Overweight and Underweight Prevalence Trends in Children from Romania - Pooled Analysis of Cross-Sectional Studies between 2006 and 2015

Status of Healthy Choices, Attitudes and Health Education of Children and Young People in Romania-A Literature Review

Background and Objectives: This study aims to assess the health status and factors influencing healthy choices among children and young people in Romania, as well as the efficacy of related health education programs. Through understanding these dynamics, the study seeks to provide insights that can shape targeted interventions, policies, and educational strategies to improve this demographic's overall health and well-being. Materials and Methods: For this study, we performed a literature review of original published papers on the health status, healthy habits, health education, predisposition to making healthy choices in the future, and accessibility to the paediatric health system of Romanian children and young people, as well as the effects of different types of educational interventions on this demographic in Romania. Results: The prevalence of dental caries is high in Romania. In terms of eating habits and nutritional status, a worrying proportion of children are overweight or obese, which can lead to a variety of future physical and psychological problems. In terms of physical activity, few adolescents demonstrate regular fitness practices. Romania presents an increase in alcohol and tobacco consumption among adolescents. The mental health of students has become a pressing public health concern, exacerbated by the COVID-19 pandemic. The use of social networks is linked to mental health issues among young people. Romania still has one of the highest rates of sexually transmitted diseases and faces a high incidence of cervical cancer, with a mortality rate three times higher than the EU average. High rates of teenage pregnancies are linked to limited information about sexuality and a lack of access to family planning at a young age. There are large discrepancies in the accessibility of medical services between urban and rural areas. Conclusions: Romania faces significant obstacles to providing high-quality healthcare to children and young people. Improving nutrition, immunisation rates, and access to medical services represent essential areas for enhancing the health of children and young people in Romania.

Assessing the Relationship between Systemic Immune-Inflammation Index and Metabolic Syndrome in Children with Obesity

Childhood obesity represents a worldwide concern as many countries have reported an increase in its incidence, with possible cardiovascular long-term implications. The mechanism that links cardiovascular disease to obesity is related to low-grade inflammation. We designed this study to investigate the diagnostic utility of inflammatory indices (NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; SII, systemic immune-inflammation index; SIRI, systemic inflammation response index) in obese children with metabolic syndrome (MetS) and their relationship with cardiometabolic risk biomarkers, such as the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), triglyceride-to-high-density lipoprotein cholesterol (TG:HDL-C), and non-high-density lipoprotein cholesterol (non-HDL-C). A total of 191 obese children from one large Romanian reference center was included in the study. Patients were classified in two groups according to the presence (MetS group) or absence (non-MetS group) of metabolic syndrome. According to our results, the SII index proved to have diagnostic value in distinguishing MetS patients among children with obesity (AUC = 0.843, a sensitivity of 0.83, and a specificity of 0.63). Furthermore, the SII was positively associated with cardiometabolic risk biomarkers (HOMA-IR, p < 0.001; TG:HDL-C, p = 0.002; non-HDL-C, p = 0.021), highlighting its possible role as an additional measure of cardiometabolic instability in obese children.

HEMATOLOGICAL INDICES RELATED TO VITAMIN D DEFICIENCY IN OBESE CHILDREN

Introduction

Vitamin D is involved in differentiation and induction of erythropoiesis in bone marrow cells.

Aim

We compared the serum 25(OH) vitamin D level in obese children versus control and found correlations between vitamin D level and hematological indices in obese children.

Materials and methods

25 overweight and obese patients and 15 normal weight children were enrolled in an observational study .

Results

In obese children, the serum level of 25(OH) vitamin D was significantly (p<0.04) lower (20.60 ng/mL) compared with the value from normal weight ones (25.63 ng/mL) and the body fat percentage BFP was higher. We found a positive correlation (r=0.44, p<0.05) between serum vitamin D and hemoglobin level and a negative one between serum vitamin D and the number of platelets (r= -0.43, p<0.05). Also, the serum iron was at the lower normal limit in the obese children and negatively correlated with the percent of the body fat (r= -0,62, p<0.05).

Conclusion

Obese children have vitamin D deficiency. The hemoglobin level and the number of platelets are correlated with the serum level of 25(OH) vitamin D. Supplements with vitamin D may have pleiotropic effects, including those on bone marrow activity.

Differences in Classification Standards For the Prevalence of Overweight and Obesity in Children. A Systematic Review and Meta-Analysis

The prevalence of childhood obesity has increased dramatically all over the world in recent years. While obesity in adults can be easily measured using the BMI calculation, determining overweight and obesity in children is more controversial. The aim was to compare the three most used international classification systems (WHO 2007, CDC 2000 and Cole-IOTF) to determine overweight and obesity in infant and adolescent populations. We performed a systematic review in accordance with the PRISMA 2020 guidelines of articles comparing any of the three classification systems. The main findings were that the WHO 2007 criteria show the highest prevalence of overweight and obesity in the child and youth population. The prevalence of childhood overweight and obesity was determined to be higher in boys than in girls in most studies, when analysing the classifications of the WHO 2007, CDC 2000 and Cole-IOTF together. However, there was a higher prevalence of overweight and obesity in girls than in boys when only the CDC 2000 and Cole-IOTF criteria were considered. Both the results of the review and the great heterogeneity found in the meta-analysis show that it is necessary to unify the criteria for the classification of childhood overweight and obesity. International standards are insufficient for working with the current population. A working group should be created to address this issue and agree on the unification of a gold standard, taking into account the geographical region, the ethnic groups and the age groups of the child and youth population and above all, the secular growth.

Evaluation of Circulating Chitotriosidase Activity in Children with Obesity

Childhood obesity progresses to metabolic disturbances via low-grade inflammation. Identifying novel molecules that reflect the activity of the immune responses is critical in understanding its underlying pathogenesis. Our exploratory study aimed to evaluate the change of chitotriosidase (CHIT1) plasma activity according to Body Mass Index (BMI)-for-age z score in pediatric patients. The study evaluated 68 children consisting of 47.1% girls with a mean age of 12.47 ± 3.71 years and 52.9% boys with a mean age of 11.93 ± 3.18 years. The effect of the most frequent CHIT1 gene variants, the 24 base pair duplication (dup24) and G102S polymorphism, upon the association between circulating CHIT1 activity and the obesity level, was also investigated. A significantly higher logCHIT1 plasma activity was found in children with extreme obesity than in children with overweight (p = 0.048 for the uncorrected CHIT1 and 0.026 for the corrected CHIT1). The BMI-for-age z score significantly (p = 0.031) predicts increased CHIT1 activity in children with overweight, obesity, and extreme obesity after controlling for the two gene variants, age, gender, and time since weight gain. Dup24 and G102S polymorphism were significant independent predictors (p-values < 0.002) for the change of CHIT1 plasma activity. Circulating CHIT1 might be an accurate indicator of inflammation in children with obesity. Its role and the effect of the dup24 and G102S variants on the CHIT1 activity should be validated in a larger cohort.

