased from 8.5/1.8% in 1982 to 12.3/2.8% in 1997.

CONCLUSION

This large study on all children entering school in Bavaria in 1997 shows patterns of overweight and obesity which are comparable with other European data but are lower than US and Australian data. Increasing prevalences since 1982 indicate that overweight and obesity in children are of increasing public health importance in Bavaria. The upwards shift of the BMI distribution in non-German children needs further investigation.

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

OBJECTIVE

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

DESIGN

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

SUBJECTS

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

MEASURES

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

RESULTS

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

CONCLUSION

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

Reference growth curves for cypriot children 6 to 17 years of age

OBJECTIVE

The purpose of the study was to present smoothed percentiles for body weight and height, waist circumference, and body mass index (BMI) in Cypriot children and to compare their BMI 85th and 95th percentiles with those of children in other countries.

RESEARCH METHODS AND PROCEDURES

The study was a cross-sectional study, including a representative sample of 2472 healthy children (49.1% boys) in Cyprus ages 6 to 17 years, who were evaluated during the 1999-2000 school year. Body weight and height and waist circumference were measured using standard procedures. BMI was calculated as weight in kilograms per height in square meters. Smoothed, sex-specific percentiles for these variables were calculated using polynomial regression models. Crude weight, height, waist, and BMI percentile values are presented in sex-specific tables and smoothed percentile curves are presented in charts. The 85th and 95th percentiles for BMI were compared with measurements from other countries, because of the concern of the upper limits of BMI in respect to the evaluation of obesity.

RESULTS

The 85th and 95th BMI percentile values are higher in Cypriot boys than in Swedish and Iranian boys through all ages and in girls ages 6 to 15 years, whereas after the age of 15 years, both Swedish and Iranian girls' percentiles are equalized with their Cypriot peers.

DISCUSSION

Weight, height, waist circumference, and BMI values and charts are presented for the first time for Cypriot children and adolescents. Much concern should be addressed to the observation that for the majority of the Cypriot sample, the upper BMI limits are higher than the peers of developing and developed countries.

Can the increase in body mass index explain the rising trend in asthma in children?

BACKGROUND

The reported association between asthma and obesity and the documented rise in each over time have led to suggestions that rising obesity might explain the increase in the prevalence of asthma. Trends in both in British children participating in the National Study of Health and Growth were marked from 1982 to 1994.

METHODS

Odd ratios for trends in asthma and symptoms in 8 and 9 year old children were calculated with and without adjustment for body mass index (BMI).

RESULTS

In a representative sample of white children the odds ratio per year for asthma was 1.09 (95% CI 1.07 to 1.11) before and after adjustment for BMI for boys and 1.09 (95% CI 1.07 to 1.12) and 1.09 (95% CI 1.05 to 1.12), respectively, for girls. Unadjusted and adjusted odds ratios were also virtually identical for wheeze and "asthma or bronchitis". The lack of effect of adjustment was due to a change in the association between BMI and symptoms with time.

CONCLUSIONS

Trends in overweight and obesity do not explain the increase in asthma. The evidence points towards the association between asthma and obesity being of recent origin. This may be explained by obesity being a marker of recent lifestyle differences now associated with both asthma and overweight.

Childhood and adolescent obesity. Prevalence and significance

The prevalence of children and adolescents with body mass index (BMI) of greater than 95th percentile has doubled in the last 2 decades (present prevalence is 10.9%) and there is a 50% increase in the prevalence of those with a BMI greater than 85th percentile (present prevalence is 22.0%) in the US. There are substantial risks for morbidity in obese children even before they reach adulthood. Further, if obesity in childhood persists into the adult years, the morbidity and mortality is greater than if the obesity developed in the adult. Screening using appropriate historical and physical data will reveal those children most in need of modification of weight gain.

Trends in BMI among Belgian children, adolescents and adults from 1969 to 1996

OBJECTIVE

To document secular data on changes in the distribution of body mass index (BMI), to determine the probability of overweight at 40 y of age in Belgian males in relation to the presence or absence of overweight at different ages in adolescence, and to estimate tracking of BMI in Belgian males in Belgium aged 12-40 y.

