Risk factors associated with overweight and obesity among urban school children and adolescents in Bangladesh: a case-control study

Water, sanitation and hygiene (WASH) practices and deworming improve nutritional status and anemia of unmarried adolescent girls in rural Bangladesh

BACKGROUND

In Bangladesh, undernutrition and anemia are more occurrent among adolescent girls. BRAC, the largest non-governmental organization (NGO), has been implementing a community-based nutrition education service package targeting adolescent girls for reducing their undernutrition and anemia.

OBJECTIVE

We aimed to explore the underlying factors associated with nutritional status and anemia among adolescent girls under the BRAC nutrition program areas to improve their existing intervention package.

METHODOLOGY

We conducted a cross-sectional and comparative study in 2016, in 24 upazilas of Bogra, Barguna, Comilla, Dinajpur, Feni, Jessore, and Meherpur districts where the BRAC nutrition program was implemented while the remaining 27 upazilas of those districts were selected as comparison area. We followed a multistage cluster random sampling for selecting 1620 unmarried adolescent girls aged 10-19 years for interviewing in the intervention and comparison areas. Data were collected on socio-demographic information, dietary intake, morbidity, water, sanitation, and hygiene (WASH) practice, anthropometry, and serum hemoglobin (Hb) level by using a pre-structured questionnaire. The nutritional status of the adolescent girls was expressed as height-for-age Z (HAZ) and body mass index-for-age Z (BMIZ) score, while anemia referred to the serum Hb at the level of below 12 g/dl for adolescent girls. All statistical analyses were done in STATA version 17 (Chicago Inc.).

FINDINGS

The prevalence of stunting (22.9% vs. 22.5%), thinness (12% vs. 14%), and anemia (34.5% vs. 37.3%) exhibited similarities between the intervention and comparison regions. Stunting and thinness were predictors for each other for this population group. Our findings indicated that adolescent girls who were not washing hands with soap after defecation were likely to be stunted [AOR 1.51 (95% CI 1.12-2.04)], and who did not utilize sanitary latrines had an increased likelihood of being thin [AOR 2.38 (95% CI 1.11-5.08)]. Conversely, those who did not watch television [AOR 1.69 (95% CI 1.12-2.56)] and did not have deworming tablets [AOR 1.33 (95% CI 1.07-1.64)] in the 6 months leading up to the interview had a 69% and 33% higher probability of being anemic, respectively.

CONCLUSION

For sustainable improvement in the undernutrition and anemia of adolescent girls, integration of WASH, consistent administration of deworming tablets and broadcasting awareness programs through television are urgent to scale up the nutrition intervention programs in similar settings like Bangladesh.

Prevalence of and risk factors for overweight among adolescents of a sub-metropolitan city of Nepal

BACKGROUND

Overweight is a global public health problem with increasing trend especially in middle to lower socioeconomic country like Nepal. The nutritional status of adolescents being shaped by socio-cultural, environmental, and economic factors has also been impacted by their food habits and level of physical activity. The current nutritional shift and rapid urbanization had emerged overweight as an additional burden for consistently prevalent undernutrition issues. So, the study aimed to identify the prevalence of and risk factors for overweight among school adolescents.

METHODS

A cross-sectional analytical study was carried out among random sample of 279 adolescents from nine schools of a Sub-metropolitan city of Nepal. The anthropometric measurement of the height and the weight were taken as per the standard. The odds ratio with a 95% CI was calculated and a p-value of ≤0.05 was considered as cut off for statistical significance by fitting into the final multivariable logistic regression.

RESULTS

The overall prevalence of overweight was obtained as 9.31% (95% CI: 6.40-13.3). The early aged adolescents were more overweight than compared to middle-aged adolescents (AOR: 0.27, CI: 0.028-2.67) and late adolescents (AOR: 0.66, CI: 0.068-6.44) respectively. Similarly, adolescents residing in rural areas had 0.35 (AOR = 0.33, CI: 0.030-3.71) odds of being overweight compared to their counterparts. Adolescents with sedentary behavior were about 4 times (AOR = 3.51, CI: 0.79-15.54) more likely of being overweight than their counterparts.

CONCLUSION

Overweight among adolescents residing in urban areas has emerged as an alarming issue due to their unhealthy lifestyle habits. It is therefore pertinent to emphasize adolescents to maintain healthy weight status through health food habits and physical activity.

Obesity and associated factors among high school adolescent students in Bahir Dar town, North West Ethiopia: A cross-sectional study

Objective

The aim of this study was to assess the magnitude and associated factors of obesity among high school adolescent students in Bahir Dar, Ethiopia.

Methods

An institution-based cross-sectional study was conducted from 10 September 2019 to 10 October 2019 in Bahir Dar town. A total of 1018 students were enrolled using a multistage sampling procedure. Epidata version 3.1 was used for data entry, and SPSS version 24 was used for data analysis. A bivariable and multivariable logistic regression analysis was performed.

Results

The magnitude of obesity among high school adolescents was 8.3%. Attending a private school (adjusted odds ratio = 6.52; 95% confidence interval: 3.13, 13.59), not participating in moderate- to vigorous-intensity activities (AOR = 3.08; 95% confidence interval: 1.44, 6.64), coming from a wealthy family (adjusted odds ratio = 7.03; 95% CI: 2.16, 22.89), and snacking frequency (adjusted odds ratio = 9.64; 95% confidence Interval: 4.79, 19.39) were all associated with obesity.

Conclusions

Obesity was prevalent among students in private schools and wealthy families in the research area. Family size, household wealth, participation in moderate-to-striving activities, and snacking frequency were all found to be significant factors of obesity.

Factors associated with overweight and obesity among Bangladeshi university students: a case-control study

Objectives: Overweight and obesity has an adverse effect on public health, and emerging adulthood (18-25 years) is recognized as a potential period for the onset of obesity, thus, this study aimed to explore risk factors associated with overweight and obesity in Bangladeshi university students. Participants: Bangladeshi university students (n = 280). Methods: A case-control study of 140 students with overweight and obesity and 140 students with normal weight. Results: Multiple logistic regression revealed having at least one overweight or obese parent (AOR = 4.2; 95% CI: 2.2-8.4) and participating in no physical activity (AOR = 3.2; 95% CI: 1.0-9.9) were potential risk factors. Reported consumption ≥4 meals in a day, junk food/fast food, and soft drinks for ≥3 days a week were potential determinants of overweight and obesity in this population. Conclusion: Increased awareness on the importance of regular physical activity and a healthy diet may reduce the risk of overweight and obesity among Bangladeshi university students.

Determinants of Double Burden of Malnutrition Among School Children and Adolescents in Urban Dhaka: A Multi-Level Analyses

Background

Bangladesh faces a double burden of malnutrition, with a rising prevalence of overweight and obesity among children and adolescents parallel to existing undernutrition.

Objective

The current study was designed to assess the determinants of double burden of malnutrition among urban school children and adolescents from Dhaka, Bangladesh.

Methods

A cross-sectional survey was conducted among 2,690 students from 14 schools in Dhaka city from January to June 2018. Anthropometric measurements were taken during school hours, and self-administered questionnaires were sent to the parents. We performed multi-level multiple logistic regression analyses to assess the determinants of underweight, overweight, and obesity.

Findings

The prevalence of overweight (33%) and obesity (23%) was highest among children and adolescents from high tuition schools but the prevalence of underweight (4%) was lowest compared to those from low (underweight 19%, overweight 17%, and obesity 6%) and medium (underweight 18%, overweight 15%, and obesity 6%) tuition schools. Children and adolescents from high-tuition schools had higher odds of being overweight/ obese (AOR: 2.92; 95% CI: 1.90, 4.49). Parental NCDs and overweight were negatively associated with underweight but positively associated with overweight and obesity among children and adolescents. Lack of physical activity inside schools was positively associated (AOR: 1.26; 95% CI: 1.02, 1.55) with overweight and obesity among school children and adolescents.

Conclusion

Our results point to opportunities in and outside schools to address the rising prevalence of underweight, overweight, and obesity among urban school children and adolescents.

Association of overweight and obesity with hypertension, diabetes and comorbidity among adults in Bangladesh: evidence from nationwide Demographic and Health Survey 2017-2018 data

OBJECTIVES

The study aimed to determine the association of overweight and obesity with hypertension, diabetes and comorbidity among the adults of Bangladesh.

STUDY DESIGN

This study used cross-sectional data from the nationally representative Bangladesh Demographic and Health Survey conducted in 2017-2018. The main outcome variables were hypertension, diabetes and comorbidity. Comorbidity was defined as the coexistence of hypertension and diabetes. Overweight and obesity, as measured by body mass index, were the main explanatory variables. The strength of the association was determined using the adjusted multiple logistic regression models.

SETTING

Rural and urban areas in Bangladesh.

PARTICIPANTS

The study included a total of 11 881 adults (5241 men and 6640 women) aged 18 years or older.

