Regional and sociodemographic determinants of the prevalence of overweight and obesity in children aged 7-9 years in Croatia

Overweight and obesity prevalence: a pilot implementation of the ‟COSI" methodology in the Republic of Srpska

OBJECTIVES

Childhood obesity has become a worldwide public health concern over the past decade, counting Bosnia and Herzegovina (BiH). The Childhood Obesity Surveillance Initiative (COSI) was established by the World Health Organization (WHO) to address the lack of standardized surveillance data on childhood obesity. However, BiH and its entity, Republic of Srpska (RS), are failing inclusion in such initiative, which hinders efforts to monitor and address the issue. Henceforth, the objective of this nationally funded study was to gather and analyse data on the prevalence of overweight and obesity among primary-school children in RS by implementing the COSI methodology.

METHODS

Weight, height, and BMI of first, second, and third grade children (aged 6-8), from 11 schools (N = 2,030) in the RS region was analysed according to the standardized COSI protocol.

RESULTS

The prevalence rates of overall overweight (OW) and obesity (OB) observed were 14.37% (OW 9.09%, OB 5.21%). No gender-related differences were noted (boys 14.36%, girls 14.88%).

CONCLUSIONS

These findings highlight a concerning trend of increasing overweight and obesity prevalence with age among primary-school children in the RS.

Gender differences and climate zones in overweight and obesity prevalence in European elementary school children from 2000 to 2020: a systematic review and meta-analysis

Introduction

After 2000, there are more obese than underweight people in the world. We face a rapid increase in average global warming of 1.5°C, reported as a syndemic problem of three interconnected epidemics: obesity, global warming, and undernutrition. We aimed to analyze the impact and association between global warming and obesity in children and differences by gender across Europe after 2000.

Methods

We searched PubMed, MEDLINE, Google Scholar, ScienceDirect, and Embase databases. The considered population were children aged 6-14. Only cross-sectional studies that defined obesity by the IOTF cutoffs and the subjects' place of residence, used to determine precise climate zones, were included. We assessed the prevalence of obesity and overweight using a random-effects and the Mantel-Haenszel fixed-effect method when heterogeneity was greater/lower than 50%. We did a subgroup analysis for prevalence across gender, obesity, and overweight, two decades, regions, countries, and the Köppen-Geiger climate zones. Random effects of the meta-regression were used to study the global warming impact and differences in trends across European countries by gender for both conditions separately.

Results

We identified 114 studies that included 985,971 children from 39 European countries. A significant difference between genders was in favor of obese girls 4.78 (95% CI: 3.85-5.93) versus boys 5.76% (95% CI: 5.11-6.48, p = 0.03), respectively, but not for overweight children. Most of the obese girls were in South Europe 7.51% (95% CI: 6.61-8.51) versus East Europe 2.86% (95% CI: 23-3.12), versus boys in South Europe 8.66% (95% CI: 7.68-9.74) and North Europe 3.49% (95% CI: 2.90-4.19), respectively. The "cold" Köppen-Geiger climate zone, with lowest temperatures, has the largest trend rise between two decades of 2.8% and 1.53% for obese girls and boys, and 5.31% and 1.81% for overweight girls and boys, respectively, followed by the smallest number of obese girls 3.28% (95% CI: 2.17-4.92) and boys 3.58% (95% CI: 2.39-5.33), versus the zone with the highest temperatures "hot" for girls 7.02% (95% CI: 6.30-7.82) and for boys 8.23% (95% CI: 7.55-8.96), respectively. The meta-regression proved global warming has a significant impact on the distribution of obesity and overweight across climate zones, R2 = 0.52 and R2 = 0.22. No significant gender differences, or significant interaction, was noted.

Conclusion

Our meta-analysis provides a comprehensive overview of the association between and impact of global warming on obesity. This impact increases obesity among children in Europe throughout all climate zones, and emphasizes an urgent call for further preventive methods in schools, since obesity differences continue their trend of disappearing into the future.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021282127, identifier: CRD42021282127.