Assessment of Actual Weight, Perceived Weight and Desired Weight of Romanian School Children-Opinions and Practices of Children and Their Parents

Objective: Children and parental awareness regarding weight is linked to the development and management of overweight and obesity. The aim of this study is to assess the actual weight, perceived weight, and desired weight of Romanian school children. Methods: A cross-sectional study was conducted in 2019 in seven schools from two counties of Romania and included 880 pupils aged between 10 and 15 years old and 665 parents. We administrated confidential questionnaires to the participants, and we measured children’s weight and height during school activities. Results: A total of 61.0% of pupils had normal weight, 7.4% were underweight, and 31.6% were overweight or obese. A total of 66.7% of normal weight children, 56.5% of overweight children, and 40% of underweight children perceived their weight accurately. Regarding parents, a majority correctly appreciated the weight of their normal weight children and only a third appreciated correctly the body weight of their underweight and overweight children. Factors such as body mass index, gender, weight related behaviors, parents’ estimation about their children’s weight, discussions of weight topics inside family, and bullying, cyberbullying and exclusion from groups were associated with misperceptions. Conclusion: The study provides useful information for health education activities targeting both children and their parents regarding appropriate body weight management of children.

Extreme Birth Weight and Metabolic Syndrome in Children

Small and large birth weights (BWs) for gestational age (GA) represent extremes, but the correlation between extreme BW and metabolic syndrome (MetS) has not been fully elucidated. In this study, we examined this correlation in obese children based on changes in their metabolic profile from childhood to adolescence. A retrospective observational study was performed on 535 obese patients aged 0–18 years in the Clinical and Emergency Hospital for Children “Louis Turcanu” in Timisoara, Romania, based on clinical and biological data from January 2015 to December 2019. We emphasized the links between extreme BW and obesity, extreme BW and cardiometabolic risk, obesity and cardiometabolic risk, and extreme BW, obesity and MetS. Children born large for gestational age (LGA) predominated over those born small for gestational age (SGA). Our findings showed that BW has an independent effect on triglycerides and insulin resistance, whereas obesity had a direct influence on hypertension, impaired glucose metabolism and hypertriglyceridemia. The influences of BW and obesity on the development of MetS and its components are difficult to separate; therefore, large prospective studies in normal-weight patients are needed.

Making Childhood Obesity a Priority: A Qualitative Study of Healthcare Professionals' Perspectives on Facilitating Communication and Improving Treatment

In Romania, one in four children has excess weight. Because childhood obesity is a sensitive topic, many healthcare professionals find it difficult to discuss children's excess weight with parents. This study aims to identify barriers and facilitators in childhood obesity-related communication, as perceived by healthcare professionals in Romania. As part of the STOP project, healthcare professionals (family physicians, pediatricians, and dieticians) who treat children with excess weight were invited to a telephone interview. The semi-structured questions were translated from a questionnaire previously used at the Swedish study site of the STOP project. Interviews were transcribed and then used for thematic analysis. Fifteen doctors and three dieticians (16 females and 2 males), with average 18.2 ± 10.1 years of experience, were interviewed. Four main themes were identified. Professionals reported that when children began experiencing obesity-related stigma or comorbidities, this became the tipping point of weight excess, where parents felt motivated to begin treatment. Barriers in communication were part of several layers of distrust, recognized as tension between professionals and caregivers due to conflicting beliefs about excess weight, as well as lack of trust in medical studies. Most respondents felt confident using models of good practice, consisting of a gentle approach and patient-centered care. Nonetheless, professionals noted systemic barriers due to a referral system and allocation of clinical time that hinder obesity treatment. They suggested that lack of specialized centers and inadequate education of healthcare professional conveys the system does not prioritize obesity treatment and prevention. The interviewed Romanian doctors and dieticians identified patient-centered care as key to treating children with obesity and building trust with their caregivers. However

their efforts are hindered by healthcare system barriers, including the lack of specialized centers, training, and a referral system. The findings therefore suggest that, to improve childhood obesity prevention and treatment, systemic barriers should be addressed.

Trial Registration:ClinicalTrials.gov, NCT03800823; 11 Jan 2019.

Updating Standards of Facial Growth in Romanian Children and Adolescents Using the Anthropometric Method-A Pilot Study

The anthropometric method is an important tri-dimensional and non-invasive assessment instrument for accurate diagnosis in paedodontics, orthodontics, and other medical fields. Our aim was to propose a technique that is accessible for clinicians and to determine the reference values for Romanian children and adolescents for the facial parameters selected. We proposed three basic instruments: a plastic compass, a ruler, and a digital caliper. Eighty-five children and adolescents (62% girls and 38% boys), aged between 3.5 and 14.5 years, were included in the study. We selected eight transversal, 12 vertical, and three sagittal measurements. Facial indices, according to Farkas L.G., were directly determined. The correlations between facial and general growth parameters, using Pearson correlation coefficient, for the entire sample were significant, direct, and strong for the following: Zy-Zy, Go-Go, N-Gn, N-Sn, Sto-Gn, Tr-Gn, Tr-Sn, Tr-Tr (r = 0.526–0.925, p < 0.001), and insignificant for Sn-Sto (r = 0.099–0.124, p > 0.354). The highest correlation coefficient is exhibited by Tr-Gn (r = 0.893 with height and r = 0.925 with weight). When performing a gender related comparison, we noticed that the vertical and transversal linear parameters and some facial indices are increased in boys (p < 0.05), depending on the age group. The simplified anthropometric technique represents an accessible method to every clinician, bringing important information related to dentofacial growth, diagnosis, and treatment planning in dentistry.

Prevalence of Underweight, Overweight and Obesity in School-Aged Children in the Urban Area of the Northwestern Part of Romania

INTRODUCTION

During the last three decades, there has been an excess weight epidemic due to changes in nutrition and lifestyle. Few data on the prevalence of overweight and obesity in children in Romania were published, without a single study representative at the national level. There are reports on the higher level of overweight and obesity in urban areas compared to rural ones. This study aimed to estimate the prevalence of underweight, overweight, obesity and severe obesity in children enrolled in schools from the urban area.

