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Tanveer M, Asghar E, Badicu G, Tanveer U, Roy N, Zeba A, Badri Al-Mhanna S, Batrakoulis A. Associations of School-Level Factors and School Sport Facility Parameters with Overweight and Obesity among Children and Adolescents in Pakistan: An Empirical Cross-Sectional Study. Sports (Basel) 2024; 12:235. [PMID: 39330712 PMCID: PMC11435805 DOI: 10.3390/sports12090235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 07/23/2024] [Accepted: 08/16/2024] [Indexed: 09/28/2024] Open
Abstract
Childhood overweight and obesity are increasingly prevalent in Pakistan, posing significant public health challenges. This study explores the associations of school-level factors and school sports facility parameters with overweight and obesity among children and adolescents in Pakistan. A cross-sectional study across seven random districts in Punjab province, Pakistan, was conducted using a representative multistage random cluster sample. Underweight (BMI < 5th percentile), overweight (85th ≤ BMI < 95th percentile), and obese (95th percentile ≤ BMI) were defined using the US Center for Disease Control (CDC) 2000 criteria. Statistical analyses including the Chi-square test, Pearson correlation coefficient, and linear regression were performed to investigate predictive characteristics. Logistic regression analysis assessed the simultaneous impact of several covariates on dichotomous outcomes, with 95% confidence intervals (CIs) computed and a significance level set at p < 0.05. The study included 4108 Pakistani school children aged 9 to 17 years (mean age = 13.92 years, 59.3% boys) from 62 schools. The prevalence of overweight and obesity was 19.4% and 10.7%, respectively. Findings revealed a concerning lack of physical education activities (60% reported 0 sessions per week), morning exercise (60%), and classroom exercises (66%) among school-aged children. Leadership attitudes toward physical education (β = 0.04, p = 0.006) and students' satisfaction with the playground (β = 0.05, p = 0.015) showed significant associations with body weight status. Conversely, provision of physical education facilities, effective fund utilization for physical education, meeting school sports facility requirements, and weekend opening of school sports grounds did not significantly impact weight status. Satisfaction with the playground was significantly associated with a lower risk of overweight (OR 0.81, 95% CI 0.69-0.95, p < 0.05), indicating reduced overweight likelihood among students satisfied with school playgrounds. The study underscores significant gaps in promoting physical activity within school environments and highlights the urgent need for interventions to enhance physical education resources and sports facilities, aiming to create healthier school environments and reduce overweight and obesity prevalence among students. Further research and interventions are crucial for promoting lifelong physical activity habits and improving student health and well-being.
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Affiliation(s)
- Moazzam Tanveer
- School of Physical Education and Sport Training, Shanghai University of Sport, Shanghai 200438, China
- Department of Allied Health Sciences, Health Services Academy, Islamabad 44000, Pakistan
| | - Ejaz Asghar
- Department of Allied Health Sciences, Health Services Academy, Islamabad 44000, Pakistan
| | - Georgian Badicu
- Department of Physical Education and Special Motricity, Transilvania University of Brasov, 500068 Brasov, Romania
| | - Umar Tanveer
- Department of Mass Communication, University of Lahore, Lahore 54000, Pakistan
| | - Nadeem Roy
- School of Physical Education, Shanxi University, Taiyuan 030006, China
| | - Asifa Zeba
- Department of Education, International Islamic University, Islamabad 44000, Pakistan
| | - Sameer Badri Al-Mhanna
- Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Alexios Batrakoulis
- Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece
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Asif M, Qureshi HAI, Seyal SM, Aslam M, Sultan MT, Elwahab MEA, Matłosz P, Wyszyńska J. Assessing Disparities about Overweight and Obesity in Pakistani Youth Using Local and International Standards for Body Mass Index. J Clin Med 2024; 13:2944. [PMID: 38792484 PMCID: PMC11122011 DOI: 10.3390/jcm13102944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Obesity is currently considered a public health problem in both developed and developing countries. Gender- and age-specific body mass index (BMI) growth standards or references are particularly effective in monitoring the global obesity pandemic. This study aimed to report disparities in age-, gender- and ethnic-specific statistical estimates of overweight and obesity for 2-18 years aged Pakistani children and adolescents using the World Health Organization (WHO), the Center for Disease Control (CDC) 2000 references, the International Obesity Task Force (IOTF) and Pakistani references for BMI. Methods: The study used secondary data of 10,668 pediatric population, aged 2-18 years. Demographic information like age (years), gender, city and anthropometric examinations, i.e., height (cm) and weight (kg) were used in this study. The recommended age- and gender-specific BMI cut-offs of the WHO, CDC 2000 and the IOTF references were used to classify the children sampled as overweight and obese. For the Pakistani reference, overweight and obesity were defined as BMI-for-age ≥ 85th percentile and BMI-for-age ≥ 95th percentile, respectively. Cohen's κ statistic was used to assess the agreement between the international references and local study population references in the classification of overweight/obesity. Results: The statistical estimates (%) of the participants for overweight and obesity varied according to the reference used: WHO (7.4% and 2.2%), CDC (4.9% and 2.1%), IOTF (5.2% and 2.0%) and Pakistan (8.8% and 6.0%), respectively; suggesting higher levels of overweight and obesity prevalence when local study references are used. The Kappa statistic shows a moderate to excellent agreement (κ ≥ 0.6) among three international references when classifying child overweight and obesity and poor agreement between local references and the WHO (0.45, 0.52), CDC (0.25, 0.50) and IOTF references (0.16, 0.31), for overweight and obesity, respectively. Conclusions: The results of the study showed a visible difference in the estimates of excess body weight after applying the WHO, CDC, IOTF and local BMI references to the study population. Based on the disparity results and poor agreement between international references and the local study reference, this study recommends using local BMI references in identifying children with overweight and obesity.
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Affiliation(s)
- Muhammad Asif
- Department of Statistics, Govt. Graduate College Qadir Pur Raan, Multan 60000, Pakistan;
| | | | - Saba Mazhar Seyal
- South City Hospital, District Headquarter (DHQ) Sadar, Multan 60000, Pakistan;
| | - Muhammad Aslam
- Department of Statistics, Bahauddin Zakariya University, Multan 60800, Pakistan;
| | | | - Maysaa Elmahi Abd Elwahab
- Department of Mathematical Sciences, College of Science, Princess Nourah bint Abdulrahman University, Riyadh 11564, Saudi Arabia;
| | - Piotr Matłosz
- Institute of Physical Culture Sciences, Medical College of Rzeszow University, 35-959 Rzeszów, Poland;
| | - Justyna Wyszyńska
- Institute of Health Sciences, Medical College of Rzeszow University, 35-959 Rzeszów, Poland
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Aasim M, Chand S. Height-for-age and weight-for-age growth charts for Pakistani infants under six months: derived from a novel case selection method using multiple indicator cluster survey data. BMC Med Res Methodol 2023; 23:289. [PMID: 38066412 PMCID: PMC10709855 DOI: 10.1186/s12874-023-02116-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND In the past two decades, there has been a growing recognition of the need to establish indigenous standards or reference growth charts, particularly following the WHO multicenter growth study in 2006. The availability of accurate and reliable growth charts is crucial for monitoring child health. The choice of an appropriate model for constructing growth charts depends on various data characteristics, including the distribution's tails and peak. While Pakistan has reported some reference growth charts, there is a notable absence of indigenous charts for children under two years of age, especially for infants aged 0-6 months who are exclusively breastfed. Additionally, acquiring data poses a significant challenge, particularly for low-income countries, as it demands substantial resources such as finances, time, and expertise. The Multiple Indicator Cluster Survey (MICS) constitutes a large-scale national survey conducted periodically in low-income countries under the auspices of UNICEF. In this study, we propose methods for generating selection variables utilizing the "Novel Case Selection Method," as previously published. Further our approach enables to select and fit appropriate model to the MICS data, selected, and to develop the standard growth charts. METHODS Out of the 11,478 children under 6 months of age included in MICS-6 (Pakistan), 3,655 children (1,831 males and 1,824 females) met the specified criteria and were selected using the "Novel Case Selection Method". The sample was distributed across provinces as follows: 841 (23.0%) from KPK, 1,464 (40.1%) from Punjab, 819 (22.4%) from Sindh, and 531 (14.5%) from Balochistan. This sample encompassed both rural (76.4%) and urban (23.6%) populations. Following data cleaning and outlier removal, a total of 3,540 records for weight (1,768 males and 1,772 females) and 3,515 records for height (1,759 males and 1,756 females) were ultimately available for the development of standard charts. The Bayesian Information Criterion (BIC) was employed to determine the optimal degrees of freedom for L, M, and S using RefCurv_0.4.2. Three families within the gamlss class-namely, Box Cox Cole and Green (BCCG), Box Cox T (BCT), and Box Cox Power Exponential (BCPE)-were applied, each with three smoothing techniques: penalized splines (ps), cubic splines (cs), and polynomial splines (poly). The best-fitted model was selected from these nine combinations based on the Akaike Information Criteria. RESULTS The Novel Case Selection Method yielded 3655 cases as per criteria. After cleaning the data, this method lead to selection of 3540 children for "weight for age" (W/A) and 3515 children for "height for age" (H/A). The "BCPE" family and "ps" as smoothing method proved to be best on AIC for all four curves, i.e. the W/A male, W/A female, H/A male, and H/A female. The optimum selected degrees of freedom for the curve "W/A", for both genders were (M = 1, L = 0, S = 0). The optimum degrees of freedom for H/A male were again (M = 1, L = 0, S = 0), but for females the selected degrees of freedom were (M = 1, L = 1, S = 1). The indigenous fitted standard curves for Pakistan were on lower trajectory in comparison to WHO standards. CONCLUSION This study uses the Novel Case Selection Method with introduced algorithms to construct tailored growth charts for lower and middle-income countries. Leveraging extensive MICS data, the methodology ensures representative national samples. The resulting charts hold practical value and await validation from established data sources, offering valuable tools for policy makers and clinicians in diverse global contexts.
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Affiliation(s)
- Muhammad Aasim
- NHRC, NIH (HRI) Research Centre, Shaikh Zayed Medical Complex, Lahore, Pakistan.
- College of Statistical Sciences, University of the Punjab, Lahore, Pakistan.
| | - Sohail Chand
- College of Statistical Sciences, University of the Punjab, Lahore, Pakistan
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Alaba OA, Chiwire P, Siya A, Saliu OA, Nhakaniso K, Nzeribe E, Okova D, Lukwa AT. Socio-Economic Inequalities in the Double Burden of Malnutrition among under-Five Children: Evidence from 10 Selected Sub-Saharan African Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085489. [PMID: 37107770 PMCID: PMC10138555 DOI: 10.3390/ijerph20085489] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/09/2023] [Accepted: 04/07/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Africa is unlikely to end hunger and all forms of malnutrition by 2030 due to public health problems such as the double burden of malnutrition (DBM). Thus, the aim of this study is to determine the prevalence of DBM and degree of socio-economic inequality in double burden of malnutrition among children under 5 years in sub-Saharan Africa. METHODS This study used multi-country data collected by the Demographic and Health Surveys (DHS) Program. Data for this analysis were drawn from the DHS women's questionnaire focusing on children under 5 years. The outcome variable for this study was the double burden of malnutrition (DBM). This variable was computed from four indicators: stunting, wasting, underweight and overweight. Inequalities in DBM among children under 5 years were measured using concentration indices (CI). RESULTS The total number of children included in this analysis was 55,285. DBM was highest in Burundi (26.74%) and lowest in Senegal (8.80%). The computed adjusted Erreygers Concentration Indices showed pro-poor socio-economic child health inequalities relative to the double burden of malnutrition. The DBM pro-poor inequalities were most intense in Zimbabwe (-0.0294) and least intense in Burundi (-0.2206). CONCLUSIONS This study has shown that across SSA, among under-five children, the poor suffer more from the DBM relative to the wealthy. If we are not to leave any child behind, we must address these socio-economic inequalities in sub-Saharan Africa.