RESULTS

The prevalence of hypertension, diabetes and comorbidity among the sample population were 28.5%, 9.9% and 4.5%, respectively. Among the respondents, 20.1% were overweight and 4.1% were obese. The risk of hypertension was 2.47 times more likely in the overweight group (adjusted OR (AOR) 2.47; 95% CI 2.22 to 2.75) and 2.65 times more likely in the obese group (AOR 2.65; 95% CI 2.16 to 3.26) compared with the normal or underweight group. Adults who were overweight and obese had 59% (AOR 1.59; 95% CI 1.37 to 1.84) and 88% (AOR 1.88; 95% CI 1.46 to 2.42) higher odds of having diabetes, respectively, than normal or underweight adults. Moreover, the risk of comorbidity was 2.21 times higher in overweight adults (AOR 2.21; 95% CI 1.81 to 2.71) and 2.86 times higher in obese adults (AOR 2.86; 95% CI 2.09 to 3.91) compared with normal or underweight adults.

CONCLUSIONS

Using large-scale nationally representative data, we found that overweight and obesity were significantly associated with hypertension, diabetes and comorbidity. So, nationally representative data can be used for programme planning to prevent and treat these chronic conditions.

Effect of Mother's Nutritional Knowledge and Hygiene Practices on School-Going Adolescents Living in Dhaka City of Bangladesh

BACKGROUND

Adolescence which is a critical stage for growth and development is influenced by various issues along with maternal nutritional knowledge, control over their earnings, freedom of movement, and participation in household decision-making over child's health care.

OBJECTIVE

This study focused on assessing mothers' nutritional knowledge and hygiene practices and their effect on dietary diversity as well as the nutritional status of school-going adolescents of Dhaka city.

METHODS

A community-based cross-sectional study was conducted at 44 schools in Dhaka city. A total of 710 school-going adolescents aged 10-17 years were randomly selected and their mothers were interviewed for assessing their knowledge on nutrition and hygiene practices. One-way ANOVA and multivariate linear regression were used to examine the association between dietary diversity and the nutritional status of the adolescents with their mother's nutritional knowledge and hygiene practices.

RESULTS

About one-third (35.8%) of the mothers maintained hygiene and sanitation satisfactorily. Although 53.1% of them had satisfactory general knowledge about a healthy diet, only 6.5% showed good knowledge of the nutritional value of food. The prevalence of stunting, thin, and overweight was 8, 4.6, and 5.8%, respectively. Fair hygiene practices were positively associated (P = 0.048) with height for age z-score. Maternal knowledge on the nutritional value of food was positively associated (P = 0.027) with the dietary diversity of the adolescents.

CONCLUSION

Adequate nutritional knowledge and hygiene practices of the mothers have positive effects on children's dietary diversity and nutritional status. Providing nutrition education to mothers would ensure better nutritional status and improved dietary practices for their children.

Determinants of overweight and/or obesity among school adolescents in Butajira Town, Southern Ethiopia. A case-control study

Background

The global rise of adolescent overweight and obesity is posing a new challenge to the public health sector by determining the forthcoming generation for the most awful and upsetting quality of social life by inducing bantering, social isolation, and stigmatization among children that contribute to the mental wellbeing of the growing adolescents. Risk factors for overweight and/or obesity might not be the same across different regions due to differences in socioeconomic characteristics, culture, ethnicity, and geographical location. Moreover, in this study area, no report has been documented so far on the determinant factors of overweight and/or obesity among school adolescents. Hence, this study aimed at identifying context-specific determinants of overweight and/or obesity among adolescents in the study area.

Methods and materials

School-based unmatched case-control study design was employed from March 1–30, 2019, in Butajira town, Southern Ethiopia. Data were collected regarding sociodemographic, dietary practice, physical activity, nutritional knowledge-related factors, and anthropometric measurements. Multivariable logistic regression models were fitted to identify independent predictors of overweight/obesity.

Results

We enrolled 297 adolescents: 99 cases, 198 controls. Multivariable binary logistic regression analysis revealed that those in high socioeconomic status [AOR = 5.8, 95% CI (2.66, 12.5)], consumed soft drinks 3 and above times per week [AOR = 3.7, 95% CI (1.8, 7.3)], physically inactive [AOR = 4.4 95% CI (1.68, 11.6)], spent free time by watching television/movies for 3 and above hours per day [AOR = 8.6, 95% CI (4.3, 17)] and with poor nutritional knowledge [AOR = 3.4, 95%CI (1.7, 6.9)] were significantly associated with overweight and/obesity.

Conclusion

High socioeconomic status, consumption of soft drinks, physical inactivity, sedentary behavior, and poor nutritional knowledge were significantly associated with overweight/obesity. Therefore, strengthening parent and school-based health education in healthy nutrition behaviors and promotion tactics such as enhancing physical activity, limiting watching television, and soft drinks will be helpful to minimize overweight and obesity among adolescents.

Association of sleep duration and sleep quality with overweight/obesity among adolescents of Bangladesh: a multilevel analysis

Background

Sleep deprivation is widely recognized as a potential contributor to childhood obesity. However, few studies have addressed this issue in low-income settings. The aim of this study was to determine the association of both sleep duration and sleep quality with overweight/obesity among adolescents of Bangladesh.

Methods

A cross-sectional study was conducted in four randomly selected schools in Gazipur, Bangladesh, from May to August 2019. Using a self-administered semi-structured questionnaire, data on sleep duration and sleep quality were collected from 1,044 adolescents between 13 and 17 years of age. The body mass indices of the study participants were evaluated using their objectively-assessed anthropometric measurements (weight and height). Multilevel logistic regression was used for data analysis.

Results

The prevalence of underweight, overweight and obesity in adolescents in this study were 14.9, 18 and 7.1%, respectively. More than 15% of the students reported sleep disturbance and poor sleep quality. After adjusting for confounders, reduced (<7 h/day) total sleep duration (OR=1.73, 95% CI=1.21-2.47), weekend sleep duration (OR=1.46, 95% CI=1.00-2.12), and night sleep duration (OR=1.55, 95% CI=1.06-2.28) were found to be significantly associated with overweight or obesity in Bangladeshi adolescents. Similarly, significant positive associations were evident between short duration of total sleep (OR=0.33, 95% CI=0.20-0.54), weekday sleep (OR=0.55, 95% CI=0.35-0.84), weekend sleep (OR=0.53, 95% CI=0.31-0.89), and night sleep (OR=0.56, 95% CI=0.36-0.87), and underweight in study participants. Adolescents with short sleep duration were found less likely to be underweight and more likely to be overweight/obese.

Conclusions

Study findings denoted short sleep duration to be associated with overweight/obesity and underweight among adolescents of Bangladesh. Adequate sleep may therefore serve as an effective obesity prevention strategy in the growing stages.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12774-0.

Dietary Habits and Obesity among Adolescent School Children: A Case Control Study in an Urban Area of Kancheepuram District

BACKGROUND

Obesity is an important public health problem and is on the rise among adolescents in developed and developing nations. This case-control study was done to assess the dietary risk factors associated with obesity among school children of the adolescent age group.

MATERIALS AND METHODS

This study was done among age-matched 110 cases and 110 controls who were adolescent children between ages 10 and 17 years. Data were collected using a pretested, structured, interviewer-administered questionnaire and was analyzed using descriptive and analytical statistics.

RESULTS

About 52.7% of children belonged to the age group 13-15 years. Adequate fruits intake was reported by 42.7% of obese adolescents and 60% of nonobese adolescents. Adequate intake of vegetables was noted in 20.9% of cases and 24.5% of controls. The risk factors which were found to be statistically associated with adolescent obesity were increased fast food intake, sweets consumption, inadequate fruit intake, and the liberty given by the parents in purchasing snacks.

CONCLUSIONS

Since adolescent obesity is rising at an alarming rate, the dietary determinants of obesity need to be addressed at the level of schools, families, and community. School health services should include education on healthy food habits and regular monitoring of the health status of children. Parents need to be aware on the significance of balanced diet, avoidance of junk foods, and ensure adequate intake of fruits and vegetables for their children to prevent early onset of noncommunicable diseases.

International study of 24-h movement behaviors of early years (SUNRISE): a pilot study from Bangladesh

BACKGROUND

The World Health Organization (WHO) released guidelines for physical activity, sedentary behavior, and sleep for children under 5 years of age in 2019. In response to these guidelines, this pilot study aimed to (i) determine the proportion of preschool children (ages 3-4 years) who met the WHO guidelines; (ii) examine the feasibility of the proposed protocol for the SUNRISE study; and (iii) assess the impact of the COVID-19 pandemic on movement behaviors of preschool children in Bangladesh.

METHODS

Time spent in physical activity, sedentary behavior and sleep were objectively measured using two types of accelerometers (ActiGraph wGT3x-BT and ActivPAL4). Screen time and sleep quality were assessed via parent questionnaire. Fine and gross motor skills were measured using the Ages and Stages Questionnaire (3rd edition). Three executive functions were assessed using the Early Years Toolbox. Focus groups were conducted with parents and childcare staff to determine the feasibility of the protocol. Follow-up data during COVID-19 pandemic was collected from parents over phone.

