Adiposity among children in Norway by urbanity and maternal education: a nationally representative study

Obesity diagnoses in children and adolescents in Norway by immigrant background

AIM

Relatively few obese children and adolescents receive specialist treatment. Our aim was to assess associations between risk of receiving an obesity diagnosis in secondary/tertiary health services by socio-economic position and immigrant background in order ultimately to improve equity in health services.

METHODS

The study population comprised Norwegian-born children aged 2-18 years between 2008 and 2018 (N=1,414,623), identified via the Medical Birth Registry. Cox regressions were used to calculate hazard ratios (HR) of an obesity diagnosis from secondary/tertiary health services (Norwegian Patient Registry) by parental education and household income and by immigrant background.

RESULTS

Higher parental education and household income were associated with a lower hazard of obesity diagnosis regardless of Norwegian versus immigrant background. Compared to having a Norwegian background, having a Latin American (HR=4.12; 95% confidence interval (CI) 3.18-5.34), African (HR=1.54; 95% CI 1.34-1.76) and Asian (HR=1.60; 95% CI 1.48-1.74) background was associated with higher hazard of obesity diagnosis. Adjusted for parental education and household income, corresponding HRs were 3.28 (95% CI 2.95-3.65) for Latin America, 0.95 (95% CI 0.90-1.01) for Africa and 1.08 (95% CI 1.04-1.11) for Asia. Within Asia, those with a background from Pakistan, Turkey, Iraq and Iran had higher hazards than those with a Norwegian background, while those with a background from Vietnam had lower hazards, even after adjusting for parental education and household income.

CONCLUSIONS

To ensure more equitable treatment, more knowledge is warranted about health-service access and referral patterns, and underlying population prevalence rates, for obese children and adolescents with different immigrant backgrounds.

Parental education and occupation in relation to childhood type 1 diabetes: nationwide cohort study

BackgroundSocioeconomic status in the risk of developing type 1 diabetes seems inconsistent. We investigated whether risk of childhood-onset type 1 diabetes differed by parental education or occupation in a nationwide cohort.

METHODS

This cohort study included all children born in Norway from 1974 to 2013. In individually linked data from nationwide population registries following children born in Norway up to 15 years of age, we identified 4647 with newly diagnosed type 1 diabetes during 15 381 923 person-years of follow-up.

RESULTS

Children of mothers with a master's degree had lower risk of type 1 diabetes than children of mothers with completed upper secondary education only (adjusted incidence rate ratio, aIRR=0.82 95% CI: 0.70 to 0.95). There was no difference between upper secondary and lower secondary maternal education (aIRR=0.98, 95% CI: 0.89 to 1.08). Paternal education was not significantly associated with type 1 diabetes, lower secondary compared with upper secondary aIRR 0.96 (0.88-1.05) and master compared with upper secondary aIRR 0.93 (0.83-1.05). While maternal elementary occupation was associated with a lower risk of type 1 diabetes, specific maternal or paternal occupations were not.

CONCLUSIONS

Our results suggested inverse U-shaped associations between maternal socioeconomic status and risk of type 1 diabetes. Non-linear associations may be part of the reason why previous literature has been inconsistent.

Is socio-economic status associated with risk of childhood type 1 diabetes? Literature review

AIMS

Studies of social inequality and risk of developing type 1 diabetes are inconsistent. The present review aimed to comprehensively review relevant literature and describe what has been reported on socio-economic status or parental occupation and risk of type 1 diabetes in children.

METHODS

We searched for publications between 1 January 1970 and 30 November 2021. We focused on the most recent and/or informative publication in cases of multiple publications from the same data source and referred to these as primary studies.

RESULTS

Our search identified 69 publications with relevant data. We identified eight primary cohort studies with individual-level data, which we considered the highest quality of evidence. Furthermore, we identified 13 primary case-control studies and 14 semi-ecological studies with area-level socio-economic status variables which provided a weaker quality of evidence. Four of eight primary cohort studies contained data on maternal education, showing non-linear associations with type 1 diabetes that were not consistent across studies. There was no consistent pattern on the association of parental occupation and childhood-onset type 1 diabetes.

CONCLUSIONS

There is a need for more high-quality studies, but the existing literature does not suggest a major and consistent role of socio-economic status in the risk of type 1 diabetes.

Overweight and Obesity in Finnish Children by Parents' Socioeconomic Position-A Registry-Based Study

Objectives: To examine associations between parents' socioeconomic position (SEP) and child overweight and obesity, using registry data. Methods: Data (final n = 194,423) on children's height, weight and parents' SEP were drawn from the national Register of Primary Health Care Visits (Avohilmo) and Statistics Finland. Risk ratios for bernoulli-distributed overweight (RROW) and obesity (RROB) according to SEP were estimated using generalized linear models and using a log -link. Results: The risk for obesity was lower in boys from high-income families (RROB 0.76), for overweight and obesity was lower in boys (RROW 0.72, RROB 0.58) and girls (RROW 0.72, RROB 0.54) with highly educated fathers, in boys (RROW 0.79, RROB 0.58) and girls (RROW 0.78, RROB 0.56) with high-educated mothers and in boys (RROW 0.85, RROB 0.77) and girls (RROW 0.80, RROB 0.69) living in urban areas, as compared to low-income families, low-educated parents, and rural residence, respectively. Conclusion: The risk of overweight and obesity was increased in children with low SEP or rural residence. Administrative registers are a valid approach to monitor childhood obesity by parents' SEP.

The influence of immigrant background and parental education on overweight and obesity in 8-year-old children in Norway

BACKGROUND

Little is known about the prevalence of overweight/obesity and socio-economic position (SEP) in children with immigrant background in Scandinavia. The purpose of this study is to examine the prevalence of overweight/obesity by immigrant background among children in Norway and to explore the role of SEP in explaining differences in weight status.

METHODS

Anthropometric data from 8,858 children (age 8.3 years) from the population-based Norwegian Childhood Growth Study were used. Information about immigrant background, country of origin, and parental education (used as an indicator of SEP) were provided by Statistics Norway. For children with immigrant background, regional background was determined based on country of origin. Prevalence ratios (PR) were estimated for overweight/obesity and weight-to-height-ratio (WHtR) ≥ 0.5 by immigration and regional background, using generalized estimating equation log-binominal models adjusting for sex, age, survey year (model 1), residential area, population density (model 2) and parental education (model 3).

RESULTS

Children with immigrant background had a higher prevalence of overweight/obesity and WHtR ≥ 0.5 than non-immigrant background children. Adjusted for parental education, children with an immigrant background from Southern and Eastern Europe, Asia except South-Asia, and Africa had a higher prevalence of overweight/obesity [PR: 1.37 (95% confidence interval (CI): 1.10-1.72), 1.28 (1.05-1.57), 1.47 (1.13-1.91), respectively] than children with a non-immigrant background. Children originating from Asia except South-Asia had a higher prevalence of WHtR ≥ 0.5 (PR: 1.64, CI: 1.25-2.15) compared to non-immigrant background children. The adjustment for parental education did not substantially change the results.

CONCLUSION

Children with immigrant background had higher prevalence of overweight/obesity than non-immigrant background children. The difference varied according to region of origin but not substantially according to parental education. There is a need for culturally acceptable preventative measures targeting the parents of immigrant background children.

