Prevalence and predictors of overweight and obesity among school-aged children in urban Ghana

Prevalence and risk factors of obesity among undergraduate student population in Ghana: an evaluation study of body composition indices

BACKGROUND

Obesity is a classified risk factor for several of the world's leading causes of death. In this study, we combined information contained in body mass index (BMI), total percentage body fat (TPBF) and relative fat mass (RFM) to estimate obesity prevalence and examine the risk factors associated with obesity.

METHODS

The study recruited 1027 undergraduate students aged between 16 and 25 years using a cross-sectional study design and two-stage stratified random sampling between January and April 2019 from the Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Demographic, lifestyle, and family history of chronic disease data, were collected using a structured questionnaire. Bioelectrical impedance, along with height, weight, age, and gender, were used to estimate BMI and TPBF. The RFM was calculated using a published equation. The TPBF and RFM ranges were evaluated based on standard BMI thresholds and an informative combined obesity prevalence estimated in a Bayesian framework. Multiple logistic regression analysis was used to evaluate potential risk factors of overweight/obesity.

RESULTS

Concordance between BMI, TPBF and RFM for obesity classification was 84% among female and 82.9% among male students. The Bayesian analysis revealed a combined prevalence means of obesity of 9.4% (95%CI: 6.9-12.2%) among female students and 6.7% (95%CI:4.3-9.5%) among male students. The odds of obesity were increased between 1.8 and 2.5 for females depending on the classification index. A significant increasing trend of obesity was observed with university-level. A family history of obesity was associated with a high estimate of general, central, and high TPBF.

CONCLUSION

Using multiple adiposity indicators conjointly in a Bayesian framework offers a greater power to examine obesity prevalence. We have applied this and reported high obesity prevalence, especially among female students. University level and family history of obesity were key determinants for obesity among the student population.

Factors associated with overweight and obesity among women of reproductive age in Cambodia: Analysis of Cambodia Demographic and Health Survey 2021-22

Overweight and obesity are associated with increased chronic disease and death rates globally. In Cambodia, the prevalence of overweight and obesity among women is high and increasing. This study aimed to determine the prevalence and factors associated with overweight and obesity among women of reproductive age (WRA) in Cambodia. We analyzed data from the 2021-22 Cambodia Demographic and Health Survey (CDHS). Data analysis was restricted to non-pregnant women, resulting in an analytic sample of 9,417 WRA. Multiple logistic regressions were performed using STATA V17 to examine factors associated with overweight and obesity. The prevalence of overweight and obesity among WRA was 22.56% and 5.61%, respectively. Factors independently associated with increased odds of overweight and obesity included women aged 20-29 years [AOR = 1.85; 95% CI: 1.22-2.80], 30-39 years [AOR = 3.34; 95% CI: 2.21-5.04], and 40-49 years [AOR = 5.57; 95% CI: 3.76-8.25], women from rich wealth quintile [AOR = 1.44; 95% C: 1.19-1.73], having three children or more [AOR = 1.40; 95% CI: 1.00-1.95], ever drink alcohol [AOR = 1.24; 95% CI: 1.04-1.47], and current drink alcohol [AOR = 1.2; 95% CI: 1.01-1.45]. Women completed at least secondary education were less likely being overweight and obese [AOR = 0.73; 95% CI: 0.58-0.91]. Overweight and obesity remains highly prevalent among WRA in Cambodia. Therefore, there is an urgent need to take interventions that target women from higher socio-demographic status to reduce the risk of life-threatening caused by being overweight and obese through raising awareness of important changing lifestyles.

Making food-related health taxes palatable in sub-Saharan Africa: lessons from Ghana

Amidst high burden of infectious diseases, undernutrition and micronutrient deficiencies, non-communicable diseases (NCDs) are predicted to become the leading cause of death in Ghana by 2030. NCDs are driven, to a large extent, by unhealthy food environments. Concerned, the Ghana Ministry of Health (MOH) has since 2012 sought to garner the support of all to address this challenge. We aimed to support the MOH to address the challenge through public health policy measures, but would soon be reminded that longstanding challenges to policy development such as data poverty, and policy inertia needed to be addressed. To do this, the we generated the needed evidence, curated the evidence, and availed the evidence to Ghanaian policymakers, researchers and civil society actors. Thus, we addressed the problem of data poverty using context-relevant research, and policy inertia through advocacy and scholar activism. In this paper, we share how a public interest coalition used context-relevant research, evidence-informed advocacy and scholar activism to valorise and increase demand for healthy food policy (including food-related health taxes) in Ghana.

Improving Body Mass Index of School-Aged Children Using a Nine-Week Rope Skipping Training Intervention: A One-Group Pre-Test Post-Test Design

Studies examining the effectiveness of rope skipping training to improve the body mass index (BMI) of school children are scarce. Hence, this study examined the effectiveness of nine-week skipping training on the BMI of primary six school-aged children (n = 77). The participants underwent 30 min of skipping training three days per week over a nine-week period. The participants’ BMI was measured at the baseline and during weeks 3, 6 and 9. The results from a one-way ANOVA with repeated measures indicated a statistically significant difference in the BMI for both males [F(3,111) = 9.42, p < 0.001, ηp2 = 0.203] and females [F(3,114) = 7.35, p < 0.001, ηp2 = 0.162], suggesting an improvement in BMI. Post hoc comparisons with a Bonferroni adjustment revealed significant differences in BMI after nine weeks of intervention for males between the pre-test (M = 21.47, SD = 4.94) and the 9-week post-test (M = 20.15, SD = 4.36), and for females between the pre-test (M = 21.56, SD = 5.80) and the 9-week post-test (M = 20.68, SD = 5.32). This study demonstrated that regular participation in vigorous physical activity such as skipping training could promote child health by preventing the likelihood of young children being overweight. This result has implications for the inclusion of skipping training into the school life of school-aged children to help manage their BMI levels.

"Some are healthy and others not": Characterization of vended food products by Accra-based food retailers

Background and objectives

Increasing the availability of healthy foods within food retail outlets can improve consumers' food environments. Such actions or inactions by food retailers may affect people's food purchasing and consumption behavior. This study explored Accra-based food retailers' perceptions and appreciation of "healthiness of food" as a concept. It also documented measures that food retailers adopt to encourage healthy food choices.

Methods

In-person semi-structured interviews were conducted with owners and managers of Accra-based supermarkets (n = 7) and corner stores (n = 13) in March 2021. The interviews were recorded, transcribed, coded, and analyzed thematically.

Results

The retailers' understanding of healthy food, or lack thereof, is exemplified by such expressions as "health, absence of disease, longevity, balanced diet, diversity, sanitation, and certification." A handful of retailers described what they sell as "products that meet consumer needs," "harmless," or "generally good." Very few retailers described the food they sell as "junk," high in sugar, fat, and salt, or energy-dense but nutrient poor foods, or as food that could pose some health risk to consumers. However, some retailers indicated that they advise their customers against the overconsumption of some foods.

Conclusion

Overall, Accra-based retailers have a fair understanding of what constitutes healthy food - exhibiting limited knowledge of the connection between very salty, very sugary, and very fatty foods and health outcomes. Retailers in Accra require interventions that improve their food, health, and nutrition literacy. Improving retailers' food and nutrition literacy may improve the availability of healthier options in food retail outlets in Accra.