RESULTS

Data from 63 preschool-aged children and their parents was analyzed in this pilot study. Only three children (4.7%) met all components of the WHO guidelines. Separately, children meeting physical activity, sedentary screen time and sleep guidelines were 71.9%, 17.5%, and 59.7% respectively. The proportion of all children who were developmentally on-track for the gross and fine motor skills was 58.7% and 50.8%, respectively. Parents and educators reported that the protocol was feasible except for the activPAL-4 accelerometer. Approximately, 39% of children (14 out of 37) who wore this device developed itchy skin and rashes resulting in the suspension of using this device mid-way through data collection. During COVID-19, there was a significant decrease in children's total physical activity (- 193 min/day), and time spent outside on weekdays (- 75 min/day) and weekend days (- 131 min/day) and a significant increase in sedentary screen time (+85 min/day).

CONCLUSION

Only a low proportion of children met the WHO guidelines. Methods and devices (except ActivPAL4) used in this pilot study proved to be feasible and this has paved the way to conduct the main SUNRISE study in Bangladesh. Future measures should be taken to address the issue of movement behaviors of children during the time of pandemics like COVID-19.

The correlation between sleep quality and the prevalence of obesity in school-age children

BACKGROUND

The prevalence of obesity increases year by year. Sleep quality is considered to be one of the obesity causes. The current average sleep range of children in Indonesia was 6-7 hours. This study aims to analyze whether sleep quality affects the prevalence of obesity in children.

DESIGN AND METHODS

This study used a prospective cohort as the research method. The samples consisted of 37 primary school-age children (4th-6th grade) from West Java and Sumatra, which were selected using the snowball sampling technique. The data were collected by using PSQI and sleep logs (within a month).

RESULT

The statistical results showed that most of the obese children, 12 out of 19, had poor sleep quality (63.2%), while most of the non-obese children (normal),15 out of 18, had good sleep quality (83.3%). Based on the chi-square statistic, the p-value =0.011 <a (0.05) indicating that H0 was rejected, which means there was a correlation between sleep quality and obesity, with OR=8.571 (95% CI: 1.818-40.423), which means the children with poor sleep quality were likely to experience obesity 8.6 times greater than those who had good sleep quality.

CONCLUSIONS

This study found there were correlations between dietary intake, physical activity, sleep quality, and obesity in school-age children. The most dominant factor related to obesity in school-age children is the habitual sleep efficiency (OR=12.354).

Childhood overweight and obesity among the Saudi population: a case-control study among school children

BACKGROUND

Childhood obesity is a global public health concern with major consequences. In Saudi Arabia, the percentage of children who are overweight or obese has significantly increased in the past two decades, raising concerns about the physical and psychosocial consequences of this burden. This study aimed at investigating the different risk factors contributing to childhood obesity in Saudi Arabia.

METHODS

A case-control study was conducted among 492 school children (246 overweight/obese children, and 246 normal weight control children aged 5-9 years). Using valid and reliable instruments, parental and child characteristics, behavioral practices, screen use, and other activities were assessed as risk factors for childhood obesity using logistic regression analysis.

RESULTS

An unemployed father (OR=11.90; 95% CI: 7.47-18.93), a father with overweight/obesity (OR=2.04; 95% CI: 1.40-2.96), an incorrect parental perception of child's weight status (OR=2.54; 95% CI: 1.75-3.68), cesarean delivery (OR=2.52; 95% CI: 1.56-4.09), daily time in active play for less than 30 min (OR=2.18; 95% CI: 1.44-3.28), frequent snacking (OR=1.74; 95% CI: 1.05-2.93), and screen time use for more than 2 h per day outside of school (OR=1.62; 95% CI: 1.12-2.34) were all independent risk factors for being overweight or obese among the selected cases.

CONCLUSION

Efforts to prevent childhood overweight and obesity in this population should focus primarily on the early identification and confrontation of risk factors. Such risk factors include parental characteristics and awareness of the magnitude of the burden obesity poses, behavioral practices such as frequent snacking, screen time use, and physical activity.

Noncommunicable Disease Risk Factors Among Adolescent Boys and Girls in Bangladesh: Evidence From a National Survey

Objectives

To assess the prevalence of noncommunicable disease (NCD) risk factors and the factors associated with the coexistence of multiple risk factors (≥ 2 risk factors) among adolescent boys and girls in Bangladesh.

Methods

Data on selected NCD risk factors collected from face to face interviews of 4,907 boys and 4,865 girls in the national Nutrition Surveillance round 2018-2019, was used. Descriptive analysis and multivariable logistic regression were performed.

Results

The prevalence of insufficient fruit and vegetable intake, inadequate physical activity, tobacco use, and being overweight/obese was 90.72%, 29.03%, 4.57%, and 6.04%, respectively among boys; and 94.32%, 50.33%, 0.43%, and 8.03%, respectively among girls. Multiple risk factors were present among 34.87% of boys and 51.74% of girls. Younger age (p < 0.001), non-slum urban (p < 0.001) and slum residence (p < 0.001), higher paternal education (p = 0.001), and depression (p < 0.001) were associated with the coexistence of multiple risk factors in both boys and girls. Additionally, higher maternal education (p < 0.001) and richest wealth quintile (p = 0.023) were associated with the coexistence of multiple risk factors in girls.

Conclusion

The government should integrate specific services into the existing health and non-health programs which are aimed at reducing the burden of NCD risk factors.

Prevalence and Associated Factors of Overweight and Obesity among High School Adolescents in Bahir Dar City, Northwest, Ethiopia: A Cross-Sectional Study

BACKGROUND

Overweight and obesity can be defined as excessive and abnormal fat deposition in our bodies. A body mass index for age of Z scores +2 to +3 was classified as overweight, whereas BMI for age >+3 Z-score was considered as obesity. Overweight and obesity in adolescents are a major health problem in low-income countries like Ethiopia. However, there is not well-established data on adolescents' overweight and obesity. Therefore, this study assessed the prevalence and associated factors of overweight and obesity among high school adolescents in Bahir Dar city, northwest of Ethiopia.

METHODS

An institution-based cross-sectional study was conducted from October 30 to November 30/2019 among 551 high school adolescents. Data were collected using a self-administrative questionnaire. Weight and height were measured by trained health professionals. World Health Organization AnthroPlus software was used to analyze anthropometric data into body mass index for age with z-score to ascertained overweight and obesity. Data were entered using Epi Info version 3.5.3 and transferred to SPSS version 22 for further analysis. Frequency and percentage were presented using tables and figures. A bivariable and multivariable logistic regression analysis was performed to determine the association between the dependent and independent variables. Adjusted odds ratio with 95% CI and p < 0.05 were used to dictate statistical significance for overweight and obesity.

RESULT

In this study, 522 high school adolescents aged 10-19 years were selected using a simple random sampling technique with a response rate of 94.74%. The mean age of the respondents was 17 years with SD ± 1.41. The overall prevalence of overweight and obesity was 12.5% (95% CI: 9.6, 15.2). Males (13.3%) were more than females (11.5%), being overweight and obese. Having self-employed mothers (AOR: 4.57; 95% CI: 1.06, 19.78), having government-employed mothers (AOR: 6.49; 95% CI: 1.96, 21.54), and having school feeding habit (AOR: 0.44; 95% CI: 0.26, 0.76) were factors associated with overweight/obesity among high school adolescents.

CONCLUSION

The prevalence of overweight/obesity in the current study was high. Adolescents having self-employed mothers, adolescents having government-employed mothers, and students having school feeding habits were significant factors of overweight and obesity. Therefore, more emphasis will be given to adolescents having self- and government-employed mothers and adolescents having school feeding habit.

Overnutrition and Associated Factors: A Comparative Cross-Sectional Study between Government and Private Primary School Students in Gondar Town, Northwest Ethiopia

Introduction

Childhood overnutrition is a public health problem in low- and middle-income countries because its effect is likely to progress into adulthood that results in developing noncommunicable diseases at a younger age. There is no such previous comparative study that investigated this issue. Therefore, the aim of this study is to assess the prevalence and associated factors of overnutrition among government and private primary school students in Gondar town, northwest Ethiopia.

Methods

Institution-based comparative cross-sectional study was conducted from March 5 to April 9, 2019. A multistage sampling technique was used to select 736 participants. Data were collected through face-to-face interview. Data was entered into EPI-info version 7.2.1.0 and exported to SPSS version 20 for analysis. Bivariable and multivariable logistic regressions were carried out to identify associated factors with overnutrition. Statistical significance was declared using p value< 0.05.

Results

The overall prevalence of overnutrition was 9.1%. The prevalence was higher among private schools (51 (14%)) than government (16 (4.3%)). Eating habit while watching television (AOR = 4.08, 95%CI: 1.10–15.16) and not having close friend (AOR = 3.72, 95%: CI: 1.21–2 11.48) were significantly associated with overnutrition in the government schools, while no father education (AOR = 2.59, 95%:CI:1.05–6.39), sweet food preference (AOR = 2.86, 95%:1.19–6.87), fat consumption more than three days per week (AOR = 3.79, 95%CI:1.61–8.91), eating habit while reading (AOR = 4.95, 95%CI:2.29–10.70), and vigorous-intensity sports (AOR = 2.23, 95%:1.02–4.86) were associated with overnutrition in private schools.