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Affiliation(s)
- Olufunke A. Alaba
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
- Correspondence:
| | - Plaxcedes Chiwire
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
- Western Cape Department: Health, Western Cape Province, P.O. Box 2060, Cape Town 8000, South Africa
| | - Aggrey Siya
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala P.O. Box 7062, Uganda
| | - Oluremi A. Saliu
- Department of Environmental Health Science, Faculty of Health Sciences, National Open University of Nigeria, Abuja 901101, Nigeria
| | - Karen Nhakaniso
- Business School, University of the People, 595 E Colorado Blvd Suite 623, Pasadena, CA 91101, USA
| | - Emmanuella Nzeribe
- Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi GPS AK-448-4944, Ghana
| | - Denis Okova
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Akim Tafadzwa Lukwa
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Private Bag X1, Matieland, Stellenbosch 7602, South Africa
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Khalid A, Qaisar R, Hussain MA, Karim A. Circulating follicle stimulating hormone levels influence body growth in pre-menarcheal girls in a latitude-dependent manner. Heliyon 2023; 9:e15293. [PMID: 37089386 PMCID: PMC10114241 DOI: 10.1016/j.heliyon.2023.e15293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction Age at menarche is an essential determinant of reproductive life of a woman. Latitude is an important driver of age at menarche, however the contributions of circulating follicle stimulating hormone (FSH) and socio-economic status (SES) to age at menarche in a latitude-dependent manner is not known. Methods This population-based cross-sectional study is a component of our major cohort of 10,050 schoolgirls aged 8-16 years from 35 schools across 10 districts. The selected districts were categorised into high and low latitudes by applying a cut-off point at latitude 31.5⁰N. We evaluated the physical parameters, SES, circulating FSH, and growth hormone (GH) levels in pre-menarche girls (N = 252) at different latitudes. Results Self-reported age at menarche of girls residing at different latitudes in Pakistan showed that higher latitude is associated with delayed age at menarche. Higher latitude was associated with reduced circulating FSH levels, as well as lower parameters of physical growth including body mass index (BMI), waist-hip ratio and, waist-height ratio (all p < 0.05) in the pre-menarcheal girls. However, circulating GH levels were not affected by latitude. On the other hand, lower SES was associated with reduced GH levels and lower BMI, which are considered as probably the primary determinants of physical growth. Conclusions Taken together, we show that higher latitude may delay the sexual maturation, while poor SES may delay the physical growth in girls.
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Affiliation(s)
- Amna Khalid
- Department of Family and Community Medicine and Behavioral Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Rizwan Qaisar
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Cardiovascular Research Group, Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - M. Azhar Hussain
- Department of Finance and Economics, College of Business Administration, University of Sharjah, Sharjah, United Arab Emirates
- Department of Social Sciences and Business, Roskilde University, Roskilde, Denmark
| | - Asima Karim
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Department of Physiology & Cell Biology, University of Health Sciences, Lahore, Pakistan
- Corresponding author. Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Tanveer M, Hohmann A, Roy N, Zeba A, Tanveer U, Siener M. The Current Prevalence of Underweight, Overweight, and Obesity Associated with Demographic Factors among Pakistan School-Aged Children and Adolescents-An Empirical Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11619. [PMID: 36141896 PMCID: PMC9517235 DOI: 10.3390/ijerph191811619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/26/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Purpose: This study investigated the most recent estimates of underweight, overweight, and obesity prevalence in Pakistani school-aged children and adolescents. Methods: A cross-sectional study was conducted using a convenience random clustered sampling approach with 3,551 Pakistani school children aged 9 to 17 years from 52 schools throughout seven districts in central Punjab province. The CDC US 2000 was used to define underweight (BMI < 5th percentile), overweight (85th ≤ BMI < 95th percentile), and obesity (95th percentile ≤ BMI) for different school grade cohorts (primary, middle, secondary, and higher secondary schools). As a trend test, the Chi-square test was used. A Spearman correlation analysis (r) was used to determine the correlations between demographic variables and weight status. A regression analysis was conducted to explore the predictive power of demographic factors in relation to body weight. Results: In Pakistani school-aged children and adolescents, the prevalence of underweight, normal weight, overweight, and obesity was 21.9%, 66.9%, 5.8%, and 5.4%, respectively. Significant correlations with body weight status were shown for individual demographic parameters (age, gender, school type, and school grade). Children in urban areas were more likely to be underweight, overweight, or obese than those in rural areas. Boys were found to have a lower BMI than girls. Accordingly, more boys than girls were underweight (odds ratio (OR) = 1.57, 95% CI: 1.33-1.85) and more girls had a higher risk of obesity than boys (OR = 1.39, 95% CI: 1.03-1.86). Lower grades showed more underweight (OR = 1.66, 95% CI: 1.39-1.99) whereas higher grades showed a higher risk of obesity (OR = 1.91, 95% CI: 1.41-2.57). Conclusions: In Pakistani school-aged children and adolescents, underweight, overweight, and obesity were prevalent. Compared with studies from 2011, the risk of overweight and obesity in Pakistan has decreased. However, this may also be due to the fact that students in Pakistan have a lower BMI compared to other countries. This issue has also been seen in the present study and is confirmed here by the high number of cases of underweight students. Future research studies should look into additional weight status correlates and factors. To evaluate the association between weight status and behavioral and other health variables, future research should use longitudinal or interventional designs.
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Affiliation(s)
- Moazzam Tanveer
- School of Physical Education and Sport Training, Shanghai University of Sport, Shanghai 200438, China
| | - Andreas Hohmann
- Department of Training and Movement Science, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95447 Bayreuth, Germany
| | - Nadeem Roy
- School of Physical Education, Shanxi University, Taiyuan 030006, China
| | - Asifa Zeba
- Department of Education, International Islamic University, Islamabad 44000, Pakistan
| | - Umar Tanveer
- Department of Mass Communication, University of Lahore, Lahore 54000, Pakistan
| | - Maximilian Siener
- Department of Training and Movement Science, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95447 Bayreuth, Germany
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Khan DSA, Das JK, Zareen S, Lassi ZS, Salman A, Raashid M, Dero AA, Khanzada A, Bhutta ZA. Nutritional Status and Dietary Intake of School-Age Children and Early Adolescents: Systematic Review in a Developing Country and Lessons for the Global Perspective. Front Nutr 2022; 8:739447. [PMID: 35187014 PMCID: PMC8848764 DOI: 10.3389/fnut.2021.739447] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background The prevalence of double burden of malnutrition (DBM) is high in low- and middle-income countries (LMICs). Data on malnutrition trends is present for children <5 years of age, however the data for school-going children and adolescents aged 5–15 years is scarce. Objective This systematic review presents the pooled prevalence of nutritional status and dietary intake among school-going children and adolescents (5–15 years of age) in an LMIC of Pakistan and the perspective for broader global nutrition in this age group. Methods An electronic search of databases was run on Pubmed and Medline (via Ovid) along with gray literature and archives of local scientific journals till 2nd January 2021. Studies meeting the eligibility criteria were included and relevant data were extracted, and a pooled proportional analysis was performed. Results A total of 51 studies including 62,148 children of 5–15 years met the inclusion criteria, of which 30 studies reported on anthropometric indices alone, eight on dietary intake patterns while 13 reported both. All of the included studies had a cross-sectional study design. There were 20 studies from the province of Punjab, 15 from Sindh, eight from Khyber Pakhtoonkhwa, two from Balochistan, and three from multiple cities across Pakistan. The pooled proportional analysis showed that the proportion of underweight children and adolescents was 25.1% (95% CI 17.3–33.7%); stunting 23% (95% CI 11.8–36.7%); wasting 24% (95% CI 15.2–34%); thinness 12.5% (95% CI 9.4–16.1%); overweight 11.4% (95% CI 7.2–16.3%); and obesity 6.9% (95% CI 3–12%). A relatively high intake of carbohydrates, soft drinks, and sweets/chocolates; and a low intake of protein-rich foods, fruits, and vegetables, compared to the recommended daily allowance (RDA), was reported. Conclusion The limited data suggests the presence of DBM amongst children aged 5–15 years and also identified that dietary intake patterns are not meeting the recommended allowance. This review highlights the gaps and the need for larger, well-designed studies for this age group with the representation of different contexts and the need for similar studies in various LMICs, so that appropriate actions be deliberated and appropriate programs should be designed focusing on this vital population.
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Affiliation(s)
| | - Jai K. Das
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Shagufta Zareen
- Policy and Strategic Planning Unit, Ministry of Health, Government of Punjab, Lahore, Pakistan
| | - Zohra S. Lassi
- Faculty of Health and Medical Sciences, Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Afsah Salman
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
| | - Muhammad Raashid
- Policy and Strategic Planning Unit, Ministry of Health, Government of Punjab, Lahore, Pakistan
| | | | - Aijaz Khanzada
- Ministry of Health, Government of Sindh, Karachi, Pakistan
| | - Zulfiqar A. Bhutta
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
- *Correspondence: Zulfiqar A. Bhutta
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Qaisar R, Karim A. BMI status relative to international and national growth references among Pakistani school-age girls. BMC Pediatr 2021; 21:535. [PMID: 34852819 PMCID: PMC8638413 DOI: 10.1186/s12887-021-03017-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 11/22/2021] [Indexed: 12/17/2022] Open
Abstract
Background A sizable proportion of school-going children from developing countries has abnormal growth parameters, often not standardized with international reference values. We aimed to assess the prevalence of underweight, overweight, and obesity in the schoolgirls of Punjab according to international and local references. Methods In this population-based cross-sectional study, 10,050 school-going girls aged 8–16 years from 12 districts of northern, central, and southern Punjab were recruited. Estimates of normal weight, underweight, overweight and obesity were calculated in the girls according to three international BMI references including centers for disease control (CDC) 2000, the international obesity task force (IOTF) 2012 and world health organisation (WHO) 2007 in addition to a local reference for the population under study. We used Cohen’s kappa statistics to analyse the agreement of our data with reference values. Results There was marked overestimation of underweight (23.9%, 14.5%, 15.2% and 4.37%), slight underestimation of overweight (5.3%, 7.3%, 7.9% and 8.97%) and moderate underestimation of obesity (1.9%, 1.5%, 2.2% and 5.67%) according to CDC, IOTF, WHO and local reference, respectively. When the weight status of the study cohort was compared with the local data, we found comparable results in all four weight categories. Conclusion We recommend population-wide further studies to estimate the prevalence of weight status in school-age girls for devising appropriate references and for planning strategies for public health policy and management.