Disparities in Childhood Obesity Prevalence and Spatial Clustering Related to Socioeconomic Factors in Isaan, Thailand

Globally, rapid economic growth has contributed to an overall increase in the incidence of childhood obesity. Although the prevalence of obesity has been well recognized, the disparities related to a region's socioeconomic environment in terms of the incidence of obesity are still less understood. Therefore, the purpose of this study was to examine the spatial pattern of childhood obesity and identify the potential associations between childhood obesity and socioeconomic environment in the northeastern region of Thailand, Isaan. Using nationally collected obesity data from children aged 0-5 years in 2019, we employed a geographic information system (GIS) to perform obesity cluster analysis at the smaller regional level, investigating a total of 322 districts in study area. Global and local statistical approaches were applied to calculate spatial associations between the socioeconomic status of neighborhoods and childhood obesity. The study revealed that 12.42% of the total area showed significant clusters at the district level, with high values observed in the western and northeastern areas. The results of the spatial statistical model revealed that childhood obesity was significantly positively associated with areas exhibiting high levels of socioeconomic environment factors. Identifying the associated factors and highlighting geographic regions with significant spatial clusters is a powerful approach towards understanding the role of location and expanding the knowledge on the factors contributing to childhood obesity. Our findings, as a first step, offer valuable references that could support policy-makers and local authorities in enhancing policy development with the aim of reducing childhood obesity and improving public health.

Adherence to Mediterranean Diet in Croatia: Lessons Learned Today for a Brighter Tomorrow

Non-communicable diseases (NCD) and lifestyle, particularly diet, have a close relationship. Based on the recent statistics, Croatian men and women lead in European overweight lists, which implies pessimistic prognosis in terms of incidence and prevalence of NCDs in the future. One of the possible solutions to overcome weight problems is turn to traditional balanced and sustainable diets, such as the Mediterranean diet. In this study, we assessed adherence towards Mediterranean diet using a validated questionnaire in an online survey and associated adherence scores with several demographic and anthropometric data. Based on the results of a validated Mediterranean Diet Adherence Screener (N = 3326), we assessed the adherence score to be 7.6 ± 2.5. The score tended to depend on sex, residence, age, education, income, and body mass index (BMI); indeed, women, residents of a coastal part of the country, older volunteers, those possessing a higher education degree, those with higher income, and those with lower BMI were associated with higher scores. As income was one of the significant findings related to higher adherence scores, we developed a dietary plan complying with Mediterranean diet principles that, on average, costed less than the average traditional balanced diet menu. Taken together, this study brought new findings regarding target groups who need to be encouraged to make lifestyle changes, and highlighted the first steps on how to make them.

Associations between Fat Mass and Fat Free Mass with Physical Fitness in Adolescent Girls: A 3-Year Longitudinal Study

The main purpose of the study was to examine the longitudinal associations between fat mass and fat free mass with health-related physical fitness. Two-hundred and forty 15-year old adolescent girls were measured at the baseline and after a period of 3 years (17 years). Health-related physical fitness included the following tests: (1) explosive power of the lower extremities (standing broad jump); (2) muscle endurance of the trunk (sit-ups in 60 s); (3) flexibility (sit-and-reach test); (4) muscle endurance of the lower extremities (squats in 60 s); (5) aerobic endurance (the 800 m run test); and (6) speed endurance (the 400 m running test). Fat mass and fat free mass were assessed using the bioelectrical impedance method. Longitudinal associations were analyzed with linear mixed model estimates. After adjusting for body mass index, fat mass was negatively associated with standing broad jump (β = −1.13, p < 0.001), sit-ups in 60 s (β = −0.27, p < 0.001), and squats in 60 s (β = −0.27, p < 0001), while positive associations with the 800 m running test (β = 0.02, p < 0.001) and the 400 m running test (β = 0.02, p < 0.001) were observed. On the other hand, fat free mass was positively associated with standing broad jump (β = 1.14, p < 0.001), sit-ups in 60 s (β = 0.28, p < 0.001), and squats in 60 s (β = 0.28, p < 0001), while the 800 m running test (β = −0.02, p < 0.001) and the 400 m running test (β = −0.02, p < 0.001) exhibited negative associations. This study shows that fat mass and fat free mass components are longitudinally, but oppositely associated with health-related physical fitness in adolescent girls.