Conclusion

Prevalence of overnutrition was higher among private than government schools. Hence, it requires attention through creating awareness about healthy diet, healthy lifestyle, and physical activity in collaboration with health and education sectors.

[Family environment, physical activity and sedentarism in preadolescents with childhood obesity: ANOBAS case-control study]

OBJECTIVE

The aim of this study is to compare the levels of physical activity and sedentary behaviours in children with obesity and normal weight through accelerometer measures, and analyze the family environment related to physical activity.

DESIGN

Case-control study.

LOCATION

A health center and colleges of the Community of Madrid.

PARTICIPANTS

A total of 50 obese children between 8 and 12 years of age (P > 97) and their mothers were matched by age, sex and socioeconomic status of their parents (1: 1) with 50 children with normopeso (GN; P < 85).

MAIN MEASUREMENTS

Physical activity levels were measured by accelerometer (ActiGraph GT3X), levels of physical activity of the primary caregiver were measured through physical activity questionnaire (IPAQ) and the environment in relation to the physical activity was measured by the Home Environment Scale (HES-S).

RESULTS

The group GO showed less vigorous physical activity than their peers in the GN group. Vigorous physical activity in the GO group was associated with modeling and parental policies regarding physical activity. A multiple regression analysis revealed that 21% of the variance of weight status of children was explained by sex, vigorous physical activity and maternal body mass index.

CONCLUSIONS

The levels of vigorous physical activity and the family environment differ between children with obesity and normal weight. Therefore, it is important to continue working on the awareness of illness and the promotion of healthy habits from Primary Care and the school and institutional context.

Challenges of promoting physical activity among school children in urban Bangladesh: A qualitative inquiry

INTRODUCTION

Physical activity (PA) confers a multitude of health benefits. Unfortunately, Bangladeshi school children get little PA. The current study assessed the barriers to promoting PA from the perspectives of school authorities and parents in urban Bangladesh.

MATERIALS AND METHODS

This study was conducted between January-June 2018 in Dhaka city. Fourteen schools were sampled to represent different school types. We used qualitative methods: 14 key Informant interviews (teachers), six focus group discussions (parents), and 14 observations of school environments. Thematic analysis was performed.

RESULTS

PA was not prioritized at most schools for two primary reasons: 1) there was a general lack of understanding of the importance of PA; and 2) physical education classes did not contribute to grades. Little time and resources were allotted for physical education classes because little priority was given to PA by school authorities. Outside school, lack of adequate safe open spaces undermined access to PA. Further, there were social barriers to PA including lack of parental support due to concerns about tiredness and injury and the perception that PA was detrimental to academic achievement. Many parents chose screen-based activities for children over PA.

CONCLUSION

Despite policies that mandate PA, PA lost out to school and parental priorities for academic achievement. Parental concerns about tiredness, injury and safe spaces impeded children's access to PA outside of school. Steps should be taken to enforce existing policies that mandate effective PA for school children, and parents and teachers should be educated about the need for and benefits of PA.

Hubungan antara Aktivitas Fisik dan Aktivitas Sedentari dengan Status Gizi Lebih pada Anak Sekolah Dasar

Background: Overnutrition status can be influenced by multifactor such as behaviors are eating habits, physical activity, sedentary activity, and genetic. Objectives: Analyze the relationship between of physical activity and sedentary activity with overnutrition status of elementary students.Methods: The study using a case control design, with respondents were 22 students in overnutrition status group and 22 students in normalnutrition status group.  Simple random sampling was used this study. Data were collected throught direct interview using Physical Activity Questionnare-Children (PAQ-C) to record respondent’s physical activity, and Adolescent Sedentari Activity Questionnaire (ASAQ) to record respondent’s sedentary activity. Analysis data using Chi-Square test for physical activity and Spearman test for physical activity. Results: The result showed that there was a relationship between physical activity with overnutrition status (p=0.016) and an OR=0.218 with CI 95% (0.061 – 0.775) which mean that student who did physical activity with good category at risk 0.218 times less to be overnutition status. As for sedentary activity (p=0.026) with OR=5.5 and CI 95% (1.145–17.679), which mean students who did sedentary activity more than 5 hour at risk 4.5 times greater than to be overnutrition status compared with students who did physical activity less than 2 hour. Conclusion: The low of physical activity and high of sedentary activityin elementary students were related with overnutrition status.  Student with overnutrition status must be increase physical activity and reduced sedentary activity.  ABSTRAK Latar Belakang: Status Gizi Lebih disebabkan oleh multifaktor yaitu faktor perilaku seperti kebiasaan makan, aktivitas fisik, aktivitas sedentari, dan faktor genetik.Tujuan: Menganalisis hubungan antara aktivitas fisik serta aktivitas sedentari dengan status gizi lebih pada anak usia sekolah dasar.Metode: Penelitian ini menggunakan desain case control, dengan sampel 22 anak kelompok status gizi lebih dan 22 anak kelompok status gizi normal. Simple random sampling merupakan metode yang digunakan dalam pengambilan sampel. Pengumpulan data menggunakan metode wawancara langsung dengan bantuan kuesioner PAQ-C (Physical Activity Questionnare-Children) untuk mencatat aktivitas fisik, dan kuesioner ASAQ (Adolescent Sedentari Activity Questionnaire) untuk mencatat aktivitas sedentari. Data dianalisis dengan uji statistik Chi-Square untuk aktivitas fisik dan Spearman untuk aktivitas sedentari.Hasil: Hasil penelitian menunjukkan bahwa terdapat hubungan yang signifikan antara aktivitas fisik dengan status gizi lebih (p 0,016) didapatkan nilai OR= 0,218 dengan CI 95% (0,061 – 0,775) dapat diartikan bahwa siswa yang melakukan aktivitas fisik dengan kategori baik beresiko 0,218 kali lebih kecil mengalami status gizi lebih. Sedangkan, untuk aktivitas sedentari (p= 0,026) dengan nilai OR = 4,5 dan CI 95% (1,145 – 17, 679) artinya siswa yang melakukan aktivitas sedentari > 5 jam maka memiliki kecenderungan 4,5 kali lebih besar untuk mengalami status gizi lebih dibandingkan dengan siswa yang melakukan aktivitas sedentari < 2 jam.Kesimpulan: Rendahnya aktivitas fisik dan tingginya aktivitas sedentari pada anak sekolah dasar berhubungan dengan masalah status gizi lebih. Siswa dengan status gizi lebih sebaiknya melakukan aktivitas fisik lebih banyak lagi, dan mengurangi kegiatan yang kurang gerak.

Trends in the prevalence of overweight among Bangladeshi children aged 24-59 months (2004-2014) by sex and socioeconomic status

BACKGROUND

While recent evidence suggests that the overall prevalence of overweight in young children in Bangladesh is low, little is known about variation in trends by sex, socioeconomic status, urbanicity, and region. We investigated the trends in overweight among children aged 24-59 months by these factors, using nationally representative samples from Bangladesh Demographic and Health Surveys (BDHS) between 2004 and 2014.

METHODS

Data from four BDHS surveys conducted between 2004 and 2014, with valid height and weight measurements of children, were included in this study (n = 15,648). BMI was calculated and the prevalence of overweight (including obesity) was reported using the International Obesity Taskforce (IOTF) classification system. To explore the association between socioeconomic status and childhood overweight, we used multivariable logistic regression.

RESULTS

The overall prevalence of overweight among children aged 24-59 months increased from 1.60% (95% CI: 1.20-2.05%) in 2004 to 2.33% (95% CI: 1.82-2.76%) in 2014. Among girls, the overweight trend increased significantly (adjusted odds ratio (OR) comparing 2014 vs. 2004: 2.02 95% CI: 1.52-2.68), whereas among boys the trend remained steady. When compared with households with the poorest wealth index, households with richest wealth index had higher odds of childhood overweight among both boys (OR 2.39, 95% CI: 1.76-3.25) and girls (OR 1.86, 95% CI: 1.35-2.55). Higher household education level was also associated with childhood overweight. Subgroup analyses showed that relative inequalities by these factors increased between 2004 and 2014 when adjusted for potential confounders.

CONCLUSIONS

There is a rising trend in overweight prevalence exclusively among girls aged 24-59 months in Bangladesh. Childhood overweight is associated with higher household education and wealth index, and the relative disparity by these factors appears to be increasing over time. These unmet inequalities should be considered while developing national public health programs and strategies.

Physical activity and sedentary behaviour in Bangladesh: a systematic scoping review

OBJECTIVES

Lack of physical activity (PA) contributes to increasing prevalence of non-communicable diseases (NCDs) globally. However, little is known about PA and sedentary behaviour (SB) among populations in low- and middle-income countries (LMICs). This systematic review examined prevalence of PA and SB in Bangladesh.

STUDY DESIGN

Systematic review of the literature.