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Affiliation(s)
- Rizwan Qaisar
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, UAE
| | - Asima Karim
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, UAE. .,Department of Physiology & Cell Biology, University of Health Sciences, Lahore, Pakistan.
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Muhsen K, Na’amnih W, Goldsmith R, Maya M, Zeidan N, Kassem E, Ornoy A. Associations of Feeding Practices in Early Life and Dietary Intake at School Age with Obesity in 10- to 12-Year-Old Arab Children. Nutrients 2021; 13:2106. [PMID: 34205416 PMCID: PMC8234619 DOI: 10.3390/nu13062106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/13/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Abstract
Understanding the role in pediatric obesity of early life feeding practices and dietary intake at school age is essential for early prevention. The study aimed to examine associations of early life feeding practices, environmental and health-related exposures, and dietary intake at school age as determinants of obesity in children aged 10-12 years. In an earlier study of 233 healthy infants in two Arab towns in northern Israel, neonatal history, feeding practices, and health information were obtained up to age 18 months. This follow-up study assessed dietary intake and anthropometric measurements at age 10-12 years using the 24 h recall method. Overall, 174 children participated in this study. Almost all (98%) the children were breastfed. The prevalence of obesity at school age was 42%. A multivariable model adjusted for energy intake and socioeconomic status showed positive associations of total fat intake and of weight-for-height z score, but not feeding practices in infancy, with obesity. Higher gestational age at birth was associated with lower odds of obesity at age 10-12 years. In conclusion, in a population with near universal breastfeeding, gestational age at birth, weight indicators but not feeding practices in infancy, and total fat intake at school age were associated with increased likelihood of obesity.
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Affiliation(s)
- Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 6997801, Israel; (W.N.); (M.M.)
| | - Wasef Na’amnih
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 6997801, Israel; (W.N.); (M.M.)
| | | | - Maayan Maya
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 6997801, Israel; (W.N.); (M.M.)
| | - Nuha Zeidan
- Clalit Health Service, Diet and Nutrition Unit, P.O. Box 789, Arara 30026, Israel;
| | - Eias Kassem
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera 38100, Israel;
| | - Asher Ornoy
- Laboratory of Teratology, Department of Medical Neurobiology, The Hebrew University Hadassah Medical School, Jerusalem 9112002, Israel
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
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Achouri I, Aboussaleh Y, Sbaibi R, Ahami A. Anthropometry, food consumption and iron deficiency anemia, among primary school children (6-15 years) in Kenitra city (North-Western Morocco). Pan Afr Med J 2021; 38:374. [PMID: 34367453 PMCID: PMC8309009 DOI: 10.11604/pamj.2021.38.374.10008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 08/14/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION the problem of malnutrition among children is a phenomenon associated with a rapid nutrition transition in Morocco and all developing countries. The objective of this study is to evaluate the nutritional status by anthropometry, food consumption and iron deficiency anemia among primary school children aged 6-12 years in Kenitra city (Morocco). METHODS the survey covered 271 students (55% of boys and 45% girls) aged 6 to 12. Information concerning food consumption patterns, socioeconomic status and other lifestyle factors was obtained using questionnaires and interviews. Anemia was defined when haemoglobin < 11.5 g/dl. RESULTS the results showed that, 6.3%, 2.2% and 17.3% children were stunted, thin and overweight respectively. No significant association was found between gender and nutritional status of children. 16.2% children were anemic and food consumption found not to be varied and below recommendations. CONCLUSION the finding in this study showed that overweight and obesity occurred more frequently than the various forms of under nutrition in the population studied. The finding support the urgent need to improve the nutritional status of children by implementing preventive strategy for the problem of malnutrition among school-aged children.
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Affiliation(s)
- Imane Achouri
- Behavioral Neurosciences and Nutritional Health Unit, Nutrition and Health Laboratory, Department of Biology, Faculty of Sciences, University Ibn Tofail, BP 133 14000 Kenitra, Morocco
| | - Youssef Aboussaleh
- Behavioral Neurosciences and Nutritional Health Unit, Nutrition and Health Laboratory, Department of Biology, Faculty of Sciences, University Ibn Tofail, BP 133 14000 Kenitra, Morocco
| | - Rachid Sbaibi
- Behavioral Neurosciences and Nutritional Health Unit, Nutrition and Health Laboratory, Department of Biology, Faculty of Sciences, University Ibn Tofail, BP 133 14000 Kenitra, Morocco
| | - Ahmed Ahami
- Behavioral Neurosciences and Nutritional Health Unit, Nutrition and Health Laboratory, Department of Biology, Faculty of Sciences, University Ibn Tofail, BP 133 14000 Kenitra, Morocco
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Karim A, Qaisar R. Anthropometric measurements of school-going-girls of the Punjab, Pakistan. BMC Pediatr 2020; 20:223. [PMID: 32416717 PMCID: PMC7229613 DOI: 10.1186/s12887-020-02135-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 05/11/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Child's growth has been considered an important indicator to evaluate health trends in a population and to devise strategies accordingly. The purpose of the present study was to determine most commonly occurring weight abnormalities among school-going girls from Punjab and to compare with international growth references devised by World Health Organization (WHO) and Centre for Disease Control and Prevention (CDC). METHODS In this cross-sectional study a sample of 10,050 child and adolescent girls from 12 districts, 35 public/private sector schools, located in rural, semi-urban and urban areas of northern, central and southern Punjab were included. Parameters were measured according to standardised techniques and centile curves obtained by Lambda, Mu, Sigma (LMS) method. RESULTS The results showed an increase in weight, height and BMI of the Punjabi girls until 15 years. When compared with international growth references, weight and BMI in our population were significantly lowered; however, height was lower during 12-16 years of age and the differences observed were more pronounced with CDC as compared to WHO. When 3rd, 50th and 90th percentiles of weight, height and BMI in our population were compared with international standards, the values were lower in our paediatric population. CONCLUSION The Punjabi schoolgirls significantly differed from CDC and WHO references, and this difference should be taken into consideration for evaluation of growth abnormalities in our paediatric population. However, in the absence of national reference data, WHO standards have been considered more appropriate for comparison.
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Affiliation(s)
- Asima Karim
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, UAE.
- Department of Physiology & Cell Biology, University of Health Sciences, Lahore, Pakistan.
| | - Rizwan Qaisar
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, UAE
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Hossain FB, Shawon MSR, Al-Abid MSU, Mahmood S, Adhikary G, Bulbul MMI. Double burden of malnutrition in children aged 24 to 59 months by socioeconomic status in five South Asian countries: evidence from demographic and health surveys. BMJ Open 2020; 10:e032866. [PMID: 32184304 PMCID: PMC7076246 DOI: 10.1136/bmjopen-2019-032866] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES We aimed to investigate the socioeconomic inequalities in the burden of underweight and overweight among children in South Asia. We also examined other factors that were associated with these outcomes independently of household's socioeconomic status. DESIGN Nationally-representative surveys. SETTINGS Demographic and Health Surveys from Bangladesh, India, Pakistan, Maldives and Nepal, which were conducted between 2009 and 2016. PARTICIPANTS Children aged 24 to 59 months with valid measurement for height and weight (n=146 996). PRIMARY EXPOSURE AND OUTCOME MEASURES Primary exposures were household's wealth index and level of education. Underweight and overweight were defined according to the WHO and International Obesity Task Force definitions, respectively. RESULTS Underweight prevalence was 37% in Bangladesh, 38% in India, 19% in Maldives, 29% in Nepal and 28% in Pakistan. Bangladesh, India and Nepal had similar overweight prevalence (between 2% and 4%) whereas Pakistan (7%) and Maldives (9%) had higher prevalence. Households with higher wealth index or education had lower odds of having underweight children. Adjusted ORs of underweight for richest versus poorest households were 0.4 (95% CI: 0.3 to 0.5), 0.5 (95% CI: 0.5 to 0.6), 0.5 (95% CI: 0.2 to 1.4), 0.5 (95% CI: 0.3 to 0.8) and 0.7 (95% CI: 0.5 to 1.1) for Bangladesh, India, Maldives, Nepal and Pakistan, respectively. Compared with poorest households, richest households were more likely to have overweight children in all countries except Pakistan, but such associations were not significant after adjustment for other factors. There were higher odds of having overweight children in households with higher education in Bangladesh (OR 2.1 (95% CI: 1.3 to 3.5)), India (OR 1.2 (95% CI: 1.2 to 1.3)) and Pakistan (OR 1.8 (95% CI: 1.1 to 2.9)) when compared with households with no education. Maternal nutritional status was consistently associated with children's nutritional outcomes after adjustments for socioeconomic status. CONCLUSIONS Our study provides evidence for socioeconomic inequalities for childhood underweight and overweight in South Asian countries, although the directions of associations for underweight and overweight might be different.
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Affiliation(s)
| | | | - Md Shehab Uddin Al-Abid
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | | | - Gourab Adhikary
- Health Systems and Population Studies Division, ICDDRB, Dhaka, Bangladesh
| | - Md M Islam Bulbul
- National Nutrition Services, Institute of Public Health Nutrition, Dhaka, Bangladesh
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Salari-Moghaddam A, Hajihashemi P, Basirat R, Mousavi SM, Salehi-Abargouie A, Larijani B, Esmaillzadeh A. Household socioeconomic status in relation to childhood general and central obesity in Farrokhshahr, Iran. ARYA ATHEROSCLEROSIS 2020; 15:211-217. [PMID: 31949447 PMCID: PMC6954359 DOI: 10.22122/arya.v15i5.1640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although the association between socioeconomic status (SES) and general/central obesity has extensively been examined, limited data are available in this regard among children. The aim of this study was to examine the association between household SES and obesity among children. METHODS This cross-sectional study was done in Farrokhshahr, Iran, among primary school children aged 6-12 years in 2009. SES was examined using participants' and their parents' oral responses to a pretested questionnaire. In the current study, participants were classified based on tertiles of SES score to low, medium, and high SES categories. General as well as central obesity was defined based on age- and sex-specific national cut-off points. RESULTS Comparing individuals in the highest versus lowest tertile of SES, there was no significant difference in mean waist circumference (WC), but those in the middle tertile of SES had greater means of body mass index (BMI) than those in the lowest tertile after controlling for potential confounders (16.19 ± 0.27 vs. 15.27 ± 0.27 kg/m2, P = 0.002). We observed a greater chance of general obesity for those in the highest tertile of SES compared with those in the lowest tertile [odds ratio (OR): 4.00, 95% confidence interval (CI): 1.53-10.59, Ptrend = 0.004]. No significant association was seen between SES and central obesity, either before or after controlling for potential confounders. CONCLUSION We found that children in the highest SES class had a greater chance of general obesity than those in the lowest SES class. There was no significant association between SES and central obesity.