Maternal nutritional status, decision-making autonomy and the nutritional status of adolescent girls: a cross-sectional analysis in the Mion District of Ghana

A mother's nutritional status and participation in household decision-making, a proxy for empowerment, are known determinants of improved nutrition and health outcomes for infants and young children; however, little is known about the association among adolescents. We examined the association between maternal nutritional status, decision-making autonomy and adolescent girls' nutritional status. We analysed data of 711 mother-adolescent girl pairs aged 10-17 years from the Mion District, Ghana. Maternal nutritional status and decision-making autonomy were the independent variables while the outcomes were adolescent girls' nutritional status as defined by anaemia, stunting and body mass index-for-age Z-score categories. Girl-level (age, menarche status and the frequency of animal-source food consumption), mother-level (age, education level, and monthly earnings) and household-level (wealth index, food security status and family size) covariates were adjusted for in the analysis. All associations were examined with hierarchical survey logistic regression. There was no association between maternal height and adolescent girls being anaemic, underweight or overweight/obese. Increasing maternal height reduced the odds of being stunted [adjusted odds ratio (OR) 0⋅92, 95 % CI (0⋅89, 0⋅95)] for the adolescent girl. Maternal overweight/obesity was positively associated with the girl being anaemic [OR 1⋅35, 95 % CI (1⋅06, 1⋅72)]. The adolescent girl was more than five times likely to be thin [OR 5⋅28, 95 % CI (1⋅64-17⋅04)] when the mother was underweight. Maternal decision-making autonomy was inversely associated with stunting [OR 0⋅88, 95 % CI (0⋅79, 0⋅99)] among the girls. Our findings suggest that intergenerational linkages of a mother's nutritional status are not limited to childhood but also during adolescence.

Does it fit better? Measures of physical activity among adolescents in relation to health indicators

BACKGROUND

Measuring physical activity (PA) is one of the pillars of successful health promotion; however, we struggle to find a tool enabling the identification of risk groups. The current standard approach of assessing moderate-to-vigorous physical activity (MVPA) every day does this inadequately. The aim of this study is to explore whether three other indicators of adolescents' PA can identify such risk groups in a better way.

METHODS

We used data on 888 11- to 15-year-old adolescents (mean age = 13.5, 56% boys) from the Health Behaviour in School-aged Children study conducted in 2018 in Slovakia. Sufficient PA was indicated by the following four indicators: (i) MVPA every day, (ii) MVPA 5-7 days a week, (iii) engagement in organized sports (team or individual) and (iv) combining MVPA 5-7 days a week and engagement in organized sports. We used binary logistic regression analysis to assess the association of various indicators of adolescents' PA with body composition, cardiovascular fitness and self-rated health (SRH), considering age and gender.

RESULTS

Being active based on various indicators was associated with better health outcomes, with the strongest associations for the indicator combining MVPA 5-7 days a week and engagement in organized sports. The only exceptions were the non-significant associations of active adolescents (being active 5-7 days per week or engaged in organized sports) with cardiovascular fitness and SRH.

CONCLUSIONS

Measuring PA using an indicator that combines MVPA 5-7 days a week and engagement in organized sports is the most valid using three health indicators as criteria.

Overweight/Obesity Prevalence among Under-Five Children and Risk Factors in India: A Cross-Sectional Study Using the National Family Health Survey (2015–2016)

The occurrence of overweight and obesity has increased in recent years in India. In this study, we investigate the prevalence and associated risk factors of overweight/obesity among children aged 0–59 months in India. Using data from the 2015–2016 National Family Health Survey-4 (NFHS-4), the research sample included 176,255 children aged 0 to 59 months. Bivariate and multivariate techniques were used to analyze children’s risk factors for overweight/obesity. We identified that the prevalence of overweight/obesity among children aged 0–59 was 2.6% in India. The study findings reveal that factors such as child sex, age, birth weight, birth rank, maternal education, number of children, age at marriage, mother’s BMI, media exposure, social group, and dietary diversity score were most significantly correlated with childhood overweight and obesity in India. Furthermore, we found that male children (ARR: 1.08) aged between 0 and 11 months (ARR: 3.77) with low birth rank (ARR: 1.24), obese (ARR: 1.81) children whose mothers married after the age of 18 (ARR: 1.15), children who belong to a scheduled tribe family (ARR: 1.46), and children who consumed 7–9 food items (ARR: 1.22) were at highest risk of being overweight and obese. However, breastfeeding (ARR: 0.85) and Muslim families (ARR: 0.87) appeared to be protective factors with respect to childhood overweight and obesity in India. Pertinent public health programs, clinical follow-up, and awareness about sedentary lifestyles can help to reduce overweight/obesity risks in children.

Lifestyle habits, macronutrient intake, and obesity prevalence among adolescents in rural-periurban community senior high schools in the Ho municipality of Ghana

Background

Adolescence is a critical stage in the life cycle that presents a window of opportunity for the formation of lifetime habits or an aversion to childhood malnutrition effects. This study assessed the lifestyle habits, macronutrient intakes, and obesity prevalence among adolescents in some selected Senior High Schools in rural communities in Ho Municipality.

Materials and methods

A cross-sectional survey was conducted among 272 adolescents aged 13–19 years and attending senior high schools in the Ho Municipality of Ghana. Data on sociodemographic, physical activity levels, dietary habits, and anthropometrics were obtained. A body mass index (BMI) and waist circumference (WC) were determined, while a repeated 24-h dietary recall was used to collect the dietary intakes of the participants.

Results

The majority of the adolescents did not meet the Recommended Dietary Allowances (RDA) for calories (94.5%), dietary protein (68.8%), and fibre (91.5%). Adolescent boys consumed more calories (1,969.7 ± 579.9 Kcal) on average than adolescent girls (1,658.0 ± 458.7 Kcal) (p = 0.001). Overweight and obesity prevalence were 15.8 and 8.5%, respectively. About 90.4% of the adolescents did not meet the WHO recommended 150 min per week of physical exercise. On sedentary, 97.6% of adolescents spent half an hour to 5 h per day watching television when at home. Breakfast was the most frequently skipped meal (47.9%), and 59.6% of adolescents consumed fast foods such as pizza, burgers, and ice cream one to three times per week. Adolescent girls also had higher odds of being overweight or obese compared with adolescent boys (AOR = 2.4, p = 0.094, 95% CI = 0.9–6.4). Adolescents who did not meet the RDA for calories had lower odds of being overweight or obese compared with those who did (UOR = 0.3, p = 0.045, 95% CI = 0.1–0.9).

Conclusion

Poor dietary habits and intake, sedentary lifestyle, and obesity prevalence were observed among the adolescents. Being an adolescent girl was associated with obesity risk, while not meeting caloric intake showed a protective effect. Efficient and effective nutrition and lifestyle education programme should be promoted in communities to improve the dietary intake and lifestyle habits of adolescents.

Nutritional status of school children in the South Tongu District, Ghana

Background

Malnutrition is a major public health problem because of the devastating consequences it has on children, their families, and society at large. Our study, therefore, sought to determine the prevalence of undernutrition and overweight/obesity and its associated factors among children aged 6–12 in the South Tongu District, Ghana.