METHODS

A systematic electronic search in eight databases and a manual search of retrieved articles' references were conducted. Original research conducted in Bangladesh with PA- and/or SB-related outcome(s) were included.

RESULTS

Out of 1,162 retrieved titles, 33 articles (32 cross-sectional and one case-control study) met the inclusion criteria. Twenty-nine studies were with healthy populations: adults (n = 19); children and adolescents (n = 7); and children, adolescents and adults (n = 3). Five studies used nationally representative samples of adults and one of adolescents. Most studies (n = 26) assessed PA only; three only SB, and four both PA and SB. All studies used self-reported measures. Among healthy adults, prevalence of insufficient PA ranged from 5% to 83%. Occupational and transport-related PA contributed the most towards total PA with negligible contribution of recreational PA. Among children and adolescents, the prevalence of insufficient PA ranged between 20% and 67%. Females engaged in less PA compared to males. Limited evidence currently exists about the prevalence of SB, especially among adults.

CONCLUSIONS

PA and SB research has received little attention in Bangladesh. Critical knowledge gaps identified in this review should be taken into account when designing new research and programmes in Bangladesh and other LMICs with similar socio-economic and cultural settings.

Trends and Correlates of Overweight among Pre-School Age Children, Adolescent Girls, and Adult Women in South Asia: An Analysis of Data from Twelve National Surveys in Six Countries over Twenty Years

Overweight has become a global pandemic and is associated with a rise in diet-related non-communicable diseases and associated co-morbidities. Most of the world’s undernourished people live in South Asia, yet the number of overweight and obese individuals in this region is growing. This study explores trends and correlates of overweight among pre-school age children, adolescent girls, and adult women in South Asia. Using pooled data from 12 national surveys in six countries, generalized linear mixed models were run to analyze relationships. Overweight children had significantly higher odds than non-overweight children of having an overweight mother (Adjusted Odds Ratio: 1.34, p < 0.01). Overweight adolescent girls were more likely to come from a wealthier household (Adjusted Prevalence Ratio (APR): 2.46, p < 0.01) in an urban area (1.74, p < 0.01), and have formal education (1.22, p < 0.01), compared to non-overweight girls. Similar relationships were seen among overweight vs. non-overweight adult women. In Bangladesh, India, and Nepal, overweight among girls and women increased over time, while differentials associated with household wealth, urban residence, and formal education attenuated over time. Overweight and obesity are becoming more prevalent across South Asia in a context of persisting undernutrition. Once a condition of the wealthier, more educated and urban, rates of overweight are increasing among poorer, less educated, and rural women. This requires immediate attention to ‘multi-use’ policies and programmes.

Towards reducing behavioral risk factors of non-communicable diseases among adolescents: protocol for a school-based health education program in Bangladesh

BACKGROUND

Developing strategies aimed at reducing behavioral risk factors and hence the prevalence of non-communicable diseases (NCDs) is a major challenge to the policy makers today. Like the same age group worldwide, the prevalence of obesity, unhealthy dietary habit, physical inactivity, smoking and alcohol intake is high among the adolescents of Bangladesh. Studies showed promising results of an early intervention at adolescent age in reducing the likelihood of NCDs at adult age. So, this study is designed to implement a behavior change intervention and evaluate the effectiveness of the intervention in reducing the behavioral risk factors of NCDs among the adolescents of Bangladesh.

METHODS

A before-after designed intervention study will be conducted in two randomly selected secondary schools- one will be selected randomly as intervention school and the another as control school. A baseline survey will be conducted among the students of both schools by a pre-tested questionnaire to attain their current status of knowledge, attitude and practices related to NCDs. Afterward, students will be enrolled in the intervention group who will meet the eligibility criteria from the intervention school. The intervention will be given through a health promotion session to a group of students, not more than 25 at a time, by trained facilitators. A post-intervention end line survey will be conducted among all the participants from both schools using the same questionnaire 3 months after the baseline survey.

DISCUSSION

An intervention has been developed based on some principals of two psychosocial theory- Motivational Interview and Social Cognitive Theory. Emphasis will be given on motivating the adolescents towards a healthy lifestyle, supporting self-efficacy to be changed, guiding self-regulatory ways along with facilitating desired changing process by empowering them with choices about the preventive measures of NCDs. This intervention is expected to increase awareness by equipping the adolescents with specific knowledge and skills and thus, facilitate an eventual change in their practiced risk behaviors. Besides, this intervention will address multiple behaviors at a time, and will be delivered to a group of adolescents, to attain the cost-effectiveness and thereby making it more realistic in the resource-poor context of Bangladesh.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03975335, registered on 01.06.2019. Retrospectively registered.

Determinants of overweight and obesity among urban school-going children and adolescents: a case-control study in Bangladesh

BACKGROUND

Childhood overweight and obesity is a major public health concern all over the world. Overweight or obese children have a higher risk of becoming obese in adulthood and are at higher risk of associated chronic diseases.

OBJECTIVE

The aim of this study was to determine the risk factors associated with overweight and obesity among urban school children and adolescents in Bangladesh.

MATERIALS AND METHODS

A case-control study was conducted among students aged 10-16 years in 10 schools of Dhaka city. A structured questionnaire was used to collect socio-demographic information and students' exposure to various risk factors. Data were analyzed by using SPSS 23.

RESULTS

Family income (p = 0.000), mother's weight (p = 0.036), school activity (p = 0.046), total physical activity (p = 0.008), sedentary activities (p = 0.014), eating fast food (0.008) and cakes/biscuits (p = 0.018) were found as potential determinants of overweight and obesity of children and adolescents. A multiple logistic regression revealed family income >50,000 per month [adjusted odds ratio (AOR) = 3.07, p = 0.001], no physical activity (AOR = 38.3, p = 0.004), more than 4 h of sedentary activities (AOR = 4.84, p = 0.02), regular consumption of fast food (AOR = 3.05, p = 0.042) are risk factors associated with childhood overweight/obesity. Whereas, having a normal weight mother (AOR = 0.51, p = 0.037) and eating cakes/biscuits less than 3 days a week (AOR = 0.33, p = 0.02) were found as protective factors.

CONCLUSION

Findings from this study will be very useful for public health professionals to increase awareness regarding risk factors of overweight and obesity, in order to reduce the future burden of obesity-associated chronic diseases.

Stunting and Overweight among 12-24-Month-Old Children Receiving Vaccination in Ho Chi Minh City, Vietnam

Introduction

Malnutrition and obesity are a double burden on children in developing countries and could induce higher risks of noncommunicable diseases in the long term. In the big cities of Vietnam, both issues are present and share the issue of nutrition problems; the prevalence of malnutrition in children is gradually decreasing while the prevalence of obesity is increasing rapidly. The paper aims to identify the prevalence of stunting and overweight/obesity in apparently healthy young children in Ho Chi Minh City (HCMC).

Methods

A prospective cross-sectional study recruited 12-24-month-old children receiving national vaccination in community health centers in HCMC from February 2016 to July 2017. Sixteen healthcare centers were randomly selected among 8 districts of HCMC. Stunting and overweight were defined by height-for-age z-score <-2 SD and BMI z-score ≥+2 SD.

Results

A total of 768 children had mean age of 16.8±4.2 months old, 51.7% boys. The prevalence of stunting and overweight/obesity was 8.2% and 10.7%, respectively. Stunting was associated with older age, boys, and low birth weight of children and occupation of mothers (P <0.05). No associated risk factor was observed for overweight/ obesity status.

Conclusion

The prevalence of overweight/obesity was higher than the prevalence of stunting in 12-24-month-old children in HCMC. Overweight/obesity would be a public health problem for children in big cities.

Socioeconomic transition and its influence on body mass index (BMI) pattern in Bangladesh

RATIONALE, AIMS, AND OBJECTIVES

Bangladesh is an underdeveloped country that has recently joined the ranks of low-middle-income countries. This study aims to investigate how socioeconomic and developmental factors have influenced women towards a shift in their body mass index (BMI).

METHODS

The trend was analysed using data on ever-married women from 6 nationwide surveys covering the years 1996 to 2014, conducted by the Bangladesh Demographic and Health Survey (BDHS). To assess the relationship between the socioeconomic factors and BMI, binary regression models were fitted for 6 surveys and forest plots were applied to display the results.

RESULTS

Factors such as age, education, residence, economic status, and contraceptive use were found to have had an increasing influence on BMI over the years that were being analysed. Age and education for women were potential factors influencing BMI. Growing urbanization and economic inequality were found to have been substantial over time, and marital status and contraceptive use were influential whilst the employment status of women held no consequence.

CONCLUSIONS

Rapid urbanization allied with growing wealth inequality and dietary alteration seems to have forced a change in the capacity of women in Bangladesh to control their weight. Additional information is still needed on such factors as the amount of time that women are inactive and sitting down, for example, as well as their daily calorie intake in order to assemble all the pieces for addressing necessary health policy changes in Bangladesh. These factors will also help to indicate a shift of focus from rural malnutrition to urban obesity.

