Trends in weight, height, BMI and obesity in schoolchildren from Santa Rosa (Argentina), 1990–2005/07

Recent changes in growth trajectories: a population-based cohort study of over 5 million Brazilian children born between 2001 and 2014

Background

There is limited evidence on recent trends in childhood growth trajectories in Low-/middle-income countries. We investigated how age-trajectories for height and Body Mass Index (BMI) have changed among Brazilian children born in two different time periods after 2000.

Methods

We used a population-based cohort (part of the "Cohort of 100-Million Brazilians") created by the linkage of three Brazilian administrative databases: the Cadastro Único of the Federal Government, the National System of Live Births and the National Nutritional and Food Surveillance System. We included longitudinal data on 5,750,214 children who were 3 to <10 years of age and born between 2001 and 2014 (20,209,133 observations). We applied fractional polynomial models with random-effects to estimate mean height and BMI trajectories for children.

Findings

Compared to children born in 2001-2007, the cohort born in 2008-2014 were on average taller, by a z-score of 0.15 in boys and 0.12 in girls. Their height trajectories shifted upwards, by approximately 1 cm in both sexes. Levels of BMI increased little, by a z-score of 0.06 (boys) and 0.04 (girls). Mean BMI trajectories also changed little. However, the prevalence of overweight/obesity increased between cohorts, e.g., from 26.8% to 30% in boys and 23.9%-26.6% in girls aged between 5 and <10 years.

Interpretation

An increase of 1 cm in mean height of Brazilian children during a short period indicates the improvement in maternal and child health, especially those from low-income families due to the new health and welfare policies in Brazil. Although mean BMI changed little, the prevalence of child overweight/obesity slightly increased and remained high.

Funding

This work was supported by National Council for Scientific and Technological Development - CNPq; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES; National Institute for Health Research (NIHR) Great Ormond Street Hospital Biomedical Research Centre; Society for the Study of Human Biology; Fundação de Amparo à Pesquisa do Estado de Minas Gerais - FAPEMIG; Departamento de Ciência e Tecnologia da Secretaria de Ciência, Tecnologia, Inovação e Complexo da Saúde do Ministério da Saúde - Decit/SECTICS/MS. The study also used resources from the Centre for Data and Knowledge Integration for Health (CIDACS), which receives funding from the Bill & Melinda Gates Foundation, the Wellcome Trust, the Health Surveillance Secretariat of the Ministry of Health and the Secretariat of Science and Technology of the State of Bahia (SECTI-BA).

Comparison of frame index reference percentiles in Argentine and European boys and girls

INTRODUCTION

The frame index (FI), based on measurements of elbow breadth and height, is the body frame size parameter most frequently used in child and adolescent populations to assess skeletal robustness. In 2018, the first FI reference percentiles were elaborated with data of boys and girls aged 0-18 years from different European populations. In Argentina, the FI reference values were published in 2022.

OBJECTIVE

The present study aims to compare the Argentine (AR) and European (EU) FI reference percentiles to evaluate possible variation in bone robustness between populations.

METHODS

The values of the 3rd, 50th and 97th percentiles of the AR and EU FI references for boys and girls aged 4-14 years were compared using the Wilcoxon test (p < .05). Percentage differences between means (PDM) were calculated to analyze the magnitude of the differences between both references. The R 3.2.0 program was used to plot the percentile curves.

RESULTS

The FI reference values were lower in AR than in EU in both the 3rd and the 50th percentiles, regardless of sex and age. Conversely, the AR reference values of the 97th percentile were higher than the EU values at most ages.

CONCLUSIONS

The comparison of the AR and EU FI references showed similar age and sex growth patterns. However, differences in percentile values between populations were observed, highlighting the importance of having local references for the evaluation of skeletal robustness.

Socio-cognitive barriers to healthy eating among mothers: A segmentation analysis in Argentina, France, and Denmark

The prevalence of childhood obesity has increased at an alarming rate despite several actions to reverse this trend. It is important to focus on tackling the constraints for healthy food provisioning. We focus on identifying segments of mothers in relation to factors acting as barriers to healthy eating. Five hundred mothers in each country (Argentina, France and Denmark) completed an online survey. In each of the three countries, four segments are identified, varying mostly on working and socio-economic status, self-efficacy and attitudes to health experts. Segments of mothers who are skeptical to nutrition advice from health professionals were identified. Another important finding is that staying-at-home mothers might face more barriers to healthy eating than mothers who work outside the home. We provide suggestions for targeted interventions addressing healthy eating behaviors among mothers with different profiles.