MATERIAL AND METHODS

For this cross-sectional study, children from 177 schools from the urban area of five counties from the northwestern part of Romania were included after the parents signed written informed consent. Anthropometric data were recorded (weight, height) based on World Health Organization (WHO) recommendations and Body-Mass-Index (BMI), and the z-score for BMI were calculated. The nutritional status was estimated using three reference criteria: WHO, International Obesity Task Force (IOTC) and the Center for Disease Control and Prevention (CDC).

RESULTS

We analyzed data of 21,650 children (48.19% boys) age between 7 and 18 years. The prevalence of overweight was 13.8%, 16.2% and 20.3%, of obesity was 10.7%, 10.0% and 5.7% and of severe obesity was 5.1%, 1.2% and 1.6% (using WHO, CDC and IOTF cut-offs). Underweight was present in 5.2% (WHO), 6% (CDC) and 2.6% (IOTF). The highest prevalence of overweight (including obesity) was found in children aged 10 years, and the lowest in adolescents at 18 years. Boys have a higher prevalence of excess weight than girls. Using IOTF cut-offs, the prevalence of obesity and severe obesity was lower than using WHO criteria.

CONCLUSIONS

The prevalence of overweight (including obesity) in children from the urban area of Western Romania was recorded at alarming levels, higher in boys and at the pre-puberty ages. There are significant differences based on the reference system used. It is important to correctly choose the reference for the definition of overweight and obesity to have the correct estimation of the target for public health measures.

Actual Weight, Perceived Weight and Desired Weight of Romanian School Children by Parents and Children

Background and Objectives: The perception of the body weight by children and parents influences the consequent actions undertaken for children’s body weight management. This study investigated the correspondence between objective evaluations of Romanian school children (actual weight) and perceptions about weight (perceived weight), preoccupation with body weight management (desired weight) and parents’ perceptions on children’s weight. Materials and Methods: A cross sectional study was performed among 344 children aged 11 to 14 and 147 parents from Cluj-Napoca, Romania. We made anthropometric measurements of children, and short questionnaires were completed by the children and the parents. Results: The results show that 3.8% of children were underweight, 68.3% had a normal weight and 27.9% were overweight. Of this sample, 61.5% of underweight children, 20% of normal weight children and 43.7% of overweight children had misperceptions about their weight. The percentage of parents who did not estimate their children’s weight correctly was 50%, 11.9% and 41.5%, respectively, for each of the three weight groups. The results of the logistic regression analyses showed that several factors were associated with the misclassification of their own body weight by the children, such as body mass index, gender, weight management practices, misclassification by the parents as well as parent–child discussions on these issues. Conclusions: Education for both Romanian parents and children is needed with regard to correctly identifying and managing children’ body weight.

Inflammation-Related Markers and Thyroid Function Measures in Pediatric Patients: Is the Grade of Obesity Relevant?

We aimed to investigate the effect of weight status on inflammation-related markers and thyroid function tests in overweight and obese pediatric patients. Children and adolescents diagnosed between January 2017 and January 2019 with overweight or obesity were included in the study. Neutrophil-to-lymphocyte ratio (NLR), platelet-to lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) were calculated for the groups defined according to Body Mass Index (BMI)-for-age z-score: overweight (≥1 BMI-for-age z-score), obese (≥2 BMI-for-age z-score) and severely obese (≥3 BMI-for-age z-score). Severely obese patients had significantly higher value of white blood cells (WBC) counts (median = 7.92) compared with overweight patients (7.37, p = 0.014). Absolute lymphocyte count was significantly associated with obesity degree in children (Spearman’s Rho coefficient ρ = 0.228. p = 0.035), whereas absolute polymorphonuclear neutrophils (PMNCs) count was significantly higher in severely obese adolescents than overweight adolescents (overweight: 4.04 vs. severely obese: 5.3 (p = 0.029)). In 8.19% of patients an elevated thyroid-stimulating hormone (TSH) level was found, and 3.36% of patients had a low level of free thyroxine with an elevated level of TSH. Total absolute WBC count may be a reliable inflammation-related marker in obese pediatric patients without metabolic syndrome, but needs to be validated in the context of all possible covariates. Subclinical and overt hypothyroidism may develop from an early age in overweight or obese patients.

Relationship between rs9939609 FTO polymorphism with waist circumference and body fat is moderated by ponderal index at birth in youth

OBJECTIVE

The goal of this study was to analyze whether the relationship between the rs9939609 polymorphism of the fat mass and obesity-associated gene (FTO) with nutritional status is moderated by the ponderal index (PI) at birth in children and adolescents.

METHODS

A cross-sectional study evaluated 382 schoolchildren aged 6-17 years. Anthropometric variables such as waist circumference (WC), body mass index (BMI) and body fat percentage (BF%) were used to assess nutritional status. Weight and height at birth were used for the PI calculation, which was divided into tertiles (lower, middle and upper). To compare the continuous variables between genotypes of the rs9939609 polymorphism, a recessive model (TT/AT vs. AA) and covariance analysis (ANCOVA) were used.

RESULTS

The AA genotype of the rs9939609 polymorphism was associated with higher WC in schoolchildren born with lower PI (β = 4.40; p = .048). However, for BF%, the genotype association was found in the upper PI tertile (β = 7.35; p = .040).

CONCLUSION

The relationship between WC and BF% with rs9939609 polymorphism (FTO) seems to be moderated by PI at birth. This is an important insight, since the data for intrauterine growth, genetic factors and the presence of obesity in children and adolescents are still contradictory.

Secular Trends in Height, Body Mass and Mean Menarche Age in Romanian Children and Adolescents, 1936-2016

Secular trends in anthropometric parameters have been documented in most European countries, but no data is available regarding Romanian. The aim of the study was to calculate secular trend in height, body mass and mean menarche age for Romanian children and adolescents.

METHODS

A secondary data analysis was performed using ten data sets for urban and eight data sets for rural boys and girls, age 5-15 years, covering 80 years (1936 to 2016). Secular trend in height (cm/decade), body mass(kg/decade) and mean menarche age (years) were calculated.

RESULTS

Overall, there was a positive secular trend for height in both genders, which parallels the gross domestic product (GDP)/capita difference, more pronounced in boys, across all age-groups, with a maximum for 15 years-old boys (~3 cm/decade) and 13 years-old girls (~2 cm/decade). Body mass trend was also positive, more accentuated in the rural population. Mean age at menarche was higher in rural compared to urban girls, had a negative trend with the disappearance of the difference in the latest available data set (2013).