Influence of lifestyle factors on Body Mass Index in preschoolers in Behbahan city, southwest Iran, 2016

Background and aim

The body mass index (BMI) of Iranian preschoolers is noticeably increasing. Thus, studying the factors influencing BMI in preschool children is crucial. The purpose of this study was to identify the effects of lifestyle factors on BMI of preschool children, residing in Behbahan city, southwest Iran, in 2016.

Methods

A total of 120 preschool children, aged 4 to 6 years, participated in this cross-sectional study. Multi-stage random sampling was done. Using researcher-developed questionnaires whose validity and reliability was confirmed, demographic and lifestyle data were obtained, as the questionnaires were completed by the subject's mothers. Lifestyle factors included physical activity, fruit and vegetable consumption, sugar-free beverage intake, and screen time. Multiple logistic regression was conducted to analyze the influence of lifestyle-related behaviors on BMI. Data were analyzed by means of the SPSS 22 software and p<0.05 was resulted as the meaningful level of statistics.

Results

The average BMI values for children was 15.13±1.90 kg/m2. A total of 88.3% of children did not receive 5 cups of fruits and vegetables each day. Also, 12.5% consumed more than one serving of sweetened beverages per day. Only 2.5% engaged in 60 minutes of structured physical activity every day and 40% did not limit screen-time viewing to 2 hours per day or less. The findings indicated that the physical activity and screen time affected the BMI (p<0.05), and the duration of physical activity had inverse relationship with obesity, and screen time was directly related to obesity.

Conclusion

Understanding the factors affecting the BMI of preschool children can inform the development of interventions to impact children's weight-related behavior and it can be used as the basis for future healthy body weight policies. Efforts to lower the obesity rate of preschoolers should be focused on the lifestyle behaviors, especially on the physical activity and screen time.

PREVALENCE OF CHILDHOOD OBESITY AND UNDERNUTRITION AMONG URBAN SCHOOL CHILDREN IN BANGLADESH

Despite the ongoing problems of undernutrition and infectious disease, obesity and overweight have become a major problem in developing countries, including Bangladesh. This cross-sectional study was undertaken to determine the prevalence of obesity, overweight and underweight among school children aged 6–12 years in Bangladesh. The study was conducted from June 2012 to May 2013 and the study sample comprised 1768 children (980 boys; 788 girls) from eight purposively selected schools in different areas of Dhaka city. Students were interviewed about their diet and physical activity, and anthropometric measurements were made, including height, weight, mid-upper-arm circumference (MUAC), waist circumference, hip circumference and body mass index (BMI). Undernutrition, overweight and obesity were defined using internationally accepted BMI cut-off points. Mean height, weight, BMI, MUAC, waist circumference and hip circumference values were found to be higher in boys than in girls, except at age 12 when these were found to be significantly higher in girls than in boys (p<0.05). The mean prevalence of overweight was 10.0% (boys 10.2%; girls 9.8%), and that of obesity 5.0% (boys 4.3%; girls 5.8%). The prevalence of underweight was 16.3% in boys and 12.7% in girls. The prevalence of underweight was significantly higher in poor than in rich children (22.1% vs 11.2%) and that of obesity was higher in rich than in poor children (9.9% vs 1.3%;p<0.001). A family history of obesity and hypertension emerged as a significant predictor of developing overweight and obesity (p<0.001). The data suggest that underweight and obesity co-exist in urban areas of Bangladesh, posing a challenge for the nutritional health of Bangladeshi children.

Sedentary behavior during leisure time, physical activity and dietary habits as risk factors of overweight among school children aged 14-15 years: case control study

OBJECTIVE

To determine the risk of sedentary behavior during leisure time, physical activity and dietary habits on overweight among school children aged 14-15 years in Kalutara District, Sri Lanka.

RESULTS

School based case-control study was conducted during September to November 2013 including 176 overweight children as cases and 704 children with normal weight as controls. Cases were defined as body mass index for age and sex of ≥ +1SD and controls as those in the range of -2SD to +1SD. Validated instruments were used for data collection. Multiple logistic regression was applied and results were expressed with adjusted odds ratios (OR) and 95% confidence intervals (CI). Risk factors for overweight were insufficient physical activity (OR 1.6, 95% CI 1.1-2.4), watching video/DVD ≥ 2 h (OR 3.1, 95% CI 1.8-5.3), watching television ≥ 2 h (OR 2.6, 95% CI 1.7-3.8) and doing homework ≥ 2 h, (OR 1.8, 95% CI 1.2-2.7). Consuming meat (OR 1.9, 95% CI 1.2-3.1), fish or other sea foods (OR 1.6, 95% CI 1.1-2.8), fast food/fried rice/oily foods (OR 1.9, 95% CI 1.2-2.9), carbonated drinks or sugary drinks (OR 1.9, 95% CI 1.2-2.8), sweets, cookies or ice cream (OR 1.8, 95% CI 1.2-2.9) were dietary risk factors for overweight. Consuming legumes and seeds (OR 0.50, 95% CI 0.3-0.7), vegetables and fruits (OR 0.6, 95% CI 0.4-0.9) were protective factors for overweight.

Exploration of the Risk Factors of Generalized and Central Obesity among Adolescents in North Lebanon

Adolescents' obesity is an emerging public health problem globally and in the Arab countries. Alarming rates of overweight/obesity have been rising progressively in Lebanon. However, the risk factors for the development of adolescents' obesity have not yet been thoroughly explored in North Lebanon. To determine the dietary and lifestyle risk factors associated with generalized and central obesity among adolescents living in Tripoli, a cross-sectional survey was conducted including a representative sample of 311 students aged 11–16 years from both sexes chosen from public and private schools in Tripoli. Data were collected using a standardized questionnaire to determine sociodemographic characteristics, dietary patterns, and physical activity and sedentary behaviors. Body mass index (BMI) was evaluated using the Center for Disease Control BMI for age percentiles. Central obesity was assessed using both waist-to-height ratio and gender-specific waist circumference for age indices. Multiple logistic regression analysis revealed that skipping breakfast and physical inactivity were the most significant independent risk factors associated with both generalized and central obesity. In addition, higher screen time and male gender were associated with increased risk for generalized and central obesity, respectively. Intervention strategies to prevent the development of obesity should be implemented among adolescent students to encourage regular breakfast intake and adopting healthy dietary and lifestyle behaviors.

Maternal undernutrition and excessive body weight and risk of birth and health outcomes

BACKGROUND

Overweight and obesity are increasing in low- and middle-income countries, while underweight remains a significant health problems. However, the association between double burden of nutrition and risk of adverse birth and health outcomes is still unclear in Bangladesh. The aim of this study was to determine the effect of maternal undernutrition and excessive body weight on a range of maternal and child health outcomes.

METHODS

In this study, we used Bangladesh Demographic and Health Survey (BDHS) 2011 and 2014 data sets to cover the maternal, child and non-communicable diseases related health outcomes. The study considered a range of outcome variables including pregnancy complication, cesarean delivery, diabetes, hypertension, stunting, and wasting, low birth weight, genital discharge, genital sore/ulcer, stillbirth, early neonatal mortality, perinatal mortality, preterm birth and prolonged labor. The key exposure variable was maternal body mass index. Multilevel regression analysis was performed to examine the association between outcomes and exposure variables.

RESULTS

Maternal overweight and obesity has increased from 10% in 2004 to 24% in 2014, a 240% increase in 10 years. Between 2004 and 2014, maternal undernutrition declined from 33% to 18%, a reduction rate of only 54% in 10 years. Compared to normal-weight women, overweight and obese women were more likely to have experienced pregnancy complication, cesarean delivery, diabetes, and hypertension. Underweight women were 1.3 times more likely to have children with stunting and 1.6 times more likely to experience wasting compared to normal weight women. Maternal BMI was not significantly associated with increased risk of genital sore or ulcer, genital discharge, menstrual irregularities, or low birth weight though in certain cases risk was higher.

CONCLUSIONS

High maternal overweight and obesity were observed to have significant adverse effects on health outcomes, while underweight was a risk factor for newborn health. The findings show that weight management is necessary to prevent adverse birth and health outcomes in Bangladesh.

TRIAL REGISTRATION

Data related to health was collected by following the guidelines of ICF international and Bangladesh Medical Research Council. The registration number of data collection is 132989.0.000 and the data-request was registered on March 11, 2015.

Prevalence and correlates of achieving recommended physical activity levels among children living in rural South Asia-A multi-centre study

Background

We report the prevalence of recommended physical activity levels (RPALs) and examine the correlates of achieving RPALs in rural South Asian children and analyse its association with anthropometric outcomes.

Methods

This analysis on rural South Asian children aged 5–14 years (n = 564) is a part of the Chronic Disease Risk Factor study conducted at three sites in India (Chennai n = 146; Goa n = 218) and Bangladesh (Matlab; n = 200). Data on socio-demographic and lifestyle factors (physical activity (PA); diet) were collected using an interviewer-administered questionnaires, along with objective anthropometric measurements. Multivariate logistic regression models were used to examine whether RPALs (active travel to school (yes/no); leisure-time PA ≥ 1 h/day; sedentary-activity ≤ 2 h/day) were associated with socio-demographic factors, diet and other forms of PA. Multivariate linear regression models were used to investigate associations between RPALs and anthropometrics (BMI- and waist z-scores).

