Childhood poverty and abdominal obesity in adulthood: a systematic review

Non-Pharmacological Treatment for Cardiovascular Risk Prevention in Children and Adolescents with Obesity

In younger generations, excess weight has reached very alarming levels. Excess weight in adults is associated with increased mortality and morbidity from cardiovascular disease. However, it is not easy to distinguish to what extent these effects are the result of obesity itself or how much is due to the various cardiovascular risk factors that often accompany excess weight. Several risk factors, such as hypertension, dyslipidemia, hyperuricemia, glucose intolerance, and type 2 diabetes mellitus, are already present in pediatric age. Therefore, early intervention with the goal of correcting and/or eliminating them is particularly important. In the child and adolescent with obesity, the first approach to achieve weight reduction and correct the risk factors associated with severe excess weight should always be non-pharmacologic and based on changing poor eating habits and unhealthy lifestyles. The purpose of this review is to give an update on non-pharmacological interventions to be implemented for cardiovascular prevention in children and adolescents with obesity, and their effectiveness. In particular, interventions targeting each individual cardiovascular risk factor will be discussed.

Childhood circumstances, social mobility and the obesity transition: Evidence from South Africa

The distribution of obesity tends to shift from rich to poor individuals as countries develop, in a process of shifting sociodemographic patterns of obesity that has been called the 'obesity transition'. This change tends to happen with economic development, but little is known about the specific mechanisms that drive the change. We propose that improvements in childhood circumstances with economic development may be one of the drivers of the obesity transition. We explore whether the social gradient in body weight differs by childhood socioeconomic status (SES), proxied by the respondent's mother having Grade 12, using South Africa's nationally representative panel National Income Dynamics Study. In support of our hypothesis, we find that the social gradient in body weight is less positive for adults who had a high childhood SES, and already appears to have reversed among high-SES women who also had a high childhood SES. Upward social mobility over an individual's life course or across a single generation is associated with higher body weight compared to a stable high SES. But a high SES sustained in childhood and adulthood - or across more than one generation - may decrease adult obesity risk, and result in a reversal of the social gradient in body weight. Random effects within-between models show that the social gradient in body weight and its interaction with childhood SES are driven more by differences in income between individuals than by short-run changes in income within individuals, again suggesting that the obesity transition is driven by long-run changes rather than by very short-run changes. Our results are broadly robust to using several alternative measures of body weight, childhood SES and adult SES. Our results are consistent with the hypothesis that widespread improvements in childhood circumstances and nutrition with economic development may contribute to the shift to later stages of the obesity transition.

Household crowding in childhood and trajectories of depressive symptoms in mid-life and older age

AIMS

We aimed to investigate the association of household crowding in childhood with trajectories of depressive symptoms in middle-aged and older adults.

METHODS

We studied 47,010 participants (56 % women, 63 years at baseline) from SHARE. Using multinomial logistic regression, we estimated odds ratio (OR) with 95 % confidence interval (CI) for the association of household crowding in childhood (number of household members/number of rooms at the age of 10) with trajectories of depressive symptoms (EURO-D scale), which were generated with growth mixture modeling. We adjusted for resources in childhood, sociodemographic and health-related characteristics in mid-life and older age and tested effect modification by sex.

RESULTS

We identified four trajectories of depressive symptoms: constantly low (n = 33,969), decreasing (n = 5595), increasing (n = 5574) and constantly high (n = 1872). When compared to the those with constantly low depressive symptoms and adjusting for all covariates, household crowding in childhood was associated with greater odds of constantly high (OR 1.12; 95 % CI 1.08-1.17), decreasing (OR 1.11; 95 % CI 1.07-1.15) and increasing (OR 1.09; 95 % CI 1.06-1.13) depressive symptoms. The associations were stronger in women than in men.

CONCLUSIONS

Prevention of household crowding in childhood may ameliorate the development of constant as well as transient depressive symptoms during ageing. The effect can be stronger in women than in men.

Impact of Household Economic and Mothers' Time Affluence on Obesity in Japanese Preschool Children: A Cross-sectional Study

Although the association between household economic affluence and children's obesity has been reported, the association between mothers' time affluence and obesity remains unclear. We conducted a cross-sectional study using Japanese national survey data (2015). The target population was 2-6-year-old preschool children and their mothers. Subjective household economic affluence and mothers' time affluence were divided into "affluent," "neither," "less affluent," and "non-affluent" groups. Obesity was defined based on the International Obesity Task Force. A logistic regression model was conducted to examine the association between household economic affluence, mothers' time affluence, and children's obesity. A total of 2254 respondents were included in the present analysis. The lower household economic affluence was not significantly associated with higher rates of children's obesity (odds ratio (OR) for the "non-affluent" compared with the "affluent" group was 1.68 (95% CI, 0.93-3.03)). A lower mothers' time affluence was not significantly associated with higher rates of children's obesity (OR for the "non-affluent" compared with the "affluent" group was 1.67 (95% CI, 0.92-3.03)). The prevalence of obesity was not synergistically higher when lower household economic affluence and lower mothers' time affluence were combined.