Association of Maternal Education With Nutritional Outcomes of Poor Children With Stunting in Indonesia

The consequences of poverty and food insecurity can indirectly contribute to obesity. Long-term effect of stunting children may be the risk factor for overweight and obesity in the poor in Indonesia. The role of parental education is also associated with overweight and obesity in children. This study aimed to observe the risk of stunted children becoming overweight and obese based on maternal education among poor people in Indonesia. This study involved three cohorts design. Cohort 1 is a 14-year cohort, and two 7-year cohorts for cohorts 2 and 3. We used secondary longitudinal data from Indonesian Family Life Survey (IFLS) 3 (2000), IFLS 4 (2007), and IFLS 5 (2014). After stratification by high maternal education and economic status of the family, there is an increased risk of stunting children becoming overweight and obese, with a risk ratio of 2 in cohort 1 and 1.69 in cohort 2. These results showed that stunted children with high-education mothers and lived in the low-income families have a 1.69 to 2 times higher risk of becoming overweight and obese. Thus, the importance of primary education and health education for women to increase children's health in the future.

Understanding weight status and dietary intakes among Australian school children by remoteness: a cross-sectional study

OBJECTIVE

To determine whether primary school children's weight status and dietary behaviours vary by remoteness as defined by the Australian Modified Monash Model (MMM).

DESIGN

A cross-sectional study design was used to conduct secondary analysis of baseline data from primary school students participating in a community-based childhood obesity trial. Logistic mixed models estimated associations between remoteness, measured weight status and self-reported dietary intake.

SETTING

Twelve regional and rural Local Government Areas in North-East Victoria, Australia.

PARTICIPANTS

Data were collected from 2456 grade 4 (approximately 9-10 years) and grade 6 (approximately 11-12 years) students.

RESULTS

The final sample included students living in regional centres (17·4 %), large rural towns (25·6 %), medium rural towns (15·1 %) and small rural towns (41·9 %). Weight status did not vary by remoteness. Compared to children in regional centres, those in small rural towns were more likely to meet fruit consumption guidelines (OR: 1·75, 95 % CI (1·24, 2·47)) and had higher odds of consuming fewer takeaway meals (OR: 1·37, 95 % CI (1·08, 1·74)) and unhealthy snacks (OR = 1·58, 95 % CI (1·15, 2·16)).

CONCLUSIONS

Living further from regional centres was associated with some healthier self-reported dietary behaviours. This study improves understanding of how dietary behaviours may differ across remoteness levels and highlights that public health initiatives may need to take into account heterogeneity across communities.

The prevalence of overweight and obesity: a measurement-based analysis of 6-9-year-old school children from Montenegro

Introduction

This study aimed to conduct a measurement-based analysis of overweight and obesity prevalence among 6-9-year-old children in Montenegro.

Methods

The population of this cross-sectional study included 1993 (1059 boys and 934 girls) primary-school children. The sample of anthropometric variables includes body height, body weight and body mass index, as well as nutrition status that were presented based on BMI standardized categories: underweight, normal weight, overweight, and obesity. The descriptive statistics described the means for each variable, while post hoc tests and ANOVA were applied to explore differences between the proposed means.

Results

The results indicate the overweight (including obesity) prevalence was 28% (15% of overweight and 13% of obese children), while boys have a higher overweight prevalence rate than girls. In addition, the tendency of higher prevalence rates to differ by age in both sexes is observed. This study also confirmed that overweight and obesity are affected by geographical regions but not by the level of urbanization in Montenegro.

Discussion

The innovation of this study is reflected in the fact that the overweight and obesity prevalence rates among 6-9-year-old children are within an acceptable range in Montenegro, since it does not deviate from the European average, but further interventions and continuous monitoring are necessary, due to the specific nature of this issue.

Investigation of obesity, eating behaviors and physical activity levels living in rural and urban areas during the covid-19 pandemic era: a study of Turkish adolescent

Background

The purpose of this study was to determine the eating behaviors, obesity and physical activity status of children of similar ages living in rural and urban areas and to examine these relationships during the coronavirus disease (COVID-19) pandemic process.

Method

The research was conducted using the scanning model. The research group consists of children living in rural and urban areas in Turkey. The sample of the study consists of a total of 733 adolescent participants, 351 females (47.9%) and 382 males (52.1%). After anthropometric measurements were made, the Physical Activity Questionnaire for older children and the Yale Food Addiction Scale for children 2.0 were used to determine the food addiction and physical activity status of children during the COVID19 pandemic process. Since the groups were homogeneously distributed, independent samples t-test and Pearson correlation test were used.

Result

In terms of food addiction and physical activity levels, children living in the urban have higher scores than children living in rural areas. In addition, children living in the urban were taller and have higher body mass values than those in rural areas. In terms of physical activity level and food addiction levels, while girls living in the urban had higher activity levels than those living in rural areas, no statistically significant difference was found between the physical activity levels of boys. When evaluated in terms of general and gender, it was determined that children living in rural areas were overweight and obese at a higher rate. Obese children had higher levels of food addiction and lower physical activity levels than non-obese children.

Conclusion

In order to prevent childhood obesity, the level of food addiction should be reduced as well as increasing the level of physical activity. This study is limited in terms of cross-sectional evaluation. Future research can experimentally reveal how much obesity is reduced by methods such as exercise and diet interventions.

Mediators of differences by parental education in weight-related outcomes in childhood and adolescence in Norway

Studies exploring mediators of socioeconomic inequalities in excess weight gain in early-life and subsequent overweight/obesity (OW/OB) among youth are limited. Thus, this study examined the mediating role of prenatal and early postnatal factors and child energy balance-related behaviours (EBRB) in the effects of parental education on (i) excess weight gain from birth to 2 years and (ii) OW/OB at 5, 8 and 14 years. The Norwegian Mother, Father and Child Cohort Study was used to include participants at the ages of 2 (n = 59,597), 5 (n = 27,134), 8 (n = 28,285) and 14 (n = 11,278) years. Causal mediation analyses using the inverse odds weighting approach were conducted. Children of low-educated parents had a higher conditional excess weight gain at 2 years compared to children of high-educated parents (total effect, RRTE = 1.06; 95% CI 1.01, 1.10). The joint mediation effects of the prenatal and early postnatal factors explained most of the total effect of low education on conditional excess weight gain at 2 years. Children of low-educated parents had a higher risk of OW/OB at 5, 8 and 14 years compared to children of high-educated parents. The mediators jointly explained 63.7%, 67% and 88.9% of the total effect of parental education on OW/OB among 5, 8 and 14 year-old-children, respectively. Of the total mediated effects at 5, 8 and 14 years, the prenatal and early postnatal mediators explained 59.2%, 61.7% and 73.7%, whereas the child EBRB explained 10.3%, 15.8.0%% and 34.8%. The mediators included were found to have a considerable mediating effect in the associations explored, in particular the prenatal and early postnatal factors. If truly causal, the findings could indicate potential targets for interventions to tackle socioeconomic inequalities in OW/OB from birth to adolescence.

A nationwide school fruit and vegetable policy and childhood and adolescent overweight: A quasi-natural experimental study

BACKGROUND

School free fruit and vegetable (FFV) policies are used to promote healthy dietary habits and tackle obesity; however, our understanding of their effects on weight outcomes is limited. We assess the effect of a nationwide FFV policy on childhood and adolescent weight status and explore heterogeneity by sex and socioeconomic position.