Exploring factors associated with obesity in Argentinian children using structural equation modeling

Habits and behaviors related to obesity risk are strongly associated with the family environment and are affected by socioeconomic factors. Structural equation modeling (SEM) allows us to hypothesize on how the relationships between these factors occur and measure their impact. This study aimed to explore the relationship between family socioeconomic indicators and childhood obesity, mediated by habits linked to energy balance, applying a SEM. A cross sectional study was performed on 861 Argentinian schoolchildren aged 6-12 years, from 2015 to 2016. The model included three latent variables: socioeconomic status, healthy habits, and obesity. Socioeconomic status indicators and healthy habits were surveyed by self-administered parental questionnaires, whereas obesity indicators were evaluated with anthropometry. The applied model showed an acceptable fit (NFI = 0.966; CFI = 0.979; RMSEA = 0.048). Socioeconomic status positively influenced parental education, health insurance, and car possession, while negatively influenced crowding (p < 0.001). Healthy habits significantly influenced physical activity, meals frequency, and sleep hours, while negatively influenced sedentary hours and mother's nutritional status (p < 0.001). Obesity factor positively influenced body mass index, body fat, and waist-to-height ratio (p < 0.001). Finally, socioeconomic status positively influenced health habits, which in turn negatively influenced obesity factor. Healthy habits (especially physical activity and mother's nutritional status) mediated the relationship between socioeconomic status and child obesity. Further research should include other indicators related to diet, eating habits, and physical activity like neighborhood characteristics.

Secular Change in Body Size and Somatotype of Indonesian Children aged 7–15 Years (1999–2019)

BACKGROUND: Secular changes assessment can help identifying the quality of health, wealth, and nutrition among populations and provide suggestions for policymakers. AIM: To examine the secular changes in weight, height, body mass index, and somatotype in Indonesian children between 1999 and 2019. METHODS: This cross-sectional study was conducted in 1999 and 2019 on 2021 children aged 7–15 years in Yogyakarta, Indonesia. Anthropometric measurements including height, weight, humerus and femur breadths, circumferences of upper arm and calf; skinfold thickness of triceps, subscapular, suprailiac, and calf were measured. Body mass index (BMI) was calculated as kg/m2. Somatotype components were defined by the Carter-Heath method. Statistical analyses used were three-ways ANOVA and least significant difference post hoc tests. RESULTS: Significant differences for boys and girls were found for height, weight, BMI, and three components of somatotype across the 2-time points. The boys in period 2019 were the tallest and girls were the heaviest, and for BMI, the highest value was observed in 2019 (girls). The children in the 1999 period had somatotype values 3.3 - 3.3 - 3.7 (boys) and 3.9 - 3.0 - 3.5 (girls), while in the 2019 period the somatotype values for boys were 3.5 - 4.5 - 3.0 and 4.3 - 4.1 - 2.4 for girls. CONCLUSION: In general, based on the order of age, there is a similar pattern between children in the two periods. Among Indonesian children from 1999 to 2019, there were positive trends in weight, BMI, endomorph, and mesomorph components, whereas a negative trend for the ectomorph component.

Nutritional status of children with cerebral palsy attending rehabilitation centers

AIM

To describe the nutritional status of children with cerebral palsy (CP) from rehabilitation and therapeutic centers in Argentina, and to analyze their risk of undernutrition based on their Gross Motor Function Classification System (GMFCS) level.

METHOD

This was a cross-sectional study with data collected from 321 children (196 males, 125 females) with CP age 2 to 19 years (mean age 9y 3mo, SD 4y 5mo) from 17 rehabilitation and therapeutic centers in five Argentine provinces. Nutritional status was defined by height, weight, and body mass index for age z-scores using World Health Organization growth charts. Odds ratios were used to evaluate the association between GMFCS level and nutritional status.

RESULTS

Of the children with CP studied, 52.4% were in GMFCS levels IV and V. Regarding the nutritional status, 41.7% were normal, 19.0% had moderate undernutrition, 33.9% severe undernutrition, 2.5% overweight, and 2.8% obese. When compared to those in GMFCS levels I to III, the odds of children in GMFCS levels IV and V having moderate undernutrition are four times greater and the odds of having severe undernutrition are 14 times greater.

INTERPRETATION

There is a high prevalence of undernutrition associated with CP (GMFCS levels IV and V) among children in rehabilitation and therapeutic centers in Argentina. Risk of severe undernutrition increases with increased motor compromises.

Estado nutricional de niños y niñas con parálisis cerebral que asisten a centros de rehabilitación

Objetivo

Describir el estado nutricional de niños con parálisis cerebral (PC) en centros de rehabilitación y terapéuticos de Argentina, y analizar el riesgo de desnutrición en relación su nivel según el sistema de la clasificación de la función motora gruesa (GMFCS).

Método

Este fue un estudio transversal con datos recolectados de 321 niños (196 varones, 125 mujeres) con PC de 2 a 19 años (edad media 9 años 3 meses, DE 4 años) de 17 centros de rehabilitación y terapéuticos en cinco provincias argentinas. El estado nutricional se definió con puntajes z según peso, talla e índice de masa corporal para la edad utilizando patrones de crecimiento de la Organización Mundial de la Salud. Se utilizó Odds ratio para evaluar la asociación entre el nivel GMFCS y el estado nutricional.

