Overweight and Obesity in School Children of a Hill State in North India: Is the Dichotomy Urban-Rural or Socio-Economic? Results from a Cross-Sectional Survey

Nutritional status of school-age children (5-19 years) in South Asia: A scoping review

Information on malnutrition for school-age children and adolescents (5-19 years) in South Asia is fragmented and inconsistent, which limits the prioritization of nutrition policies, programmes and research for this age group. This scoping review aimed to synthesize existing evidence on the burden of malnutrition for children and adolescents aged 5-19 years in South Asia, and on interventions to improve their nutritional status. Cochrane Library, EMBASE, Medline and Google Scholar were systematically searched for articles published between January 2016 and November 2022. Eligible studies reported the prevalence of undernutrition, overweight/obesity, micronutrient deficiencies and unhealthy dietary intakes, and interventions that aimed to address these in South Asia. In total, 296 articles met our inclusion criteria. Evidence revealed widespread, yet heterogeneous, prevalence of undernutrition among South Asian children and adolescents: thinness (1.9%-88.8%), wasting (3%-48%), underweight (9.5%-84.4%) and stunting (3.7%-71.7%). A triple burden of malnutrition was evident: the prevalence of overweight and obesity ranged from 0.2% to 73% and 0% to 38% (with rapidly rising trends), respectively, alongside persistent micronutrient deficiencies. Diets often failed to meet nutritional requirements and high levels of fast-food consumption were reported. Education, fortification, supplementation and school feeding programmes demonstrated beneficial effects on nutritional status. Comprehensive and regular monitoring of all forms of malnutrition among children and adolescents, across all countries in South Asia is required. Further, more large-scale intervention research is needed to ensure policy and programmes effectively target and address malnutrition among children and adolescents in South Asia.

Multipronged effects of increased screen time on the nutritional imbalance: A cross-sectional study of students of Amritsar aged 6-16 years

Background

Intense marketing of fast-food items impacts the eating habits among children and adolescents. Various studies suggest that increased screen time leads to increased fast-food consumption and decreased sleep duration, both of which are linked to obesity in growing age.

Objectives

To assess screen time and dietary habits among the study group and to estimate their effect on sleep deprivation and obesity.

Methods

This cross-sectional study was conducted from January 2019 to December 2019 in three schools in Amritsar selected by lottery method of simple random sampling. Out of 4,226 students, 355 overweight and obese students were interviewed regarding their dietary habits. An informed written assent was taken from the mothers. The information was collected on a semi-structured, pre-designed questionnaire by interviewing the mothers of students between 6 and 11 years of age and the students of 12-16 years.

Results

94.4% of students preferred fast foods to regular meals and 58.3% were in the habit of skipping breakfast. 59.4% had a history of daily intake of fast foods while 76.1% had a habit of consuming fast foods while watching television. Only 31.7% had an adequate sleeping pattern of 9-11 hours and 79.7% of the students had a screen time of over 3 hours.

Conclusions

More the screen time, the more the chances of missing meals. Being awake for a long odd time leads to increased consumption of foods/snacks furthermore. Regarding the harmful effects of fast foods, the source of information was from schools, but only 41.4% were aware about these effects.

Dietary factors associated with being overweight and obese among school-going adolescents in Region One, The Gambia

BACKGROUND

The purpose of this study was to determine the dietary factors associated with being overweight and obese among school-going adolescents in Region One, The Gambia.

METHOD

This was a school-based cross-sectional study and 1008 students from eight Senior Secondary Schools in Region one of The Gambia participated in it. Data were collected through questionnaire self-administered method, and weight and height measurements. Using the age and gender-specific cutoff points proposed by World Health Organization, body mass index (BMI) was calculated using the weight and height measures. The data were analyzed using frequencies for underweight, overweight, and obesity, and the association between dietary factors and weight status of participants was determined using the Chi-square test.