Methods

A school-based cross-sectional study was conducted among 423 school children aged 6–12 years in the South Tongu District of Ghana. A multistage sampling method was employed to recruit the school children for the study. A semi-structured questionnaire was used to collect data from the respondents. We used a dual-purpose (height and weight) measuring scale to obtain the anthropometric data. The World Health Organization’s AnthroPlus software was used to generate the z-scores for determining the nutritional status. Percentages were used to present the results of the prevalence of undernutrition and overweight/obesity among school children. Bivariate and multivariable binary logistic regression were used to examine the factors associated with undernutrition and overweight/obesity among school children. The results were presented as crude odds ratios (CORs) and adjusted odds ratios (AORs), with their 95% confidence interval (CI). Statistical significance was set at p<0.05. Stata 16.0 was used to perform the analyses.

Results

The overall prevalence of undernutrition and overweight/obesity were 21.5% (CI = 17.7, 25.7) and 24.8% (CI = 20.8, 29.2), respectively. Specifically, the prevalence of stunting, thinness, underweight, overweight, and obesity were 10.4%, 12.1%, 3.8%, 11.1%, and 13.7%, respectively. School children whose household used water from non-portable sources were more likely to be undernourished [AOR = 2.03, 95% CI = 1.13, 3.63]. The odds of overweight/obesity was higher among school children whose mothers had attained formal education [AOR = 2.10, 95% CI = 1.09, 4.06], those who consumed beverages between meals per day [AOR = 1.87, CI = 1.08, 3.24], and those who had adequate dietary diversity score [AOR = 1.65, 95% CI = 1.02, 2.67]. School children aged 10–12 were less likely to be overweight/obese [AOR = 0.58, 95% CI = 0.35, 0.94] compared to those aged 6–9.

Conclusion

The study showed a relatively high prevalence of undernutrition and overweight/obesity among school children in the South Tongu District. The identified risk factor(s) for undernutrition was the usage of water from non-potable sources whilst those of overweight/obesity were age (10–12 years), maternal formal education, beverage consumption between meals per day, and adequate dietary diversity. The findings reaffirm that malnutrition is still prevalent among school children. Hence, there is a need for the Ministry of Health, Ghana Education Service, and other Non-Governmental Organizations to pay critical attention to these factors to achieve the Sustainable Development Goal 2, target 2.2. Nutritional behavioural change education should be carried out among parents and school children. School health service activities should be intensified with a special focus on nutritional screening.

Measuring the Overall Burden of Early Childhood Malnutrition in Ghana: A Comparison of Estimates From Multiple Data Sources

BACKGROUND

Childhood malnutrition contributes to nearly half (45%) of all deaths among children under 5 globally. The United Nations' Sustainable Development Goals (SDGs) aims to end all forms of malnutrition by 2030; however, measuring progress towards these goals is challenging, particularly in countries with emerging economies where nationally-representative data are limited. The primary objective of this study was to estimate the overall burden of childhood malnutrition in Ghana at national and regional levels using 3 data sources.

METHODS

Using data from the long-standing Ghana Demographic and Health Surveys (GDHS), Ghana Multiple Indicator Cluster Survey (GMICS), and the emerging Ghana Socioeconomic Panel Survey (GSPS), we compared the prevalence of malnutrition using the extended composite index of anthropometric failure (eCIAF) for the period 2008- 2011. This study included data for children aged 6-59 months and calculated all anthropometric z-scores based on the World Health Organization (WHO) Growth Standards. We tested for differences in malnutrition subtypes using two-group configural frequency analysis (CFA).

RESULTS

Of the 10 281 children (6532 from GMICS, 2141 from GDHS and 1608 from GSPS) included in the study, the only demographic difference observed was the children included in the GSPS were slightly older than those included in the GDHS and GMICS (median age of 36 vs 30 vs 33 months, P<.001). Based on the eCIAF, the overall prevalence of malnutrition at the national level was higher among children in the GSPS (57.3%, 95% CI: 53.9%-60.6%), followed by the GDHS (39.7%, 95% CI: 37.0%-42.5%), and then those in the GMICS (31.2%, 95% CI: 29.3%-33.1%). The two-group CFA showed that the 3 data sources also estimated different prevalence rates for most of the malnutrition subtypes included in the eCIAF.

CONCLUSION

Depending on the data source adopted, our estimates of eCIAF showed that between one-third and half of all Ghanaian children aged 6-59 months had at least one form of malnutrition over the period 2008-2011. These eCIAF estimates should complement the commonly reported measures such as stunting and wasting when interpreting the severity of malnutrition in the country to inform policy decisions.

Multilevel exploration of individual- and community-level factors contributing to overweight and obesity among reproductive-aged women: a pooled analysis of Bangladesh Demographic and Health Survey, 2004-2018

OBJECTIVES

Overweight and obesity have been related to a variety of adverse health outcomes. Understanding the overweight and obesity epidemic in Bangladesh, particularly among reproductive-aged women, is critical for monitoring and designing effective control measures. The purpose of this study was to determine the prevalence of overweight and obesity in reproductive-aged women and to identify the risk factors of overweight and obesity.

DESIGN

A total of 70 651 women were obtained from the five most recent and successive Bangladesh Demographic and Health Surveys (BDHS). The multilevel logistic regression model was used to explore the individual- and community-level factors of overweight and obesity.

SETTING

Five most recent nationally representative household surveys across all regions.

PARTICIPANTS

Reproductive-aged (15-49 years) non-pregnant women.

RESULTS

Approximately 35·2 % (95 % CI: 34·9-35·6 %) of women were either overweight or obese in Bangladesh. At the individual- and community-level, higher age (adjusted odds ratio (aOR) = 5·79, 95 % CI: 5·28-6·34), secondary or higher education (aOR = 1·69 [1·60-1·78]), relatively wealthiest households (aOR = 4·41 [4·10-4·74]), electronic media access (aOR = 1·32 [1·26-1·37]) and community high literacy (aOR = 1·10 [1·04-1·15]) of women were significantly positively associated with being overweight or obese. Whereas, rural residents (aOR = 0·79 [0·76-0·82]) from larger-sized households (aOR = 0·80 [0·73-0·87]) and have high community employment (aOR = 0·92 [0·88-0·97]) were negatively associated with the probability of being overweight or obese.

CONCLUSION

Individual- and community-level factors influenced the overweight and obesity of Bangladeshi reproductive-aged women. Interventions and a comprehensive public health plan aimed at identifying and addressing the growing burden of overweight and obesity should be a top focus.

Blood pressure profile of primary school children in Eastern Cape province, South Africa: prevalence and risk factors

Abstract

Background

The problem of cardiovascular diseases and lack of adequate information about the blood pressure profiles among children in South Africa has enormous consequences for public health and the general well-being of communities.

Aim

The aim of this study is to determine the blood pressure profiles and associated risk factors of primary school children in South Africa.

Methods

A cross sectional study was conducted among 876 children aged 9 to 14 years from 18 randomly selected schools in the Eastern Cape province of South Africa. Standardised blood pressure measuring instruments were used and an average of three readings was considered. Blood pressure status was classified according to the percentiles of systolic blood pressure (SBP).