Results

The majority of children (71.8 %) belonged to households where a parent had at least a secondary education. Two-thirds (66.7 %) actively travelled to school; 74.6 % reported ≥1 h/day of leisure-time PA and 55.7 % had ≤2 h/day of sedentary-activity; 25.2 % of children reported RPALs in all three dimensions. Older (10–14 years, OR = 2.0; 95 % CI: 1.3, 3.0) and female (OR = 1.7; 95 % CI: 1.1, 2.5) children were more likely to travel actively to school. Leisure-time PA ≥ 1 h/day was more common among boys (OR = 2.5; 95 % CI: 1.5, 4.0), children in Matlab, Bangladesh (OR = 3.0; 95 % CI: 1.6, 5.5), and those with higher processed-food consumption (OR = 2.3; 95 % CI: 1.2, 4.1). Sedentary activity ≤ 2 h/day was associated with younger children (5–9 years, OR = 1.6; 95 % CI: 1.1, 2.4), children of Goa (OR = 3.5; 95 % CI: 2.1, 6.1) and Chennai (OR = 2.5; 95 % CI: 1.5, 4.3) and low household education (OR = 2.1; 95 % CI: 1.1, 4.1). In multivariate analyses, sedentary activity ≤ 2 h/day was associated with lower BMI-z-scores (β = −0.3; 95 % CI: −0.5, −0.08) and lower waist-z-scores (β = −1.1; 95 % CI: −2.2, −0.07).

Conclusion

Only one quarter of children in these rural areas achieved RPAL in active travel, leisure and sedentary activity. Improved understanding of RPAL in rural South Asian children is important due to rapid socio-economic transition.

Obesity and Hypertension among School-going Adolescents in Peru

BACKGROUND

Adolescent obesity and hypertension are global public health issues. The burden of adolescent obesity and hypertension in Peru is unclear. The aim of this study was to determine the prevalence of obesity and hypertension and their relationship among school-attending adolescents and to assess the need for health-promoting school programs in the study area.

METHODS

A cross-sectional school-based survey was conducted in a randomly selected sample of 952 secondary school adolescents from 11 schools in Lima or Callao, Peru, in 2014. Weight, height, and blood pressure (BP) were measured and categorized. Obesity was defined as ≥ 95(th) percentile in body mass index (BMI) for age and sex. Hypertension was defined as average systolic blood pressure and/or diastolic blood pressure ≥95(th) percentile in BP for sex, age, and height. Chi-square test and univariate logistic regressions were used at a 5% significance level to determine the relationship between BMI and BP category.

RESULTS

The mean age of subjects was 14.6 years; 46.4% were boys and 53.6% were girls. The prevalence of overweight and obesity was 20.2% and 9.5% overall, 17.4% and 11.1% for boys, and 22.5% and 8.0% for girls, respectively. The prevalence of hypertension was 26.7% overall, 34.8% for boys, and 19.6% for girls. In both sexes, BMI was strongly associated with BP (p < 0.01).

CONCLUSION

The prevalence of obesity and hypertension observed in the study area is relatively high. Overweight and obesity are strongly associated with BP status among adolescents. Health-promoting school programs may reduce the burdens of obesity and hypertension among school-going adolescents.

Family-related risk factors of obesity among preschool children: results from a series of national epidemiological surveys in China

Background

Family-based child obesity prevention and control strategy has not yet established in many countries or regions, including China, thus what it needs to do now is to continuously develop and improve the strategies. The purpose of this study were to describe a wider spectrum of risk factors of obesity among preschool children and add to the mounting evidence for further improving suggested intervention measures in future family-based programs.

Methods

Data was collected as part of a series of national epidemiological surveys in childhood conducted in 9 Chinese cities. A population-based, 1:1 matched case–control design was employed to examine risk factors of obesity by means of conditional logistic regression. Obesity was defined as the International Obesity Task Force (IOTF) BMI-for-age cut offs. Eligible subjects were 1234 boys and 610 girls aged 3–7 years in 1996 and 2290 boys and 1008 girls in 2006, including obese and non-obese.

Results

High birth weight, gestational hypertension and parents’ BMI were closely associated with childhood obesity. Breast feeding in the first 4 months was a protective factor in univariate model in 2006 (OR = 0.834, P = 0.0234), but the association was not seen in multivariate. Appetite, eating speed, daily time and intensity for outdoor activities, night sleep time, and time for TV viewing were identified statistically by multivariate model. Those children brought up in extended family or mainly raised by their grandparents or lived in high income or low education families might have an increased risk of becoming obese. Parents’ attitudes on weight control of their children significantly differed between obese and non-obese groups.

Discussion

A wider spectrum of risk factors and an empirical aggregation of family-related risk factors are discussed to further improve future family-based child obesity prevention and control strategies. Most of the risk factors identified by this study presented ranked or quantitative characteristics which might be transformed from unhealthy threshold to healthy range by behavior modification. Some variables are likely to interact each other, such as appetite and eating speed, or outdoor activity and TV viewing, or BMI and income, but which needs to be further explored in future surveys.

Conclusions

The family-related risk factors were summarized from our identified risk factors of obesity among preschool children which strongly supported the further development of family-based programs in preschool period.

Trend of Overweight and Obesity, Based on Population Study among School Children in North West of Iran: Implications for When to Intervene

INTRODUCTION

Childhood overweight and obesity is a major public health problem in both developed and developing countries. Overweight and obesity in children may have severe consequences later in a dolescence and adulthood. The aim of current study was to determine the prevalence trend of overweight and obesity in school-aged children from 2009 to 2011.

METHODS

The present study was a population-based study and conducted in three consecutive years, from 2009 to 2011. The study population included all of primary, secondary and high school children in rural and urban regions of West Azerbaijan province in West-North of Iran. Body mass index (BMI), the ratio of weight to height squared [weight (kg)]/ [height (m)]2, was calculated to the nearest decimal place. Overweight and obesity were classified using CDC recommendations for age and sex: a BMI 85th- 95th percentile was classified as overweight and a BMI >95th percentile was classified as obese. All statistical analyses were performed using the Excel Software. Descriptive statistics were used to characterize the sample in different time periods. The prevalence was calculated as the ratio of number present cases to a given population number in a given subgroup at a given time.

RESULTS

Overall, 165740, 145146 and 146203 school children were assessed at 2009, 2010 and 2011, respectively. Prevalence of overweight in primary school children among girls were 52.83, 86.93 and 116.36 and for boys were 57.07, 53.4 and 93.55 per 1000 person in 2009, 2010 and 2011 years, respectively. The prevalence of obesity in secondary school children for girls were 22.26, 27.75 and 28.43 and 26.52, 25.72 and 35.85 for boys per 1000 person in 2009, 2010 and 2011, respectively, The highest prevalence of overweight was 77.58, 142.4 and 126.46 per 1000 person among primary, secondary and high school children, respectively, in 2011. The lowest prevalence of obesity was 12.52, 24.1 and 21.61 per 1000 person among primary, secondary and high school children, respectively, in 2009.

CONCLUSIONS

However, the rapid increase in both obesity and overweight should have a special attention. Research on prevalence trend of overweight and obesity in children is poorly reported in Iran. So that, future studies need to follow-up on the associations between overweight and obesity with health outcomes when children develop and reach adolescence and adulthood.

Maternal caloric restriction prior to pregnancy increases the body weight of the second-generation male offspring and shortens their longevity in rats

Maternal undernutrition can affect offspring's physical status and various health parameters that might be transmittable across several generations. Many studies have focused on undernutrition throughout pregnancy, whereas maternal undernutrition prior to pregnancy is not sufficiently studied. The objective of our study was to explore the effects of food restriction prior to and during pregnancy on body weight and longevity of the second generation offspring. Adult female Wistar rats ("F0" generation) were 50% food restricted for one month prior to pregnancy (pre-pregnancy) or during pre-pregnancy and pregnancy. The third group was fed normally (control). The first generation offspring were normally fed until the 6(th) month of age to produce the second generation offspring; namely, the first-generation female rats were mated with male breeders from outside the experiment. The second generation offspring thus obtained were observed until natural death (up to 36 months). Compared to the controls, the second-generation male offspring whose "grandmothers (F0 females)" undernourished only during pre-pregnancy were significantly heavier from the 8(th) month of age, whereas no significant weight difference was found in the male offspring whose "grandmothers" were food-restricted during pre-pregnancy and pregnancy. Shorter lifespan was observed in the second-generation male offspring of "grandmothers" that were food-restricted either during pre-pregnancy or during pre-pregnancy and pregnancy. By contrast, no differences in body weight and lifespan were observed in all second-generation female offspring. In conclusion, maternal caloric restriction prior to pregnancy increases the body weight and shortens the longevity of the second-generation male offspring, indicating the sex-dependent transgenerational effect of maternal caloric restriction.