Socioeconomic disadvantages over the life-course and their influence on obesity among older Hong Kong Chinese adults

BACKGROUND

The life-course perspective on socioeconomic inequality in health is a burgeoning field of research. Nonetheless, the three classic life-course models (i.e. sensitive period, cumulative risk and social mobility models) have rarely been simultaneously applied to studies on obesity. Therefore, this study examined the associations of socioeconomic positions (SEPs) across life stages and their associated life-course models with both general and abdominal obesity.

METHODS

Face-to-face interviews were conducted among 1077 community-dwelling adults aged 50 or above during 2014-15 in Hong Kong. Experiences of poverty, educational attainment and deprivation of necessities represented respondents' SEP in childhood, early adulthood and late adulthood, respectively. General and abdominal obesity were defined as body mass index ≥25 kg m-2 and waist-to-height ratio >0.5. Multivariable modified Poisson regression with a robust error variance was performed.

RESULTS

Respondents with low childhood SEP tended to have reduced risk of general obesity [relative risk (RR) = 0.85; 95% confidence interval (CI) = 0.72-1.00], whereas those with low childhood SEP and low late-adulthood SEP tended to have increased risk of abdominal obesity (RR = 1.10; 95% CI = 1.00-1.21 and RR = 1.14; 95% CI = 1.03-1.26, respectively). Cumulative socioeconomic disadvantages showed a dose-response relationship with abdominal obesity. Also, those with upward socioeconomic mobility had lower risk of abdominal obesity, whereas those with downward socioeconomic mobility had greater risk.

CONCLUSIONS

Low SEP, especially in childhood, exerted contrasting effects on general and abdominal obesity among older Hong Kong Chinese adults. The three life-course models operated simultaneously in determining the risk of abdominal obesity, while support for cumulative risk and social mobility models was weak in general obesity.

Sex differences in the association of childhood socioeconomic position and later-life depressive symptoms in Europe: the mediating effect of education

PURPOSE

We aimed to study sex differences in the association of childhood socioeconomic position (SEP) with later-life depressive symptoms, the mediating effect of education and explore regional differences across Europe.

METHODS

The study included 58,851 participants (55% women, mean age 65 years) from the multicentre, population-based Survey on Health, Ageing and Retirement in Europe. Interviews were conducted in six waves and included measurements of childhood SEP (household characteristics at the age of 10) and depressive symptoms (EURO-D scale). Linear regression was used to study the association of childhood SEP with depressive symptoms, adjusting for covariates, and structural equation modelling assessed the mediating effect of education.

RESULTS

In the fully adjusted model, higher childhood SEP was associated with lower depressive symptoms with a greater magnitude in women (B = - 0.07; 95% CI - 0.08, - 0.05) than in men (B = - 0.02; 95% CI - 0.03, - 0.00). Relative to men, childhood SEP had 3 times greater direct effect on depressive symptoms in women, and education had 3.7 times stronger mediating effect against childhood SEP. These associations and the sex differences were particularly pronounced in Southern, Central and Eastern Europe.

CONCLUSION

Growing up in poor socioeconomic conditions is a stronger risk factor for the development of depressive symptoms for women than for men. Education may have a stronger preventive potential for women in reducing the adverse effects of childhood socioeconomic hardship. Central and Eastern European populations experience disproportionately higher risk of later-life depression due to lower SEP and greater sex differences.

Accelerated progression of waist-to-hip ratio but not body mass index associated with lower socioeconomic position: a cohort study of nonobese early postmenopausal Chinese women

OBJECTIVE

Menopausal changes are linked to increase in body fat mass and central fat distribution; nonetheless, the impact of socioeconomic position on such changes has rarely been examined. This cohort study assessed the temporal associations of socioeconomic position with changes in body mass index (BMI) and waist-to-hip ratio (WHR) among early postmenopausal women.

METHODS

Between 2002 and 2004, 518 Hong Kong Chinese women aged 50 to 64 and within 10 years since menopause were recruited and followed up at 3 and 5 years. Weight, height, and waist and hip circumferences were measured by trained interviewers at baseline and follow-up interviews. Socioeconomic positions including educational attainment, economic activity status and household income level, and other baseline demographic characteristics, lifestyle behaviors, and mental health status were collected based on a structured questionnaire. In total, 287 and 267 women with no general and abdominal obesity, respectively, at baseline were included in multiple regression analyses.

RESULTS

Mean intrapersonal increases in BMI and WHR between baseline and 5-year interview were 0.46 kg/m and 2.80%, respectively. Women with no secondary education were 75% more likely to have a greater than-mean WHR increase than their more educated counterparts (P = 0.039). Also, having no secondary education (P = 0.041) and being a homemaker (P = 0.034) had accelerated surge in WHR. Nonetheless, baseline socioeconomic positions were not significantly associated with BMI changes.