METHODS AND FINDINGS

This study used a quasi-natural experimental design. Between 2007 and 2014, Norwegian combined schools (grades 1-10, age 6 to 16 years) were obligated to provide FFVs while elementary schools (grades 1-7) were not. We used 4 nationwide studies (n = 11,215 children) from the Norwegian Growth Cohort with longitudinal or cross-sectional anthropometric data up to age 8.5 and 13 years to capture variation in FFV exposure. Outcomes were body mass index standard deviation score (BMISDS), overweight and obesity (OW/OB), waist circumference (WC), and weight to height ratio (WtHR) at age 8.5 years, and BMISDS and OW/OB at age 13 years. Analyses included longitudinal models of the pre- and post-exposure trajectories to estimate the policy effect. The participation rate in each cohort was >80%, and in most analyses <4% were excluded due to missing data. Estimates were adjusted for region, population density, and parental education. In pooled models additionally adjusted for pre-exposure BMISDS, there was little evidence of any benefit or unintended consequence from 1-2.5 years of exposure to the FFV policy on BMISDS, OW/OB, WC, or WtHR in either sex. For example, boys exposed to the FFV policy had a 0.05 higher BMISDS (95% CI: -0.04, 0.14), a 1.20-fold higher odds of OW/OB (95% CI: 0.86, 1.66) and a 0.3 cm bigger WC (95% CI: -0.3, 0.8); while exposed girls had a 0.04 higher BMISDS (95% CI: -0.04, 0.13), a 1.03 fold higher odds of OW/OB (95% CI: 0.75, 1.39), and a 0-cm difference in WC (95% CI: -0.6, 0.6). There was evidence of heterogeneity in the policy effect estimates at 8.5 years across cohorts and socioeconomic position; however, these results were inconsistent with other comparisons. Analysis at age 13 years, after 4 years of policy exposure, also showed little evidence of an effect on BMISDS or OW/OB. The main limitations of this study are the potential for residual confounding and exposure misclassification, despite efforts to minimize their impact on conclusions.

CONCLUSIONS

In this study we observed little evidence that the Norwegian nationwide FFV policy had any notable beneficial effect or unintended consequence on weight status among Norwegian children and adolescents.

[Assessment and operationalization of the characteristic "gender" in representative population-based surveys: challenges and implications with the example of the GeSiD study]

Repräsentative quantitative Surveys erheben das Geschlecht der Teilnehmenden, um geschlechtsspezifische Analysen im Hinblick auf die jeweiligen Fragestellungen zuzulassen und Rückschlüsse auf die Populationen zu ziehen. Dies ist wichtig, um zielgruppenspezifische Informationen und Angebote zu entwickeln. Doch obwohl Geschlecht nicht mehr ausschließlich als ein binäres Konstrukt betrachtet wird, wird es noch oft durch eine binäre Variable mit den Antwortmöglichkeiten Frau/Mann oder weiblich/männlich erhoben. In diesem Artikel erörtern wir, warum dieses Vorgehen veraltet bzw. unvollständig und eine Abkehr von diesem Ansatz wichtig und notwendig ist. Anhand der GeSiD-Studie zu „Gesundheit und Sexualität in Deutschland“ zeigen wir in diesem Diskussionsbeitrag exemplarisch auf, wie Geschlecht anhand eines zweistufigen Modells erhoben werden kann, bei dem im ersten Schritt das bei der Geburt zugewiesene Geschlecht und im zweiten Schritt die subjektive Geschlechtszugehörigkeit abgefragt wird. Gleichzeitig erörtern wir die Herausforderungen, die dieser Ansatz mit sich bringt. Die Erfahrungen aus der GeSiD-Studie setzen wir in einen größeren Kontext und diskutieren die Implikationen und Möglichkeiten zur Operationalisierung von Geschlecht in repräsentativen Befragungen.

Incidence, sociodemographic factors and treatment penetration of rheumatoid arthritis and psoriatic arthritis in Norway

OBJECTIVES

To evaluate nationwide incidence, sociodemographic associations and treatment penetration of rheumatoid arthritis (RA) and psoriatic arthritis (PsA) in Norway.

METHODS

The study combined data from nationwide registries on the total Norwegian adult population (age ≥ 18). From the Norwegian Patient Registry, incident RA and PsA cases during 2011-2015 were identified with records of first and second healthcare episodes listing RA/PsA diagnostic codes, and ≥ 1 episode in an internal medicine or rheumatology unit with RA/PsA code during the two-year period after the first episode. Dispensed DMARD prescriptions were obtained from the Norwegian Prescription Database. Persons with dispensed DMARD prescriptions or biologic DMARDs given in hospitals > 12 months before the index date were excluded.

RESULTS

Incidence of RA/PsA in Norway was 42/26 per 100,000 person-years (55/28 among women and 28/23 among men). RA peak incidence was observed at ages 70-79 in both sexes, whereas the peak incidence of PsA occurred at ages 50-59. Age- and sex-standardized incidences of RA and PsA were lower among persons with higher education levels. Within a year from the index date, 82.4/57.4% of RA/PsA patients used synthetic DMARDs while 9.4/9.5% used biologic DMARDs.

CONCLUSIONS

Register-based incidence estimates for RA and PsA in Norway are similar to other Nordic countries, but slightly higher than in previous Norwegian studies. Furthermore, we found that higher socioeconomic status was associated with lower incidence of both RA and PsA. Although conventional synthetic DMARDs were less often used in early PsA than RA, frequency of biologic DMARD prescriptions was comparable.

Overweight and obesity among children in rural areas: The importance of culture

AIMS

This paper focuses on how social inequality is associated with overweight and obesity in children. There is a lack of research with a focus on an important distinction in social inequality, namely geography. The aim of this study was to reduce this knowledge gap by looking closely at the links between rurality and overweight.

METHODS

The findings in this paper are based on in-depth interviews with school nurses and teachers in rural Norway. The focus was on their experiences with and knowledge about overweight and obesity numbers in rural versus urban areas.

RESULTS

We used Bourdieu's terminology to address the challenges related to urban-rural differences, and found that cultural factors connected to tradition, identity and courtesy play an important role in the rural overweight and obesity discourse.

CONCLUSIONS

Actors and 'experts' working with overweight and obesity and national guidelines need to understand rural contexts and customs and address problems of the countryside on rural, not exclusively urban, premises. Different contexts imply different needs when it comes to reducing the inequalities between rural and urban areas regarding overweight and obesity.

Overweight, obesity, and thinness among a nationally representative sample of Norwegian adolescents and changes from childhood: Associations with sex, region, and population density

Objective

To estimate the prevalence of overweight, obesity, and thinness among Norwegian 13-year-olds and the changes from childhood (age 8 years) to adolescence (age 13 years); and to explore associations with sex, region, and population density from childhood to adolescence.

Design

We used longitudinal, anthropometric data collected by school health nurses conducted in Norway. Weight status was classified according to the International Obesity Task Force cut-offs for overweight, obesity, and thinness, and according to mean body mass index (kg/m²).

Participants

The Norwegian Youth Growth Study, consisting of a nationally representative sample of Norwegian 13-year-olds (n = 1852; 50.7% girls), which is a part of The Norwegian Growth Cohort.

Results

Among 13-year-old Norwegians, the prevalence of overweight (including obesity), obesity, and thinness was 15.8%, 2.5%, and 7.3%, respectively. There was little evidence that these had changed from 8 to 13 years. From 8 to 13 years, the odds of obesity was highest in the Northern region of Norway compared to the South-East (odds ratio (OR): 3.78 (95% confidence interval (CI): 1.13, 12.65; p = 0.036) and in rural areas (OR: 4.76 (95% CI: 1.52, 14.90; p = 0.027). Over the same age period, girls had a trend towards a higher odds of thinness compared to boys (OR: 1.65 (95% CI: 0.98, 2.78; p = 0.057).

Conclusions

In Norway, the prevalence of overweight, obesity, and thinness among 13-year-olds seem to be established by age 8 years. The prevalence of obesity was higher in the North and in rural areas. The results indicate the continued need for early prevention and treatment, and targeted interventions to certain areas.