FINDINGS

Out of the 1008 students recruited in the study, 981 of them completed and returned the questionnaires, resulting in a total response rate of 97%. The mean age of the participants was 17.3 years (SD = 1.9) and 385 of them (39.2%) were from grade 10. There were 627 (63.9%) females. The mean BMI for all the students was 20.0 ± 3.4 kg/m2. Most of the students (n = 672; 68.5 %) had normal body weight, but 226 (23%), 76 (7.7 %) and 7 (0.7%) of them were underweight, overweight and obese respectively. There was a significantly higher number of female students who were overweight (n = 64, 10.2%) than their male counterparts (χ2 = 72.336, p < 0.001). The frequency of drinking sugar added juices and full cream milk, eating fish, shrimps, oysters, lobsters, and snacks such as cakes and biscuits were significantly associated with overweight and obesity among the participants (p < 0.05). In conclusion, the problem of under-nutrition and over-nutrition co-existed among the students which were associated with poor eating habits.

Nutritional status of Indian adolescents (15-19 years) from National Family Health Surveys 3 and 4: Revised estimates using WHO 2007 Growth reference

BACKGROUND

The National Family Health Surveys (NFHS) in India apply adult cutoffs of nutritional status for the estimation of undernutrition/overweight in the 15-19 age group. The prevalence of thinness in boys and girls thus estimated is 58.1% and 46.8% in NFHS-3, and 45% and 42% in NFHS-4 respectively. But the WHO recommends using age and sex-specific reference for adolescents. We reanalyzed the nutritional status of the adolescents using the WHO 2007 Growth Reference to obtain revised estimates of thinness, overweight and stunting across states, rural-urban residence, and wealth quintiles.

METHODS AND FINDINGS

Demographic information, anthropometric data, and wealth index were accessed from the Demographic and Health Survey (DHS) database. We re-analyzed the anthropometric data using WHO AnthroPlus software which uses the WHO 2007 Growth reference. The revised estimates of thinness assessed by BMI-for-age z-scores in boys and girls was 22.3% (95%CI: 21.6, 23.0) and 9.9% (95%CI: 9.5, 10.3) in NFHS-3 and 16.5% (95%CI: 16.0,17.0) and 9% (95%CI: 8.9, 9.2) in NFHS-4 respectively. Stunting was found to be 32.2% (95% CI: 31.6, 32.9) in boys and 34.4% (95% CI: 34.2, 34.7) in girls in NFHS-4. This was higher than that in NFHS-3; 25.2% (95% CI: 24.4, 26) in boys and 31.2 (95% CI: 30.6, 31.8) in girls. There was a clear socioeconomic gradient as there were higher thinness and stunting in rural areas. There was wide variation among the states with pockets of a double burden of malnutrition.

CONCLUSION

Using the adult cutoffs significantly overestimates thinness in adolescents in the age group of 15-19 years old in India. Stunting, which is an indicator of long term nutrition is also widely prevalent in them. Future editions of DHS and NFHS should consider adolescents as a separate age group for nutritional assessment for a better understanding of nutritional transition in the population.

Childhood Obesity and Its Associated Factors among School Children in Udupi, Karnataka, India

Background

Childhood obesity has become a serious public health problem in many low-and-middle income countries. This study aims to determine the prevalence and assess the factors associated with obesity among school children.

Methods

A cross-sectional school-based study was conducted among the 1185 secondary school students in Udupi, India. Data were collected using self-administered questionnaires. Weight and height were measured and Body Mass Index (BMI) was calculated. The z-score was calculated, and BMI was categorized based on its distribution by gender and age according to the World Health Organization (WHO). The BMI categories were reported as frequencies and percentages. Chi-square tests, followed by multiple logistic regressions, were used at 5% level of significance to identify factors associated with overweight and obese children.

Results

The overall prevalence of overweight and obese children was found to be 10.8% and 6.2%, respectively. Both ‘overweight’ and ‘obese’ were found more frequently among males (11.0% and 7.1%, respectively) than females (10.6% and 5.4%, respectively). Attending private schools, (AOR: 2.87, CI: 1.55–5.31), identifying as Muslim (AOR: 2.26, CI: 1.39–3.67), and having a father with a business occupation (AOR: 2.43, CI: 1.05–5.62) were found to be significantly associated with overweight/obese status.

Conclusion

We found a high prevalence of overweight and obese children in our study. Since obesity in adulthood has its onset in childhood, it is important to have effective implementation of school health activities to reduce and curb the burden of childhood obesity.