CONCLUSION

In summary, an overall positive and ongoing secular trend in height and body mass was documented in Romanian children and adolescents, especially for the pubertal age-range, in concordance to other western countries, but out of phase by approximately 20 years.

Plasma RBP4 Level in Association with Body Composition, Metabolic Profile, STRA6 and RBP4 Gene Polymorphisms in Obese Romanian Children

BACKGROUND

Pediatric obesity continues to remain a serious health concern which has significantly increased the morbidity risk in adulthood. Recent studies have analyzed the impact of the two adipokines, RBP4 (retinol binding protein 4) and STRA6 (stimulated by retinoic acid 6) in pediatric obese subjects with contradictory results.

METHODS

An observational study was conducted in the Pediatric and Endocrinology Departments, Targu-Mures, Romania, including 213 children between 5-17 years of age, divided into two groups according to body mass index (BMI) standard deviation score (SDS): case (overweight or obese) and control (normal SDS). Age, sex, basic anthropometric and biochemical measurements and genotype of rs3758539, and rs10882280 for RBP4 gene and rs974456 and rs351224 of STRA6 gene were analyzed. Statistical analysis used SPSS v. 25.0, with a level of significance α = 0.05.

RESULTS

There is no association between the two gene's polymorphisms and obesity in our pediatric population. In regression analysis, with HOMA IR (homeostatic model assessment of insulin resistance) as the outcome, the plasmatic level of RBP4 and fat mass percentage are significant predictors, with the model explaining 42% of the HOMA variability. Hypercholesterolemia was significantly associated with male sex, carrying variant allele and heterozygote status of rs10882280 RBP4 gene and wild-type allele rs351224 of STRA6 gene.

CONCLUSION

There is no significant association between obesity and SNPs of the RBP4 and STRA6 in our population, but they seem to play a role in insulin resistance and hypercholesterolemia.

The application of stem cell therapy and brown adipose tissue transplantation in metabolic disorders

The discovery of brown fat in adult humans has led to increased research of the thermogenic function of this tissue in various metabolic diseases. In addition, high levels of brown fat have been correlated with lower body mass index values. Therefore, increasing brown fat mass and/or activity through methods such as the browning of white fat is considered a promising strategy to prevent and treat obesity-associated diseases. Cell-based approaches using mesenchymal stromal cells and brown adipose tissue (BAT) have been utilized to directly increase BAT mass/activity through cell and tissue implantation into animals. In addition, recent studies evaluating the transplantation of human embryonic stem cells and induced pluripotent stem (iPS) cells have shown promising results in terms of positive metabolic function. In this comprehensive review, we provide a summary of the research over the past 10 years with regard to stem cell therapy and brown fat tissue transplantation for the effective treatment of metabolic syndrome. Recent advancements in stem cell methods have allowed for the production of brown adipocytes from human iPS cells, which represent an unlimited source of cellular material with which to study adipocyte development. In addition, this process is expected to be used to further explore drug- and cell-based therapies to treat obesity-related metabolic complications.

Comparison of International Growth Standards for Assessing Nutritional Status in Cystic Fibrosis: The GreeCF Study

OBJECTIVE

The aim of the study was to compare 3 international growth references and explore their differences in assessing growth in Greek school-aged patients with cystic fibrosis (CF).

METHODS

Sample included 114 patients (50 boys, age 11.5 ± 3.9 years), provided care at Aghia Sofia Children's Hospital, Greece. Anthropometrics and predicted forced expiratory volume in 1 second (FEV1%) were measured. Body mass index (BMI) and height z scores were computed according to the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and International Obesity Task Force (IOTF) references. Agreement between methods was analyzed with kappa statistics, repeated-measures analysis of variance, and Bland-Altman analysis. The relationship between FEV1% and BMI was explored with linear regression.

RESULTS

Mean CDC BMI z score was the lowest (0.06 ± 1.08), followed by WHO (0.17 ± 1.14) and IOTF (0.35 ± 1.05) (P ≤ 0.001 for all). The CDC and WHO growth references highly agreed for most weight status strata and stunting; all other comparisons produced lower agreements. Except for CDC and IOTF BMI z scores, all other comparisons produced wide levels of agreement and proportional bias. CDC reference classified more children as attaining low or normal weight, against WHO or IOTF (P ≤ 0.001 for all). Lowest prevalence of ideal and excess weight was recorded by CDC, compared to all other standards (P ≤ 0.001 for all). All BMI z scores provided moderate associations with FEV1%.

CONCLUSION

Large variations across weight status classification were present when employing 3 growth standards in school-aged patients . Given than BMI z-scores from all references provided comparable associations with pulmonary function, our data indicate that no studied reference is better than others in assessing growth in CF.

Implications of visfatin genetic variants in the metabolic profile of the Romanian pediatric population

Background: Conflictual results regarding the relationship between plasmatic level of visfatin and obesity could be explained by the influence of the gene variants involved in the synthesis or action of these hormones.

Objectives: The present study examined the potential implication of single nucleotide polymorphisms (SNPs) of nicotinamide phosphoribosyltransferase (NAMPT) gene that encodes visfatin, in obesity, in a Romanian pediatric population.

Method: A case-control study was conducted on a group of 213 children, divided into two: the case group - 130 overweight and obese children with BMI >1 SD, and the control group - 83 children with normal BMI. The variables analyzed were age, sex, anthropometric parameters, body composition based on bioimpedance analysis, lipid profile, visfatin and insulin plasmatic levels, rs4730153 and rs2302559 visfatin SNPs.

Results: Significant associations were not found between rs4730153 and rs2302559 visfatin SNPs and obesity. Regarding lipid metabolism, there are statistically significant differences between triglyceride levels according to NAMPT rs2302559 genotypes (p=0.045), with heterozygous genotype having the highest level of triglycerides, and also between cholesterol levels according to NAMPT rs4730153 genotypes (p=0.030), with carriers of heterozygote genotype having the highest level of cholesterol. There is a statistically significant difference between the studied parameters in the investigated groups, regarding cholesterol, in carrier of wild-type genotype of NAMPT rs2302559 (p=0.040) and carrier of wild-type genotype of NAMPT rs4730153 (p=0.036). We observed no association of NAMPT rs4730153 and rs2302559 with visfatin levels in the studied groups. Visfatin level was lower in the case group and was correlated with weight (p=0.042), abdominal circumference (p=0.010), waist to height ratio (p=0.040), but not with the elements of the metabolic profile.