Results

The overall prevalence of hypertension was 5.2% and pre-hypertension was 18.5% while normal blood pressure was 76.3%. The multilevel binary logistic regression’s crude and adjusted analysis revealed that increase in age was significantly associated with elevated BP in children ([crude OR = 1.17 [1.05 – 1.29] and [adjusted OR = 1.12 [1.01 – 1.25]). In addition, increase in BMI was significantly associated with elevated BP in children ([crude OR = 1.08 [1.04 – 1.12] and [adjusted OR = 1.06 [1.02 – 1.11]). There was no statistically significant association between elevated BP and gender for both the univariate and multivariate models. There was also no statistical significant risk for elevated BP associated with place of residence.

Conclusions

In this sampled population the established proportion of primary school children with elevated BP is of great concern. In addition, older children and those with high BMI (that is, overweight/obesity) were associated with elevated BP. Interventions towards promoting healthy lifestyles among school learners is a necessity if we are to prevent cardiovascular diseases.

Food Security, Dietary Diversity, Dietary Patterns and the Double Burden of Malnutrition among School-Aged Children and Adolescents in Two Nigerian States

BACKGROUND

Little evidence exists on the relationship between diet-related factors and child/adolescent malnutrition in Nigeria. This study aimed to assess the associations between household food insecurity (HFI), dietary diversity (DD), and dietary patterns (DP) with the double burden of malnutrition (DBM) among 6-19-year-olds in two Nigerian States.

METHODS

This community-based cross-sectional study was carried out among 1200 respondents (6-19 years in age) in the Gombe and Osun States of Nigeria. HFI was assessed using the HFI access scale. DD was assessed using a 24-h dietary recall. DP were determined by principal component analysis using a 30-day food frequency questionnaire. DP scores were categorized into quartiles (Q) for statistical analysis. Diet-related predictors of DBM were assessed using logistic regression.

RESULTS

HFI was experienced by 568 (47.3%) respondents. The median DD score was 7.0 (maximum of 14). Two DPs were identified, diversified DP (DDP) and traditional DP (TDP). TDP was significantly associated with both thinness (Q4:OR: 2.91; 95% CI: 1.52-5.55; Ptrend: 0.002) and overweight/obesity (Q4:OR: 2.50; 95% CI: 1.43-4.35; Ptrend: 0.007), while DDP was inversely related with thinness (Q4:OR: 0.36; 95% CI: 0.21-0.61; Ptrend: 0.008) as compared to Q1.

CONCLUSIONS

TDP increased the odds for DBM, while the DDP reduced the odds.

Prevalence and Predictors of Overweight and Obesity Among Adolescents in Seremban, Negeri Sembilan, Malaysia

Introduction: Obesity is recognized as a serious public health threat. Recent evidence has warned of the alarming rise in the prevalence of childhood overweight and obesity throughout the world. This study aimed to determine the prevalence of overweight and obesity, and its associations with socio-demographic, behavioral, and psychosocial factors among school-going adolescents in Seremban, Negeri Sembilan.

Methods: Cross-sectional study was conducted. A total of 2,221 adolescents were randomly selected from eight secondary schools. A questionnaire was administered to assess socio-demographic profiles, meal patterns, physical activity level, self-efficacy, self-esteem, body size satisfaction, perception of body weight status, depression, anxiety, stress, and nutrition knowledge. Bodyweight and height were measured and BMI-for-age z scores were computed to determine the body weight status. Bivariate analysis and multivariate logistic regression were used for the data analysis.

Results: The prevalence of overweight among the participants in this study was 17.0%, while the prevalence of obesity was 14.9%. The significant predictors of overweight and obesity in this study were breakfast skipping, low physical activity level, low self-efficacy scores in terms of healthy eating, weight and physical activity, body dissatisfaction, and perception of large body size.

Conclusion: The results emphasize the need to broaden the scope of nutrition guidelines, public health policies, and programs to address overweight and obesity among adolescents in Malaysia. The findings also suggest that health education programs should cover practical advice for modifying healthy eating behaviors, increasing physical activity, as well as matters on body image and body satisfaction.

Distribution of Cardiometabolic Risk Factors in School-Aged Children with Excess Body Weight in the Al Ain City, United Arab Emirates: A Cross-Sectional Study

(1) Background: This study aimed to examine the distribution of cardiometabolic risk factors (CMRF) in school-aged children with excess body weight (overweight and obese) in Al Ain City, United Arab Emirates and identify the factors associated with increased cardiovascular risk factors between boys and girls. (2) Methods: A cross-sectional survey of children aged 6-17 years was conducted in Al Ain from 1 August 2019 to 31 December 2020. Binary logistic regression analysis was performed to investigate the relationship between excess body weight and CMRF between the groups and reported odds ratios (OR) with 95% confidence intervals (CI). (3) Results: A total of 966 school-aged children (490 boys and 476 girls) participated in the study, and the mean age of the children was 11.8 ± 2.9 years. The proportions of overweight and obesity were 13.5% and 10.2% in boys and 11.1% and 10.3% in girls. Higher glucose of ≥100 mg/dL (26.4%), triglycerides of ≥150 mg/dL and low-density lipoprotein cholesterol: ≥130 mg/dL (23.2%) were more prevalent in children with excess body weight. These children were at least two times more likely to have higher triglycerides levels, high total cholesterol (≥200 mg/dL) in girls (OR:2.06, 95% CI: 1.01-4.21) and low high-density lipoprotein (<35 mg/dL) in boys (OR: 2.20; 95% CI: 1.12-4.31). (4) Conclusions: Excess body weight in school-aged children was associated with increased CMRF, particularly triglycerides.

Clustering of noncommunicable disease risk factors among adolescents attending higher secondary schools in Kasaragod District, Kerala, India [version 2; peer review: 1 approved with reservations]

Background

Limited evidence exists on the presence of collective non-communicable disease (NCD) risk factors among adolescents in Kerala, India. We aimed to assess the prevalence and factors associated with multiple NCD risk factors and the clustering of these risk factors among adolescents in Kasaragod District, Kerala.

Methods

We selected 470 adolescents (mean age 16.6 years, male 53.8%) through multi-stage cluster sampling from higher secondary schools of Kasaragod district. Self-administered questionnaires were used, and anthropometric measurements were taken using standard techniques and protocols. Tobacco use, alcohol consumption, low fruits and vegetable consumption, inadequate physical activity, extra salt intake, overweight, consumption of soft drinks and packed foods were the eight NCD risk factors included.The factors associated with one, two and three or more NCD risk factors were analysed using multinomial logistic regression and the standard errors were adjusted for the four clusters.

Results

Risk factor clusters with two risk factors (dyads) and three risk factors (triads) were observed in 163 (34.7%) and 102 (21.7%) of the sample, respectively. Adolescents residing in urban areas (odds ratio (OR) = 3.55; 95% confidence interval (CI) = 1.45-8.73), whose father's education level was lower (OR = 3.54; 95% CI = 1.24-10.10), whose mother's education was lower (OR= 4.13; 95% CI = 1.27-13.51), who had restrictions on physical activity (OR = 5.41; 95% CI = 1.20-24.30) and who did not have a kitchen garden (an area where fruits and vegetables are grown for domestic use) (OR=4.51;95% CI = 1.44-14.12) were more likely to have three or more NCD risk factors compared to their counterparts.

