Computer Game Use and Television Viewing Increased Risk for Overweight among Low Activity Girls: Fourth Thai National Health Examination Survey 2008-2009

A systematic analysis and future projections of the nutritional status and interpretation of its drivers among school-aged children in South-East Asian countries

Background

Nutrition inadequacy during childhood and adolescence can cause suboptimal growth, intergenerational effects on offspring and an increased risk of chronic diseases in adulthood. There is little information on the prevalence and drivers of malnutrition in children aged 5-19 years, in the South-East Asian setting, since most existing interventions have to date targeted undernutrition. We assessed the national prevalence of nutritional indicators, their trends, and associated risk factors among children aged 5-19 years from 11 countries of WHO South-East Asia Region (SEA Region) in order to provide evidence to guide future policy direction.

Methods

We included 5,210,646 children for analysis from 345 studies and 25 survey datasets. A Newcastle-Ottawa Scale was used to assess the quality of the study. Bayesian regression models were used to estimate the prevalence of malnutrition between 2000 and 2030, and a series of subgroup analyses were performed to assess variation in pooled estimates by different socio-demographic and lifestyle factors. The protocol was registered with PROSPERO database (CRD42023400104).

Findings

Overall, pooled analysis demonstrated that indicators of undernutrition in SEA is predicted to decrease between 2000 and 2030 including stunting (36.6%-27.2%), thinness (29.5%-6.2%), and underweight (29.2%-15.9%). However, a substantial increase in prevalence of overweight (6.0% in 2000-16.9% in 2030), and obesity (2.6%-9.5%) are predicted. The prevalence of micronutrient deficiencies between 2000 and 2030 is predicted to decrease-vitamin A by 84% and vitamin D by 53%. Parents' education levels and household wealth were inversely associated with malnutrition. Children's health-related behaviours, such as unhealthy dietary habits and spending more time watching TV, playing games, or using the computer, were associated with increased chance of overweight and obesity. There were no clear signs of publication bias in our study.

Interpretation

Our analysis highlights the pattern of a double burden of malnutrition, with clear differences between different socio-demographic groups. Despite a substantial reduction in the prevalence of stunting, underweight, and anaemia since 2000, an emerging increase in overweight/obesity and micronutrient deficiencies warrants urgent attention.

Funding

World Health Organization Regional Office for South-East Asia New Delhi, India.

Perceptions and behaviors related to noncommunicable diseases in Palau: a qualitative study

The increasing burden of noncommunicable diseases (NCDs) is a major public health concern in Palau. This study aims to identify social and psychological factors related to NCDs among Palauan people using a qualitative approach. We conducted eight key informant interviews and eight focus group discussions, which were audio-recorded, transcribed and translated into English. Ideas of the respondents were extracted and labeled, and the labels were analyzed using an inductive multistage approach referred to as qualitative content analysis. Three themes emerged: (1) home education, (2) traditional local community, and (3) modernization and westernization of lifestyle. Respondents believed that the influence of the family on lifestyle was significant, but that disciplining children at home had become difficult. They considered that the traditional lifestyle was mostly healthy, and were reluctant to abandon certain unhealthy customs, such as serving abundant food to guests as a sign of fraternity. They also thought that they overate because of their stressful modernized lifestyle. This is the first qualitative study to analyze perception and behavior of the Palauan people in relation to NCDs. We found that the increase in NCDs was related to two concurrent trends: preserving certain traditional customs unfavorable to good health, and abandoning time-consuming healthy traditional lifestyle to adopt a modernized one. We also found that Palauan people were not confident in their ability to prevent NCDs. Therefore, health promotion activities should be designed to empower people to make positive changes.

Physical activity level of Thai children and youth: Evidence from Thailand's 2018 report card on physical activity for children and youth

BACKGROUND

While enabling and supporting factors have been in place to facilitate the pupils to be more active, only a fourth of Thai children have met the WHO recommendation.

OBJECTIVE

This study aims to present the physical activity (PA) level of Thai children and youth, based on the indicators established by Active Health Kids Global Alliance's Report Card (RC).