The impact of lifestyle and socioeconomic parameters on body fat level in early childhood

The aim of this study was to examine the differences between selected lifestyle and socioeconomic parameters among preschool (3-7 years of age) children of differing adiposity status. The study was conducted from February to June 2018 in 20 randomly selected kindergartens in Kraków, Poland. Triceps, biceps, subscapular, suprailiac, abdominal and calf skinfold thicknesses were measured. The sum of all six skinfolds was calculated and the children were subsequently characterized by low (≤-1 SD [standard deviation]), normal (-1 to 1 SD) or high body fat (≥1 SD). Socioeconomic and lifestyle characteristics were obtained using a questionnaire filled out by the children's parents or legal guardians. Preschool children in the high adiposity category had, on average, fewer siblings and longer screen time; additionally, their parents had lower education and more often worked in manual jobs, in comparison to the children in the low and average adiposity categories. In conclusion, it was observed that children in different adiposity categories varied in terms of some socioeconomic as well as lifestyle characteristics. Knowledge regarding the influence that those factors can have on the metabolic health of children is essential for children's present as well as future well-being. Moreover, it can help health care professionals and parents decide what intervention and/ or preventive measures should be undertaken to ensure the best possible outcomes, as the development of successful obesity prevention strategies should rely on evidence-based information. Nonetheless, future research examining the issue of factors influencing the metabolic health of children, as well as these outcomes later in life, is crucial. Well-planned studies including a large number of individuals, as well as longitudinal research, will be particularly beneficial in this regard.

Parental income gradients in adult health: a national cohort study

BACKGROUND

Disparities in health by adult income are well documented, but we know less about the childhood origins of health inequalities, and it remains unclear how the shape of the gradient varies across health conditions. This study examined the association between parental income in childhood and several measures of morbidity in adulthood.

METHODS

We used administrative data on seven complete Norwegian birth cohorts born in 1967-1973 (N = 429,886) to estimate the association between parental income from birth to age 18, obtained from tax records available from 1967, linked with administrative registries on health. Health measures, observed between ages 39 and 43, were taken from registry data on consultations at primary health care services based on diagnostic codes from the International Classification of Primary Care (ICPC-2) and hospitalizations and outpatient specialist consultations registered in the National Patient Registry (ICD-10).

RESULTS

Low parental income during childhood was associated with a higher risk of being diagnosed with several chronic and pain-related disorders, as well as hospitalization, but not overall primary health care use. Absolute differences were largest for disorders related to musculoskeletal pain, injuries, and depression (7-9 percentage point difference). There were also differences for chronic disorders such as hypertension (8%, CI 7.9-8.5 versus 4%, CI 4.1-4.7) and diabetes (3.2%, CI 3.0-3.4 versus 1.4%, CI 1.2-1.6). There was no difference in consultations related to respiratory disorders (20.9%, CI 20.4-21.5 versus 19.7%, CI 19.2-20.3). Childhood characteristics (parental education, low birth weight, and parental marital status) and own adult characteristics (education and income) explained a large share of the association.

CONCLUSIONS

Children growing up at the bottom of the parental income distribution, compared to children in the top of the income distribution, had a two- to threefold increase in somatic and psychological disorders measured in adulthood. This shows that health inequalities by socioeconomic family background persist in a Scandinavian welfare-state context with universal access to health care.

Sociodemographic Correlates of Obesity among Spanish Schoolchildren: A Cross-Sectional Study

Some studies have been conducted in order to assess the association between weight status (assessed by body mass index) and socio-demographic factors. Nevertheless, only a few of them have indicated these associations by other anthropometric parameters (e.g., skinfolds). The aim of this study was to determine, compare, and examine the influence of age, sex, type of the schooling, per capita income, area of residence, and immigrant status on obesity parameters in schoolchildren aged 6-13 from the Region of Murcia. A cross-sectional study was carried out in six different Primary schools of the Region of Murcia (Spain). A total sample of 370 children (166 girls) aged 6-13 (8.7 ± 1.8) were selected. In order to determine participants' body composition, body mass index, waist circumference, waist-to-height ratio, and skinfold measurements were calculated. Higher associations of excess of weight (OR = 1.96; 95%CI = 1.19-3.20) and abdominal obesity (OR = 3.12; 95CI% = 1.49-6.94) were shown in the case of children from public schools. A greater association of high trunk fat mass was found in children from municipalities with high per capita income (OR = 3.20; 95%CI = 1.05-9.77). Therefore, lower association of having an inadequate %BF was found in the participants aged 6-9 (OR = 0.38; 95%CI = 0.24-0.54), and immigrant students (OR = 2.63; 95%CI = 1.69-4.10). Our study suggested that overweight/obesity among schoolchildren in the Region of Murcia is higher than the overall prevalence of Spain. The results of the adjusted analyses showed that age, type of schooling, per capita income, and immigrant status were associated with obesity parameters.

Facilitators and barriers to healthy food selection at children's sports arenas in Norway: a qualitative study among club managers and parents

Objective:

To investigate club managers’ and parents’ experiences with food selection at handball halls in order to identify facilitators and barriers to the availability of healthy food.

Design:

Individual interviews with club managers (n 6) and focus groups (n 5) with parents (n 21) were conducted. Interviews were recorded and transcribed verbatim, transcripts were coded in NVivo and the analysis was guided by thematic analysis.

Setting:

Interviews were conducted at five handball clubs with varying socio-economic user populations and sizes in the area of Oslo, Norway.

Participants:

The club managers were responsible for food selection at the handball clubs. The participating parents had one or two active children between the ages of 6 and 12 years who took part in the clubs.

Results:

The club managers and parents generally described food selection at the handball halls as unhealthy and wanted a healthier selection of food. The club managers’ primary barriers to providing a healthier food selection included the potential to lose profits, limited facilities and time to prepare these foods. The parents often valued unhealthy food, as they believed that it supported the social environment and served as a reward for the children. Trainers were perceived as important role models for the promotion of healthy eating. The participants thought that national guidelines could facilitate healthy food environments in sports arenas.

Conclusion:

Healthier food options in sports settings could be facilitated through national guidelines that describe healthy foods and establish who is responsible for providing healthy food selections.

Maternal Education in Early Life and Risk of Metabolic Syndrome in Young Adult American Females and Males: Disentangling Life Course Processes Through Causal Models

BACKGROUND

Maternal education in a child's early life may directly affect the child's adult cardiometabolic health, but this is difficult to disentangle from biological, social, and behavioral life course processes that are associated with maternal education. These processes may also differ between males and females.

METHODS

Using data from the National Longitudinal Study of Adolescent to Adult Health (1995-2009) (N = 4,026 females and 3,192 males), we estimated sex-stratified associations between maternal attainment of less than high school (<HS), high school diploma (HS), or college degree (CD) at the respondent's birth and respondent's risk of metabolic syndrome (MetS); we used marginal structural models (MSM) to account for the influence of major life course risk factors, such as childhood maltreatment, adolescent overweight, adult education, household income, smoking, and physical activity, in mediating associations between maternal education and offspring MetS risk.

RESULTS

Each higher level of maternal education was associated with a 36% (Relative Risk = 0.64 [95% Confidence Interval (CI): 0.50-0.82]) reduced risk of MetS among females, but only 19% (RR = 0.81 [95% CI: 0.64-1.01]) reduction among males (P-value interaction < 0.05). Stronger inverse associations were also observed for waist circumference and glycated hemoglobin (HbA1c) among females compared with males (-5 cm vs. -2.4 cm and -1.5% vs. -1.0%, respectively).

CONCLUSION

High maternal education in early life was associated with a lower risk of MetS in young adulthood even after accounting for life course risk factors, particularly among females. Results were robust to altered model specifications.

Diet diversity score and healthy eating index in relation to diet quality and socio-demographic factors: results from a cross-sectional national dietary survey of Swedish adolescents

Objective:

Groups with low socio-economic status have less healthy diets and higher prevalence of non-communicable diseases. Using the latest Swedish national dietary survey data, we developed a healthy eating index and a diet diversity score with the aim to explore associations between the scores and socio-demographic factors.