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Affiliation(s)
- Asma Salari-Moghaddam
- PhD Candidate, Students Scientific Research Center AND Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Hajihashemi
- PhD Candidate, Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reyhane Basirat
- PhD Candidate, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Mohammad Mousavi
- PhD Candidate, Students Scientific Research Center AND Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Salehi-Abargouie
- Assistant Professor, Nutrition and Food Security Research Center AND Department of Nutrition, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Bagher Larijani
- Professor, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Esmaillzadeh
- Professor, Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute AND Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran AND Food Security Research Center AND Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Robinson HA, Dam R, Hassan L, Jenkins D, Buchan I, Sperrin M. Post-2000 growth trajectories in children aged 4-11 years: A review and quantitative analysis. Prev Med Rep 2019; 14:100834. [PMID: 30976485 PMCID: PMC6439270 DOI: 10.1016/j.pmedr.2019.100834] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 02/15/2019] [Accepted: 02/16/2019] [Indexed: 02/08/2023] Open
Abstract
Children's body mass index (BMI) growth trajectories are associated with adult health outcomes, and vary by geography and epoch. Understanding these trajectories could help to identify high risk children and thus support improved health outcomes. In this review, we compare and quantitatively analyse BMI level and trajectory data published since 2010. We characterise recent growth in children aged 4-11 years, an age range most frequently targeted for BMI intervention, yet less studied than young childhood or infancy. Through searches in OVID, we identified 54 relevant texts which describe either post-2000 summary BMI values by age and gender in cohorts with sample sizes of over 1000 children, or the results of latent class analyses of BMI trajectories within the 4-11 year age range. Population level median growth curves were projected and visualised as weighted means. These BMI curves, based on data from 729,692 children, can be visually clustered into 'high' and 'low' charting groups with extreme outlying values. Within populations, latent class analyses converge on 3-4 individual child trajectories, two of which predispose adult overweight. These growth pathways diverge early in childhood, yet are not effectively distinguished via isolated BMI measurements taken between 4 and 11 years, meaning some high risk children may currently be poorly identified.
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Mansori K, Khateri S, Moradi Y, Khazaei Z, Mirzaei H, Hanis SM, Aliabadi MA, Ranjbaran M, Varse F, Parang S. Prevalence of obesity and overweight in Iranian children aged less than 5 years: a systematic review and meta-analysis. KOREAN JOURNAL OF PEDIATRICS 2019; 62:206-212. [PMID: 31096744 PMCID: PMC6584232 DOI: 10.3345/kjp.2018.07255] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/22/2019] [Indexed: 12/22/2022]
Abstract
Purpose The present study aimed to determine the prevalence of childhood obesity and overweight in Iranian children under 5 years of age using a systematic review and meta-analysis. Methods We searched MEDLINE (PubMed), Web of Science, Google Scholar, Scopus, CINHAL, and the Iranian databases, including Scientific Information Database (www.sid.ir), Iranian Research Institute for Information Science and Technology (Irandoc.ac.ir), Iranmedex (www.iranmedex.com), and Magiran (www.magiran.com), for all articles published between January 1989 and August 2017. Sources of heterogeneity were determined using subgroup analysis and meta-regression. Results Six articles were ultimately included in the meta-analysis to estimate the pooled prevalence, based on which the prevalence of obesity and overweight were estimated to be 8% (95% confidence interval [CI], 6%–10%) and 9% (95% CI, 7%–11%), respectively. The results of the subgroup analysis showed that the prevalence of obesity in boys and girls was 9% (95% CI, 6%–13%) and 7% (95% CI, 4–10%), respectively, and the prevalence of overweight in boys and girls was 10% (95% CI, 5%–15%) and 9% (95% CI, 5%–13%), respectively. Conclusion Despite high heterogeneity among the results of the articles included in the meta-analysis, the prevalence of obesity and overweight is higher in Iranian children under 5 years of age. Therefore, parents and the health system must pay more attention to the lifestyle, nutritional habits, and physical activity of these children.
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Affiliation(s)
- Kamyar Mansori
- Student Research Committee, Dezful University of Medical Sciences, Dezful, Iran.,Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Sorour Khateri
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Yousef Moradi
- Student Research Committee, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Zaher Khazaei
- Student Research Committee, Sabzevar University of Medical Science, Sabzevar, Iran
| | - Hossein Mirzaei
- Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Shiva Mansouri Hanis
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehran Asadi Aliabadi
- Preventive Medicine and Public Health Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Ranjbaran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Varse
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Serveh Parang
- Department of Midwifery, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Gautam S, Jeong HS. Childhood Obesity and Its Associated Factors among School Children in Udupi, Karnataka, India. J Lifestyle Med 2019; 9:27-35. [PMID: 30918831 PMCID: PMC6425906 DOI: 10.15280/jlm.2019.9.1.27] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/29/2018] [Indexed: 11/22/2022] Open
Abstract
Background Childhood obesity has become a serious public health problem in many low-and-middle income countries. This study aims to determine the prevalence and assess the factors associated with obesity among school children. Methods A cross-sectional school-based study was conducted among the 1185 secondary school students in Udupi, India. Data were collected using self-administered questionnaires. Weight and height were measured and Body Mass Index (BMI) was calculated. The z-score was calculated, and BMI was categorized based on its distribution by gender and age according to the World Health Organization (WHO). The BMI categories were reported as frequencies and percentages. Chi-square tests, followed by multiple logistic regressions, were used at 5% level of significance to identify factors associated with overweight and obese children. Results The overall prevalence of overweight and obese children was found to be 10.8% and 6.2%, respectively. Both ‘overweight’ and ‘obese’ were found more frequently among males (11.0% and 7.1%, respectively) than females (10.6% and 5.4%, respectively). Attending private schools, (AOR: 2.87, CI: 1.55–5.31), identifying as Muslim (AOR: 2.26, CI: 1.39–3.67), and having a father with a business occupation (AOR: 2.43, CI: 1.05–5.62) were found to be significantly associated with overweight/obese status. Conclusion We found a high prevalence of overweight and obese children in our study. Since obesity in adulthood has its onset in childhood, it is important to have effective implementation of school health activities to reduce and curb the burden of childhood obesity.
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Affiliation(s)
- Sujan Gautam
- Department of Health Administration, Graduate School, Yonsei University, Wonju, Korea
| | - Hyoung-Sun Jeong
- Department of Health Administration, Graduate School, Yonsei University, Wonju, Korea
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Asif M, Aslam M, Altaf S. Evaluation of anthropometric parameters of central obesity in Pakistani children aged 5-12 years, using receiver operating characteristic (ROC) analysis. J Pediatr Endocrinol Metab 2018; 31:971-977. [PMID: 30183666 DOI: 10.1515/jpem-2018-0193] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 07/30/2018] [Indexed: 01/17/2023]
Abstract
Background Different anthropometric parameters have been proposed for assessing central obesity in children, but the ability of these anthropometric parameters to correctly measure central obesity in Pakistani children is questionable and needs to be assessed. The aims of this investigation were to examine the diagnostic performance of anthropometric parameters as indicators of central obesity in Pakistani children as measured by waist circumference (WC) and to determine the sex-specific best cut-off values for these parameters that would identify obese children. Methods Anthropometric measurements - height, weight, WC, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), conicity index (CI) and neck circumference (NC) - from a cross-sectional sample of 5964 Pakistani children aged 5-12 years were analyzed. Receiver operating characteristics (ROC) analysis was used to examine the diagnostic performance and to determine the optimal cut-off point of each anthropometric parameter for identifying centrally obese children. Results It was found that WC had a significantly positive correlation with all studied anthropometric parameters. The ROC curve analysis indicated that all the parameters analyzed had good performance but WHtR had the highest value of the area under the curve (AUC). Optimal cut-off points associated with central obesity for boys and girls were, respectively, 0.47 and 0.48 for WHtR, 1.20 and 1.23 for CI, 0.96 and 0.96 for WHR and 26.36 and 26.54 cm for NC. Conclusions The sex-specific cut-off points for WHtR, CI, WHR and NC can be used to detect central obesity in Pakistani children.
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Affiliation(s)
- Muhammad Asif
- Department of Statistics, Government College, Qadirpur Raan, Multan, Pakistan
| | - Muhammad Aslam
- Department of Statistics, Bahauddin Zakariya University, Multan, Pakistan
| | - Saima Altaf
- Department of Statistics, Bahauddin Zakariya University, Multan, Pakistan
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Asif M, Aslam M, Altaf S. Mid-upper-arm circumference as a screening measure for identifying children with elevated body mass index: a study for Pakistan. KOREAN JOURNAL OF PEDIATRICS 2018; 61:6-11. [PMID: 29441106 PMCID: PMC5807990 DOI: 10.3345/kjp.2018.61.1.6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/26/2017] [Accepted: 10/12/2017] [Indexed: 11/27/2022]
Abstract
Purpose Mid-upper-arm circumference (MUAC) is considered an alternative screening method for obesity. The aims of this investigation were to examine the ability of MUAC to correctly identify children with elevated body mass index (BMI) and to determine the best MUAC cutoff point for identification of children with high BMI. Methods Anthropometric measurements (height, weight, and MUAC) from a cross-sectional sample of 7,921 Pakistani children aged 5–14 years were analyzed. Pearson correlation coefficients between MUAC and other anthropometric measurements were calculated. Receiver operating characteristic curve analysis was used to determine the optimal MUAC cutoff point for identifying children with high BMI. Results Among 7,921 children, the mean (±standard deviation) age, BMI, and MUAC were 10.00 (±2.86 years), 16.16 (±2.66 kg/m2), and 17.73 (±2.59 cm), respectively. The MUAC had a strong positive correlation with BMI. The optimal MUAC cutoff points indicating elevated BMI in boys ranged from 16.76 to 22.73, while the corresponding values in girls ranged from 16.38 to 20.57. Conclusion MUAC may be used as a simple indicator of overweight/obesity in children, with reasonable accuracy in clinical settings.
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Affiliation(s)
- Muhammad Asif
- Governmemnt Degree College, Qadir Pur Raan, Multan, Pakistan
| | - Muhammad Aslam
- Department of Statistics, Bahauddin Zakariya University, Multan, Pakistan
| | - Saima Altaf
- Department of Statistics, Bahauddin Zakariya University, Multan, Pakistan
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Differential prevalence and associations of overweight and obesity by gender and population group among school learners in South Africa: a cross-sectional study. BMC OBESITY 2017; 4:29. [PMID: 28725448 PMCID: PMC5514529 DOI: 10.1186/s40608-017-0165-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 07/11/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Factors influencing the increasing prevalence of overweight/obesity among children and adolescents in sub-Saharan Africa remain unclear. We assessed the prevalence and determinants of overweight and obesity and effects on cardio-metabolic profile in school learners in the Western Cape, South Africa. METHODS Cross-sectional data were collected from 7 to 18-year-old South African school learners attending 14 schools, randomly selected from 107 government schools in the areas. The learners were selected through stratified random sampling techniques. Logistic regressions were used to assess the determinants of overweight/obesity and its association with cardio-metabolic profile. RESULTS Among the 1559 participants, the overall prevalence of overweight/obesity was 22.9%. Being a girl (Odds ratio 2.51, 95% CI: 1.92-3.29), or Black African (1.35, 1.04-.75) was associated with increased odds of being overweight/obese. The identified health consequences among the overweight/obese learners differed between the ethnic groups. Overweight/obese coloured (mixed ancestry) learners were more likely to have hypertension (3.27, 1.18-9.08), hypertriglyceridemia (1.94, 0.99-3.78) and low high-density lipoprotein cholesterol (HDL-C) (3.65, 2.33-5.72), overweight/obese Black African learners had higher odds for hypertension (3.62, 1.31-10.04) and low HDL-C (1.56, 1.01-2.40) and overweight/obese White learners were prone to low HDL-C (5.04, 1.35-18.80). CONCLUSIONS Overweight/obesity is highly prevalent among school learners in Western Cape (South Africa), with being female or Black African increasing the odds. That overweight/obesity is also associated with adverse cardio-metabolic risk profile aggravates the problem and suggests worse cardiovascular outcomes in South African young adults in the future.