METHODS

The 2016 Thailand RC Survey and the 2015-2017 Thailand's Surveillance on Physical Activity (SPA) were employed for the analysis. PA of Thai children aged 6-17 years old was assessed in 9 aspects 1) Overall PA, 2) Organized Sports and PA, 3) Active Play, 4) Active Transportation, 5) Sedentary Behavior, 6) Family and Peers, 7) School, 8) Community and Environment, and 9) Government.

RESULTS

Only 26.2% of Thai children and youth met the recommended level of 60 min MVPA. Boys are generally more active compared to girls in all age groups (34.9% versus 16.3%, respectively). Almost half had participated in organized sports and/or PA program, but only 8.7% of Thai children and youth engaged in unstructured/unorganized active play. The settings and source of influence indicators achieved better grades, shown by 71.0% of family members (e.g., parents, guardians) facilitated PA and sports opportunities for their children.

CONCLUSION

Although schools' facilities are available, Thai curriculum provides less opportunity for the children to move during classes and have enough playing time during recess. As there is no standardized guidance for PA in Thai schools, Thailand needs to promote a unified PA in order to improve PA and to reduce recreational screen time of children and youth.

Problematic Internet Use and Digital Gaming in Adolescents: Problems, Nursing Interventions, and Outcomes

The aim of the current study was to determine problems of adolescents with problematic internet use and digital gaming using the Omaha System and to evaluate the results by applying nursing interventions. Data were collected using the Internet Addiction Test, Digital Game Addiction Scale, and Nightingale Notes software. The sample comprised 30 adolescents selected from a total of 125 adolescents with problematic internet use and digital gaming from a high school. Results showed that problematic internet use and digital gaming rates were higher in males compared to females. Seven problems identified most frequently among adolescents were: mental health, vision, pain, sleep and rest patterns, nutrition, social contact, and physical activity. The Omaha System can be used by psychiatric-mental health nurses and school nurses to determine the problems of adolescents with problematic internet use and digital gaming, apply interventions, and evaluate health outcomes. [Journal of Psychosocial Nursing and Mental Health Services, 58(12), 51-59.].

Exploring the myth of the chubby gamer: A meta-analysis on sedentary video gaming and body mass

RATIONALE

High body mass and obesity are frequently linked to the use of sedentary media, like television (TV) or non-active video games. Empirical evidence regarding video gaming, however, has been mixed, and theoretical considerations explaining a relationship between general screen time and body mass may not generalize to non-active video gaming.

OBJECTIVE

The current meta-analysis had two main goals. First, we wanted to provide an estimate of the average effect size of the relationship between sedentary video gaming and body mass. In doing so we acknowledged several context variables to gauge the stability of the average effect. Second, to provide additional evidence on processes, we tested the displacement effect of physical activity by video gaming time with the help of a meta-analytic structural equation model (MASEM).

METHOD

Published and unpublished studies were identified through keyword searches in different databases and references in relevant reports were inspected for further studies. We present a random-effects, three-level meta-analysis based on 20 studies (total N = 38,097) with 32 effect sizes.

RESULTS

The analyses revealed a small positive relationship between non-active video game use and body mass, ρˆ=.09, 95% CI [0.03, 0.14], indicating that they shared less than 1% in variance. The studies showed significant heterogeneity, Q (31) = 593.03, p < .001, I² = 95.13. Moderator analyses revealed that the relationship was more pronounced for adults, ρˆ=.22, 95% CI [0.04, 0.40], as compared to adolescents, ρˆ=.01, 95% CI [-0.21, 0.23], or children, ρˆ=.09, 95% CI [-0.07, 0.25]. Meta-analytic structural equation modeling found little evidence for a displacement of physical activity through time spent on video gaming.

CONCLUSION

These results do not corroborate the assumption of a strong link between video gaming and body mass as respective associations are small and primarily observed among adults.

Correlates of physical activity and sedentary behaviour in the Thai population: a systematic review

BACKGROUND

Given the importance of knowing the potential impediments and enablers for physical activity (PA) and sedentary behaviour (SB) in a specific population, the aim of this study was to systematically review and summarise evidence on individual, social, environmental, and policy correlates of PA and SB in the Thai population.

METHODS

A systematic review of articles written in Thai and English was conducted. Studies that reported at least one correlate for PA and/or SB in a healthy Thai population were selected independently by two authors. Data on 21 variables were extracted. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale.