CONCLUSIONS

Socioeconomic patterning was observed for the progression of WHR among nonobese Chinese women soon after menopause. Early postmenopausal stage may be a critical window for prevention of abdominal obesity among women with a lower educational attainment.

Role of sex in the association between childhood socioeconomic position and cognitive ageing in later life

We aimed to explore sex differences in the association of childhood socioeconomic position (SEP) with the level of cognitive performance and the rate of cognitive decline. We studied 84,059 individuals (55% women; mean age 64 years) from the Survey on Health, Ageing and Retirement in Europe. Sex differences in the association of childhood SEP (household characteristics at age 10) with the level of cognitive performance (verbal fluency, immediate recall, delayed recall) were analysed using multilevel linear regression. Structural equation modelling tested education, depressive symptoms and physical state as mediators. The relationship between childhood socioeconomic advantage and disadvantage and the rate of cognitive decline was assessed using linear mixed-effects models. Higher childhood SEP was associated with a higher level of cognitive performance to a greater extent in women (B = 0.122; 95% CI 0.092–0.151) than in men (B = 0.109; 95% CI 0.084–0.135). The strongest mediator was education. Childhood socioeconomic disadvantage was related to a higher rate of decline in delayed recall in both sexes, with a greater association in women. Strategies to prevent impaired late-life cognitive functioning, such as reducing childhood socioeconomic disadvantages and improving education, might have a greater benefit for women.

Life course socioeconomic position and body composition in adulthood: a systematic review and narrative synthesis

INTRODUCTION

Multiple systematic reviews have investigated the relation between socioeconomic position (SEP) and body mass index (BMI) throughout the life course. However, BMI does not capture quantity and distribution of fat and muscle, which are better indicators of obesity than BMI, and have been independently linked to adverse health outcomes. Less is known about the relation between SEP and body composition, and the literature has not been reviewed. We therefore systematically reviewed the literature on the association between life course SEP and body composition in adulthood.

METHODS

A protocol was registered on PROSPERO (CRD42019119937), and the review followed PRISMA guidelines. An electronic search of three databases (MEDLINE, Embase Classic + Embase and SPORTDiscus) was conducted. Original studies in the English language were included that examine the association between any recognised measure of SEP at any age and body composition (fat mass, fat-free mass, ratio and distribution) in adulthood, measured using a direct technique, i.e., not an anthropometric measure. A narrative synthesis was conducted.

RESULTS

A total of 47 papers were included in the final review, none were from low-income countries (LICs). Greater advantage in childhood and adulthood was associated with lower fat levels in high-income countries (HICs). Associations in the opposite direction were found exclusively in middle-income countries (MICs). No studies in MICs reported associations for childhood SEP. For measures of lean mass, the majority of papers reported no association, or greater advantage in adulthood associated with higher lean mass, with little variation between HICs and MICs. Associations in HICs are more often observed in women than men.

CONCLUSION

The results indicate that fat measures follow similar patterns to those seen for BMI, and that women in HICs are more likely to experience inequalities in both fat and lean measures. Further research in LICs and MICs is needed.

Socioeconomic position and body composition across the life course: a systematic review protocol

INTRODUCTION

The relation between socioeconomic position (SEP) and obesity measured by body mass index (BMI) has been extensively reviewed, but there is less research on the association between SEP and body composition. Fat distribution and muscle quality have been linked to adverse health outcomes such as cardiovascular disease, diabetes and poor physical capability. There is some evidence of secular changes in body composition with increasing fat-mass and reducing muscle quantity and strength, but it is unclear whether there have been secular changes in social inequalities in body composition. The aim is to perform a systematic review of the existing literature on the association between SEP and body composition and to explore any secular changes.

METHODS

The systematic review will be carried out according to PRISMA guidelines. An electronic search of MEDLINE and Embase Classic + Embase will be conducted using OvidSP as the database interface, as well as SPORTDiscus using EBSCO. Two independently working reviewers will initially screen abstracts to exclude papers that are clearly ineligible, followed by a full-text screening to exclude papers not meeting all inclusion criteria. Any disagreements will be resolved through discussion. Data extraction and quality assessment of eligible papers will be carried out by 2 reviewers using a standardised form. The reference lists of identified papers will be searched for additional papers. Original studies in the English language, which examine the association between SEP at any age and body composition at the same or later age will be included if they use any recognised measures of SEP (e.g. income, occupation, over-crowding) and a recognised measure of body composition (total, proportional or location of fat mass and fat-free mass, using any appropriate methods, excluding anthropometry). Due to expected heterogeneity, a narrative synthesis is expected, with a descriptive summary to be provided in tables. If there is consistency in reporting of associations, a random-effects meta-analysis will be used to provide an overall summary estimate.

DISCUSSION

The results of the review will summarise the existing evidence on social inequalities in body composition. Findings will identify gaps in knowledge and where further research is required.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019119937.

Environmental risk factors and nonpharmacological and nonsurgical interventions for obesity: An umbrella review of meta-analyses of cohort studies and randomized controlled trials

BACKGROUND

Multiple environmental factors have been implicated in obesity, and multiple interventions, besides drugs and surgery, have been assessed in obese patients. Results are scattered across many studies and meta-analyses, and they often mix obese and overweight individuals.