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Prevalence of overweight and malnutrition among ethnic minority children and adolescents in China, 1991-2010. Sci Rep 2016; 6:37491. [PMID: 27881845 PMCID: PMC5121587 DOI: 10.1038/srep37491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 10/05/2016] [Indexed: 11/08/2022] Open
Abstract
This study aimed to determine the trends in prevalence of childhood overweight and malnutrition in a large Chinese ethnic minority population from 1991 to 2010. In the Chinese National Survey on Students’ Constitution and Health from 1991 to 2010, multistage stratified sampling was conducted in the series of cross-sectional studies. Participants were 7–18-year-old students randomly selected by sex and region, and included Han and 26 ethnic minorities. During the survey period, the overall prevalence of overweight increased from 5.8% to 13.5%, and malnutrition trend increased from 3.6% to 4.1% in ethnic minority children and adolescents. Moreover, Korean and Mongol children were more likely than Han children to be obese (Korean: RR = 1.52; 95% CI: 1.48–1.56; Mongol: RR = 1.24; 95% CI: 1.20–1.28). Among these minorities, the Dongxiang and Li children were more likely to be malnourished (Li: RR = 1.47; 95% CI: 1.37–1.57; Dongxiang: RR = 1.45; 95% CI: 1.34–1.58). Shui, Khalkhas, Lisu, and Monguor children were less likely to be overweight and malnourished compared with the Hans. The prevalence of overweight among ethnicities increased yearly while that for malnutrition has fluctuated over the past few decades.
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Sarki M, Robertson A, Parlesak A. Association between socioeconomic status of mothers, food security, food safety practices and the double burden of malnutrition in the Lalitpur district, Nepal. ACTA ACUST UNITED AC 2016; 74:35. [PMID: 27625786 PMCID: PMC5020528 DOI: 10.1186/s13690-016-0150-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/21/2016] [Indexed: 01/05/2023]
Abstract
Background The prevalence of childhood overweight and obesity is increasing in low-and middle income countries such as Nepal. At the same time, high prevalence of chronic undernutrition persists leading to a double burden of malnutrition. Aim To identify associations between the socioeconomic status of mothers, food security, the food safety environment within the household, and prevalence of stunting and overweight of the children. Methods Statistical analysis of socioeconomic, food safety-related and anthropometric data from 289 mother-child dyads in an urban area of the Kathmandu Valley, Nepal. Results According to WHO standards, 26 % of the children, aged 0–59 months, were stunted, 10 % were underweight, and 6.6 % were either overweight or obese. Significantly more boys than girls were underweight (p = 0.004) and stunted (p < 0.001). The higher education level of mothers was associated with a higher height-for-age (HAZ) score in girls, but not with HAZ in boys. Irrespective of sex, children of mothers with highest education level had significantly lower BMI-for-age scores (BAZ) than those of mothers with low education levels. None of the food safety indicators were associated with either HAZ or the BAZ. Conclusion The education level of mothers seems to be relevant to help reduce the double burden of malnutrition at least in some regions of Nepal. This should be taken into consideration when designing programmes to prevent both chronic undernutrition and non-communicable diseases.
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Affiliation(s)
- Mahesh Sarki
- Global Nutrition and Health, Metropolitan University College, Pustervig 8, 1126 København K, Denmark ; Nutrition Promotion and Consultancy Services (NPCS), NGO, Kathmandu, Nepal
| | - Aileen Robertson
- Global Nutrition and Health, Metropolitan University College, Pustervig 8, 1126 København K, Denmark ; WHO Collaborating Centre for Global Nutrition and Health, Copenhagen, Denmark
| | - Alexandr Parlesak
- Global Nutrition and Health, Metropolitan University College, Pustervig 8, 1126 København K, Denmark ; WHO Collaborating Centre for Global Nutrition and Health, Copenhagen, Denmark
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Salehiniya H, Yazdani K, Barekati H, Asadi Lari M. The Prevalence of Overweight and Obesity in Children Under 5 Years in Tehran, Iran, in 2012: A Population-Based Study. Res Cardiovasc Med 2016; 5:e30425. [PMID: 26889459 PMCID: PMC4752595 DOI: 10.5812/cardiovascmed.30425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 06/23/2015] [Accepted: 07/08/2015] [Indexed: 12/23/2022] Open
Abstract
Background: Overweight and obesity in children are a serious problem. They are increasingly prevalent and associated with a wide range of health problems in adulthood. Monitoring their status is essential for effective planning in the health system. Objectives: This study aimed to assess the prevalence of overweight and obesity in children below 5 years in Tehran in 2012. Patients and Methods: This cross-sectional study employed data provided by the urban health equity assessment in Tehran. The sample comprised a total of 4656 children under 5 years, recruited via multistage sampling. Data were collected through questionnaires and anthropometric measures of height and weight. The WHO child growth standards were used to determine overweight and obesity. Data were analyzed using chi-square tests, with SPSS version 11.5. Results: The prevalence of overweight and obesity in children were 12% and 23.7% respectively. The prevalence of overweight was significantly higher in girls than boys and the prevalence of obesity was significantly higher in boys than girls (P = 0.001). Obesity was more prevalent in children from high economic percentiles, but this finding was not statistically significant. Conclusions: The prevalence of overweight and obesity in children under 5 years is high. Overweight and obesity should be considered an epidemic and serious health problem in Tehran. They certainly require more attention and intervention.
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Affiliation(s)
- Hamid Salehiniya
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Kamran Yazdani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Hamed Barekati
- Ministry of Health and Medical Education, Tehran, IR Iran
| | - Mohsen Asadi Lari
- Department of Epidemiology and Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mohsen Asadi Lari, Department of Epidemiology and Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9122115440, E-mail:
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Yuan ZP, Yang M, Liang L, Fu JF, Xiong F, Liu GL, Gong CX, Luo FH, Chen SK, Zhang DD, Zhang S, Zhu YM. Possible role of birth weight on general and central obesity in Chinese children and adolescents: a cross-sectional study. Ann Epidemiol 2015. [DOI: 10.1016/j.annepidem.2015.05.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Wu S, Ding Y, Wu F, Li R, Hu Y, Hou J, Mao P. Socio-economic position as an intervention against overweight and obesity in children: a systematic review and meta-analysis. Sci Rep 2015; 5:11354. [PMID: 26112253 PMCID: PMC4481703 DOI: 10.1038/srep11354] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/22/2015] [Indexed: 12/22/2022] Open
Abstract
Studies that investigated the association between socio-economic position (SEP) and obesity in children suggest inconsistent results. The aim of this study is to summarize and quantify the current evidence on SEP and risks of overweight and obesity in children aged 0–15 years. Relevant studies published between 1990 to Sep 4, 2014 were searched in Medline, Web of Science, Embase, and the Cochrane Database of Systematic Reviews. Risk estimates from individual studies were pooled using random-effects models, according to lowest vs the highest SEP category. A total of 62 articles were included in the meta-analysis. The odds of both overweight risk and obesity risk were higher in the children with lowest SEP than in those with highest SEP (OR, 1.10, 95% CI: 1.03–1.17, and OR, 1.41, 95% CI: 1.29–1.55, respectively). Sub-group analyses showed that the inverse relationships between SEP and childhood overweight and obesity were only found in high-income countries and in more economic developed areas. In conclusion, our study suggests that children with lower SEP had higher risks of overweight and obesity, and the increased risks were independent of the income levels of countries.
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Affiliation(s)
- Shunquan Wu
- Research and Technology Service Center, 302 Hospital of PLA, Beijing, China
| | - Yingying Ding
- Department of Medical Microbiology and Parasitology, Second Military Medical University, Shanghai, China
| | - Fuquan Wu
- International Cooperation Laboratory on Signal Transduction, Eastern Hepatobiliary Surgery Institute, Second Military Medical University, Shanghai, China
| | - Ruisheng Li
- Research and Technology Service Center, 302 Hospital of PLA, Beijing, China
| | - Yan Hu
- Research and Technology Service Center, 302 Hospital of PLA, Beijing, China
| | - Jun Hou
- Research and Technology Service Center, 302 Hospital of PLA, Beijing, China
| | - Panyong Mao
- Research and Technology Service Center, 302 Hospital of PLA, Beijing, China
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Lourenço BH, Villamor E, Augusto RA, Cardoso MA. Influence of early life factors on body mass index trajectory during childhood: a population-based longitudinal analysis in the Western Brazilian Amazon. MATERNAL & CHILD NUTRITION 2015; 11:240-52. [PMID: 23020806 PMCID: PMC6860355 DOI: 10.1111/mcn.12005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Low- to middle-income countries may experience the occurrence of a dual burden of under and overnutrition. To better understand the overall progression of body mass index (BMI) during childhood, we estimated average BMI-for-age z-score (BAZ) growth curves in a population-based longitudinal study of 255 children living in the Brazilian Amazon. Children were aged 0.1-5.5 years at recruitment (2003). We collected data on socio-economic and maternal characteristics, children's birthweight and infant feeding practices. Child anthropometric measurements were taken in 2003, 2007 and 2009. BAZ differences among categories of exposure variables were calculated at 6 and 12 months, and 2, 7 and 10 years. At baseline, the mean (standard deviation) age was 2.6 (1.4) years; 12.9% were overweight and 3.9% thin. After adjustment, mean BAZ estimates were mostly negative. Boys were close to the median value for BAZ until 12 months, whereas girls were below the median (P=0.05). Children from households above the wealth median were 0.36 z- and 0.49 z-less underweight than poorer children at 7 and 10 years, respectively (P<0.01). Maternal BMI was positively associated with children's BAZ since 12 months old; BAZ in children from overweight mothers was higher by 0.69 compared with their counterparts at 10 years (P<0.01). Birthweight was positively related to BAZ up until 2 years (P=0.01). Socio-economic background and maternal nutritional status are important predictors of BAZ throughout childhood. Although excessive weight gain is a public health concern, it is critical to restrict inequities, while promoting healthier growth in developing countries.
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Affiliation(s)
- Barbara H. Lourenço
- Public Health Nutrition ProgramSchool of Public HealthUniversity of São PauloSão PauloBrazil
| | - Eduardo Villamor
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - Rosângela A. Augusto
- Public Health Nutrition ProgramSchool of Public HealthUniversity of São PauloSão PauloBrazil
| | - Marly A. Cardoso
- Department of NutritionSchool of Public HealthUniversity of São PauloSão PauloBrazil
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Faghih S, Keshani P, Salar A, Rajaei SH, Mirzaei Z, Moosavi SM, Hematdar Z. Assessment of Obesity, Unhealthy Food Habits, and Nutritional Knowledge of Primary School Children. INTERNATIONAL JOURNAL OF SCHOOL HEALTH 2015. [DOI: 10.17795/intjsh-25186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Mistry SK, Puthussery S. Risk factors of overweight and obesity in childhood and adolescence in South Asian countries: a systematic review of the evidence. Public Health 2015; 129:200-9. [PMID: 25746156 DOI: 10.1016/j.puhe.2014.12.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 12/01/2014] [Accepted: 12/04/2014] [Indexed: 01/30/2023]
Abstract
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.
