Overweight and obesity of school-age children in El Salvador according to two international systems: a population-based multilevel and spatial analysis

Differences in the temporal trends of childhood overweight and obesity in Spain in the 2011-2019 period by sex, age and socioeconomic level: results of the ALADINO study

INTRODUCTION

Childhood excess weight is a growing public health problem. The aim of this study was to assess temporal trends in the prevalence of overweight, obesity and central obesity in schoolchildren aged 6-9 years in Spain between 2011 and 2019 based on demographic and socioeconomic characteristics.

METHODOLOGY

The analysis included data from the 2011, 2015 and 2019 rounds of the cross-sectional observational and descriptive ALADINO study in schoolchildren of both sexes aged 6-9 years. We conducted a descriptive analysis of the trends in the prevalence of overweight and obesity (defined according to the criteria of the World Health Organization and the International Obesity Task Force) and of central obesity, in addition to associated demographic and socioeconomic variables.

RESULTS

Between 2011 and 2019, the prevalence of overweight (WHO criteria) decreased in boys aged 6, 7 and 8 years (by -5.4%, -5.7% and -5.3%, respectively) and boys whose parents had a higher educational attainment (by -5.3%). In relation to the socioeconomic level, overweight in boys declined at all income levels. However, between 2011 and 2019, both the prevalence of overweight in girls and the prevalence of obesity (applying the WHO and IOTF criteria) and the prevalence of central obesity in both sexes remained stable.

CONCLUSIONS

The prevalence of overweight and the prevalence of obesity in schoolchildren aged 6-9 years in Spain remain high. Between 2011 and 2019, the prevalence of overweight in children aged 6-8 years and in children whose parents had university degrees decreased, whereas obesity in boys, overweight and obesity in girls and central obesity in both sexes remained stable.

Convenience stores: an obesogenic promoter in a metropolitan area of northern Mexico?

Introduction

The prevalence of obesity in the Mexican school-age (5-11 years old) population increased from 8.9 to 18.1% between 1999 and 2022. Although overweight and obesity (OW + Ob) is a complex and multifactorial phenomenon, alongside its increasing trend, changes in eating patterns as a result of obesogenic environments that promote higher energy intake have been documented. The objective of the present study was to detect possible associations between schools and their proximity to and density of convenience stores in Monterrey, Mexico from 2015 to 2018.

Materials and methods

Anthropometric data were obtained from a subset of measurements of the National Registry of Weight and Height (RNPT) performed in the Monterrey Mexico metropolitan area in 2015 and 2018, and obesity prevalence was computed and classified into quintiles at the school level. Convenience store data were obtained from the National Directory of Economic Units (DNUE). The analyses consisted of densities within 400-800 m buffers, distance to the nearest stores, and cartographic visualization of the store's kernel density versus OW + Ob hotspots for both periods.

Results

A total of 175,804 children in 2015 and 175,964 in 2018 belonging to 1,552 elementary schools were included in the study; during this period, OW + Ob prevalence increased from 38.7 to 39.3%, and a directly proportional relationship was found between the quintiles with the higher OW + Ob prevalence and the number of stores for both radii. Hotspots of OW + Ob ranged from 63 to 91 between 2015 and 2018, and it was visually confirmed that such spots were associated with areas with a higher density of convenience stores regardless of socioeconomic conditions.

Conclusion

Although some relationships between the store's proximity/density and OW + Ob could be identified, more research is needed to gather evidence about this. However, due to the trends and the magnitude of the problem, guidelines aimed at limiting or reducing the availability of junk food and sweetened beverages on the school's periphery must be implemented to control the obesogenic environment.

Prevalence of obesity, diabetes and hypertension in immigrant populations in northeastern Mexico

Introduction

Hispanic immigrants are a fast-growing population in the United States of America (USA) that disproportionately suffer from chronic diseases. Despite the increasing prevalence of obesity in Latin-American countries, only a few studies have examined the onset of chronic diseases in Mexican and Central American migrants in Mexico.

Objective

The objective of this study is to determine the prevalence of obesity, diabetes, and hypertension in Central American immigrants who are in the process of traveling through northeastern Mexico to the United States.

Methods

An observational, descriptive, cross-sectional study was conducted among migrants, mostly Central Americans. Migrants who agreed to participate in the study were interviewed face-to-face by researchers to obtain their sociodemographic data. To obtain the prevalence, many health indicators related to obesity, diabetes, and hypertension, including weight, height, fasting glucose, and blood pressure, were measured.