MATERIALS AND METHODS

PubMed and Cochrane Database of Systematic Reviews were searched through 21 January 2017 for meta-analyses of cohort studies assessing environmental risk factors for obesity, and randomized controlled trials investigating nonpharmacological and nonsurgical therapeutic interventions for obesity. We excluded data on overweight participants. Evidence from observational studies was graded according to criteria that included the statistical significance of the random-effects summary estimate and of the largest study in a meta-analysis, the number of obesity cases, heterogeneity between studies, 95% prediction intervals, small-study effects and excess significance. The evidence of intervention studies for obesity was assessed with the GRADE framework.

RESULTS

Fifty-four articles met eligibility criteria, including 26 meta-analyses of environmental risk factors (166 studies) and 46 meta-analyses of nondrug, nonsurgical interventions (206 trials). In adults, the only risk factor with convincing evidence was depression, and childhood obesity, adolescent obesity, childhood abuse and short sleep duration had highly suggestive evidence. Infancy weight gain during the first year of life, depression and low maternal education had convincing evidence for association with paediatric obesity. All interventions had low or very-low-quality evidence with one exception of moderate-quality evidence for one comparison (no differences in efficacy between brief lifestyle primary care interventions and other interventions for paediatric obesity). Summary effect sizes were mostly small across compared interventions (maximum 5.1 kg in adults and 1.78 kg in children) and even these estimates may be inflated.

CONCLUSIONS

Depression, obesity in earlier age groups, short sleep duration, childhood abuse and low maternal education have the strongest support among proposed risk factors for obesity. Furthermore, there is no high-quality evidence to recommend treating obesity with a specific nonpharmacological and nonsurgical intervention among many available, and whatever benefits in terms of magnitude of weight loss appear small.

Childhood poverty dynamics and adulthood overweight/obesity: Unpacking the black box of childhood

Integrating several life course models, this study examines how childhood poverty dynamics shape the risk of adulthood overweight/obesity. Growth mixture models of yearly poverty data from age 0-16 from the U.S. Panel Study of Income Dynamics identify four childhood poverty trajectories: chronic poverty, early childhood poverty, downward mobility, and poverty-free. Chronic poverty and early childhood poverty groups have higher risk of adulthood overweight/obesity than the poverty-free group. Overweight/obesity risk is not significantly different between the chronic poverty group and the early childhood poverty group, suggesting that the effects of early childhood exposure persist despite subsequent upward mobility. Downward mobility in the absence of early childhood poverty does not significantly increase adulthood obesity risk, providing further evidence that early childhood is a critical period for developing risk of overweight and obesity. These findings shed new light on the timing model, social mobility model, cumulative model, and cumulative inequality theory.

Trends and association of BMI between sociodemographic and living conditions variables in the Brazilian elderly: 2002/03-2008/09

This study aimed to describe BMI's short-term trends and analyze the association between the Body Mass Index (BMI) and the sociodemographic variables and variables of family perception of the sufficiency and type of food consumed by Brazilian elderly of both sexes. The authors used data from the Household Budget Surveys (HBS) collected by the Brazilian Institute of Geography and Statistics (IBGE) in 2002/03 and 2008/09. The prevalence of overweight and obesity increased, whereas normal and low weight decreased. Multinomial regression models were used for 2008/09 to analyze the association between BMI and sociodemographic variables and variables of family perception of the sufficiency and type of food intake. Income and age were more associated with BMI. We suggest that health and nutrition prevention and monitoring measures be implemented through public policies, considering multifactorial overweight in the Brazilian elderly.

Socioeconomic status in childhood and obesity in adults: a population-based study

OBJECTIVE To test whether there is an association between socioeconomic status in childhood and measures of body mass index, waist circumference and the presence of overall and abdominal obesity in adult life. METHODS A cross-sectional analysis of a population-based cohort study, including a sample of adults (22-63 years old) living in Florianópolis, Southern Brazil. The socioeconomic status in childhood was analyzed through the education level of the participant's parents. Height, weight and waist circumference were measured by previously trained interviewers. Linear and logistic regressions with adjustment for confounding factors and stratification of data according to gender were used. RESULTS Of the 1,222 adults evaluated, 20.4% (95%CI 18.1-22.8) presented overall obesity and 24.8% (95%CI 22.4-27.4), abdominal obesity. The body mass index and waist circumference averages among women were, respectively, 1.2 kg/m2 (95%CI -2.3- -0.04) and 2.8 cm (95%CI -5.3- -0.2) lower among those with higher socioeconomic status in childhood. Among men, waist circumference was 3.9 cm (95%CI 1.0-6.8) higher in individuals with higher socioeconomic status in childhood. Regarding obesity, women of higher socioeconomic status in childhood had lower odds of abdominal obesity (OR = 0.56, 95%CI 0.34-0.90), and no such association was observed among men. CONCLUSIONS The socioeconomic status in childhood influences body mass index, waist circumference and obesity in adults, with a difference in the direction of association according to gender. The higher socioeconomic status among men and the lower socioeconomic status among women were associated with higher adiposity indicators.