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Affiliation(s)
- S K Mistry
- Research and Evaluation Division, BRAC, BRAC Centre, 75 Mohakhali, Dhaka-1212, Bangladesh.
| | - S Puthussery
- Department of Clinical Education and Leadership, University of Bedfordshire, Putteridge Bury - Rm32, Hitchin Road, Luton, Bedfordshire LU2 8LE, UK.
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Koirala M, Khatri RB, Khanal V, Amatya A. Prevalence and factors associated with childhood overweight/obesity of private school children in Nepal. Obes Res Clin Pract 2014; 9:220-7. [PMID: 25434691 DOI: 10.1016/j.orcp.2014.10.219] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 10/20/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Childhood overweight/obesity is a global health problem because of adverse health and nutrition consequences worldwide. Currently, there is a paucity of information on childhood overweight/obesity in Nepal. Therefore, the objective of this study was to assess the prevalence of, and the factors associated with, childhood overweight/obesity among primary school children. METHODS A cross-sectional study was conducted in June-December, 2013. We collected data using the structured self-administered questionnaire with parents of children aged 6-13 years in grades 1-6 studying at private schools of the Lalitpur district of Nepal. Height and weight measurements of 986 children were taken, and the corresponding body mass index (BMI)-for-age was calculated. The prevalence of childhood overweight/obesity was reported in proportion. Factors associated with childhood overweight/obesity were examined using the Chi-square tests followed by multiple logistic regression analyses. RESULTS Of 986 children, 144 (14.6%) were overweight and 111 (11.3%) were obese. Overall, 255 (25.9%) children were found to be overweight/obese. Children from families, having ≤2 siblings (adjusted odds ratio (aOR)=1.958, 95% confidence interval (CI): 1.163-3.296), upper class family (aOR=3.672; 95% CI: 1.154-11.690), and advantaged ethnic group (aOR=1.561; 95% CI: 1.00-2.437) and children who were of larger birth weight (>4.0kg) had a greater likelihood of being (aOR=2.557, 95% CI: 1.222-5.349) overweight/obese. CONCLUSIONS A quarter of children were found to be overweight/obese in private primary schools. Preventive interventions should focus on the advantaged ethnic groups, families with fewer siblings, and upper class families. A greater emphasis ought to be placed on formulation and implementation of policies aimed at addressing the newly emerging problems of childhood overweight/obesity in Nepal. New school health programs are to be launched and strengthened including avoidance of high energy junk food, and promoting outdoor activities.
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Affiliation(s)
- M Koirala
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - R B Khatri
- Save the Children, Saving Newborn Lives Program, Kathmandu, Nepal.
| | - V Khanal
- School of Public Health, Curtin University, Perth, Australia
| | - A Amatya
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Kelishadi R, Azizi-Soleiman F. Controlling childhood obesity: A systematic review on strategies and challenges. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2014; 19:993-1008. [PMID: 25538786 PMCID: PMC4274579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/26/2014] [Accepted: 03/03/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Childhood obesity is a global health problem with short- and long-term health consequences. This systematic review presents a summary of the experiences on different family-, school-, and clinic-based interventions. MATERIALS AND METHODS Electronic search was conducted in MEDLINE, PubMed, ISI Web of Science, and Scopus scientific databases. We included those studies conducted among obese individuals aged up to 18 years. Our search yielded 105 relevant papers, 70 of them were conducted as high quality clinical trials. RESULTS Our findings propose that school-based programs can have long-term effects in a large target group. This can be related to this fact that children spend a considerable part of their time in school, and adopt some parts of lifestyle there. They have remarkable consequences on health behaviors, but as there are some common limitations, their effects on anthropometric measures are not clear. Due to the crucial role of parents in development of children's behaviors, family-based interventions are reported to have successful effects in some aspects; but selection bias and high dropout rate can confound their results. Clinic-based interventions revealed favorable effects. They include dietary or other lifestyle changes like increasing physical activity or behavior therapy. It seems that a comprehensive intervention including diet and exercise are more practical. When they have different designs, results are controversial. CONCLUSION We suggest that among different types of interventional programs, a multidisciplinary approach in schools in which children's family are involved, can be the best and most sustainable approach for management of childhood obesity.
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Affiliation(s)
- Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primary Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Azizi-Soleiman
- School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Fatemeh Azizi-Soleiman, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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Hoque ME, Doi SAR, Mannan M, Long K, Niessen LW, Mamun AA. Prevalence of overweight and obesity among children and adolescents of the Indian subcontinent: a meta-analysis. Nutr Rev 2014; 72:541-50. [DOI: 10.1111/nure.12130] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mohammad E Hoque
- School of Population Health; University of Queensland; Brisbane Queensland Australia
| | - Suhail AR Doi
- School of Population Health; University of Queensland; Brisbane Queensland Australia
| | - Munim Mannan
- School of Population Health; University of Queensland; Brisbane Queensland Australia
| | - Kurt Long
- School of Population Health; University of Queensland; Brisbane Queensland Australia
| | - Louis W Niessen
- Center for Global Health; Johns Hopkins School of Public Health; Baltimore Maryland USA
| | - Abdullah A Mamun
- School of Population Health; University of Queensland; Brisbane Queensland Australia
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Abril V, Manuel-y-keenoy B, Solà R, García JL, Nessier C, Rojas R, Donoso S, Arija V. Prevalence of overweight and obesity among 6-to 9-year-old school children in Cuenca, Ecuador: relationship with physical activity, poverty, and eating habits. Food Nutr Bull 2014; 34:388-401. [PMID: 24605689 DOI: 10.1177/156482651303400404] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The high prevalence of childhood overweight and obesity is a health problem worldwide. In developing countries, we lack information on the extent of the problem and the risk factors involved. OBJECTIVE To determine the prevalence rates of overweight and obesity and of abdominal obesity, and their relationship with physical activity, poverty, and eating habits in schoolchildren in Cuenca, Ecuador. METHODS A cross-sectional survey in a representative sample (n = 743) schoolchildren aged 6 to 9 years was conducted. Overweight and obesity were detected using the International Obesity Task Force cutoffs according to body mass index (BMI), and abdominal obesity was detected according to waist circumference. Poverty, physical activity, and eating habits were assessed with validated questionnaires. RESULTS The prevalence rates of overweight and obesity and of abdominal obesity were 26.0% and 10.6%, respectively. There were no differences between the sexes, but the prevalence of overweight and obesity was 1.5- to 2-fold higher in 9-year-old than in 6-year-old children (p < .05). Multivariate models demonstrated that higher BMI and waist circumference were significantly related to low physical activity and nonpoverty. Insufficient physical activity (in 75% of children) was associated with a 13% to 18% increased risk of overweight and obesity and abdominal obesity. Eating breakfast and eating more than three meals per day (in 96.7% and 85.9% of children, respectively) were not related to the prevalence of overweight and obesity. Eating fruits during school break was associated with a lower BMI.L CONCLUSIONS: The high prevalence of overweight and obesity observed in schoolchildren increased from the ages of 6 to 9 years and was associated with insufficient physical activity and nonpoverty. Promoting physical activity and fruit consumption in school snacks should be explored as intervention measures to prevent and reduce overweight and obesity in Cuenca schoolchildren.
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Affiliation(s)
| | | | | | | | - Celeste Nessier
- Instituto de la Salud "Juan Lazarte" Universidad Nacional de Rosario, Argentina
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Wang C, Kane RL, Xu D, Li L, Guan W, Li H, Meng Q. Maternal education and micro-geographic disparities in nutritional status among school-aged children in rural northwestern China. PLoS One 2013; 8:e82500. [PMID: 24340034 PMCID: PMC3858303 DOI: 10.1371/journal.pone.0082500] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 10/24/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Prior evidence suggests geographic disparities in the effect of maternal education on child nutritional status between countries, between regions and between urban and rural areas. We postulated its effect would also vary by micro-geographic locations (indicated by mountain areas, plain areas and the edge areas) in a Chinese minority area. METHODS A cross-sectional study was conducted with a multistage random sample of 1474 school children aged 5-12 years in Guyuan, China. Child nutritional status was measured by height-for-age z scores (HAZ). Linear mixed models were used to examine its association with place of residence and maternal education. RESULTS Micro-geographic disparities in child nutritional status and the level of socioeconomic composition were found. Children living in mountain areas had poorer nutritional status, even after adjusting for demographic (plain versus mountain, β = 0.16, P = 0.033; edge versus mountain, β = 0.29, P = 0.002) and socioeconomic factors (plain versus mountain, β = 0.12, P = 0.137; edge versus mountain, β = 0.25, P = 0.009). The disparities significantly widened with increasing years of mothers' schooling (maternal education*plain versus mountain: β = 0.06, P = 0.007; maternal education*edge versus mountain: β = 0.07, P = 0.005). Moreover, the association between maternal education and child nutrition was negative (β = -0.03, P = 0.056) in mountain areas but positive in plain areas (β = 0.02, P = 0.094) or in the edge areas (β = 0.04, P = 0.055). CONCLUSIONS Micro-geographic disparities in child nutritional status increase with increasing level of maternal education and the effect of maternal education varies by micro-geographic locations, which exacerbates child health inequity. Educating rural girls alone is not sufficient; improving unfavorable conditions in mountain areas might make such investments more effective in promoting child health. Nutrition programs targeting to the least educated groups in plain and in edge areas would be critical to their cost-effectiveness.
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Affiliation(s)
- Cuili Wang
- Shandong University School of Nursing, Jinan, Shandong, China
- Shandong University Center for Health Management and Policy, Jinan, Shandong, China
| | - Robert L. Kane
- University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America
| | - Dongjuan Xu
- Shandong University School of Nursing, Jinan, Shandong, China
- University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America
| | - Lingui Li
- Ningxia Medical University College of Management, Yinchuan, Ningxia, China
| | - Weihua Guan
- University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America
| | - Hui Li
- Shandong University Center for Health Management and Policy, Jinan, Shandong, China
| | - Qingyue Meng
- Shandong University Center for Health Management and Policy, Jinan, Shandong, China
- Peking University China Center for Health Development Studies, Beijing, China
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Ochiai H, Shirasawa T, Ohtsu T, Nishimura R, Morimoto A, Hoshino H, Tajima N, Kokaze A. The impact of eating quickly on anthropometric variables among schoolgirls: a prospective cohort study in Japan. Eur J Public Health 2013; 24:691-5. [PMID: 23981896 DOI: 10.1093/eurpub/ckt120] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Because most studies about the relationship between eating quickly and overweight/obesity have been cross-sectional, it is necessary to investigate prospectively the influence of eating quickly on anthropometric variables in order to examine the causal relationship. The aim of the present study was to investigate the impact of eating quickly on anthropometric variables among schoolgirls in a prospective cohort study. METHODS We investigated 427 non-overweight/obese schoolgirls from fourth grade (aged 9 or 10 years) in Ina-town, Japan from 2004 to 2006. Physical examinations and a questionnaire survey were conducted in fourth grade and 3 years later (in seventh grade). Height, weight, percent body fat (%BF) and waist circumference (WC) were measured in physical examinations, and information on eating speed was collected in a questionnaire survey. RESULTS The differences in anthropometric variables (body mass index, %BF, WC and waist-to-height ratio) between fourth and seventh grade were significantly greater in girls who continued to eat quickly from fourth to seventh grade than in those who did not continue to eat quickly during this 3-year period. In contrast, these differences were not statistically significant in girls who ate quickly in fourth grade but not in seventh grade compared with those who did not continue to eat quickly during the 3-year period. CONCLUSION Eating quickly was associated with excess gains in anthropometric variables. The present study also suggested that stopping a habit of eating quickly prevents these excess gains in non-overweight/obese girls, which could contribute to the prevention of childhood overweight and obesity.