Results

In total, 520 migrants were interviewed; sociodemographic data indicated that most participants were men (76%), from Honduras (72.6%), single (61.2%), and have elementary level of education (48.6%). The somatometric evaluation revealed that 28.9% were diagnosed as overweight, 10.7% with obesity, and 3.3% with malnutrition. Of less prevalence, 8.8% were detected with hypertension and 4.6% had fasting hyperglycemia. The mean participant age was 29.11 ± 10.00 years. For each participant, the average weight was 66.72 ± 13.09 kg; the average height was 1.64 ± 0.08 m; the average body mass index (BMI) was 24.59 ± 4.32; the mean systolic and diastolic pressures were 116.26 ± 15.13 and 74 ± 9.65, respectively; and the average glycemia was 100.97 ± 21.99. El Salvador showed the highest proportion of people with diabetes (14.7%). Women who participated in this study had a higher proportion of obesity (23.4%, p = 0.02) and overweight (36.2%) than men (8.4 and 29.2%, respectively). People from Mexico, Nicaragua, and Honduras reported a high prevalence of overweight participants (63.6, 47.4, and 30.7%, respectively), while people from El Salvador and Nicaragua had a high prevalence of obese participants (23.5 and 21.1%, respectively).

Conclusion

We found significant differences in the rates of obesity, diabetes, and hypertension between groups of Central American migrants and their place of origin, age, educational level, and gender. Our findings highlight the importance of exploring differences within groups of Central American migrants traveling through northeastern Mexico to the United States, which may explain several health indicators.

Left atrial remodeling in adolescents with obesity evaluated by speckle-tracking echocardiography

BACKGROUND AND AIMS

In adolescents with obesity, a left atrial (LA) enlargement has been reported. However, data regarding its function and its stiffness are missing. The aim of this study was to describe LA morphology and function, using speckle-tracking echocardiography (STE) and to explore their potential determinants in adolescents with obesity.

METHODS

Twenty-eight adolescent women with obesity (13.2 ± 1.4 yr) with an illness duration of 130 ± 27 months and 33 controls (14.1 ± 2.0 yr) underwent a resting echocardiography including an analysis of left ventricular (LV) and LA morphologies and strains. A fasting venous blood sample was performed to biochemical determinations including inflammation markers.

RESULTS

LA volume and stiffness index were increased in adolescents with obesity compared to controls. LA reservoir, conduit and booster pump functions were not different between groups. By stepwise forward multivariate regression analyses, systolic blood pressures, cardiac output and sedimentation rate were the independent determinants of LA volume (p < 0.0001, β-coefficient = 0.460) whereas only the body mass index was an independent determinant of LA stiffness (p = 0.003, β-coefficient = 0.413).

CONCLUSION

In adolescents with obesity, we observed a specific LA remodeling, including higher volume and lower stiffness, which could constitute early signs of an altered LV diastolic function.

Impact of BMI z-score on left ventricular mechanics in adolescent girls

Background

Adolescent weight disorders ranging from anorexia nervosa (AN) to obesity (OB) can impact the heart by causing opposite alterations in its morphology, suggesting a direct impact of body mass index (BMI) on the heart. Cardiac function is relatively preserved as assessed by standard echocardiography. However, few studies have used 2D speckle-tracking echocardiography (2D-STE), which can detect subtle alterations of left ventricular (LV) function by evaluating deformations. This study aimed to assess the link between the BMI z-score of adolescent girls and myocardial function.

Methods

Ninety-one adolescent girls comprising 26 AN patients (age 14.6 ± 1.9 years), 28 OB patients (age 13.2 ± 1.4 years), and 37 controls (age 14.0 ± 2.0 years) underwent 2D-STE to assess LV morphology and myocardial global and regional deformations.

Results

The BMI z-score of our population ranged from -4.6 to 5.2. LV morphological remodeling was significantly and positively correlated with the BMI z-score (R2 = 0.456, p < 0.0001 for LV mass). Global longitudinal strain (LS) and regional LS recorded at the mid and apical levels were significantly correlated with the BMI z-score (R2 = 0.196, p = 0.0001 and R2 = 0.274, p < 0.0001, respectively, for apical and medial LS). Circumferential strains and twisting mechanics were not correlated with the BMI z-score. Fibrinogen and systolic blood pressure were the main variables explaining the alteration of LS.

Conclusion

We observed that the BMI z-score had an impact on LV mechanics, especially on medial and apical LS. Neither circumferential nor twisting mechanics were altered by the BMI z-score in adolescent girls.

Accuracy of international growth charts to assess nutritional status in children and adolescents: a systematic review

OBJECTIVE

To verify, through a systematic review, the accuracy of nutritional assessment in children and adolescents using the length/height-for-age and BMI-for-age growth charts of the Centers for Disease Control and Prevention (CDC) (2000), the World Health Organization (WHO) (2006/2007) and the International Obesity Task Force (IOTF) (2012).

DATA SOURCE

We selected articles from the databases Medical Literature Analysis and Retrieval System Online (MEDLINE), through PubMed, National Library of Medicine and The National Institutes of Health (NIH), Scientific Electronic Library Online (SciELO) and Virtual Health Library (VHL). The following descriptors were used for the search: "Child", "Adolescent", "Nutritional Assessment", "Growth Chart", "Ethnic Groups", "Stature by age", "Body Mass Index", "Comparison", "CDC", "WHO", and "IOTF". The selected articles were assessed for quality through the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the NIH.