Design:

Cross-sectional national dietary survey. A web-based retrospective registration of food and beverages during 2 d was used to assess dietary intake. This information was used to construct the Swedish Healthy Eating Index for Adolescents 2015 (SHEIA15) and the Riksmaten Adolescents Diet Diversity Score (RADDS). The scores were based on the latest Swedish dietary guidelines from 2015. Intakes of food and nutrients across the scores were examined. Mixed-effects multilevel models were used to assess associations between the scores and household education, sex, school grade, weight status and school municipality.

Setting:

School-based survey in Sweden.

Participants:

2905 adolescents in grades 5, 8 and 11, 56 % girls.

Results:

High scores on SHEIA15 and RADDS were associated with higher intake of vegetables, fish and several nutrients, and lower intake of sugar-sweetened beverages and red meat. Boys and participants in households with lower education level scored lower on both indices. Individuals with overweight/obesity scored lower on RADDS.

Conclusions:

The newly developed indices can be used to identify healthy eating patterns among Swedish adolescents. Both indices show that boys and adolescents from households with lower education level have poorer dietary habits. Lower diet diversity was related to overweight/obesity, but the overall healthy eating index was not.

Time Trends and Sociodemographic Factors Associated With Overweight and Obesity in Children and Adolescents in Spain

IMPORTANCE

Time-trend studies of overweight and obesity in childhood by sociodemographic factors are important for prioritizing public health initiatives. However, little is known about these trends in Spain, where high levels of obesity are found and where important demographic changes have occurred during the last 2 decades.

OBJECTIVE

To examine how time trends in the prevalence and incidence of overweight and obesity among children and adolescents differ by age, sex, socioeconomic status, urban/rural residence, and nationality.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study included 1.1 million children and adolescents (aged 2-17 years) with at least 1 measure of height and weight in Catalonia, Spain, from 2006 to 2016. Electronic health records were accessed from the Information System for Research in Primary Care. Data analysis was conducted from January to December 2018.

MAIN OUTCOMES AND MEASURES

Prevalence and incidence rates and trends of overweight/obesity and obesity (overweight/obesity defined as having of BMI z score greater than 2.0 among children aged <5 years and greater than 1.0 among children aged ≥5 years; obesity defined as having of BMI z score greater than 3.0 among children aged <5 years and greater than 2.0 among children aged ≥5 years) between 2006 and 2016 were calculated and stratified by sociodemographic characteristics (ie, age, sex, deprivation index, urban/rural residence, and nationality).

RESULTS

The study population included 1 166 609 children and adolescents (570 982 [48.9%] girls; median [interquartile range] age at entry to electronic health record system, 2.4 [0-7.7] years; 1 006 892 [86.3%] with Spanish nationality). Of 941 041 children (80.7%) who lived in urban areas, 197 427 (20.7%) lived in the most deprived areas. Overall, the prevalence of overweight/obesity and obesity decreased between 2006 and 2016 in all sex and age groups; for example, among boys and girls aged 6 to 11 years, overweight/obesity prevalence decreased from 41.9% (95% CI, 41.5%-42.2%) to 39.9% (95% CI, 39.6%-40.3%) and from 39.7% (95% CI, 39.3%-40.2%) to 37.6% (95% CI, 37.3%-38.0%), respectively. Incidence rates of overweight/obesity and obesity were highest among children aged 6 to 7 years (overweight/obesity among boys: 11.9 [95% CI, 11.8-12.0] new cases per 100 person-years; obesity among boys: 4.9 [95% CI, 4.8-4.9] new cases per 100 person-years). Prevalence and incidence rates were highest in the most deprived areas, in urban areas, and among children with North, Central, or South American nationalities. Between 2006 and 2016, prevalence increased in the most deprived areas in almost all sex and age groups. Among girls aged 6 to 11 years living in the most deprived areas, the obesity prevalence ratio increased from 1.59 (95% CI, 1.46-1.74) to 2.03 (95% CI, 1.88-2.19) compared with those living in the least deprived areas. Furthermore, during this period, prevalence increased among children with non-Spanish nationalities, especially in the African and Asian nationality groups (eg, boys aged 6-11 years with Asian nationality compared with Spanish nationality, 2006: prevalence rate, 0.78 [95% CI, 0.60-1.01]; 2016: prevalence rate, 1.27 [95% CI, 1.15-1.39]). Incidence rates decreased among younger groups (eg, ≤7 years: incidence rate ratio for January 1, 2006, to June 30, 2011, vs July 1, 2011, to December 31, 2016: 0.94; 95% CI, 0.91-0.98) but remained stable in older groups.

CONCLUSIONS AND RELEVANCE

In this study, the overall prevalence and incidence rates of childhood overweight/obesity and obesity slightly decreased during the last decade. However, increased deprivation disparities in childhood obesity were found, given that the prevalence increased among children living in deprived areas and with non-Spanish nationalities.

Comparison of Obesity Prevalence and Dietary Intake in School-Aged Children Living in Rural and Urban Area of Croatia

The aim of this study was to explore the differences in nutritional status and dietary intakes in 12~17 year-old children living in urban (Zagreb) and the rural (Sinj and Drniš) area of Croatia. A validated food frequency questionnaire was used to assess dietary intake. For each participant, body weight and body height were measured and bioelectrical impedance was used to estimate the body fat percentage. There was an overall of 310 children included: 105 (33.9%) from urban area and 205 (66.1%) from rural area; 191 (61.6%) were female with a mean age 14.9 (range 12~17) years. When adjusted for age and gender, there was no statistically significant difference in body mass index for age Z-scores between urban and rural parts (0.23±0.07 vs. 0.30±1.15; P=0.650) or in average daily energy intake (2,479.2±1,111.2 kcal vs. 2,338.2±920.2 kcal; P=0.702). There was a statistically significant difference in nutritional status between genders, with a higher percentage of boys being overweight or obese compared to girls. When combined, 'Fast food' and 'Snacks' were major contributors to the total energy intake for both areas. The mean contribution of 'Fast food' to total energy intake was significantly higher in the urban area. The prevalence of obesity among Croatian children is high and unrelated to the urban/rural setting, which could be partially explained by the high intake of 'Fast food' and 'Snacks'.

Adolescents' perspectives on everyday life with obesity: a qualitative study

Purpose: This study aimed to gain an in-depth understanding of the perspectives and life experiences of adolescents living with obesity. Methods: Five adolescents living with obesity were involved in repeated interviews, and qualitative content analysis was performed. Results: Three themes emerged: obesity as a multi-faceted and difficult to solve condition; obesity as a shameful and vulnerable subject; and bullying and fragile social relationships. Adolescents living with obesity described everyday life challenges as difficult to interpret and solve. Adolescents living with obesity perceived causes for obesity differently, and those who emphasised familial determinants seemed to face greater challenges. Lack of support from parents, trusted friends and health-care providers and bullying, shame, guilt and self-blame represented threats that decreased motivation for help seeking and successful life-style changes. The adolescents were ambivalent regarding disclosing their concerns and seeking help. The adolescents feared that health care providers would demand too much from them, and peers were perceived as a possible source of support. Conclusion: Care providers need to be skilled in assessing each individual’s resources and interpretations of their condition, to be able to communicate in a respectful, patient-centred manner and to assist adolescents to explore their ambivalence and set their own realistic goals. More research is needed.

School sociodemographic characteristics and obesity in schoolchildren: does the obesity definition matter?

BACKGROUND

Existing evidence on the role of sociodemographic variables as risk factors for overweight and obesity in school-aged children is inconsistent. Furthermore, findings seem to be influenced by the obesity definition applied. Therefore, this study aimed to investigate if school sociodemographic indicators were associated with weight status in Irish primary schoolchildren and whether this association was sensitive to different obesity classification systems.