Conclusions

Clustering of NCD risk factors was prevalent in more than half of the adolescents. Efforts are warranted to reduce multiple risk factors, focussing on children of low educated parents and urban residents.

Providing Measurement, Evaluation, Accountability, and Leadership Support (MEALS) for Non-communicable Diseases Prevention in Ghana: Project Implementation Protocol

Background: This study describes the rationale, adaptation, and final protocol of a project developed to address the increase in obesity and nutrition-related non-communicable diseases (NR-NCDs) in Ghana. Code-named the Measurement, Evaluation, Accountability, and Leadership Support for NCDs (MEALS4NCDs) project, it aims to measure and support public sector actions that create healthy food marketing, retail, and provisioning environments for Ghanaian children using adapted methods from the International Network for Food and Obesity/NCDs Research Monitoring and Action Support (INFORMAS).

Methods: The protocol for this observational study draws substantially from the INFORMAS' Food Promotion and Food Provision Modules. However, to appraise the readiness of local communities to implement interventions with strong potential to improve food environments of Ghanaian children, the MEALS4NCDs protocol has innovatively integrated a local community participatory approach based on the community readiness model (CRM) into the INFORMAS approaches. The setting is Ghana, and the participants include health and nutrition policy-makers, nutrition and food service providers, consumers, school authorities, and pupils of Ghanaian basic schools.

Results: The study establishes a standardized approach to providing implementation science evidence for the prevention of non-communicable diseases (NCDs) in Ghana. It demonstrates feasibility and the innovative application of the INFORMAS expanded food promotion and food provision modules, together with the integration of the CRM in a lower-middle income setting.

Conclusion: The research will facilitate the understanding of the processes through which the INFORMAS approach is contextualized to a lower-middle income African context. The protocol could be adapted for similar country settings to monitor relevant aspects of food environments of children.

Trends and factors associated with the nutritional status of adolescent girls in Ghana: a secondary analysis of the 2003-2014 Ghana demographic and health survey (GDHS) data

OBJECTIVE

We examined the trends over time and the factors associated with malnutrition among adolescent girls in Ghana.

DESIGN

Cross-sectional analysis from 3 nationwide Ghana Demographic and Health Surveys conducted in 2003 (n 983), 2008 (n 955) and 2014 (n 857). We used Cox proportional hazard models with sample weighting to model the prevalence ratio (PR) of malnutrition.

SETTING

Countrywide, covering rural and urban areas in Ghana.

PARTICIPANTS

Non-pregnant adolescent girls aged 15-19 years.

RESULTS

Compared with 2003, thinness declined marginally (PR 0·88 (95 % CI 0·45, 1·73)) in 2008 and in 2014 (PR 0·71 (95 % CI 0·38, 1·56)). Stunting declined marginally by 19 % in 2008 (PR 0·81 (95 % CI 0·59, 1·12)), flattening out in 2014 (PR 0·81 (95 % CI 0·57, 1·17)). We found an increasing trend of overweight/obesity with the PR peaking in 2014 (PR 1·39 (95 % CI 1·02, 1·88)) compared to 2003. The anaemia prevalence remained severe without a clear trend. A low level of education of the adolescent girl was positively associated with stunting. Increasing age was positively associated with stunting but inversely associated with thinness and anaemia. Girls who ever bore a child were more likely to be anaemic compared to those who never did. A lower level of household wealth and a unit increase in household size was negatively associated with overweight/obesity. Urban dwelling girls were less likely to be stunted.

CONCLUSIONS

The stagnant burden of under-nutrition and rising over-nutrition emphasise the need for double-duty actions to tackle malnutrition in all its forms in Ghanaian adolescent girls.

Clustering of noncommunicable disease risk factors among adolescents attending higher secondary schools in Kasaragod District, Kerala, India

Background: Limited evidence exists on the presence of collective non-communicable disease (NCD) risk factors among adolescents in Kerala, India. We aimed to assess the prevalence and factors associated with multiple NCD risk factors and clustering of these risk factors among adolescents in Kasaragod District, Kerala. Methods: We selected 470 adolescents (mean age 16.6 years, male 53.8%) through multi-stage cluster sampling from higher secondary schools of Kasaragod district. Self-administered questionnaires were used, and anthropometric measurements were taken using standard techniques and protocols. Tobacco use, alcohol consumption, low fruits and vegetable consumption, inadequate physical activity, extra salt intake, overweight, consumption of soft drinks and packed foods were the eight NCD risk factors included. Multinomial logistic regression analysis was done to find out the factors associated with one, two and three or more NCD risk factors. Results: Risk factor clusters with two risk factors (dyads) and three risk factors (triads) were observed in 163 (34.7%) and 102 (21.7%) of the sample, respectively. Adolescents residing in urban areas (odds ratio (OR) = 3.55; 95% confidence interval (CI) = 1.45-8.73), whose father’s education level was lower (OR = 3.54;  95% CI = 1.24-10.10), whose mother’s education was lower (OR= 4.13; 95% CI = 1.27-13.51), who had restrictions on physical activity (OR = 5.41; 95% CI = 1.20-24.30) and who did not have a kitchen garden (an area where fruits and vegetables are grown for domestic use) (OR=4.51;95%  CI = 1.44-14.12) were more likely to have three or more NCD risk factors compared to their counterparts.   Conclusions: Clustering of NCD risk factors was prevalent in more than half of the adolescents. Efforts are warranted to reduce multiple risk factors, focussing on children of low educated parents and urban residents. Parents of adolescents may be encouraged to have kitchen gardens and not to restrict adolescent’s physical activity.

High prevalence of overall overweight/obesity and abdominal obesity amongst adolescents: An emerging nutritional problem in rural high schools in Limpopo Province, South Africa

BACKGROUND

As the gap in nutritional profiles between urban and rural rapidly reduces because of nutrition transition, rural adolescents are likely to engage in urban lifestyle behaviours.

AIM

The study determined the prevalence of overweight/obesity amongst adolescents in rural high schools and the association with selected factors.

SETTING

Fetakgomo Municipality in rural Limpopo Province, South Africa.

METHODS

A cross-sectional study was conducted amongst 378 adolescents selected through multistage sampling from high schools. Data collected were socio-demography, nutritional knowledge, dietary practices and anthropometry. The International Obesity Task Force age and sex-specific body mass index (BMI) cut-off values were used to determine overweight/obesity, whilst adult BMI cut-off values were used for those ≥ 18 years. Waist-to-height ratio (WHtR) greater than 0.5 indicated abdominal obesity, as well as waist circumference (WC) and waist-to-hip ratio (WHR) above the cut-off values.

RESULTS

The proportion of overweight/obesity amongst adolescents was 35%, whilst 25% had abdominal obesity by WHR and 21% by WHtR. Multivariate logistic regression showed that being a girl (AOR = 2.9, 95% CI: 1.74-4.85), older adolescent (AOR = 3.1, 95% CI: 1.57-6.29) and living in a household with employed adults (AOR = 2.3, 95% CI: 1.19-4.51) were associated with increased odds of being overweight/obese. Eating breakfast was associated with reduced odds of being overweight/obese (AOR = 0.6, 95% CI: 0.34-0.97).