Maternal obesity, environmental factors, cesarean delivery and breastfeeding as determinants of overweight and obesity in children: results from a cohort

BACKGROUND

Overweight and obesity are a public health problem with a multifactorial aetiology. The objective of this study was to evaluate risk factors for overweight and obesity in children at 6 years of age, including type of delivery and breastfeeding.

METHODS

This study relates to a cohort of 672 mother-baby pairs who have been followed from birth up to 6 years of age. The sample included mothers and infants seen at all ten maternity units in a large Brazilian city. Genetic, socioeconomic, demographic variables and postnatal characteristics were analyzed. The outcome analyzed was overweight and/or obesity defined as a body mass index greater than or equal to +1 z-score. The sample was stratified by breastfeeding duration, and a descriptive analysis was performed using a hierarchical logistic regression. P-values of <0.05 were considered significant.

RESULTS

Prevalence rates (PR) of overweight and obesity among the children were 15.6% and 12.9%, respectively. Among the subset of breastfed children, factors associated with the outcome were maternal overweight and/or obesity (PR 1.92; 95% confidence interval "95% CI" 1.15-3.24) and lower income (PR 0.50; 95% CI 0.29-0.85). Among children who had not been breastfed or had been breastfed for shorter periods (less than 12 months), predictors were mothers with lower levels of education (PR 0.39; 95% CI 0.19-0.78), working mothers (PR 1.83; 95% CI 1.05-3.21), caesarean delivery (PR 1.98; 95% CI 1.14 - 3.50) and maternal obesity (PR 3.05; 95% CI 1.81 - 5.25).

CONCLUSIONS

Maternal obesity and caesarean delivery were strongly associated with childhood overweight and/or obesity. Lower family income and lower levels of education were identified as protective factors. Breastfeeding duration appeared to modify the association between overweight/obesity and the other predictors studied.

Risk factors of overweight and obesity in childhood and adolescence in South Asian countries: a systematic review of the evidence

OBJECTIVE

To assess and synthesize the published evidence on risk factors of overweight and obesity in childhood and adolescence in South Asia.

STUDY DESIGN

A systematically conducted narrative review.

METHODS

A systematic review was conducted of all primary studies published between January 1990 and June 2013 from India, Pakistan, Nepal, Bangladesh, Sri Lanka, Bhutan, and Maldives located through the following data bases: PubMed, PubMed central, EMBASE, MEDLINE, BioMed central, Directory of Open Access Journals (DOAJ) and electronic libraries of the authors' institutions. Data extraction and quality appraisal of included studies was done independently by two authors and findings were synthesized in a narrative manner as meta-analysis was found to be inappropriate due to heterogeneity of the included studies.

RESULTS

Eleven primary studies were included in the final review, all of which were conducted in school settings in India, Pakistan and Bangladesh. Prevalence of overweight and obesity showed wide variations in the included studies. The key individual risk factors with statistically significant associations to overweight and obesity included: lack of physical activities reported in six studies; prolonged TV watching/playing computer games reported in four studies; frequent consumption of fast food/junk food reported in four studies; and frequent consumption of calorie dense food items reported in two studies. Family level risk factors included higher socioeconomic status reported in four studies and family history of obesity reported in three studies.

CONCLUSION

This review provides evidence of key contributors to the increasing burden of obesity and overweight among children and adolescents in South Asia, and demonstrates the nutritional transition that characterizes other developing countries and regions around the world. The findings have implications for policy, practice and the development of interventions at various levels to promote healthy eating and physical activity among children and adolescents in the region as well as more globally.

Effect of combined aerobic and resistance training in body composition of obese postmenopausal women

The aim of this study was to investigate the effects of a 16-week program of combined aerobic and resistance training on the body composition of postmenopausal women who are obese. The participants were divided into two groups: training group (TG, n = 37) and non-trained control group (CG, n = 18). The trunk fat, fat mass, percentage of fat mass and fat-free mass were estimated using DXA. Three nonconsecutive 24-hour dietary recalls were conducted. The training protocol consisted of 50 minutes of resistance training followed by 30 minutes of aerobic training. After the 16-week training program, differences were observed in trunk fat (CG= 0.064 x TG= -0.571 Kg; p-value = .020), fat mass (CG= -0.088 x TG= -1.037 Kg; p-value = .020) and fat-free mass (CG= -0.388 x TG= 1.049 Kg; p = .001). Therefore, a 16-week program of systematic combined aerobic and resistance training in obese postmenopausal women was effective in improving fat-free mass and decreasing both whole and abdominal adiposity.

Reference curves of anthropometric indices in two national studies conducted among Iranian children in 2003-2004 and 2009-2010: The Caspian study

BACKGROUND

Reference percentile curves are usually used as a screening tool to determine growth disorders. Anthropometric indices are population-dependent and may differ according to ethnicity, dietary pattern and lifestyle habits. This study aims to compare the curves of anthropometric measures obtained in two national studies conducted among Iranian children and adolescents in 2003-2004 and 2009-2010.

MATERIALS AND METHODS

Anthropometric measures obtained in two nationwide surveys conducted in 10-18-year-old Iranian students were compared. Lambda-mu-sigma (LMS) Chart Maker Pro program was used to develop age- and gender-specific percentiles and to smooth and fit the model.

RESULTS

In 2003-2004, the mean and standard deviation (SD) of body mass index (BMI) and waist circumference (WC) were 18.98 ± 3.81 kg/m(2) and 67.50 ± 11.05 cm in boys; and 19.44 ± 3.78 kg/m(2) and 66.55 ± 9.89 cm in girls, respectively. In 2009-2010, the corresponding figures were 19.16 ± 4.07 kg/m(2), 69.42 ± 11.43 cm, 19.63 ± 4.11 kg/m(2), and 67.29 ± 9.69 cm, respectively. Height curves did not show considerable changes in two studies. Comparison of two series of studies showed that the weight, BMI, WC, and waist-to-height ratio were lower in adolescent girls than boys especially in higher percentiles. Moreover, in both genders, weight, BMI, and WC percentiles decreased.

CONCLUSION

The growth charts of Iranian children and adolescents aged 10-18 years have changed over 5 years. The reference growth curves change over time in the pediatric age group, repeated surveys should be conducted to update the age- and gender-specific reference curves in different populations.

Obesity and overweight in Bangladeshi children and adolescents: a scoping review

BACKGROUND

Obesity and overweight in children and adolescents is an emerging public health concern alongside under-nutrition in low and middle income countries. Our aim was to conduct a scoping review of literature to ascertain what is known about childhood and adolescent overweight and/or obesity in Bangladesh.

METHOD

Using the scoping review based on York methodology, a comprehensive search of published academic articles, conference proceedings and grey literature was carried out through PubMed, BanglaJOL, Google and Google scholar limited to English-written papers. We summarized prevalence, risk factors and health outcomes of obesity/overweight in young children and adolescents aged between 0 to 19 years old in Bangladesh and highlighted use of different reference standards to measure childhood obesity.

RESULTS

In total 21 studies met the inclusion criteria. Nearly all of the reviewed articles used data from cross sectional studies, while only two used case-control design. Overall thirteen studies (62%) were primary research and eight (38%) included secondary data. Studies indicated an increasing trend in childhood obesity over time. Prevalence ranged from less than 1% to 17.9% based on different reference standards, with higher percentage amongst urban children across different age groups and sexes.

CONCLUSION

This review demonstrated paucity of comprehensive literature on childhood obesity in Bangladesh, which might be explored through population-based prospective studies based on strong methodology and uniform reference standards. Sustainable and scalable preventative measures targeting high risk groups are required to avoid further rise.

Prevalence of diabetes and prediabetes and their risk factors among Bangladeshi adults: a nationwide survey

OBJECTIVE

To estimate the prevalence of diabetes and prediabetes in Bangladesh using national survey data and to identify risk factors.

METHODS

Sociodemographic and anthropometric data and data on blood pressure and blood glucose levels were obtained for 7541 adults aged 35 years or more from the biomarker sample of the 2011 Bangladesh Demographic and Health Survey (DHS), which was a nationally representative survey with a stratified, multistage, cluster sampling design. Risk factors for diabetes and prediabetes were identified using multilevel logistic regression models, with adjustment for clustering within households and communities.

FINDINGS

The overall age-adjusted prevalence of diabetes and prediabetes was 9.7% and 22.4%, respectively. Among urban residents, the age-adjusted prevalence of diabetes was 15.2% compared with 8.3% among rural residents. In total, 56.0% of diabetics were not aware they had the condition and only 39.5% were receiving treatment regularly. The likelihood of diabetes in individuals aged 55 to 59 years was almost double that in those aged 35 to 39 years. Study participants from the richest households were more likely to have diabetes than those from the poorest. In addition, the likelihood of diabetes was also significantly associated with educational level, body weight and the presence of hypertension. The prevalence of diabetes varied significantly with region of residence.

CONCLUSION

Almost one in ten adults in Bangladesh was found to have diabetes, which has recently become a major public health issue. Urgent action is needed to counter the rise in diabetes through better detection, awareness, prevention and treatment.