METHODS

A nationally representative cross-sectional sample of 7542 Irish children (53.9% girls), mean age 10.4 (±1.2SD) years, participating in the Childhood Obesity Surveillance Initiative in the 2010, 2012/2013 or 2015/2016 waves were included. Height, weight and waist circumference were objectively measured. Five definitions of obesity were employed using different approaches for either body mass index (BMI) or abdominal obesity. Associations between overweight and obesity and sociodemographic variables were investigated using adjusted multilevel logistic regression analyses.

RESULTS

Children attending disadvantaged schools were more likely to be overweight and obese than their peers attending non-disadvantaged schools, regardless of the obesity classification system used. Associations remained significant for the BMI-based obesity definitions when the sample was stratified by sex and age group, except for boys aged 8-10.5 years. Only boys aged ≥10.5 years in disadvantaged schools had higher odds of abdominal obesity (UK 1990 waist circumference growth charts: OR = 1.56, 95%CI = 1.09-2.24; waist-to-height ratio: OR = 1.78, 95%CI = 1.14-2.79) than those in non-disadvantaged schools. No associations were observed for school urbanisation level.

CONCLUSIONS

School socioeconomic status was a strong determinant of overweight and obesity in Irish schoolchildren, and these associations were age- and sex-dependent. School location was not associated with overweight or obesity. There remains a need to intervene with school-aged children in disadvantaged schools, specifically among those approaching adolescence, to prevent a trajectory of obesity into adult life.

Social and somatic determinants of underweight, overweight and obesity at 5 years of age: a Norwegian regional cohort study

OBJECTIVE

To identify associations between the weight groups underweight (UW), overweight (OW) and obesity (OB) at 5 years of age and exposures related to pregnancy, anthropometric measures at birth, sociodemographic factors, and family health, anthropometric measures and habits.

DESIGN

Regional cohort study.

SETTING

Oppland County, Norway.

METHODS

Pregnancy data were obtained from a prospective perinatal register for children born in the county, and weight and height were measured by midwives at birth and by public health nurses at 5 years. Other information was obtained from questionnaires completed by parents.

PARTICIPANTS

Of 1895 eligible children, current weight and height were obtained for all, weight and length at birth and information from parents for 1119 (59%) and pregnancy register data for 749 (40%) of the children. The significance of potential explanatory variables from descriptive statistics was tested in multinomial logistic regression analysis.

RESULTS

The prevalence of UW, OW and OB among participants was 7.8%, 10.6% and 3.5%, respectively. UW was associated with anthropometric measures at birth and those of parents, but not with sociodemographic or behavioural characteristics. OW and OB were associated with anthropometric measures of parents and siblings and with a variety of unfavourable social characteristics, lack of prolonged breast feeding, sedentary behaviour and dental caries, but not with current dietary habits. After adjustments, OW and OB were marginally related to birth parameters and diet and unrelated to physical activity, but significantly related to parental body mass index, low parental education and maternal smoking.

CONCLUSION

The strong associations between sociodemographic and behavioural factors and OW and OB, but not with UW, may suggest that environmental factors are major contributing causes of OW and particularly OB at 5 years. These results may be helpful in targeting preventive measures against OW and OB.

Prevalence and geographic variation of abdominal obesity in 7- and 9-year-old children in Greece; World Health Organization Childhood Obesity Surveillance Initiative 2010

Background

In children, abdominal obesity is a better predictor of the presence of cardiovascular risk factors than body mass index (BMI)-defined obesity. We aimed to evaluate the prevalence of abdominal obesity in the Greek pediatric population and to assess the impact of residence on the prevalence of both BMI-defined and abdominal obesity.

Methods

In the context of the Childhood Obesity Surveillance Initiative of the World Health Organization (WHO) Regional Office for Europe, a national representative sample of 7.0–7.9 and 9.0–9.9-year-old children was evaluated (n = 2,531 and 2,700, respectively). Overweight and obesity according to BMI were estimated using both the WHO and International Obesity Task Force cut-off points. Abdominal obesity was defined as waist circumference/height ratio >0.5.

Results

The prevalence of abdominal obesity did not differ between 7-year-old boys and girls (25.2 and 25.3%, respectively; p = NS). Among 9-year-old children, abdominal obesity was more prevalent in boys than in girls (33.2 and 28.2%, respectively; p = 0.005). Among normal weight and overweight children, the prevalence of abdominal obesity was 1.6–6.8 and 21.8–49.1%, respectively. The prevalence of abdominal and BMI-defined obesity did not differ between children living in the mainland, in Crete and in other islands except in 7-year-old girls, where the prevalence of BMI-defined obesity was highest in those living in Crete, intermediate in those living in other islands and lowest in those living in the mainland. In 9-year-old boys and in 7- and 9-year-old girls, the prevalence of abdominal obesity was highest in children living in Athens and lowest in children living in Thessaloniki, whereas children living in other cities and in villages showed intermediate rates. The prevalence of abdominal obesity in 7-year-old boys and the prevalence of BMI-defined obesity did not differ between children living in cities and villages.

Conclusions

The prevalence of pediatric abdominal obesity in Greece is among the highest worldwide. Boys and children living in the capital are at higher risk for becoming obese. Given that abdominal obesity is more prevalent than BMI-defined obesity and appears to be more sensitive in identifying cardiovascular risk, measurement of waist circumference might have to be incorporated in the screening for childhood obesity.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4061-x) contains supplementary material, which is available to authorized users.

WHO European Childhood Obesity Surveillance Initiative in Serbia: a prevalence of overweight and obesity among 6-9-year-old school children

BACKGROUND

The World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) is a public health program established in order to understand the progress of the obesity epidemic in young populations and gain inter-country comparisons within the European region, yet the data from a number of East European countries, including Serbia, were not available then. Therefore, the main aim of this cross-sectional study was to collect data about the prevalence of overweight and obesity among 6-9-year-old school children in Serbia according to the standardized protocol during the Fourth COSI Implementation Round.

METHODS

From September 2015 to November 2015, 5102 first- and second-grade primary-school children (age 7.7±0.6 years) were assessed for weight, height, and body mass index (BMI) in 14 Serbian school districts.

RESULTS

The prevalence rates of obesity, as calculated using the International Obesity Task Force (IOTF) cut-off points, vary across different age groups, with the lowest obesity rates reported in 7-year-old boys (6.2%), while the highest obesity prevalence rates were observed in 6-year-old boys (9.7%). In addition, being overweight was strongly associated with poor local community development and lower level of urbanization. The overall prevalence of overweight (23.1%, including obesity) and obesity (6.9%) in Serbian primary-school children seem to be comparable to rather high rates previously reported in other countries participating in the COSI program, indicating an obesity epidemic in Serbian children.

CONCLUSIONS

This surveillance system should be regularly implemented throughout Europe, providing comparable data on rates of overweight/obesity in primary schools that might drive prudent actions to reverse the pandemic trend of childhood obesity.

Can socioeconomic factors explain geographic variation in overweight in Norway?

We explore if the geographic variation in excess body-mass in Norway can be explained by socioeconomic status, as this has consequences for public policy. The analysis was based on individual height and weight for 198,311 Norwegian youth in 2011, 2012 and 2013, stemming from a compulsory screening for military service, which covers the whole population aged seventeen. These data were merged with municipality-level socioeconomic status (SES) variables and we estimated both ecological models and two-level models with a random term at the municipality level. Overweight was negatively associated with income, education and occupation at municipality level. Furthermore, the municipality-level variance in overweight was reduced by 57% in females and 40% in males, when SES factors were taken into account. This suggests that successful interventions aimed at reducing socioeconomic variation in overweight will also contribute to reducing the geographic variation in overweight, especially in females.