Socio-economic status over the life course and obesity: Systematic review and meta-analysis

BACKGROUND

The purpose of this review was to summarize the published literature on the association of childhood, adulthood and life course socio-economic status (SES) with obesity between January 1990 and June 2015.

METHODS

The major medical electronic databases were searched to identify studies that examined SES over the life-course in relation to obesity. A total of 219 studies were identified through the initial search, and 35 qualified for full review. Of these, 14 publications met our inclusion criteria for the meta-analysis, all from developed or upper-middle income countries.

RESULTS

There was a consistent association between lower life course SES and obesity among women (summary OR: 1.35, 95% CI: 1.04, 1.76), but not among men (summary OR: 0.92, 95% CI: 0.60, 1.40). Overall, mean BMI was higher among individuals with lower life course SES compared with those with higher life course SES (summary mean BMI difference: 0.65, 95% CI: 0.59, 0.71). Mean waist circumference (WC) was higher among women with lower life course SES compared with those with higher life course SES (summary mean WC: 4.67, 95% CI: 4.15, 5.20), but lower among men (summary mean WC difference: -0.10, 95% CI: -0.11, -0.08).

CONCLUSION

The inverse relationship between life course SES and obesity among women was consistent, based mostly on studies in developed countries. Nevertheless, critical information gaps remain in relation to the impact of childhood and life course SES on obesity in developing countries.

Association of Childhood Economic Hardship with Adult Height and Adult Adiposity among Hispanics/Latinos. The HCHS/SOL Socio-Cultural Ancillary Study

The study examined the association of childhood and current economic hardship with anthropometric indices in Hispanic/Latino adults, using data from the HCHS/SOL Socio-cultural ancillary study (N = 5,084), a community-based study of Hispanic/Latinos living in four urban areas (Bronx, NY, Chicago, IL, Miami, FL, and San Diego, CA). Childhood economic hardship was defined as having experienced a period of time when one's family had trouble paying for basic needs (e.g., food, housing), and when this economic hardship occurred: between 0-12, 13-18 years old, or throughout both of those times. Current economic hardship was defined as experiencing trouble paying for basic needs during the past 12 months. Anthropometry included height, body mass index (BMI), waist circumference (WC), and percentage body fat (%BF). Complex survey linear regression models were used to test the associations of childhood economic hardship with adult anthropometric indices, adjusting for potential confounders (e.g., age, sex, Hispanic background). Childhood economic hardship varied by Hispanic background, place of birth, and adult socio-economic status. Childhood economic hardship during both periods, childhood and adolescence, was associated with shorter height. Childhood economic hardship was associated with greater adiposity among US born individuals only. Current economic hardship was significantly associated with all three measures of adiposity (BMI, WC, %BF). These findings suggest that previous periods of childhood economic hardship appear to influence adult height more than adiposity, whereas current economic hardship may be a better determinant of adult adiposity in Hispanics.

A Prospective Examination of the Mechanisms Linking Childhood Physical Abuse to Body Mass Index in Adulthood

Previous research has reported associations between childhood physical abuse and body mass index (BMI) in adulthood. This article examined the role of four potential mediators (anxiety, depression, posttraumatic stress, and coping) hypothesized to explain this relationship. Using data from a prospective cohort design, court-substantiated cases of childhood physical abuse (N = 78) and nonmaltreated comparisons (N = 349) were followed up and assessed in adulthood at three time points (1989-1995, 2000-2002, and 2003-2005) when participants were of age 29.2, 39.5, and 41.2, respectively. At age 41, average BMI of the current sample was 29.97, falling between overweight and obese categories. Meditation analyses were conducted, controlling for age, sex, race, smoking, and self-reported weight. Childhood physical abuse was positively associated with subsequent generalized anxiety, major depression, and post-traumatic stress disorder symptoms at age 29.2 and higher levels of depression and posttraumatic stress predicted higher BMI at age 41.2. In contrast, higher levels of anxiety predicted lower BMI. Coping did not mediate between physical abuse and BMI. Anxiety symptoms mediated the relationship between physical abuse and BMI for women, but not for men. These findings illustrate the complexity of studying the consequences of physical abuse, particularly the relationship between psychiatric symptoms and adult health outcomes.