Conclusion: NAMPT rs2302559 and rs4730153 polymorphisms do not seem to have a major impact in the development of obesity in children, however there may be an association with lipid profile, but further studies are needed..

Childhood Obesity and Overweight in Ghana: A Systematic Review and Meta-Analysis

The increasing prevalence of childhood obesity and overweight is considered a public health issue in both developed and developing countries. This systematic review and meta-analysis estimates the prevalence of childhood obesity and overweight in Ghana. A multiple database search was conducted for articles published between January 1, 2001, and October 31, 2019, reporting the prevalence of childhood obesity and overweight in Ghana. Databases searched include PubMed, Google Scholar, Scopus, Cochrane Library, World Health Organization (WHO) Library Information System, and Africa Journals Online. Data were pooled from the articles to calculate an overall estimate of childhood obesity and overweight using a random-effects model after variance stabilization with Freeman–Tukey double arcsine transformation. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Sixteen studies with a combined sample size of 29,160 were included in the review. Analysis indicates that approximately 19% of children in Ghana either have obesity or are overweight. The prevalence of childhood obesity and overweight was 8.6% (95% CI: 4.8%–13.4%) and 10.7% (95% CI: 5.9%–16.6%), respectively. Although not significant, higher obesity (4.6% vs. 2.6%) and overweight (11.0% vs. 7.2%) prevalence were estimated for females than for males. There was a significantly higher obesity prevalence estimate (17.4% vs. 8.9%) in rural settings than in urban settings (p=0.0255). The high prevalence of childhood obesity and overweight estimated in this review is of worrying concern. It is a significant public health problem that has implications on the health of present and future generations in Ghana and as such calls for proactive measures to be put in place. Also, the driving forces behind the increasing prevalence of childhood obesity in Ghana need to be investigated.

Brain Breaks® Physical Activity Solutions in the Classroom and on Attitudes toward Physical Activity: A Randomized Controlled Trial among Primary Students from Eight Countries

Classroom-based physical activity (PA) interventions have received considerable attention due to improvements seen in academic achievement, classroom behaviors, and attitude toward PA. The purpose of this study was to evaluate the effectiveness of the Brain Breaks® Physical Activity Solutions in changing children’s attitudes toward PA. Students (N = 3036) aged 8–11 years from schools in Croatia, Lithuania, Macedonia, Poland, Romania, Serbia, South Africa, and Turkey were randomly assigned to either a control or an experimental group. The experimental group received Brain Breaks® videos during classroom sessions throughout the four months of intervention. Student attitudes toward PA were measured using the Attitudes toward Physical Activity Scale (APAS) before and after the intervention. Repeated measures ANOVA indicated a time interaction effect for all APAS variables except fitness. Time-by-group interaction effects with different effect sizes were found for most APAS variables, with the greatest gain effect noted in the experimental group for self-efficacy, followed by learning from the videos concerning PA benefits, exercise importance, and enjoyment from engaging in PA. This study provides evidence supporting Brain Breaks® in terms of learning experience, attitudes towards PA, and personal motivation. Using exercise videos is recommended as an interactive, technology-based PA solution that can be easily integrated into the school setting.

CHDH-PNPLA3 Gene-Gene Interactions Predict Insulin Resistance in Children with Obesity

INTRODUCTION

Insulin resistance plays a major role in metabolic syndrome and is recognized as the most common risk factor for non-alcoholic fatty liver disease (NAFLD). Identifying predictors for insulin resistance could optimize screening and prevention.

PURPOSE

To evaluate the contribution of multiple single nucleotide polymorphisms across genes related to NAFLD and choline metabolism, in predicting insulin resistance in children with obesity.

METHODS

One hundred fifty-three children with obesity (73 girls), aged 7-18 years, were evaluated within the NutriGen Study (ClinicalTrials.gov-NCT02837367). Insulin resistance was defined by Homeostatic Model Assessment for insulin-resistance cut-offs that accommodated pubertal and gender differences. Anthropometric, metabolic, intake-related variables, and 55 single nucleotide polymorphisms related to NAFLD and choline metabolism were evaluated. Gene-gene interaction effects were assessed using Multiple Data Reduction Software.

RESULTS

Sixty percent (93/153) of participants showed insulin resistance (58.7% of boys, 63% of girls). Children with insulin resistance presented significantly higher values for standardized body mass index, triglycerides, transaminases and plasma choline when compared to those without insulin resistance. Out of 52 single nucleotide polymorphisms analysed, the interaction between genotypes CHDH(rs12676) and PNPLA3(rs738409) predicted insulin resistance. The model presented a 6/10 cross-validation consistency and 0.58 testing accuracy. Plasma choline levels and alanine aminotransferase modulated the gene interaction effect, significantly improving the model.

CONCLUSION

The interaction between genotypes in CHDH and PNPLA3 genes, modulated by choline and alanine aminotransferase levels, predicted insulin-resistance status in children with obesity. If replicated in larger cohorts, these findings could help identify metabolic risk in children with obesity.

The assessment of liver fibrosis in children with obesity on two methods: transient and two dimensional shear wave elastography

The aim of this study was to assess the liver stiffness values in children with obesity versus healthy children on 2D-SWE and TE taking into account different laboratory parameters. We performed a case-control study on 287 children aged between 3 to 18 years, admitted in a Romanian Pediatric Tertiary Hospital, which we divided according to the body mass index (BMI) into two groups: the study group-77 children with obesity, and control group-210 children with normal weight. All children underwent anamnesis, clinical exam, laboratory parameters, ultrasound exam, and elastography. Children with obesity presented higher values of platelets, AST, ALT, and AAR as compared to control group (p = 0.0005/p = 0.0065/p < 0.0001/p < 0.0001). We found no significant differences for APRI between the two groups (p = 0.9827), although the values were higher in children with obesity. Significantly higher values of liver stiffness in children with obesity on both 2D-SWE and TE (p = 0.0314/p < 0.0001) were obtained. Similarly, the velocity values measured by 2D-SWE were also significantly higher in the study group (p < 0.0001). Our findings revealed significantly higher levels of platelets, transaminases, AAR, and liver stiffness values on both TE and 2D-SWE in children with obesity. 2D-SWE and TE might represent useful non-invasive methods for predicting liver impairment associated to pediatric obesity.