RESULTS

A total of 25,007 records were screened and 167 studies were included. The studies reported associations with PA for a total of 261 variables, mostly for adults and older adults. For most of the variables, evidence was available from a limited number of studies. Consistent evidence was found for individual-level and social correlates of PA in children/adolescents and adults and for individual-level correlates of PA in older adults. Self-efficacy and perceived barriers were consistently associated with PA in all age groups. Other consistently identified individual-level correlates in adults and older adults included self-rated general health, mental health, perceived benefits, and attitudes towards PA. Consistent evidence was also found for social correlates of PA in adults, including social support, interpersonal influences, parent/family influences, and information support. The influence of friendship/companionship was identified as a correlate of PA only in children/adolescents. A limited number of studies examined SB correlates, especially in older adults. The studies reported associations with SB for a total of 41 variables. Consistent evidence of association with SB was only found for obesity in adults. Some evidence suggests that male adults engage more in SB than females.

CONCLUSIONS

More Thai studies are needed on (i) PA correlates, particularly among children/adolescents, and that focus on environment- and policy-related factors and (ii) SB correlates, particularly among older adults. Researchers are also encouraged to conduct longitudinal studies to provide evidence on prospective and causal relationships, and subject to feasibility, use device-based measures of PA and SB.

Prevalence and associates of obesity and overweight among school-age children in a rural community of Thailand

Purpose

Information about overweight and obesity among students in rural areas of Thailand is limited. Therefore, we aimed to determine overweight and obesity prevalences and associated factors among school-aged children in a rural community of Thailand.

Methods

We selected 9 public schools through cluster sampling in 2 provinces located in central Thailand in 2016. Anthropometric measurements were measured using standard techniques, classified as overweight (>1 standard deviation [SD]) and obese (>2 SD) with respect to their age and sex using 2007 World Health Organization reference charts. Standardized questionnaires on risk factors were sent to parents to be completed together with their child.

Results

Among 1,749 students, 8.98% had overweight and 7.26% had obesity. Mean age (range) was 11.5 years (5–18 years). Independent factors associated with overweight and obesity included primary school student (reference as secondary school) (adjusted odds ratio [aOR], 2.25; 95% confidence interval [CI], 1.24–4.08; P=0.07), mother’s body mass index (aOR, 1.07; 95% CI, 1.02–1.12; P=0.001), self-employed father (aOR, 1.99; 95% CI, 1.12–3.55; P=0.018), number of siblings (aOR, 0.61; 95% CI, 0.47–0.81; P=0.001), having sibling(s) with obesity (aOR, 1.82; 95% CI, 1.20–2.77; P=0.005), more than one (aOR, 7.16; 95% CI, 2.40–21.32; P<0.001), consuming 2–3 ladles of rice/meal (aOR, 2.14; 95% CI, 1.38–3.32; P=0.001), consuming >3 ladles of rice/meal (aOR, 2.69; 95% CI, 1.11–6.46; P= 0.27), watching <2 hours of television/day (aOR, 2.18; 95% CI, 1.19–4.01; P=0.012), and watching >2 hours of television/day (aOR, 2.60; 95% CI, 1.36–4.96; P=0.004).

Conclusion

Many sociodemographic, dietary, and behavioral factors were related to overweight and obesity among school-aged children not only in urban but also rural communities of Thailand.