Chronic exposure of grandparents to poverty and body mass index trajectories of grandchildren: a prospective intergenerational study

In this study, I used the growth curve model to examine the association between grandparents' (first generation (G1)) life-course exposure to chronic poverty and grandchildren's (third generation (G3)) body mass index (BMI; weight (kg)/height (m)(2)) growth trajectories. This association was estimated separately for male and female grandchildren. Analyses were based on prospective data from a US longitudinal survey, the Panel Study of Income Dynamics (1968-2011), and 2 of its supplemental studies: the Child Development Supplement (1997-2011) and the Transition into Adulthood Study (1997-2011). A prospectively enrolled nationally representative cohort of 2,613 G3 youth (1,323 male, 1,290 female) sampled in the 2 supplemental studies was linked to 1,719 grandparents from the Panel Study of Income Dynamics core sample. Chronic exposure to poverty among grandparents was prospectively ascertained annually over a 30-year period prior to the collection of data on grandchildren. Findings suggested that grandparents' chronic poverty exposure was positively associated with the slope of the BMI trajectory among granddaughters (β = 0.10, 95% confidence interval: 0.03, 0.17) but not among grandsons (β = 0.02, 95% confidence interval: -0.04, 0.08). The association between grandparents' chronic poverty exposure and granddaughters' BMI growth slope remained even after controlling for parental (second generation (G2)) socioeconomic status and BMI.

Socioeconomic inequalities in abdominal obesity in Brazilian female adolescents: a national-based study

The aim of the present study was to identify the prevalence of abdominal obesity and verify the socioeconomic inequities in abdominal obesity among female adolescents from all regions of Brazil. A cross sectional nationwide study was carried out on abdominal obesity with 2,488 women aged 15 to 19 years in the National Survey on Demography and Health of Women and Children (PNDS), 2006. Abdominal obesity was identified based on waist circumference (WC). Demographic and socioeconomic data (age, skin color, schooling level, socioeconomic status, area of residence, geographic region, marital status, and private health insurance) were collected. Poisson regression was used for multivariate analysis. The prevalence of abdominal obesity was 24.7 % (95 % confidence intervals; 20.9, 28.3). The mean WC value was 74.1 cm (SD=9.3). Adolescents who studied fewer years, those living in a socially and economically more developed region and those who had a partner, showed higher prevalence of abdominal obesity. Effective actions to reduce abdominal obesity include equitable early childhood development programs and education and interventions within the health systems should be complemented with population-based policies specifically designed to reduce socioeconomic inequalities.

Trends in adiposity in Brazilian 7-10-year-old schoolchildren: evidence for increasing overweight but not obesity between 2002 and 2007

BACKGROUND

The negative health consequences of childhood overweight/obesity (OW/OB) are well known. Therefore, an accurate monitoring of the OW/OB prevalence is essential. Anthropometry is the most practical and cost-effective method for nutritional status evaluation.

AIM

To describe trends in the nutritional status among 7-10-year-old children by investigating changes in the prevalence of stunting, thinness, overweight, obesity, risk and excess abdominal adiposity, and to study changes in height-for-age, body mass index (BMI) and waist circumference (WC).

SUBJECTS AND METHODS

A school-based sample of 7-10-year-old children participated in two cross-sectional studies in 2002 (n = 2936) and 2007 (n = 1232) in Florianopolis, southern Brazil. Prevalence of stunting, risk and excess abdominal adiposity and changes in the distribution of height-for-age, BMI-for-age, WC-for-age z-scores were evaluated. Three BMI-based references were used to define the prevalence of thinness, overweight and obesity.

RESULTS

Between 2002-2007, the prevalence of stunting, thinness, obesity and excess abdominal adiposity remained stable, whereas overweight (including obesity) increased 10-23% in boys and 18-21% in girls, depending on the BMI reference used. The risk of abdominal adiposity increased in boys, but not in girls. No significant change was observed in mean height, BMI, WC-for-age z-scores.

CONCLUSIONS

This study identified a potential levelling off in the prevalence of obesity and excess abdominal adiposity, but a continuing increase in the prevalence of overweight.

[Evidence-based practices published in Brazil: identification and analysis studies about human health prevention]

Integrative review of Brazilian studies about evidence-based practices (EBP) about prevention in human health, published in Web of Science/JCR journals, between October 2010 and April 2011. The aim was to identify the specialties that most accomplished these studies, their foci and methodological approaches. Based on inclusion criteria, 84 studies were selected, mainly published in public health journals, focusing on primary care and also addressing clinical issues and different specialties. Prevention foci and methodological approaches also varied, with a predominance of systematic reviews without meta-analysis. The results indicate that there is no single way to conceptualize and practice EBP in the field of prevention, and that its application may not only serve to obtain indisputable evidence to equip intervention actions. This endless knowledge area is under construction, with a view to the analysis and further understanding of health phenomena.

Life-course socioeconomic status and obesity among older Singaporean Chinese men and women

OBJECTIVES

To elucidate the association between life-course socioeconomic status (SES) and obesity among older (aged 60 and older) Singaporean Chinese men and women.

METHODS

Data from the Social Isolation, Health and Lifestyles Survey (single-stage stratified random sampling design) was utilized. Obesity (body mass index >27.4 kg/m(2)) was assessed for 1,530 men and 2,036 women. Childhood (family financial status while growing up), adult (education), and older adult (housing type) SES indicators were used to define the accumulation of risk (cumulative socioeconomic disadvantage), social mobility (8 trajectories using the 3 SES indicators), and sensitive period (independent effect of each SES indicator) conceptual models. Association between the 3 life-course SES conceptual models and obesity was assessed using logistic regression analysis.