The adipokines and inflammatory status in the era of pediatric obesity

INTRODUCTION

Obesity is associated with a chronic inflammation due to the deficiency in immune activity related to adipose tissue. A wide-spectrum of pro-inflammatory cytokines secreted by adipocytes play an important role in the assessment of obesity-associated inflammatory status. The aim of this study was to assess the relationship between IL and 1β, IL-6, TNF α, leptin, and inflammatory status in children with overweight/obesity.

MATERIAL AND METHODS

We performed a cross-sectional study on 193 children, admitted to a Pediatric Tertiary Hospital in Romania. The children were divided according to BMI into: the study group-91 children with overweight/obesity, and the control group-102 children with normal BMI. Demographic, anthropometric, and laboratory parameters including the serum levels of several adipokines (leptin, IL-1β, IL-6, and TNF α) were assessed in both groups.

RESULTS

Our findings revealed significantly higher values of leukocytes, lymphocytes, platelets, AST, and ALT, as well as for the lipid metabolism parameters including cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, and CRP, in children with overweight/obesity. We found significantly higher levels of adipokines in the serum of children with overweight and obesity assessed for leptin, IL6, and TNF α (p = 0.0145/p < 0.0001/p = 0.004/), except for IL-1β serum levels.

CONCLUSIONS

Childhood overweight and/or obesity is associated with a systemic inflammatory status demonstrated by increased levels of CBC parameters. Pro-inflammatory adipokines are also an essential factor in obesity-related inflammatory status according to our findings that underlined the importance of increased serum levels of IL-6, TNF α, and leptin in pediatric patients with overweight/obesity. Clinically, CBC parameters along with adipokines might represent useful diagnostic tools for low-grade systemic inflammation in children with overweight or obesity.

Single Nucleotide Polymorphisms in PEMT and MTHFR Genes are Associated with Omega 3 and 6 Fatty Acid Levels in the Red Blood Cells of Children with Obesity

Polyunsaturated fatty acids (PUFAs) play important roles in health and disease. PUFA levels are influenced by nutrition and genetic factors. The relationship between PUFA composition in red blood cells (RBCs) and genetic variations involved in PUFA metabolism has not been investigated in children with obesity. This study evaluated the association between several genetic variations and PUFA levels in RBCs in children with obesity. One hundred ninety-six children with obesity (101 females, 95 males) were evaluated using anthropometric measurements, dietary intakes, plasma and RBC PUFA quantification, blood biochemistry, and 55 single nucleotide polymorphisms within 14 genes. phosphatidylethanolamine N-methyltransferase (PEMT) rs1109859 and methylenetetrahydrofolate reductase gene (MTHFR) rs4846052 genotypes were associated with PUFA levels in RBCs. PUFA intake did not influence the RBC eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) levels. Higher RBC DHA and EPA levels were observed for PEMT rs1109859 GG and GA genotypes versus the AA genotype. Higher levels of RBC DHA, EPA, arachidonic acid (ARA), and linoleic acid (LA) and were observed for MTHFR rs4846052 TT genotype versus TC and CC genotypes. Genetic variations in PEMT rs1109859 and MTHFR rs4846052 were associated with different PUFA levels in RBC membranes and are estimators for PUFA species in RBCs. Further research is needed to establish whether these genotype-specific alterations are specific to overweight children.

Prevalence of overweight and obesity among African primary school learners: a systematic review and meta-analysis

INTRODUCTION

The increasing trend in the global prevalence of childhood overweight and obesity presents a major public health challenge. This study reports the results of a systematic review and meta-analysis to estimate the prevalence of overweight and obesity among primary school learners residing in Africa according to the different body mass index criteria and population level characteristics.

METHODS

A search of multiple databases was conducted to identify relevant research articles published between January 1980 and February 2017. Random effects models were used to pool prevalence data within and across population level characteristics after variance stabilization through arcsine transformation (PROSPERO registration number CRD42016035248).

RESULTS

Data from 45 studies across 15 African countries, and comprising 92,379 and 89,468 participants for overweight and obesity estimates were included. Estimated overweight and obesity prevalence differed significantly across criteria: 10.5% [95% confidence interval, CI: 7.1-14.3] and 6.1% [3.4-9.7] by World Health Organization; 9.5% [6.5-13.0] and 4.0% [2.5-5.9] by International Obesity Task Force; and 11.5% [9.6-13.4] and 6.9% [5.0-9.0] by Centre for Diseases Control, respectively (p = 0.0027 for overweight; p < 0.0001 for obesity). Estimates were mostly higher in urban, and private schools, but generally similar by gender, major geographic regions, publication year and sample size. Substantial heterogeneity in the estimates across and within criteria were not always explained by major study characteristics.

CONCLUSION

Overweight and obesity are prevalent among African primary school learners, particularly those attending urban, and private schools. The results from this meta-analysis could be helpful in making informed decisions on childhood obesity prevention efforts in African countries.

A randomized controlled trial for overweight and obesity in preschoolers: the More and Less Europe study - an intervention within the STOP project

Background

Childhood overweight and obesity is a serious public health issue with an increase being observed in preschool-aged children. Treating childhood obesity is difficult and few countries use standardized treatments. Therefore, there is a need to find effective approaches that are feasible for both health care providers and families. Thus, the overall aim of this study is to assess the acceptance and effectiveness of a parent support program (the More and Less, ML) for the management of overweight and obesity followed by a mobile health (mHealth) program (the MINISTOP application) in a socially diverse population of families.

Methods/design

A two-arm, parallel design randomized controlled trial in 300 2-to 6-year-old children with overweight and obesity from Romania, Spain and Sweden (n = 100 from each). Following baseline assessments children are randomized into the intervention or control group in a 1:1 ratio. The intervention, the ML program, consists of 10-weekly group sessions which focus on evidence-based parenting practices, followed by the previously validated MINISTOP application for 6-months to support healthy eating and physical activity behaviors. The primary outcome is change in body mass index (BMI) z-score after 9-months and secondary outcomes include: waist circumference, eating behavior (Child Eating Behavior Questionnaire), parenting behavior (Comprehensive Feeding Practices Questionnaire), physical activity (ActiGraph wGT3x-BT), dietary patterns (based on metabolic markers from urine and 24 h dietary recalls), epigenetic and gut hormones (fasting blood samples), and the overall acceptance of the overweight and obesity management in young children (semi-structured interviews). Outcomes are measured at baseline and after: 10-weeks (only BMI z-score, waist circumference), 9-months (all outcomes), 15- and 21-months (all outcomes except physical activity, dietary patterns, epigenetics and gut hormones) post-baseline.