DATA SYNTHESIS

Thirty-three studies published between 2007 and 2020 were selected and, of these, 20 presented good quality, 12 presented fair quality and one presented poor quality. For children under five years old, the WHO length/height-for-age growth charts were shown appropriate for children from Argentina, South Africa, Brazil, Gabon, Qatar, Pakistan and the United States. For those five years old and older, the WHO BMI-for-age growth charts were accurate for the Brazilian and Canadian populations, while the IOTF growth charts were accurate for the European populations.

CONCLUSIONS

There are difficulties in obtaining international growth charts for children from 5 years old and older that go along with a long period of growth, and which include genetic, cultural and socioeconomic differences of multiethnic populations who have already overcome the secular trend in height.

Global and Regional Myocardial Work in Female Adolescents with Weight Disorders

Background: Anorexia nervosa (AN) and obesity (OB) lead to changes in SBP (i.e., loading conditions) that may affect left ventricular (LV) myocardial work (MW). The novel concept of LV pressure-strain loops allows non-invasive estimation of MW, this latter being correlated with cardiac energy metabolism. In addition, the study of regional MW can detect subtle alterations in cardiac function by highlighting an abnormal distribution of MW. Objective: The aim of this study was to assess the cardiac function of AN and OB patients by evaluating global and regional LV strains and MW. Methods: Eighty-seven female adolescents, comprising 26 with AN (14.6 ± 1.9 yrs. old), 28 with OB (13.2 ± 1.4 yrs. old), and 33 controls (14.0 ± 2.0 yrs. old) underwent speckle-tracking echography to assess global and regional LV strains and MW. Results: SBP was higher in adolescents with obesity than in AN patients or controls. Global MW was similar between groups. In AN patients and controls, longitudinal strains were higher at the apex than at the base of the LV, whereas they were similar in obesity patients, owing to a decrease in their apical longitudinal strain. Consequently, their MW was higher at the basal level than either of the other two groups (1854 ± 272 vs. 1501 ± 280 vs. 1575 ± 295 mmHg% in OB patients, AN patients, and controls, respectively. Conclusion: Despite altered SBP, the global MW of adolescents with weight disorders was unaffected. However, in adolescents with obesity, the distribution of their regional LV MW was altered, which might reflect specific regional remodeling.

Mala nutrición en población escolar mexicana: factores geográficos y escolares asociados

OBJETIVOS

Determinar prevalencias de mala nutrición [sobrepeso u obesidad (Sp+O) y talla baja (TB)] en población mexicana de 6 a 12 años de edad de nivel básico de primaria, y su asociación con características geográficas (ámbito, marginación y región del país), y de la escuela (tipo, turno y grado).

MÉTODOS

Con información de 10 528 676 escolares, se estimaron prevalencias (e I.C. 95%), a nivel nacional y por características de interés, y su asociación mediante modelos de regresión logística.

RESULTADOS

La prevalencia nacional de Sp+O fue 34.4%, 36.5% en ámbito urbano y 40.2% en escuelas privadas. La prevalencia nacional de TB fue 8.7%; en área rural, 13.7% y 28.8% en escuelas tipo indígenas. El Sp+O y la TB se asociaron significativamente con características geográficas y de escuelas.

CONCLUSIONES

Existe una polarización nutricional en el contexto escolar del país. Es importante continuar con sistemas de monitoreo y vigilancia nutricional.

[Weight status in the 6- to 9-year-old school population in Spain: results of the ALADINO 2019 Study]

INTRODUCTION

childhood obesity is a public health problem whose prevalence has grown steadily in recent decades.

OBJECTIVE

to describe the weight status of schoolchildren aged 6 to 9 years in Spain in 2019, and their associated factors.

METHODS

ALADINO is a cross-sectional study in schoolchildren aged 6 to 9 years, representative of the Spanish population, and aligned with the Child Obesity Surveillance Initative of the WHO Regional Office for Europe. Participants' weight, height, and abdominal circumference were measured, defining weight status according to different standards (WHO, IOTF, and Orbegozo). A questionnaire on lifestyle and socio-demographic characteristics was administered to parents.

RESULTS

a total of 16,665 schoolchildren from 276 schools were measured. Excess weight was observed in 40.6 %: 23.3 % overweight and 17.3 % obesity, with obesity being more prevalent in boys and overweight in girls, both increasing with age. The prevalence of abdominal obesity was 22.6 %. Excess weight decreased by 3.9 percentage points since 2011, mainly due to overweight in boys. Obesity remained stable. Excess weight was more prevalent in schoolchildren with less healthy eating and physical activity habits, and in families with a lower socioeconomic status.

CONCLUSIONS

the prevalence of excess weight is high, although it has declined since 2011 and remains stable since 2015 among schoolchildren aged 6-9 years in Spain, this reduction being mainly due to a decrease in overweight in children. It is necessary to continue promoting healthy habits from the earliest stages of life, thus reducing health inequalities.