RESULTS

Among women and men, low childhood SES lowered the odds of obesity. Low adult SES increased the odds of obesity only among women. There was no association between cumulative socioeconomic disadvantage and obesity. Women experiencing upward social mobility had lower odds of obesity relative to both those experiencing low SES and high SES through the life-course.

DISCUSSION

Association of the life-course SES conceptual models with obesity among older Singaporeans is different from that reported among younger Western populations, suggesting the association to be context specific. The different conceptual models complement each other.

Predictors of binge drinking in adolescents: ultimate and distal factors - a representative study

BACKGROUND

As epidemiological surveys have shown, binge drinking is a constant and wide-spread problem behavior in adolescents. It is not rare to find that more than half of all adolescents engage in this behavior when assessing only the last 4 weeks of time independent of the urbanity of the region they live in. There have been several reviews on predictors of substance consumption in adolescents in general, but there has been less high quality research on predictors of binge drinking, and most studies have not been theoretically based. The current study aimed to analyze the ultimate and distal factors predicting substance consumption according to Petraitis' theory of triadic influence. We assessed the predictive value of these factors with respect to binge drinking in German adolescents, including the identification of influence direction.

METHODS

In the years 2007/2008, a representative written survey of N = 44,610 students in the 9th grade of different school types in Germany was carried out (net sample). The return rate of questionnaires was 88% regarding all students whose teachers or school directors had agreed to participate in the study. In this survey, prevalence of binge drinking was investigated as well as potential predictors from the social/interpersonal, the attitudinal/environmental, and the intrapersonal fields (3 factors of Petraitis). In a multivariate logistic regression analysis, these variables were included after testing for multicollinearity in order to assess their ability to predict binge drinking.

RESULTS

Prevalence of binge drinking in the last 30 days was 52.3% for the surveyed adolescents with a higher prevalence for boys (56.9%) than for girls (47.5%). The two most influential factors found to protect against binge drinking with p < .001 were low economic status and importance of religion. The four most relevant risk factors for binge drinking (p < .001) were life-time prevalence of school absenteeism/truancy, academic failure, suicidal thoughts, and violence at school in the form of aggressive behavior of teachers. The model of Petraitis was partly confirmed for Binge Drinking in German adolescents and the direction of influence factors was clarified.

CONCLUSIONS

Whereas some of the risk and protective factors for binge drinking are not surprising since they are known for substance abuse in general, there are two points that could be targeted in interventions that do not focus on adolescents alone: (a) training teachers in positive, reassuring behavior and constructive criticism and (b) a focus on high risk adolescents either because they have a lack of coping strategies when in a negative mood or because of their low academic achievement in combination with absenteeism from school.

Lifecourse infectious origins of sexual inequalities in central adiposity

BACKGROUND

Social disparities in obesity are often more marked among women than men, possibly due to social factors. Taking a life-history perspective, we hypothesized that childhood infections could be relevant via sex-specific effects of immune system activation on sexual development and, hence, body shape.

METHODS

We used multivariable linear regression to assess the sex-specific, adjusted associations of 'childhood' pathogens [0 (n = 1002), 1 (n = 2199), 2 (n = 3442) or 3 (n = 4833) of HSV1, CMV and hepatitis A antibodies] and 'adult' pathogens [0 (n = 5836), 1 (n = 3018) or ≥ 2 (n = 720) of HSV2, HHV8 and hepatitis B or C) with waist-hip ratio (WHR) and body mass index (BMI) standard deviations (SDs) using NHANES III (1988-94). As validation, we assessed associations with height.

RESULTS

'Childhood' pathogens were positively associated with WHR among women [0.18 SD, 95% confidence interval (95% CI) 0.04-0.32 for 3, compared with 0], but not men (-0.04 SD, 95% CI -0.15 to 0.08), adjusted for age, education, race/ethnicity, smoking and alcohol. Further adjustments for leg length barely changed the estimates. There were no such sex-specific associations for BMI or for adult pathogens. 'Childhood', but not 'adult', pathogens were negatively associated with height, adjusted for age, sex, education and race/ethnicity.

CONCLUSIONS

These observations are consistent with the lifecourse hypothesis that early exposure to infections makes women vulnerable to central obesity. This hypothesis potentially sheds new light on the developmental origins of obesity, and is consistent with the generally higher levels of central obesity among women than men in developing populations.

[Evidence-based practices published in Brazil: identification and analysis of their types and methodological approches]

This is an integrative review of Brazilian studies on evidence-based practices (EBP) in health, published in ISI/JCR journals in the last 10 years. The aim was to identify the specialty areas that most accomplished these studies, their foci and methodological approaches. Based on inclusion criteria, 144 studies were selected. The results indicate that most EBP studies addressed childhood and adolescence, infectious diseases, psychiatrics/mental health and surgery. The predominant foci were prevention, treatment/rehabilitation, diagnosis and assessment. The most used methods were systematic review with or without meta-analysis, protocol review or synthesis of available evidence studies, and integrative review. A strong multiprofessional expansion of EBP is found in Brazil, contributing to the search for more selective practices by collecting, recognizing and critically analyzing the produced knowledge. The study also contributes to the analysis itself of ways to do research and new research possibilities.