Discussion

This study will evaluate a parent support program for weight management in young children in three European countries. To boost the effect of the ML program the families will be supported by an app for 6-months. If the program is found to be effective, it has the potential to be implemented into routine care to reduce overweight and obesity in young children and the app could prove to be a viable option for sustained effects of the care provided.

Trial registration

ClinicalTrials.gov NCT03800823; 11 Jan 2019.

The relationship among GNB3 rs5443, PNPLA3 rs738409, GCKR rs780094 gene polymorphisms, type of maternal gestational weight gain and neonatal outcomes (STROBE-compliant article)

The gestational weight gain is determined by food habits, environmental and genetic factors.The aims of this paper were to establish relationships between maternal gene polymorphisms (patatin-like phospholipase domain-containing protein 3 rs738409 [PNPLA3 rs738409], glucokinase regulatory protein rs780094 [GCKR rs780094], and guanine nucleotide-binding protein rs5443 [GNB3 rs5443]) and mothers' gestational weight gain, but also neonatal outcomes (birth weight, length, and ponderal index [PI]).We performed a cross-sectional study in a sample of 158 mothers and their product of conception' in an Obstetrics-Gynecology Clinic from Romania. We divided the pregnant women according to the Institute of Medicine recommendations into 3 subgroups: (1) insufficient gestational weight gain; (2) normal gestational weight gain; and (3) excessive gestational weight gain.The gestational weight gain among pregnant women included in this study was classified as insufficient (10.1%), normal (31%), and excessive (58.9%). We found a tendency towards statistical significance for mothers that were overweight or obese before pregnancy to present an excessive gestational weight gain as compared to the normal weight ones. Similarly, we identified a tendency for statistical significance regarding the association between the variant genotype of GNB3 rs5443 and excessive gestational weight gain. We noticed differences that tended to be statistical significant concerning aspartate aminotransferase values between the 3 subgroups, mothers with excessive gestational weight gain having higher values than mothers with normal gestational weight gain (median, IQR: 22.89[17.53; 31.59] for mothers with excessive gestational weight gain versus 22.71[18.58; 27.37] for mothers with normal gestational weight gain). In mothers with excessive gestational weight gain, we found a significant association between the variant genotype of PNPLA3 rs738409 polymorphism and neonatal PI noticing a decrease of this index in case of newborns from mothers carrying the variant genotype.Excessive gestational weight gain was noticed in pregnant women that were obese and overweight before pregnancy. We found a positive association between the variant genotype of GNB3 rs5443 polymorphism and excessive gestational weight gain. Similarly, the presence of variant genotype of PNPLA3 rs738409 in mothers was associated with a lower PI in their newborns. Our study pointed out the most important factors that influence gestational weight gain and related birth outcomes.

Toward a Romanian version of the Three-Factor Eating Questionnaire-R21 for children and adolescents (CTFEQ-R21): Preliminary psychometric analysis and relation with body composition

OBJECTIVE

Purpose: The aim of this study was to develop and validate a Romanian version of the Three-Factor Eating Questionnaire-R21 for children and adolescents CTFEQ-R21, and to assess its psychometric properties and factor structure. Associations between the present version of the CTFEQ-R21 and anthropometric measures as well as body composition were also examined.

PATIENTS AND METHODS

Material and methods: 153 children and adolescents (68 boys and 95 girls; 10.8±3.5 years) took part in this study (BMI of 17.7±3.1 kg/m²). The participants were first interviewed to ascertain their understanding of the CTFEQ-R21 and were then asked to self-complete the questionnaire. Height and weight were measured and body composition assessed using bio impedance analyzers (Tanita MC 780).

RESULTS

Results: The CTFEQ-R21 showed satisfactory internal consistency (Cronbach's α=0.78). Cronbach's alpha coefficients were 0.55 for CR (cognitive restriction), 0.75 for UE (Uncontrolled Eating), and 0.76 for EE (Emotional Eating) separately. UE and EE were found to be significantly correlated (r=0.54, p<0.05). The three factors explained 43% of the total variance. Correlation between CR, UE and EE with body weight, BMI and FFM were significant but low to moderate, with coefficients ranging from 0.20 to 0.37. The higher the CR, UE and EE tertiles, the higher the weight, fat mass (kg) and fat-free mass values.

CONCLUSION

Conclusions: According to the psychometric analysis of the questionnaire, the version of the CTFEQ-R21 proposed here is a satisfactory tool to assess eating behaviors in the Romanian child population that remains to be further developed.

No clinical utility of common polymorphisms in IGF1, IRS1, GCKR, PPARG, GCK1 and KCTD1 genes previously associated with insulin resistance in overweight children from Romania and Moldova

Background Previous genome-wide association studies (GWAS) identified IGF1, IRS1, GCKR, PPARG, GCK1 and KCTD1 as candidate genes for insulin resistance and type 2 diabetes (T2D). We investigated the associations of these previously reported common variants in these genes with insulin resistance in overweight children from Romania and Moldova. Methods Six single nucleotide polymorphisms (SNPs), IGF1 (rs35767), IRS1 (rs2943634), GCKR (rs780094), PPARG (rs1801282), GCK1 (rs1799884) and KCTD15 (rs29941), were genotyped in 100 overweight children along with clinical and metabolic parameters. Homeostatic model assessment of insulin resistance (HOMA-IR) above 3.4 (defining insulin resistance) was used as the outcome. Results Children differed in insulin resistance status despite having similar body mass index (BMI) standard deviation scores (SDS) (World Health Organization, [WHO] reference). The identified predictors for altered insulin metabolism were higher cholesterol levels, higher diastolic blood pressure and higher waist-to-hip-ratio (as a marker for increased abdominal fat). None of the SNPs showed significant association with increase in the risk for insulin resistance in children (p range=0.478-0.724; odds ratio [OR] range=1.924-4.842); however, the risk allele in GCKR (rs780094, p=0.06, OR=6.871) demonstrated near statistical significance. Conclusions The interrogated risk alleles did not show any significant association with insulin resistance in children in our cohort; however, the GCKR (rs780094) might be a viable candidate in larger cohorts. The lack of replication of the proposed association may point to differences in linkage disequilibrium or effect modifiers across studies.