Tracking of overweight and obesity from early childhood to adolescence in a population-based cohort - the Tromsø Study, Fit Futures

Background

Obesity is a serious childhood health problem today. Studies have shown that overweight and obesity tend to be stable (track) from birth, through childhood and adolescence, to adulthood. However, existing studies are heterogeneous; there is still no consensus on the strength of the association between high birth weight or high body mass index (BMI) early in life and overweight and obesity later in life, nor on the appropriate age or target group for intervention and prevention efforts. This study aimed to determine the presence and degree of tracking of overweight and obesity and development in BMI and BMI standard deviation scores (SDS) from childhood to adolescence in the Fit Futures cohort from North Norway.

Methods

Using a retrospective cohort design, data on 532 adolescents from the Fit Futures cohort were supplemented with height and weight data from childhood health records, and BMI was calculated at 2–4, 5–7, and 15–17 years of age. Participants were categorized into weight classes by BMI according to the International Obesity Taskforce’s age- and sex-specific cut-off values for children 2–18 years of age (thinness: adult BMI <18.5 kg/m², normal weight: adult BMI ≥18.5- < 25 kg/m², overweight: adult BMI ≥25- < 30 kg/m², obesity: adult BMI ≥30 kg/m²). Non-parametric tests, Cohen’s weighted Kappa statistic and logistic regression were used in the analyses.

Results

The prevalence of overweight and obesity combined, increased from 11.5 % at 2–4 years of age and 13.7 % at 5–7 years of age, to 20.1 % at 15–17 years of age. Children who were overweight/obese at 5–7 years of age had increased odds of being overweight/obese at 15–17 years of age, compared to thin/normal weight children (crude odds ratio: 11.1, 95 % confidence interval: 6.4–19.2). Six out of 10 children who were overweight/obese at 5–7 years of age were overweight/obese at 15–17 years of age.

Conclusions

The prevalence of overweight and obesity increased with age. We found a moderate indication of tracking of overweight/obesity from childhood to adolescence. Preventive and treatment initiatives among children at high risk of overweight and obesity should start before 5–7 years of age, but general preventive efforts targeting all children are most important.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-016-0599-5) contains supplementary material, which is available to authorized users.

Age and time effects on children's lifestyle and overweight in Sweden

BACKGROUND

High physical activity, low sedentary behavior and low consumption of sugar-sweetened beverages can be markers of a healthy lifestyle. We aim to observe longitudinal changes and secular trends in these lifestyle variables as well as in the prevalence of overweight and obesity in 7-to-9-year-old schoolchildren related to gender and socioeconomic position.

METHODS

Three cross-sectional surveys were carried out on schoolchildren in grades 1 and 2 (7-to-9-year-olds) in 2008 (n = 833), 2010 (n = 1085), and 2013 (n = 1135). Information on children's level of physical activity, sedentary behavior, diet, and parent's education level was collected through parental questionnaires. Children's height and weight were also measured. Longitudinal measurements were carried out on a subsample (n = 678) which was included both in 2008 (7-to-9-year-olds) and 2010 (9-to-11-year-olds). BMI was used to classify children into overweight (including obese) and obese based on the International Obesity Task Force reference. Questionnaire reported maternal education level was used as a proxy for socioeconomic position (SEP).

RESULTS

Longitudinally, consumption of sugar-sweetened beverages ≥ 4 days/week increased from 7% to 16% in children with low SEP. Overall, sedentary behavior > 4 hours/day doubled from 14% to 31% (p < 0.001) and sport participation ≥ 3 days/week increased from 17% to 37% (p < 0.001). No longitudinal changes in overweight or obesity were detected. In the repeated cross-sectional observations sedentary behavior increased (p = 0.001) both in high and low SEP groups, and overweight increased from 13.8% to 20.9% in girls (p < 0.05). Overall, children with high SEP were less-often overweight (p < 0.001) and more physically active (p < 0.001) than children with low SEP.

CONCLUSIONS

Children's lifestyles changed longitudinally in a relatively short period of two years. Secular trends were also observed, indicating that 7-9-year-olds could be susceptible to actions that promote a healthy lifestyle. Socioeconomic differences were consistent and even increasing when it came to sugar-sweetened beverage consumption. Decreasing the socioeconomic gap in weight status and related lifestyle variables should be prioritized. Primary school is an arena where most children could be reached and where their lifestyle could be influenced by health promoting activities.

A cross-sectional study of Health Related Quality of Life and body mass index in a Norwegian school sample (8-18 years): a comparison of child and parent perspectives

Background

Because consequences of pediatric overweight and obesity are largely psychosocial, the aim of this study was to describe health related quality of life (HRQoL), the prevalence of overweight and obesity, and to examine the relationships between HRQoL and body mass index (BMI), age, and gender in a Norwegian sample of schoolchildren. In addition, because children are dependent upon their parents’ judgment of their condition, the aim was also to compare child- and parent-reported HRQoL and BMI, age, and gender.

Methods

This cross-sectional study involved 1238 children (8–18 years) and 828 parents. HRQoL was measured with the Norwegian version of the KIDSCREEN-52, child and parent version. Child BMI was calculated based on objective measures of height and weight, and adjusted for age and gender. Multiple regressions were used to determine how variations in BMI, age, and gender affected child- and parent-reported HRQoL.

Results

HRQoL decreased significantly with age and girls had lower HRQoL than boys on the majority of the KIDSCREEN subscales. Of the total sample, approximately 16% were overweight and 3% were obese. BMI contributed significantly to explaining the variations in the KIDSCREEN subscales of Physical well-being and Self-perception. Higher BMI was associated with lower HRQoL scores. Although there were significant differences between child and parent ratings on most KIDSCREEN subscales, the direction of the differences varied. In some scales, parents rated their child’s HRQoL higher than the child, and in some scales lower. Increasing age of the child seems to increase the differences, while gender and the child being overweight and/or obese affected the differences to a smaller extent.

Conclusions

This study showed that almost 20% of the children and adolescents in a representative Norwegian school sample were overweight or obese. Age and gender were the most significant factors associated with variations in HRQoL in the sample; however, increasing BMI added to the negative effect of other factors. The study also found substantial differences between the child and parent ratings of the child’s HRQoL. Misinterpretations of the child’s well-being might result in less targeted actions to improve the child’s HRQoL.

Does maternal psychopathology increase the risk of pre-schooler obesity? A systematic review

The preschool years may be a critical period for child obesity onset; however, literature examining obesity risk factors to date has largely focused on school-aged children. Several links have been made between maternal depression and childhood obesity risks; however, other types of maternal psychopathology have been widely neglected. The aim of the present review was to systematically identify articles that examined relationships between maternal psychopathology variables, including depressive and anxiety symptoms, self-esteem and body dissatisfaction, and risks for pre-schooler obesity, including weight outcomes, physical activity and sedentary behaviour levels, and nutrition/diet variables. Twenty articles meeting review criteria were identified. Results showed positive associations between maternal depressive symptoms and increased risks for pre-schooler obesity in the majority of studies. Results were inconsistent depending on the time at which depression was measured (i.e., antenatal, postnatal, in isolation or longitudinally). Anxiety and body dissatisfaction were only measured in single studies; however, both were linked to pre-schooler obesity risks; self-esteem was not measured by any studies. We concluded that maternal depressive symptoms are important to consider when assessing risks for obesity in preschool-aged children; however, more research is needed examining the impact of other facets of maternal psychopathology on obesity risk in pre-schoolers.

Stable prevalence of obesity in Swedish schoolchildren from 2008 to 2013 but widening socio-economic gap in girls

AIM

The aim of this study was to follow the 5-year prevalence of overweight, obesity and thinness in 7- to 9-year-old children in West Sweden and to investigate whether trends differed according to gender and socio-economic status.