CONCLUSION

Overweight/obesity and abdominal obesity amongst adolescents were more prevalent than underweight. The Integrated School Health Programme should have clear guidelines on food items served and sold at schools.

Overweight/Obesity and Associated Factors Among Second Cycle Primary School Children in Kirkos Sub-City, Addis Ababa, Ethiopia

Background

Although overweight/obesity is becoming a public health issue in low income countries, there is a paucity of evidence concerning overweight/obesity in Ethiopia. The aim of the study was to assess the magnitude of overweight/obesity and associated factors among second cycle primary school children in Kirkos Sub-City, Addis Ababa, Ethiopia.

Methods

A school based cross-sectional study was conducted among 482 children from May to June, 2019. Data were collected using a questionnaire and checklist. Data were entered using EpiData version 3.1 and exported into SPSS version 22.0. Bivariable and multivariable logistic regression analyses were done to identify factors associated with overweight/obesity. Level of statistical significance was declared at p ≤ 0.05.

Results

The overall magnitude of overweight/obesity was 21.2%. The magnitude of overweight was 13.7% while obesity was 7.5%. Vehicle availability, being from private school, not having friend(s), preferring sweet foods, eating breakfast irregularly, watching movies/Television while eating and physical inactivity were the factors significantly associated with overweight/obesity among second cycle primary school children.

Conclusions

The magnitude of overweight/obesity was high in the study area. Therefore, health and education sectors should promote healthy lifestyle to curb child overweight/obesity.

Breakfast Eating Habits and Lifestyle Behaviors among Saudi Primary School Children Attending Public Versus Private Schools

We investigated breakfast eating habits and lifestyle behaviors among Saudi school children attending public versus private schools. A random sample of 1149 children (girls: 54.4%) from public and private schools was selected from elementary schools using the multistage stratified cluster method. Measurements included body weight, height, body mass index (BMI), and self-reported questionnaires filled by the child’s parents. There was no significant (p = 0.44) difference in the prevalence of breakfast intake between children attending public (20.6%) versus private (19.4%) schools. However, there was a gender by school type interactions in breakfast intake frequency, as boys in private but not in public schools had significantly (p = 0.006) higher (26.3%) daily breakfast intake than girls (13.3%). Over 56% of the children ate and drank from the school canteen, and impacting factors on children’s choices were children’s desire, food taste, and parental influence. More parents of children in private (12.1%) than in public (6.9%) schools were satisfied with the food in the school canteen. Younger age (aOR = 0.889, 95% CI = 0.815–0.970, p = 0.008), higher father education (aOR = 1.380, 95% CI = 1.130–1.686, p = 0.002), family income (aOR = 1.227, 95% CI = 1.005–1.498, p = 0.044), and insufficient sleep duration (aOR = 0.740, 95% CI = 0.553–0.990, p = 0.042) were significantly associated with being in a private school. Furthermore, no significant differences, when adjusted for socio-demographic factors, appeared in breakfast intake or overweight/obesity relative to school type. Interventions to improve daily breakfast consumption and lifestyle behaviors of Saudi children are warranted.

Prevalence of Obesity and Overweight among School-Aged Children in Saudi Arabia and Its Association with Vitamin D Status

BACKGROUND

Childhood obesity is a significant global public health problem. Worldwide data showed an increasing trend over the years. We aimed to explore the prevalence of obesity, and its association with vitamin D status.

METHODS

This cross-sectional study was conducted during the period from 2016 to 2017. The study included 3613 schoolchildren aged 6-19 years in the western, central, and eastern regions in Saudi Arabia. Anthropometric data including age, sex and body mass index (BMI) was collected and the serum 25OH- vitamin D (25OHD) was measured. Age-sex standardized BMI Z-scores using the 2007 World Health Organization growth standards were applied.

RESULTS

Data from 3613 school-aged children (females = 51.8%), with equal percentage of participants from each region were analyzed. Prevalence of obesity and overweight was estimated at 7.1% and 14.4% respectively. An increasing trend was detected with age (p: 0.006). Obesity started to increase at the age of 10 years and continued to increase until 19 years. Most of the obese children (64.2%) had deficient vitamin D levels, compared to 33.7% of them with suboptimal levels and only 2.0% with optimal levels (p: <0.001).

CONCLUSIONS

This large cohort study revealed a high prevalence (21.5%) of obesity and overweight in school children aged between 6-19 years with increasing trend with age.  Children with high BMI showed extremely high prevalence of VDD and VDI. These findings are alarming and point to the need for effective national interventions that include improving and encouraging access to physical activity and exposure to sunlight, educational activities for students, parents, and schoolteachers and possible enrichment of staple food with vitamin D.

Overweight and obesity in Eastern Morocco: Prevalence and associated risk factors among high school students

BACKGROUND

Overweight and obesity in children and adolescents have become a major public health problem affecting most countries worldwide. The purpose of the study was to assess the prevalence and risk factors of overweight and obesity among public high school students in Eastern Morocco.

METHODS

A cross-sectional survey was conducted between February and May 2014 among a sample of 2271 students (1086 girls and 1185 boys). References from the International Obesity Task Force (IOTF) were used to determine the prevalence of overweight and obesity.

RESULTS

The prevalence of overweight and obesity reached 12.2% (14.2% in girls vs 10.4% in boys, P<0.01) and 3.0% (3.1% in girls vs 2.8% in boys), respectively. Risk factors associated with overweight and obesity were urban residence (OR=1.76; [1.18-2.63]; P<0.01), father's income≥5000MAD (OR=1.32; [1.02-1.70]; P<0.05), father's overweight (including obesity) (OR=1.87; [1.38-2.54]; P<0.001) and female sex (OR=1.31; [1.02-1.68]; P<0.05).

CONCLUSION

The prevalence of overweight/obesity has reached an alarming rate among high school students in the Eastern region of Morocco. The findings of the present study suggest an urgent need to set up a strategy to prevent and combat this epidemic.

Malnutrition, Hypertension Risk, and Correlates: An Analysis of the 2014 Ghana Demographic and Health Survey Data for 15-19 Years Adolescent Boys and Girls

The sex differences in malnutrition and hypertension during adolescence is largely inconclusive. There is also a paucity of data on the sex-specific correlates of malnutrition and hypertension for adolescents. Hence, this study aimed to assess the association between malnutrition, pre-hypertension/hypertension (PHH) and sex among adolescents. The study also aimed to determine and contrast the factors associated with these risks in Ghana. We analysed data of non-pregnant adolescent girls (n = 857) and adolescent boys (n = 870) aged 15–19 years from the 2014 Ghana Demographic and Health Survey (DHS). We modelled the prevalence risk ratio (PRR) of malnutrition and PHH using Cox proportional hazard models. Compared to adolescent girls, boys were more than twice likely to be stunted (PRR = 2.58, 95% C.I (1.77, 3.76)) and underweight (PRR = 2.67, 95% C.I (1.41, 5.09)) but less likely to be overweight/obese (PRR = 0.85, 95% C.I (0.08, 0.29)). Boys were also about twice likely to have PHH (PRR = 1.96, 95% C.I (1.47, 2.59)) compared to their female peers. Girls were more at risk of the detrimental effects of poor education on stunting and PHH. Empowerment index while protective of stunting for girls (PRR = 0.82, 95% C.I (0.67, 0.99)) also increased their risk of overweight/obesity (PRR = 1.31, 95% C.I (1.02, 1.68)). A higher household wealth index (HWI) increased the risk of overweight/obesity for adolescent girls but was protective of stunting and PHH for adolescent boys. Improvement in household water, hygiene, and sanitation (WASH) reduced the risk of stunting by 15% for adolescent boys. Overall, our findings suggest a double-burden of malnutrition with an up-coming non-communicable disease burden for adolescents in Ghana. Our findings may also be highlighting the need to target adolescent boys alongside girls in nutrition and health intervention programmes.