Fatores associados à obesidade central em adultos de Florianópolis, Santa Catarina: estudo de base populacional

OBJETIVO: Estimar a prevalência e os fatores sociodemográficos e comportamentais associados à obesidade central em adultos de Florianópolis, Santa Catarina. MÉTODOS: Pesquisa de delineamento transversal de base populacional com amostra de 1.720 adultos de 20 a 59 anos. A obesidade central foi avaliada pela razão entre as medidas da cintura e estatura, sendo considerada como acima do recomendável > 0,50. A Regressão de Poisson foi utilizada para estimar Razões de Prevalência (RP) nas análises brutas e multivariável entre a obesidade central e os indicadores sociodemográficos e comportamentos relacionados à saúde. Todas as análises foram estratificadas por sexo. RESULTADOS: A prevalência de obesidade central foi de 50,5% (IC 95%: 46,6-54,4) para os homens e 38,9% (IC 95%: 34,4-43,5) para as mulheres. Após a análise multivariável, maiores prevalências de obesidade central foram observadas para as mulheres com faixa de idade de 50 a 59 anos e aquelas que vivem com companheiro(a) e, com menores prevalências, para as mulheres com escolaridade maior e igual a 12 anos (RP: 0,63; IC 95%: 0,47-0,85) e maior renda (RP: 0,64; IC 95%: 0,47-0,86). Para os homens, maiores prevalências foram evidenciadas com a faixa de idade de 50 a 59 anos, que vivem com companheiro(a) e com menor renda. CONCLUSÃO: A prevalência de obesidade central foi elevada nesta população e as variáveis demográficas e socioeconômicas foram fortemente discriminantes da prevalência de obesidade central em ambos os sexos. O conhecimento dos fatores associados à obesidade central pode orientar as intervenções dirigidas à prevenção deste importante problema de saúde pública.

Nutritional status of pre-school children from low income families

Background

We evaluated growth and nutritional status of preschool children between 2 and 6 years old from low income families from 14 daycare centers.

Methods

Cross-sectional study with 1544 children from daycare centers of Santo Andre, Brazil. Body weight (W), height (H) and body mass index (BMI) were classified according to the 2000 National Center for Health Statistics (CDC/NCHS). Cutoff points for nutritional disorders: -2 z scores and 2.5 and 10 percentiles for malnutrition risk, 85 to 95 percentile for overweight and above BMI 95 percentile for obesity. Stepwise Forward Regression method was used including age, gender, birth weight, breastfeeding duration, age of mother at birth and period of time they attended the daycare center.

Results

Children presented mean z scores of H, W and BMI above the median of the CDC/NCHS reference. Girls were taller and heavier than boys, while we observed similar BMI between both genders. The z scores tended to rise with age. A Pearson Coefficient of Correlation of 0.89 for W, 0.93 for H and 0.95 for BMI was documented indicating positive association of age with weight, height and BMI. The frequency of children below -2 z scores was lower than expected: 1.5% for W, 1.75% for H and 0% for BMI, which suggests that there were no malnourished children. The other extremity of the distribution evidenced prevalence of overweight and obesity of 16.8% and 10.8%, respectively.

Conclusion

Low income preschool children are in an advanced stage of nutritional transition with a high prevalence of overweight.

Velocidade de ganho de peso nos primeiros anos de vida e excesso de peso entre 5-11 anos de idade, Salvador, Bahia, Brasil

Crianças com sobrepeso estão mais propensas a se tornarem adultos com sobrepeso ou obesos, sendo a prevenção mais eficaz a intervenção em fases precoces da vida. Analisou-se a associação entre ganho de peso nos primeiros anos de vida e sobrepeso/obesidade em 1.056 crianças menores de 11 anos de idade. Foram coletadas informações relacionadas ao estilo de vida, saneamento, condições socioeconômicas, peso ao nascer e aleitamento materno. O ganho de peso do nascimento até diferentes intervalos (até 12 meses, > 12 a 18, > 18 a 24, e > 24 a 60 meses) foi considerado de forma contínua em escores-z. Foi considerado excesso de peso o índice de massa corporal (IMC) maior ou igual a +1 escore-z, usando referências da Organização Mundial da Saúde (OMS) de 2006 e 2007. Adotou-se a regressão linear e Poisson multivariada. A velocidade do ganho ponderal mostrou-se associada ao IMC, observando-se duas vezes mais sobrepeso/obesidade a cada incremento de uma unidade no desvio-padrão da velocidade do ganho ponderal para o intervalo de 24 e 60 meses (RR = 2,08; IC95%: 1,87-2,32). Encontrou-se associação entre o rápido ganho de peso em todos os intervalos de idade e a ocorrência de sobrepeso/obesidade anos mais tarde.