DESIGN

Cross-sectional and mixed longitudinal surveys in nationally representative samples of Belgian males and females.

SUBJECTS

Cross-sectional-more than 21 000 boys and 9698 girls; to examine secular trends-3164 boys and 5140 girls; to examine tracking-161 males.

MEASURES

Body mass and height to determine BMI.

RESULTS

In Belgian children the degree of overweight has increased between 1969 and 1993. Tracking of BMI is high in adolescence (r=0.77) and adulthood (r=0.69-0.91) and moderate from adolescence to adulthood (r=0.49). In Belgian males, the probability of overweight at 40 y of age in the presence of overweight at different ages in adolescence is important (odds ratios 5.0-6.9).

CONCLUSIONS

Cross-sectional and longitudinal data, trends and tracking of BMI from 1969 until 1996 in Belgium indicate an increase in the degree of childhood overweight and obesity. Moreover, the risk of an overweight male adolescent becoming an overweight adult is substantial. Measures to restrict the Belgian overweight and obesity epidemic should be taken.

Association between obesity and asthma in 4-11 year old children in the UK

BACKGROUND

There is evidence of a positive association between asthma and obesity in adults and in children. We investigated, in a large sample of English and Scottish primary school children, whether there is a consistent association between fatness and asthma symptoms in Britain.

METHODS

A cross sectional analysis was made of 18 218 children aged 4-11 years who participated in the 1993 or 1994 surveys of the National Study of Health and Growth (NSHG). Children belonged either to English or Scottish representative samples, or an English inner city sample. Asthma attacks in the previous year, occasional wheeze, or persistent wheeze were the symptoms used in the analysis. Body mass index (BMI) and the sum of triceps and subscapular skinfolds converted to standard deviation scores (SDS) were used to assess levels of fatness.

RESULTS

A total of 14 908 children (81.8%) were included in the analysis. In the multiple logistic analysis BMI and asthma (asthma attacks or wheeze) were associated in the representative sample (OR for the comparison of the 10th and 90th centiles of BMI 1.28, 95% CI 1.11 to 1.48), but sum of skinfolds was unrelated to asthma symptoms in most analyses. The association between asthma and BMI was stronger in girls than in boys in the inner city sample, but less convincingly in the representative sample.

CONCLUSIONS

Levels of obesity are associated with asthma symptoms regardless of ethnicity. The association is more consistent for BMI than for sum of skinfolds, partly because obese children are more advanced in their maturation than other children. There is some evidence that, as in adults, the association is stronger in girls than in boys, but only in the multiethnic inner city sample.

Prevalence and trends in overweight and obesity in three cross sectional studies of British Children, 1974-94

OBJECTIVES

To report trends in overweight and obesity, defined by new internationally agreed cut-off points, in children in the United Kingdom.

DESIGN

Three independent cross sectional surveys.

SETTING

Primary schools in England and Scotland.

PARTICIPANTS

10 414 boys and 9737 girls in England and 5385 boys and 5219 girls in Scotland aged 4 to 11 years.

MAIN OUTCOME MEASURES

Prevalence and change in prevalence of overweight and obesity, as defined by the international obesity task force, in 1974, 1984, and 1994, for each sex and country.

RESULTS

Little change was found in the prevalence of overweight or obesity from 1974 to 1984. From 1984 to 1994 overweight increased from 5.4% to 9.0% in English boys (increase 3. 6%, 95% confidence interval 2.3% to 5.0%) and from 6.4% to 10.0% in Scottish boys (3.6%, 1.9% to 5.4%). Values for girls were 9.3% to 13. 5% (4.1%, 2.4% to 5.9%) and 10.4% to 15.8% (5.4%, 3.2% to 7.6%), respectively. The prevalence of obesity increased correspondingly, reaching 1.7% (English boys), 2.1% (Scottish boys), 2.6% (English girls), and 3.2% (Scottish girls).

CONCLUSION

These results form a base from which trends can be monitored. The rising trends are likely to be reflected in increases in adult obesity and associated morbidity.