Primary school-based nutrition education intervention on nutrition knowledge, attitude and practices among school-age children in Ghana

This study was performed to evaluate the effect of a six-week nutrition education intervention on the nutrition knowledge, attitude, practices, and nutrition status of school-age children (aged 6-12 years) in basic schools in Ghana. Short-term effects of nutrition education training sessions on teachers and caregivers were also assessed. Pre-post controlled design was used to evaluate the program. Intervention groups had significantly higher nutrition knowledge scores (8.8 ± 2.0 vs. 5.9 ± 2.1, P < 0.0001) compared to controls in the lower primary level. A higher proportion of children in the intervention group strongly agreed they enjoyed learning about food and nutrition issues compared to the control group (88% vs. 77%, P = 0.031). There was no significant difference in dietary diversity scores (4.8 ± 2.0 vs. 5.1 ± 1.4, P = 0.184) or in measured anthropometric indices (3.6% vs. 8.2%, P = 0.08). A marginally lower proportion of stunted schoolchildren was observed among the intervention group compared to the control group (3.6% vs. 8.2%, P = 0.080). Nutrition knowledge of teachers and caregivers significantly improved (12.5 ± 1.87 vs. 9.2 ± 2.1; P = 0.031) and (5.86 ± 0.73 to 6.24 ± 1.02, P = 0.009), respectively. Nutrition education intervention could have positive impacts on knowledge and attitudes of school children, and may be crucial in the development of healthy behaviors for improved nutrition status.

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

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

Nutritional status of school age children in Abakaliki metropolis, Ebonyi State, Nigeria

BACKGROUND

Malnutrition is a major public health problem with short and long-term adverse effects on children particularly in middle and low-income countries. Three out of every ten under-five children are said to be stunted and 19.4% underweight in Nigeria. In Ebonyi State, between 2013 and 2015, the proportion of preschool children with chronic undernutrition rose from 16.2 to 20.6%. Little is documented about the nutritional status of school-age children in Ebonyi State and Nigeria.

METHODS

We conducted a descriptive cross-sectional study among 780 children aged 6 to 12 years from 10 primary schools in Abakaliki metropolis. A multistage sampling method was used to select the participants. A pre-tested interviewer-administered structured questionnaire was used to collect information from the children and their parents. Body Mass Index (BMI), Z scores of the weight for age, BMI for age and height for age were obtained using the WHO AnthroPlus software. We estimated the prevalence of undernutrition, over-nutrition, underweight, thinness, stunting, overweight and obesity.

RESULT

Out of 751 pupils that participated, 397 (52.9%) were females and 595 (79.2%) were in public schools. The overall prevalence of undernutrition was 15.7% and that of over-nutrition was 2.1%. The prevalence of underweight, thinness and stunting, overweight and obesity were 8, 7.2, 9.9, 1.4 and 0.7% respectively. The proportion of pupils who were thin was higher among males (8.7%), those attending public schools (8.6%) and those dwelling in rural parts of the metropolis (14.3%) compared to females (5.8%) private school attendees (1.9%) and urban dwellers (4.6%). Stunting was found to be higher among pupils attending public schools (11.8%) compared to those attending private schools (2.5%). The prevalence of stunting was 19.3% among the pupils residing in rural areas and 5% among the pupils living in urban areas of the metropolis. No pupil in private schools was underweight. Over-nutrition was not found among the pupils in rural areas.

CONCLUSION

Both under and over nutrition exist in Abakaliki metropolis. Undernutrition is the more prevalent form of malnutrition among school age children in the metropolis.

Overweight and obesity among children under five in Ethiopia: further analysis of 2016 national demographic health survey: a case control study

OBJECTIVE

The objective of this study was to assess the determinants of overweight and obesity among children under 5 years in Ethiopia.

RESULTS

Data from a total of 672 (224 cases and 448 controls) under 5 years of age children were included in the study. Urban residence (AOR = 2.63, 95% CI 1.29, 5.34), boys (AOR = 1.56, 95% CI 1.10, 2.22) and age of the child less than 6 months (AOR = 3.40, 95% CI 2.05, 5.64) were the determinants for being childhood overweight and obesity.

Weight management among school-aged children and adolescents: a quantitative assessment in a Ghanaian municipality

Background

Childhood and adolescent overweight, obesity and underweight have become an issue of grave concern to both the developed and developing countries in context of global burden of non-communicable diseases. Unhealthy weight status is a significant public health issue for developing countries, of which Ghana is not excluded. This study evaluated the prevalence of overweight, obesity and underweight and its related factors among school-aged children and adolescents.

Methods

A total of 1004 participants were randomly selected from six schools. A structured questionnaire on demography and socioeconomic status of students’ parents/guardians was completed by the selected students. Anthropometric parameters were measured, and body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. BMI-for-age z-scores were used to categorize anthropometric data of the children as underweight, normal, overweight or obese. A cut-off value of > 0.50 was used to define obesity by WHtR.

Results

Overweight prevalence of 13.8% and 12.6 was observed among basic school and high school students respectively based on BMI classification. Obesity prevalence of 8.8% was found in basic school students and 8.9% among high school students. Underweight was observed in 114 (11.3%) basic school students and 86 (8.6%) high school students. There was a difference in sex prevalence in unhealthy weight-behaviours; with more girls being overweight (19.4% vs 7.6%, p < 0.001) and obese (10.2% vs. 7.3%, p = 0.177) compared to boys. High WHtR found in 10.5% of basic students and 5.0% of high school students, with a statistical difference. Overweight/obesity was significantly associated with taking snacks before bed among basic school students [aOR = 10.45(5.95–18)] and high school students [aOR = 10.23(5.95–18.37)] respectively. Watching TV [aOR = 0.39(0.22–0.70)], sleeping during leisure periods [aOR = 0.43(0.23–0.81)] and bicycling as a means of transport [aOR = 0.37(0.19–0.72)] to school was protective of obesity among basic school students.

Conclusion

High prevalence of unhealthy weight-related behaviours was observed among school-aged children in the Bekwai Municipality. Snacking before bed was a major factor promoting obesity among school-aged children while leisure behaviours such as TV watching, and sleeping were protective of obesity. Therefore, it is recommended to promote and support healthy eating habits among school-aged children which are likely beneficial in reducing the risk of childhood unhealthy weight-related behaviours.