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Affiliation(s)
- Hirotaka Ochiai
- 1 Department of Public Health, Showa University School of Medicine Tokyo, Japan
| | - Takako Shirasawa
- 1 Department of Public Health, Showa University School of Medicine Tokyo, Japan
| | - Tadahiro Ohtsu
- 1 Department of Public Health, Showa University School of Medicine Tokyo, Japan
| | - Rimei Nishimura
- 2 Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Aya Morimoto
- 2 Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Hiromi Hoshino
- 1 Department of Public Health, Showa University School of Medicine Tokyo, Japan
| | - Naoko Tajima
- 3 Jikei University School of Medicine, Tokyo, Japan
| | - Akatsuki Kokaze
- 1 Department of Public Health, Showa University School of Medicine Tokyo, Japan
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Evidence for interventions to prevent and control obesity among children and adolescents: its applicability to India. Indian J Pediatr 2013; 80 Suppl 1:S115-22. [PMID: 23054854 DOI: 10.1007/s12098-012-0881-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 08/23/2012] [Indexed: 01/06/2023]
Abstract
Childhood obesity is on the rise worldwide and its increasing prevalence in low and middle income countries is well-known. Obesity interventions have the potential to prevent adverse health outcomes; however, large gaps in research and knowledge about the efficacy and sustainability of such interventions remain. The objectives of this article were to review the evidence for interventions to prevent and control obesity among children and adolescents, evaluate their applicability in India, and discuss the challenges to sustain such interventions. The authors reviewed published research focusing on childhood obesity interventions, especially in India and other lower-resource countries. Nine observational and 10 interventional studies were reviewed. Most studies identified were from developed countries and took place at day-care settings, schools, and after school programs. Nineteen reported studies were grouped into categories: diet (2), physical activity (4), childcare programs (2), media-based programs (2), parental involvement (2), multi-component studies (1), and screen time (6). Most interventions were effective in reducing BMI, decreasing sedentary behaviors, and increasing physical activity. Sustainability of these interventions was not evaluated. While there is no one method or simple intervention to address obesity, multi-component approaches involving home and school environments are promising and warrant evaluation in India. Literature on obesity prevention and control in India and in lower-resource countries, however, is sparse. Existing gaps in knowledge about obesity should be addressed by conducting research in India and carrying out interventions to determine what strategies will be successful and sustainable locally.
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Goktas Z, Moustaid-Moussa N, Shen CL, Boylan M, Mo H, Wang S. Effects of bariatric surgery on adipokine-induced inflammation and insulin resistance. Front Endocrinol (Lausanne) 2013; 4:69. [PMID: 23772224 PMCID: PMC3677351 DOI: 10.3389/fendo.2013.00069] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 05/23/2013] [Indexed: 12/31/2022] Open
Abstract
Over a third of the US population is obese and at high risk for developing type 2 diabetes, insulin resistance, and other metabolic disorders. Obesity is considered a chronic low-grade inflammatory condition that is primarily attributed to expansion and inflammation of adipose tissues. Indeed, adipocytes produce and secrete numerous proinflammatory and anti-inflammatory cytokines known as adipokines. When the balance of these adipokines is shifted toward higher production of proinflammatory factors, local inflammation within adipose tissues and subsequently systemic inflammation occur. These adipokines including leptin, visfatin, resistin, apelin, vaspin, and retinol binding protein-4 can regulate inflammatory responses and contribute to the pathogenesis of diabetes. These effects are mediated by key inflammatory signaling molecules including activated serine kinases such as c-Jun N-terminal kinase and serine kinases inhibitor κB kinase and insulin signaling molecules including insulin receptor substrates, protein kinase B (PKB, also known as Akt), and nuclear factor kappa B. Bariatric surgery can decrease body weight and improve insulin resistance in morbidly obese subjects. However, despite reports suggesting reduced inflammation and weight-independent effects of bariatric surgery on glucose metabolism, mechanisms behind such improvements are not yet well understood. This review article focuses on some of these novel adipokines and discusses their changes after bariatric surgery and their relationship to insulin resistance, fat mass, inflammation, and glucose homeostasis.
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Affiliation(s)
- Zeynep Goktas
- Nutritional Sciences Program, College of Human Science, Texas Tech University, Lubbock, TX, USA
| | - Naima Moustaid-Moussa
- Nutritional Sciences Program, College of Human Science, Texas Tech University, Lubbock, TX, USA
| | - Chwan-Li Shen
- Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Mallory Boylan
- Nutritional Sciences Program, College of Human Science, Texas Tech University, Lubbock, TX, USA
| | - Huanbiao Mo
- Department of Nutrition and Food Sciences, Texas Woman’s University, Denton, TX, USA
| | - Shu Wang
- Nutritional Sciences Program, College of Human Science, Texas Tech University, Lubbock, TX, USA
- *Correspondence: Shu Wang, Nutritional Science Program, College of Human Science, Texas Tech University, P.O. Box: 41240, Lubbock, TX 79409-1240, USA e-mail:
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Liu L, Xue F, Ma J, Ma M, Long Y, Newschaffer CJ. Social position and chronic conditions across the life span and risk of stroke: a life course epidemiological analysis of 22,847 American adults in ages over 50. Int J Stroke 2012; 8 Suppl A100:50-5. [PMID: 23231424 DOI: 10.1111/j.1747-4949.2012.00927.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evidence is limited on the impact of childhood socioeconomic status, adulthood socioeconomic status and chronic conditions on risk of incident stroke in later life. We aimed to examine these associations using data from a nationally representative sample of the Health and Retirement Study. METHODS Stroke-free participants (n = 22,847) aged > 50 years in the Health and Retirement Study (1992-2008) were analyzed. Childhood and adulthood socioeconomic status were assessed using parental and participant's education attainments. Incident stroke was defined as self-reported first incident stroke. RESULTS Of the study sample, 2298 subjects experienced first incident stroke (10.06%). Cox's regression models indicate that subjects with low childhood socioeconomic status had 1.36 times higher risk (95% confidence interval: 1.18-1.57) of first incident stroke than those with high childhood socioeconomic status. There was an 8% reduction of this association after adjustment for adulthood socioeconomic status. Adults with diabetes mellitus had the highest hazard ratio (1.91, 95% confidence interval: 1.63-2.23) for incident stroke, followed by heart disease (1.69, 1.48-1.93), and then hypertension (1.56, 1.40-1.75). Significant interaction effect of childhood socioeconomic status and diabetes mellitus, and combined effects of socioeconomic status and chronic conditions on risk of incident stroke were observed. CONCLUSIONS Both low socioeconomic status in childhood and adulthood socioeconomic status predict the risk of stroke. There are significantly combined effects of socioeconomic status and chronic conditions on the risk of stroke. Improving socioeconomic status across the life span and aggressive control of chronic conditions may play pivotal roles in the prevention of stroke development.
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Affiliation(s)
- Longjian Liu
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA, USA
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Mushtaq MU, Gull S, Abdullah HM, Shahid U, Shad MA, Akram J. Erratum to: prevalence and socioeconomic correlates of overweight and obesity among Pakistani primary school children. BMC Public Health 2012. [PMCID: PMC3528647 DOI: 10.1186/1471-2458-12-532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Guo X, Zheng L, Li Y, Yu S, Sun G, Yang H, Zhou X, Zhang X, Sun Z, Sun Y. Differences in lifestyle behaviors, dietary habits, and familial factors among normal-weight, overweight, and obese Chinese children and adolescents. Int J Behav Nutr Phys Act 2012; 9:120. [PMID: 23031205 PMCID: PMC3522535 DOI: 10.1186/1479-5868-9-120] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 09/25/2012] [Indexed: 12/21/2022] Open
Abstract
Background Pediatric obesity has become a global public health problem. Data on the lifestyle behaviors, dietary habits, and familial factors of overweight and obese children and adolescents are limited. The present study aims to compare health-related factors among normal-weight, overweight, and obese Chinese children and adolescents. Methods We conducted a cross-sectional study consisted of 4262 children and adolescents aged 5–18 years old from rural areas of the northeast China. Anthropometric measurements and self-reported information on health-related variables, such as physical activities, sleep duration, dietary habits, family income, and recognition of weight status from the views of both children and parents, were collected by trained personnel. Results The prevalence rates of overweight and obesity were 15.3 and 6.4%, respectively. Compared to girls, boys were more commonly overweight (17.5% vs. 12.9%) and obese (9.5% vs. 3.1%). Approximately half of the parents with an overweight or obese child reported that they failed to recognize their child’s excess weight status, and 65% of patients with an overweight child reported that they would not take measures to decrease their child’s body weight. Obese children and adolescents were more likely to be nonsnackers [odds ratio (OR): 1.348; 95% confidence interval (CI): 1.039–1.748] and to have a family income of 2000 CNY or more per month (OR: 1.442; 95% CI: 1.045–1.99) and less likely to sleep longer (≥7.5 h) (OR: 0.475; 95% CI: 0.31–0.728) than the normal-weight participants. Conclusions Our study revealed a high prevalence of overweight and obesity in a large Chinese pediatric population. Differences in sleep duration, snacking, family income, and parental recognition of children’s weight status among participants in different weight categories were observed, which should be considered when planning prevention and treatment programs for pediatric obesity.