TRACKING OF NUTRITIONAL STATUS BETWEEN CHILDHOOD AND ADOLESCENCE IN SCHOOLCHILDREN

ABSTRACT Introduction: In view of the growing prevalence of childhood excess weight and obesity In Brazil In recent decades, it is necessary to observe how this phenomenon occurs in the period of transition to adolescence. Objective: To verify the tracking of excess weight between childhood and adolescence in schoolchildren of both sexes. Methods: The study has a longitudinal design and the data used are part of a prospective study carried out from 2002 to 2005. Participants included 397 schoolchildren of both sexes (211 boys and 186 girls). The nutritional status was determined by the body mass index, and the participants were divided into the following groups: Normal Weight to Normal Weight, Normal Weight to Excess Weight, Excess Weight to Excess Weight, Excess Weight to Normal Weight. The tracking was analyzed using the intraclass correlation coefficient (ICC) and Kappa (k) index. Results: A significant difference (P <0.05) was observed between all variables (age and anthropometric indicators) between 2002 and 2005 for boys and girls. The ICC indicated tracking classified as high (ICC = 0.87) for the BMI values, and the tracking percentage showed that 87% of the subjects remained in the same category of normal weight and excess weight. The values of k = 0.68 show good tracking (P <0.001), indicating a strong maintenance of the subjects in the normal and excess weight categories. Conclusion: The tracking percentage was high, indicating that both boys and girls maintained the classification of excess weight during the period analyzed. Level of Evidence II; Lesser quality prospective study (eg, patients enrolled at different points in their disease or <80% followup).

Physical activity and sedentary behaviour research in Thailand: a systematic scoping review

BACKGROUND

The number of deaths per year attributed to non-communicable diseases is increasing in low- and middle-income countries, including Thailand. To facilitate the development of evidence-based public health programs and policies in Thailand, research on physical activity (PA) and sedentary behaviour (SB) is needed. The aims of this scoping review were to: (i) map all available evidence on PA and SB in Thailand; (ii) identify research gaps; and (iii) suggest directions for future research.

METHODS

A systematic literature search was conducted through 10 bibliographic databases. Additional articles were identified through secondary searches of reference lists, websites of relevant Thai health organisations, Google, and Google Scholar. Studies written in Thai or English were screened independently by two authors and included if they presented quantitative or qualitative data relevant to public health research on PA and/or SB.

RESULTS

Out of 25,007 screened articles, a total of 564 studies were included in the review. Most studies included PA only (80%), 6.7% included SB only, and 13.3% included both PA and SB. The most common research focus was correlates (58.9%), followed by outcomes of PA/SB (22.2%), prevalence of PA/SB (12.4%), and instrument validation (3.2%). Most PA/SB research was cross-sectional (69.3%), while interventions (19.7%) and longitudinal studies (2.8%) were less represented. Most studies (94%) used self-reports of PA/SB, and few (2.5%) used device-based measures. Both sexes were examined in most studies (82.5%). Adults were the main target population group (51.1%), followed by older adults (26.9%), adolescents (15.7%), and children (6.3%). Clinical populations were investigated in the context of PA/SB in a relatively large number of studies (15.3%), most frequently those with cardiovascular disease, diabetes, and hypertension (22%, 21%, and 21% respectively).

CONCLUSIONS

The number of Thai papers on PA published per year has been increasing, indicating a growing interest in this research area. More studies using population-representative samples are needed, particularly among children and adolescents, and investigating SB as a health risk factor. To provide stronger evidence on determinants and outcomes of PA/SB, longitudinal studies using standardised measures of PA and SB are required.

Dietary iron intake and availability are related to maternal education level in overweight/obese adolescents

PURPOSE

To compare intakes of dietary iron and enhancers and inhibitors of iron absorption between overweight/obese (OW/OB) adolescents and their normal weight (NW) peers, and between parental education levels stratified by weight status.

METHODS

This was a comparative cross-sectional study of adolescents (n 121 OW/OB and n 102 NW) aged 12-14 years, attending a secondary school in Nonthaburi province, Thailand. Socio-demographic data were obtained from participants' parents using a questionnaire. Participants recorded their intakes for 3 non-consecutive days, using a prospective food record.

RESULTS

Compared with NW adolescents, OW/OB adolescents consumed more total protein and animal protein after adjustment for energy intake (both p = 0.047). OW/OB adolescents whose mothers were less educated consumed more total iron and available iron after adjustment for energy intake, compared with their OW/OB peers whose mothers were more educated (p = 0.045 and p = 0.040). NW adolescents with more highly educated mothers had higher absolute and energy-adjusted fibre intakes (both p = 0.047). However, NW adolescents of mothers with a high-intermediate level of education consumed less calcium, after adjustment for energy intake (p = 0.028).

CONCLUSIONS

OW/OB adolescents with less educated mothers had higher energy-adjusted intakes of iron and available iron. Dietary differences in OW/OB adolescents relative to maternal education, and other socioeconomic indicators, should be explored in a nationally representative data set.