Patterns and risk factors of double burden of malnutrition among adolescent girls and boys in Indonesia

OBJECTIVES

As an emerging middle-income country, Indonesia is grappling with the double burden of malnutrition across all age groups, including adolescents. Slow gains in reducing undernutrition are compounded by rapidly increasing overnutrition. This study aims to determine the patterns and determinants of this double burden, particularly stunting, thinness and overweight, among adolescent girls and boys aged 12-18 years in Indonesia.

METHODS

A cross-sectional survey was conducted among 2,160 girls and boys in the districts of Klaten and Lombok Barat in 2017. Data were collected on adolescents' nutritional status, sociodemographic characteristics, morbidity, dietary intake and physical activity and other relevant factors. Multivariable logistic regression models using generalized estimation equation were employed to determine risk factors for stunting, thinness and overweight.

RESULTS

About a quarter of adolescent girls (25%) and boys (21%) were stunted. Approximately 5% of girls and 11% of boys were thin, whereas 11% girls and boys each were overweight. Living in a higher wealth household (OR = 0.67; 95% CI: 0.49-0.91), compared to a lower wealth household, and living in a district with higher socioeconomic status (OR = 0.63; 95% CI: 0.51-0.79) were associated with lower odds of being stunted. Adolescent education was also protective against stunting (OR = 0.52; 95% CI: 0.33-0.88). Older adolescents aged 15-18 years were more likely to be stunted (OR = 1.88; 95% CI: 1.42-2.46). Being a girl was associated with reduced odds of being thin (OR = 0.42; 95% CI: 0.30-0.58). Higher household wealth (OR = 1.93; 95% CI: 1.27-2.97) predicted being overweight, while maternal primary or some secondary education, compared to no or incomplete primary education, was protective against adolescent overweight (OR = 0.60; 95% CI: 0.40-0.90).

CONCLUSION

Indonesian adolescent girls and boys face both extreme spectrums of malnutrition. Addressing the dual burden of malnutrition requires a multi-pronged approach, and urgent shift is warranted in nutrition policy and programmes targeting adolescents to effectively address the associated underlying determinants.

Prevalence and correlates of overweight and obesity among school children in an urban district in Ghana

Background

There is limited data on risk factors associated with childhood overweight and obesity in Ghanaian school children. Therefore, the aim of this study was to assess the prevalence of overweight and obesity and associated risk factors in Ghanaian school children.

Methods

Data for this study were obtained from a cross-sectional survey of 543 children aged 8 and 11 years, attending private and public primary schools in the Adentan Municipality of Greater Accra Region, Ghana. Anthropometric, dietary, physical activity, sedentary behaviours, sleep duration and socio-demographic data were collected. BMI-for-age Z-scores were used to classify children as overweight/obesity. Multivariable logistic regressions were used to assess the determinants of overweight and obesity.

Results

The overall prevalence of overweight/obesity was 16.4%. Children living in middle (OR = 1.88; 95% CI = 1.01–3.50) and high socioeconomic status (SES) households (2.58; 1.41–4.70) had increased odds of being overweight or obese compared to those living in low SES household. Attending private school (2.44; 1.39–4.29) and watching television for more than 2 h each day (1.72; 1.05–2.82) were significantly associated with increased likelihood of overweight and obesity. Children who slept for more than 9 h a night (0.53; 0.31–0.88) and walked or cycled to school (0.51; 0.31–0.82) had lower odds of being overweight or obese.

Conclusions

A number of modifiable risk factors were associated with overweight and obesity in this study. Public health strategies to prevent childhood obesity should target reduction in television watching time, promoting active transport to and from school, and increasing sleep duration.

Dietary patterns and associated risk factors among school age children in urban Ghana

Background

Understanding dietary patterns in the study of diet-disease relationships is crucial for designing dietary behaviour interventions. This study aimed to determine associations between dietary patterns and background characteristics among school age children (9–15 years) in Ghana.

Methods

A cross-sectional sample of 487 urban-dwelling children age 9–15 years was recruited using simple random sampling from 24 schools (12 private and 12 public) in the Ga-East Municipality in Southern Ghana. A 7-day food frequency questionnaire was used to record children’s consumption of over 100 unique food items. Principal component analyses based on 14 food groups was used to describe emerging dietary patterns (DP). BMI-for-age z-scores segregated by sex were derived using WHO Anthro plus software. Linear regression was used to test associations between ‘diet factor’ scores, and weight status controlling for age.

Results

Four DPs were identified that explained 53.2% of variation in the diets of children: (1) energy dense; (2) starchy root staple and vegetables; (3) cereal-grain staples and poultry; and (4) fish & seafoods. Energy dense DP characterised by processed meat, fried foods, and sugary foods was associated with child overweight/obese status after controlling for age, sex, SES and school type [F(5, 484) = 6.868, p < 0.001]. Starchy root with vegetable DP was negatively associated with overweight/obese status, private school attendance and higher SES after controlling for age at bivariate level. However, relationship between ‘starchy root staples and vegetables’ DP and overweight/obese status lost significance after controlling for other covariates.

Conclusion

Our data identified energy-dense dietary pattern to be significantly associated with childhood overweight and obesity. Targeted dietary messages are required to address energy-dense dietary patterns among school-age children.

Electronic supplementary material

The online version of this article (10.1186/s40795-018-0230-2) contains supplementary material, which is available to authorized users.

Lipid profile and dyslipidemia among school-age children in urban Ghana

Background

Dyslipidemia during childhood has been associated with higher risk of atherosclerosis later in life. Information on the lipid profile of Ghanaian children is scarce. The aim of this study was to assess the lipid profiles of school children between the ages of 9–15 years, living in urban Ghana.

Methods

A total of 802 randomly selected school-age children participated in the Ghana School Survey implemented in Kumasi and Accra, Ghana. A structured questionnaire was used to collect information on child and maternal socio-demographic characteristics (including age, education, and occupation), 7-day food frequency, home and school activity, as well as measurement of weight and standing height. Weight, height, and age data were converted into BMI-for-age indices to determine weight status. Finger-prick fasting blood samples were taken from the school-age children. Total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) cholesterol levels were determined using the CardioChek® PA Test System. Reference lipid levels based on the US National Cholesterol Education Program 2001 guidelines were used to determine the proportion of children with dyslipidemia.

Results

The mean TC, LDL-C, HDL-C, and TG levels were 149.0 ± 57.0 mg/dl, 80.1 ± 38.6 mg/dl, 53.5 ± 19.4 mg/dl, and 71.4 ± 54.7 mg/dl, respectively. Mean TC/HDL-C ratio was 3.0 ± 1.0. The proportion of children with abnormal values were 12.1% for TC, 4.5% for TG, 28.4% for HDL-C, 9.2% for LDL-C, and 6.6% for TC/HDL-C ratio. The levels of dyslipidemia (HDL, LDL, and TC/HDL-C ratio) were higher among overweight/obese compared to normal-weight children. More frequent fruit consumption was also linked with lower LDL-C (p = 0.020) while watching television (TV) in the mornings was linked with both higher TC (p = 0.011) and TG (p = 0.006).

Conclusions

Majority of urban-dwelling Ghanaian school children had normal lipid profiles. However, the higher levels of dyslipidemia observed among overweight and obese children suggest the need for population level physical activity and dietary interventions among children to reduce risk of cardiovascular diseases in adult life.