Early Inflammatory Status Related to Pediatric Obesity

Background: Obese individuals are often in a chronic inflammatory condition due to the malfunction of immune-related activities in the adipose tissue, involving a transient infiltration of neutrophils within the abdominal fat and their binding to adipocytes. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are considered cost-effective markers for the detection of subclinical inflammation. Our study intends to assess the early stages of inflammation associated with overweight and obesity in children. Materials and Methods: We performed a prospective study with 164 children, aged between 5 and 18 years, admitted to a Pediatric Tertiary Hospital in Romania between January 2018 and January 2019. The patients were divided according to body mass index (BMI) into two groups: Group 1: 77 overweight and obese children (BMI percentile ≥85), and Group 2: 87 children with a normal BMI, in order to evaluate the correlation between BMI and laboratory parameters (CBC, ESR, transaminase, total protein, albumin, and blood glucose levels), inflammatory biomarkers, NLR and PLR, and changes in abdominal ultrasound findings. Results: We found that the leukocyte, lymphocyte, erythrocyte, platelet, CRP, and transaminase levels were significantly higher in the overweight/obese group (p = 0.0379, p = 0.0002, p = 0.0003, p = 0.0006, p < 0.0001, p = 0.0332, and p < 0.0001, respectively). No significant statistical differences between the two groups in terms of neutrophil, hemoglobin, albumin, total protein, and glycemia levels were noted (p > 0.05). Moreover, NLR and PLR did not differ significantly between the two groups (p = 0.4674 and p = 0.9973, respectively). Conclusions: Obesity is associated with systemic low-grade inflammation which is reaching alarming rates worldwide among both children and adults. Our study proved that leukocyte, lymphocyte, erythrocyte, and platelet levels are significantly higher in overweight/obese children, emphasizing the inflammatory status related to this condition. Therefore, obesity-related studies involving pediatric patients are of major interest in order to develop appropriate methods to prevent the development of further complications in adulthood.

New Insights Regarding Genetic Aspects of Childhood Obesity: A Minireview

Introduction: Childhood obesity is occurring at alarming rates in both developed and developing countries. "Obesogenic" environmental factors must be associated with variants of different risk alleles to determine polygenic or common obesity, and their impact depends on different developmental stages.The interaction between obesogenic environment and genetic susceptibility results in the so-called polygenic forms of obesity. In contrast, monogenic and syndromic obesity are not influenced by environmental events. Therefore, this review aimed to underline the roles of some of the most studied genes in the development of monogenic and polygenic obesity in children. Results: Among the most common obesity related genes, we chose the fat mass and obesity-associated (FTO) gene, leptin gene and its receptor, tumor necrosis factor alpha (TNF-α), the melanocortin 4 receptor gene (MC4R), Ectoenzyme nucleotide pyrophosphate phosphodiesterase 1 (ENPP1), and others, such as peroxisome proliferator-activated receptor gamma (PPARG), angiotensin-converting enzyme (ACE), glutathione S-transferase (GST), and interleukin-6 (IL-6) genes. The roles of these genes are complex and interdependent, being linked to different cornerstones in obesity development, such as appetite behavior, control of food intake and energy balance, insulin signaling, lipid and glucose metabolism, metabolic disorders, adipocyte differentiation, and so on. Conclusions: Genetic predisposition is mandatory, but not enough to trigger obesity.Dietary interventions and proper lifestyle changes can prevent obesity development in genetically predisposed children. Further studies are needed to identify the precise role of both genetic and obesogenic factors in the development of childhood obesity in order to design effective preventive methods.

Thinness in young schoolchildren in Serbia: another case of the double burden of malnutrition?

OBJECTIVE

Thinness is rarely highlighted or regularly monitored among children in developed countries although it may be rather frequent and pose a significant risk to children's health. We aimed to describe the prevalence of mild, moderate and severe thinness among young Serbian schoolchildren.

DESIGN

Cross-sectional study of schoolchildren aged 6-9 years. Children were assessed for weight, height and BMI as part of the WHO European Childhood Obesity Surveillance Initiative in Serbia. Thinness grades were defined as gender- and age-specific cut-offs for BMI according to the International Obesity Task Force criteria.

SETTING

Serbia, September to November 2015.

SUBJECTS

Students (n 4861) in grades 2 and 3 (6-9 years, 2397 girls).

RESULTS

Overall prevalence of thinness in Serbian schoolchildren was 9·6 %. Mild thinness was clearly the largest category with a prevalence of 7·6 %, moderate thinness was present in 1·7 % of children and severe thinness was found in 0·3 % of children. OR indicated a significant risk of being thin for girls (1·44 times higher compared with boys) and children attending schools with no health-focused educational programme (1·57 times more likely to be thin than peers enrolled in schools with such programmes). In addition, OR for thinness tended to be 1·23 times higher in children living in an economically disadvantaged region of Serbia (P=0·06).

CONCLUSIONS

A rather high prevalence of thinness highlights this malnutrition disorder as an emerging health issue that should trigger public health policies to tackle thinness, especially in girls of young age and children living in economically disadvantaged areas.

DIFFERENCES IN THE PREVALENCE OF OVERWEIGHT AND OBESITY IN 5- to 14-YEAR-OLD CHILDREN IN KRAKÓW, POLAND, USING THREE NATIONAL BMI CUT-OFFS

The problem of overweight and obesity in children and adolescents has been noted in many different countries. The aim of this study was to evaluate the differences in the percentage occurrence of overweight and obesity in Polish children depending on the criteria used, and to evaluate the usefulness of the Polish national database. The study sample comprised 3405 children aged 5-14 years (1674 girls and 1731 boys) from the city of Kraków, Poland, in 2009-2010. The BMI of each child was calculated and classified as overweight or obese according to three different reference BMI cut-offs: the International Obesity Task Force (IOTF), the Centers for Disease Control and Prevention (CDC) and the Polish 2010 standard. To assess the statistical significance of the differences between these three applied reference datasets, a comparison of two proportions was performed and Cohen's kappa coefficient calculated. The prevalences of overweight were 15%, 11.3% and 9.5% (IOTF, CDC, Polish 2010, respectively) among boys and 15.5%, 11.6% and 9.9% among girls. The prevalences of obesity were 3.3%, 6.1% and 5.5% (IOTF, CDC, Polish 2010, respectively) among boys and 3.4%, 6.3% and 5.7% among girls. The different methods used generally showed good agreement. Nevertheless the prevalence of overweight and obesity differed significantly depending on the criteria used. In conclusion, the creation and updating of national databases based on large, representative groups is justified and provides the best reference for regional data. However, in order to ensure the comparability of results with those from other countries, it seems advisable to use cut-offs based on international data as well.