METHODS

Cross-sectional anthropometric measurements of three cohorts in grades one and two were performed in 3492 7- to 9-year-old children in 2008, 2010 and 2013. For body mass index classification, the IOTF/Cole and WHO 2007 references were used. Percentage of inhabitants with high education in the school area was used for socio-economic classification.

RESULTS

Between 2008, 2010 and 2013, the overall time-trends in overweight 17.7%, 19.3% and 18.8%, obesity 3.2%, 3.3% and 3.1%, and thinness 6.5%, 4.7% and 6.9%, respectively, were fairly stable using the IOTF/Cole references. Thinness defined by the Cole reference increased in girls. The socio-economic gradient for overweight and obesity was clear by both references, but using the IOTF reference, the gap increased for obesity among girls (p = 0.024). No significant trends were observed with the WHO reference.

CONCLUSION

The overall prevalence of overweight and obesity was stable over 5 years, but we detected growing inequality in obesity and increasing prevalence of thinness in girls. With these regionally representative data, we can draw conclusions about West Sweden, despite an absence of continued national surveillance.

Prevalence of overweight in 2 to 17 year-old children and adolescents whose parents live separately: a Nordic cross-sectional study

Background

Comparative data of parental separation and childhood overweight has not been available before across the Nordic countries. The aim of this study was to examine the within-country prevalence and association between parental cohabitation and overweight in Nordic children.

Methods

A cross-sectional survey of 2-17-year-old children was conducted in 2011, titled: “NordChild”. A random sample of 3,200 parents in each of the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden were invited to participate in the study with parents of 6,609 children accepting to give answers about their children’s health and welfare including information on height and weight of each child and parental cohabitation (response rate 41.5%). The group differences in prevalence and adjusted odds ratio (OR) for overweight, with corresponding 95% confidence intervals (CI) were performed in children whose parents lived separately. Additionally, a missing data analysis was performed to determine whether the adjusted estimates might result from confounding or selection bias.

Results

A significant difference was observed in Iceland between children whose parents live separately compared to those who live with both parents (difference: 9.4%, 95% CI: 2.8; 15.9) but no such difference was observed in Denmark, Finland, Norway and Sweden. No significant odds of overweight were observed in children whose parents lived separately compared to children in normal weight at the time of study; Denmark: OR 1.03 (95% CI: 0.42; 2.53), Finland: OR 1.27 (95% CI: 0.74; 2.20), Iceland: OR 1.50 (95% CI: 0.79; 2.84), Norway: OR 1.46 (95% CI: 0.81; 2.62), and Sweden: 1.07 (95% CI: 0.61; 1.86). The missing data analysis indicated that the findings in Norway, Finland and Iceland were partly observed due to selection effects, whereas the adjustment in Denmark was due to confounding. The crude OR for overweight was higher in the 2-9-year-old group than in the 10-17-year-old group whose parents lived separately in Iceland, Norway and Sweden.

Conclusions

No association between parental cohabitation and overweight in Nordic children was found. Our finding of greater prevalence of overweight in Icelandic children whose parents live separately may be an indication that the welfare system in Iceland is separating from the other Nordic countries.

Tracking of body size from birth to 7 years of age and factors associated with maintenance of a high body size from birth to 7 years of age – the Norwegian Mother and Child Cohort study (MoBa)

Objective

To examine tracking of body size among children participating in the Norwegian Mother and Child Cohort Study (MoBa) from birth to 7 years of age and additionally to explore child and parental characteristics associated with maintenance of a high body size in this period of life.

Design

Anthropometric data at birth and at 1, 3 and 7 years of age were collected by questionnaires addressed to the mother.

Setting

Participants were recruited from all over Norway during the period 1999–2008.

Subjects

A total of 3771 children had complete anthropometric data at birth and at 1, 3 and 7 years of age; the sample includes children born between 2002 and 2004.

Results

Cohen’s weighted kappa pointed to fair (0·36) to moderate (0·43) tracking of body size from birth to 7 years of age. Generalized estimating equations further indicated that children in the highest tertile of ponderal index at birth had nearly one unit higher BMI (kg/m2) at the age of 7 years compared with children in other tertiles of ponderal index at birth. Having parents with high BMI (≥25·0 kg/m2) increased the odds of having a stable high body size from birth to 7 years of age; moreover, girls had significantly higher odds compared with boys.

Conclusions

The study indicates fair to moderate tracking of body size from birth to 7 years of age. From a public health perspective, early prevention of childhood overweight and obesity seems to be especially important among children of parents having a high BMI.

Socioeconomic status and overweight prevalence in polish adolescents: the impact of single factors and a complex index of socioeconomic status in respect to age and sex

BACKGROUND

The aim of this study was to analyze the association between overweight prevalence and socioeconomic status (SES) measured by complex SES index and single SES factors in Polish adolescents in respect to age and sex.

METHODS

This cross-sectional study was conducted in 2010-2011. A total of 1,176 adolescents aged 13.0-18.9 years were included. The respondents were students of junior-high and high schools from northern, eastern and central Poland. Quota sampling by sex and age was used. The SES was determined by: place of residence, self-declared economic situation, and parental education level. Respondents with low, average or high SES index (SESI) were identified. The level of overweight was assessed using Polish and international standards.

RESULTS

The odds ratio (OR) for overweight prevalence in the oldest girls (aged 17.0-18.9 years) with high SESI was 0.34 (95%CI:0.13-0.92; P < 0.05) by Polish standards and 0.22 (95%CI:0.05-0.95; P < 0.05) by international standards, in comparison to the reference group (low SESI). In total girls who had mothers with higher education level, the OR adjusted for age was 0.44 (95%CI:0.21-0.90; P <0.05) by Polish standards and 0.35 (95%CI:0.15-0.81; P < 0.05) by international standards, in comparison to the reference group (maternal elementary education). The other single SES factors were not significant for overweight prevalence.

CONCLUSIONS

The relationship between socioeconomic status and prevalence of overweight was related to sex and age. The high socioeconomic status strongly lowered the risk of overweight prevalence in the oldest girls, but not in boys, irrespective of age. Maternal education level lowered risk of overweight prevalence in girls.

Parental marital status and childhood overweight and obesity in Norway: a nationally representative cross-sectional study

OBJECTIVE

Sociodemographic changes in Norway and other western industrialised countries, including family structure and an increasing proportion of cohabiting and divorced parents, might affect the prevalence of childhood overweight and obesity issues. We aimed to examine whether parental marital status was associated with general and abdominal obesity among children. We also sought to explore whether the associations differed by gender.

DESIGN

Cross-sectional.

SETTING

127 primary schools across Norway.

PARTICIPANT

3166 third graders (mean age 8.3 years) participating in the nationally representative Norwegian Child Growth Study in 2010.

MEASUREMENTS

Height, weight and waist circumference were objectively measured. The main outcome measures were general overweight (including obesity; body mass index ≥25 kg/m(2)) using International Obesity Task Force (IOTF) cut-offs and abdominal obesity (waist-to-height ratio ≥0.5) by gender and parental marital status. Prevalence ratios, adjusted for possible confounders, were calculated by log-binomial regression.

RESULTS

General overweight (including obesity) was 1.54 (95% CI 1.21 to 1.95) times more prevalent among children of divorced parents compared with children of married parents, and the corresponding prevalence ratio for abdominal obesity was 1.89 (95% CI 1.35 to 2.65). Formal tests of the interaction term parental marital status by gender were not statistically significant. However, in gender-specific analyses the association between parental marital status and adiposity measures was only statistically significant in boys (p=0.04 for general overweight (including obesity) and p=0.01 for abdominal obesity). The estimates were robust against adjustment for maternal education, family country background and current area of residence.

CONCLUSIONS

General and abdominal obesities were more prevalent among children of divorced parents. This study provides valuable information by focusing on societal changes in order to identify vulnerable groups.