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Affiliation(s)
- Xiaofan Guo
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang 110001, People's Republic of China
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Mushtaq MU, Gull S, Mushtaq K, Abdullah HM, Khurshid U, Shahid U, Shad MA, Akram J. Height, weight and BMI percentiles and nutritional status relative to the international growth references among Pakistani school-aged children. BMC Pediatr 2012; 12:31. [PMID: 22429910 PMCID: PMC3337223 DOI: 10.1186/1471-2431-12-31] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 03/19/2012] [Indexed: 11/10/2022] Open
Abstract
Background Child growth is internationally recognized as an important indicator of nutritional status and health in populations. This study was aimed to compare age- and gender-specific height, weight and BMI percentiles and nutritional status relative to the international growth references among Pakistani school-aged children. Methods A population-based study was conducted with a multistage cluster sample of 1860 children aged five to twelve years in Lahore, Pakistan. Smoothed height, weight and BMI percentile curves were obtained and comparison was made with the World Health Organization 2007 (WHO) and United States' Centers for Disease Control and Prevention 2000 (USCDC) references. Over- and under-nutrition were defined according to the WHO and USCDC references, and the International Obesity Task Force (IOTF) cut-offs. Simple descriptive statistics were used and statistical significance was considered at P < 0.05. Results Height, weight and BMI percentiles increased with age among both boys and girls, and both had approximately the same height and a lower weight and BMI as compared to the WHO and USCDC references. Mean differences from zero for height-, weight- and BMI-for-age z score values relative to the WHO and USCDC references were significant (P < 0.001). Means of height-for-age (present study: 0.00, WHO: -0.19, USCDC: -0.24), weight-for-age (present study: 0.00, WHO: -0.22, USCDC: -0.48) and BMI-for-age (present study: 0.00, WHO: -0.32, USCDC: -0.53) z score values relative to the WHO reference were closer to zero and the present study as compared to the USCDC reference. Mean differences between weight-for-age (0.19, 95% CI 0.10-0.30) and BMI-for-age (0.21, 95% CI 0.11-0.30) z scores relative to the WHO and USCDC references were significant. Over-nutrition estimates were higher (P < 0.001) by the WHO reference as compared to the USCDC reference (17% vs. 15% overweight and 7.5% vs. 4% obesity) while underweight and thinness/wasting were lower (P < 0.001) by the WHO reference as compared to the USCDC reference (7% vs. 12% underweight and 10% vs. 13% thinness). Significantly lower overweight (8%) and obesity (5%) prevalence and higher thinness grade one prevalence (19%) was seen with use of the IOTF cut-offs as compared to the WHO and USCDC references. Mean difference between height-for-age z scores and difference in stunting prevalence relative to the WHO and USCDC references was not significant. Conclusion Pakistani school-aged children significantly differed from the WHO and USCDC references. However, z score means relative to the WHO reference were closer to zero and the present study as compared to the USCDC reference. Overweight and obesity were significantly higher while underweight and thinness/wasting were significantly lower relative to the WHO reference as compared to the USCDC reference and the IOTF cut-offs. New growth charts for Pakistani children based on a nationally representative sample should be developed. Nevertheless, shifting to use of the 2007 WHO child growth reference might have important implications for child health programs and primary care pediatric clinics.
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Mushtaq MU, Gull S, Shahid U, Shafique MM, Abdullah HM, Shad MA, Siddiqui AM. Family-based factors associated with overweight and obesity among Pakistani primary school children. BMC Pediatr 2011; 11:114. [PMID: 22172239 PMCID: PMC3266195 DOI: 10.1186/1471-2431-11-114] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 12/16/2011] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Childhood obesity epidemic is now penetrating the developing countries including Pakistan, especially in the affluent urban population. There is no data on association of family-based factors with overweight and obesity among school-aged children in Pakistan. The study aimed to explore the family-based factors associated with overweight and obesity among Pakistani primary school children. METHODS A population-based cross-sectional study was conducted with a representative multistage cluster sample of 1860 children aged five to twelve years in Lahore, Pakistan. Overweight (> +1SD BMI-for-age z-score) and obesity (> +2SD BMI-for-age z-score) were defined using the World Health Organization reference 2007. Chi-square test was used as the test of trend. Linear regression was used to examine the predictive power of independent variables in relation to BMI. Logistic regression was used to quantify the independent predictors of overweight and adjusted odds ratios (aOR) with 95% confidence intervals (CI) were obtained. All regression analyses were controlled for age and gender and statistical significance was considered at P < 0.05. RESULTS Significant family-based correlates of overweight and obesity included higher parental education (P < 0.001), both parents working (P = 0.002), fewer siblings (P < 0.001), fewer persons in child's living room (P < 0.001) and residence in high-income neighborhoods (P < 0.001). Smoking in living place was not associated with overweight and obesity. Higher parental education (P < 0.001) and living in high-income neighborhoods (P < 0.001) showed a significant independent positive association with BMI while greater number of siblings (P = 0.001) and persons in child's living room (P = 0.022) showed a significant independent inverse association. College-level or higher parental education as compared to high school-level or lower parental education (aOR 2.54, 95% CI 1.76-3.67), living in high-income neighborhoods as compared to low-income neighborhoods (aOR 2.13, 95% CI 1.31-3.46) and three or less siblings as compared to more than three siblings (aOR 1.75, 95% CI 1.26-2.42) were significant independent predictors of overweight. CONCLUSION Family-based factors were significantly associated with overweight and obesity among school-aged children in Pakistan. Higher parental education, living in high-income neighborhoods and fewer siblings were independent predictors of overweight. These findings support the need to design evidence-based child health policy and implement targeted interventions, considering the impact of family-based factors and involving communities.
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Affiliation(s)
- Muhammad Umair Mushtaq
- Ubeera Memorial Research Society, Allama Iqbal Medical College, Lahore, 54000 Punjab, Pakistan.
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Mushtaq MU, Gull S, Mushtaq K, Shahid U, Shad MA, Akram J. Dietary behaviors, physical activity and sedentary lifestyle associated with overweight and obesity, and their socio-demographic correlates, among Pakistani primary school children. Int J Behav Nutr Phys Act 2011; 8:130. [PMID: 22117626 PMCID: PMC3250930 DOI: 10.1186/1479-5868-8-130] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Accepted: 11/25/2011] [Indexed: 11/29/2022] Open
Abstract
Background There is no data on diet- and activity-related behaviors associated with overweight and obesity among Pakistani school-aged children. The study aimed to explore dietary behaviors, physical activity and sedentary lifestyle associated with overweight and obesity, and their socio-demographic correlates, among Pakistani primary school children. Methods A population-based cross-sectional study was conducted with a representative multistage random cluster sample of 1860 children aged five to twelve years in Lahore, Pakistan. Overweight (> +1 SD) and obesity (> +2 SD) were defined using the World Health Organization reference 2007. Chi-square test was used as the test of trend. Linear regression was used to examine the predictive power of independent variables in relation to body mass index (BMI). Logistic regression was used to quantify the independent predictors and adjusted odds ratios (aOR) with 95% confidence intervals (CI) were obtained. Statistical significance was considered at P < 0.05. Results Children skipping breakfast (8%), eating fast food and snacks ≥ once a week (43%) and being involved in sedentary lifestyle > one hour a day (49%) were significantly more likely to be overweight and obese while those participating in physical activity > twice a week (53%) were significantly less likely to be overweight and obese (all P < 0.01). Skipping breakfast (P < 0.001), eating fast food and snacks (P = 0.001) and sedentary lifestyle (P < 0.001) showed an independent positive association with BMI while physical activity showed an independent inverse association (P = 0.001). Skipping breakfast (aOR 1.82, 95% CI 1.22-2.71), eating fast food and snacks ≥ once a week (OR 1.41, 95% CI 1.07-1.86), physical activity > twice a week (aOR 0.49, 95% CI 0.34-0.70) and sedentary lifestyle > one hour a day (aOR 1.56, 95% CI 1.19-2.03) were independent predictors of being overweight. Skipping breakfast had independent inverse association with physical activity (aOR 0.63, 95% CI 0.45-0.89) and eating fast food and snacks had independent positive association with sedentary lifestyle (aOR 1.79, 95% CI 1.49-2.16). Female gender was independently associated with skipping breakfast (aOR 1.50, 95% CI 1.04-2.16). Male gender (aOR 1.64, 95% CI 1.33-2.02), urban area with high SES (aOR 5.09, 95% CI 3.02-8.60) and higher parental education (aOR 1.74, 95% CI 1.12-2.68) were significant independent predictors of eating fast food and snacks ≥ once a week. Living in the rural area was independently associated (aOR 2.51, 95% CI 1.71-3.68) with physical activity > twice a week. Male gender (aOR 1.60, 95% CI 1.31-1.95), urban area with low SES (aOR 1.46, 95% CI 1.02-2.09), high-income neighborhoods (aOR 1.52, 95% CI 1.02-2.25), higher parental education (aOR 1.55, 95% CI 1.03-2.34) and fewer siblings (aOR 1.38, 95% CI 1.10-1.73) were independent predictors of sedentary lifestyle > one hour a day. Conclusions Dietary behaviors, physical activity and sedentary lifestyle are independent predictors of overweight and higher BMI among Pakistani primary school children, and are significantly affected by the child's socio-demographic characteristics. These findings support the urgent need to develop a National strategy for diet and physical activity and to implement culturally relevant behavioral interventions in the resource-poor developing country settings.
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Affiliation(s)
- Muhammad Umair Mushtaq
- Ubeera Memorial Research Society, Allama Iqbal Medical College, Lahore, 54000 Punjab, Pakistan.
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Mushtaq MU, Gull S, Abdullah HM, Shahid U, Shad MA, Akram J. Waist circumference, waist-hip ratio and waist-height ratio percentiles and central obesity among Pakistani children aged five to twelve years. BMC Pediatr 2011; 11:105. [PMID: 22104025 PMCID: PMC3239239 DOI: 10.1186/1471-2431-11-105] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 11/21/2011] [Indexed: 12/26/2022] Open
Abstract
Background Central obesity has been associated with the risk of cardiovascular and metabolic disease in children and anthropometric indices predictive of central obesity include waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR). South Asian children have higher body fat distribution in the trunk region but the literature regarding WC and related indices is scarce in this region. The study was aimed to provide age- and gender-specific WC, WHR and WHtR smoothed percentiles, and to explore prevalence and correlates of central obesity, among Pakistani children aged five to twelve years. Methods A population-based cross-sectional study was conducted with a representative multistage random cluster sample of 1860 primary school children aged five to twelve years in Lahore, Pakistan. Smoothed percentile curves were constructed for WC, WHR and WHtR by the LMS method. Central obesity was defined as having both age- and gender-specific WC percentile ≥90th and WHtR ≥0.5. Chi-square test was used as the test of trend. Multivariate logistic regression was used to quantify the independent predictors of central obesity and adjusted odds ratios (aOR) with 95% CI were obtained. Linear regression was used to explore the independent determinants of WC and WHtR. Statistical significance was considered at P < 0.05. Results First ever age- and gender-specific smoothed WC, WHR and WHtR reference curves for Pakistani children aged five to twelve years are presented. WC increased with age among both boys and girls. Fiftieth WC percentile curves for Pakistani children were higher as compared to those for Hong Kong and British children, and were lower as compared to those for Iranian, German and Swiss children. WHR showed a plateau pattern among boys while plateau among girls until nine years of age and decreased afterwards. WHtR was age-independent among both boys and girls, and WHtR cut-off of ≥0.5 for defining central obesity corresponded to 85th WHtR percentile irrespective of age and gender. Twelve percent children (95% CI 10.1-13.0) had a WC ≥90th percentile and 16.5% children (95% CI 14.7-18.1) had a WHtR ≥0.5 while 11% children (95% CI 8.9-11.6) had both WC ≥90th percentile and WHtR ≥0.5. Significant predictors of central obesity included higher grade, urban area with high socioeconomic status (SES), high-income neighborhood and higher parental education. Children studying in higher grade (aOR 5.11, 95% CI 1.76-14.85) and those living in urban area with high SES (aOR 82.34, 95% CI 15.76-430.31) showed a significant independent association. Urban area with high SES and higher parental education showed a significant independent association with higher WC and higher WHtR while higher grade showed a significant independent association with higher WC. Conclusions Comprehensive worldwide reference values are needed to define central obesity and the present study is the first one to report anthropometric indices predictive of central obesity for Pakistani school-aged children. Eleven percent children were centrally obese and strong predictors included higher grade, urban area with high SES and higher parental education. These findings support the need for developing a National strategy for childhood obesity and implementing targeted interventions, prioritizing the higher social class and involving communities.
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