Defining Optimal Cut-Points for Cardiorespiratory Fitness Associated With Overweight/Obesity in Children: A School-Based Study

The main purpose of the study was to define optimal criterion-referenced cut-points for cardiorespiratory fitness (CRF) associated with overweight/obesity. In this cross-sectional study, participants were 1,612 children aged 7–14 years (mean age ± SD = 9.7 ± 2.4 years; 52.5% girls). CRF was assessed by the Maximal multistage 20-m shuttle run test, from which maximal oxygen uptake (VO₂max) was estimated. Anthropometric indices included body-mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR). Receiver operating characteristic (ROC) curves were performed to determine cut-off points. In boys, the optimal cut-off points of CRF in defining overweight/obesity for BMI, WC, and WHtR were 44.6, 46.4, and 46.9 mlO₂/kg/min. The areas under the curves (AUC) were 0.83 (95% CI 0.78–0.88, p < 0.001), 0.77 (95% CI 0.71–0.83, p < 0.001), and 0.90 (95% CI 0.86–0.93, p < 0.001). In girls, the optimal cut-off points were 41.0, 40.8, and 40.7 mlO₂/kg/min for BMI, WC, and WHtR, with the AUCs of 0.86 (95% CI 0.82–0.90, p < 0.001), 0.83 (95% CI 0.79–0.88), and 0.88 (95% CI 0.84–0.93, p < 0.001). In conclusion, our newly developed cut-off points for CRF assessed by the Maximal multistage 20-m shuttle run test may adequately detect primary school-aged boys and girls with general and abdominal obesity.

The Role of Socioeconomic Status in Adherence to the Mediterranean Diet and Body Mass Index Change: A Follow-Up Study in the General Population of Southern Croatia

The Mediterranean diet (MD) is one of the most healthful dietary patterns, beneficial for humans and the environment. However, the MD has recently exhibited a declining trend, especially in younger and less affluent people. This study investigated the association between socioeconomic indicators and adherence to the MD in 4671 adult subjects from Dalmatia, Croatia (age range 18–98 years; 61.9% were women). Additionally, in the follow-up we examined the change in adherence to the MD and in BMI (subsample, N = 1342; 62.5% were women; mean follow-up time of 5.8 years). The adherence to the MD was based on the Mediterranean Diet Serving Score (range 0–24 points, cut-off value ≥ 14 points), with a prevalence in the overall sample of 28.5%. Higher odds of adherence to the MD were recorded in women, older subjects, and those with higher level of objective material status, while it was less likely in the period after economic crisis of 2007–2008. Additionally, we detected no change in adherence to the MD in the follow-up subsample (−8.5%, p = 0.056), but there was an increase in BMI (+6.5%, p < 0.001). We recorded an increase in adherence for nuts (+127.5%), sweets (+112.6%), red meat (+56.4%), and wine (+50.0%), unlike the reduction in adherence for vegetables (−35.1%), fish (−23.4%), white meat (−11.6%), cereals (−10.9%), and dairy products (−9.6%). Similar results were obtained across all quartiles of objective material status. Over time, the absolute change in the MD score was positively associated with female gender, age, higher education, and moderate physical activity, but it was negatively associated with adherence to the MD at baseline. BMI change was positively associated with female gender, and negatively with initial BMI, initial adherence to the MD, and MD change. Our findings point towards a less than ideal adherence to the MD in the general population of southern Croatia, and identify important characteristics associated with adherence change over time, informing necessary interventions aimed at increasing MD uptake.

Childhood Obesity in Serbia on the Rise

The aim of the study was to examine changes in obesity prevalence among primary school children in Serbia between 2015 and 2019 rounds of the national WHO European Childhood Obesity Surveillance Initiative (COSI-Serbia). Cross-sectional studies were conducted in 2015 and 2019. The nationally representative samples of primary school children were measured for body height and weight, following the COSI protocol. Body Mass Index was calculated, and the IOTF and WHO definitions were used to classify children as overweight or obese. Participants were children of both sexes aged 7.00–8.99 years (n = 6105). Significant differences in overweight (obesity included) prevalence between two COSI rounds were identified regardless of definitions applied. According to the WHO definitions, prevalence of overweight and obesity combined increased in 7–9-year-old children in Serbia from 30.7% in 2015 to 34.8% in 2019 (z = −3.309, p < 0.05), and according to the IOTF standards, the increase from 22.8% to 30% was registered (z = −6.08, p = 0.00). The childhood overweight/obesity rate is increasing in Serbia, which places monitoring and surveillance of children’s nutritional status high on the public health agenda.