Resultados

De los niños con PC estudiados, 52.4% tenían nivel IV y V de GMFCS. En cuanto al estado nutricional, 41,7% eran normales, 19,0% tenían desnutrición moderada, 33,9% desnutrición severa, 2,5 % sobrepeso, y 2,8% obesidad. En comparación con los niños con niveles I–III de GMFCS, los niños con niveles IV y V de GMFCS presentaron 4 veces más probabilidades de presentar desnutrición moderada y 14 veces más probabilidades de tener desnutrición severa.

Interpretación

Existe una alta prevalencia de desnutrición asociada a la PC (niveles IV y V de GMFCS) entre niños de centros de rehabilitación y terapéuticos en Argentina. El riesgo de desnutrición severa aumenta cuando aumenta el compromiso motor.

Short sleep and low milk intake are associated with obesity in a community of school aged children from Argentina

OBJECTIVES

Understanding the factors related to obesity during childhood allows for improved preventive actions specifically adapted to particular communities. The purpose of this study was to identify individual and familiar factors related to obesity in children.

METHODS

A cross-sectional study was conducted in an urban community in Argentina during the years 2015-2016. Weight and height were measured on a probabilistic sample of 1366 schoolchildren aged 6 to 12 years. BMI categories were established according to International Obesity Task Force (IOTF) cut-offs. Data were analyzed using multivariate and logistic regression models. Independent variables corresponded to four domains: anthropometric, socioeconomic and demographic, nutritional, and energy balance.

RESULTS

Twenty percent of children were categorized as overweight (OW) and 12.2% were obese (OB). Parental IOTF grade was positively associated with childhood OW/OB (father B = 0.421 P = 0.000, OR = 1.52, 95% CI 1.24-1.88; mother B = 0.498 P = 0.000, OR = 1.65, 95% CI 1.37-1.97). The remaining variables were negatively associated with OW/OB: hours of sleep (B = -0.566 P = 0.001, OR = 0.57, 95% CI 0.41-0.79), physical activity (B = -0.362 P = 0.017, OR = 0.70, 95% CI 0-52-0.94), and daily milk intake (B = -0.178 P = 0.045, OR = 0.84, 95% CI 0.70-0.99). Parental IOTF predicted both OW and OB, while sleep hours predicted OW and physical activity predicted OB.

CONCLUSIONS

Family should be considered the initial target for effective strategies to reduce obesity. Like physical activity, the promotion of milk and dairy intake, as well as sleep, may have a major role in obesity reduction because of their protective effects in this community.

The Use of Arm Span as a Substitute for Height in Calculating Body Mass Index (BMI) for Spine Deformity Patients

OBJECTIVE

To compare arm span and height in body mass index (BMI) calculation in patients with spinal curvature and investigate their impact on interpretation of BMI.

STUDY DESIGN

Prospective case-control cohorts.

SUMMARY OF BACKGROUND DATA

The BMI value is based on weight to height ratio. Spine deformity patients experience height loss and its use in calculating BMI is likely to produce errors. A surrogate for height should therefore be sought in BMI determination.

METHODS

Ninety-three spine deformity patients were matched with 64 normal children. Anthropometric values (height, arm span, and weight) and spinal curve were obtained. BMIs using arm span and height were calculated, and statistical analysis performed to assess the relationship between BMI/height and BMI/arm span in both groups as well as the relationship between these values and Arm Span to Height difference (Delta AH).

RESULTS

There were 46 males and 47 females, the average age was 15.5 years in Group 1 versus 33 males and 31 females, average age 14.8 years in Group 2. Major scoliosis in Group 1 averaged 125.7° (21° to 252°). The extreme curves show vertebral transposition, with overlapping segments making it more than 180°. A logistic regression showed that there was linearity in BMI scores (R² = 0.97) for both arm span and height (R² = 0.94) in group 2 patients. For group 1 patients there was a significant difference in the BMI values when comparing BMI/arm span versus BMI/height (p < .0001). Mean BMI values using height was overstated by 2.8 (18.6%). The threshold at which BMI score must be calculated using arm span as opposed to the height (Delta AH) was determined to be 3 cm.

CONCLUSIONS

Spine deformity patients experience height loss, which can impact their true BMI values thereby giving an erroneous impression of their nutritional status. The arm span should be used in patients with Delta AH >3 cm to properly assess nutritional status.

Secular trends in height, weight and body mass index of primary school children in Turkey between 1993 and 2016

BACKGROUND

The aim of the study was to analyze the secular trends in height, weight and body mass index (BMI) of children in a Turkish primary school in a 23-year time interval.

METHODS

The height, weight and BMI of 1099 children between 7 and 15 years old were measured. Data were compared to those of children of the same ages from previous measurements carried out in 1993 (867 children) and in 2003 (1214 children) in the same school. The changes in weight, height and BMI were determined and analyzed statistically.

RESULTS

Weight increments between 7.7 and 16.2 kg/23 years and height increments between 1.1 and 8.3 cm/23 years were observed in boys. For girls, weight increments between 6.5 and 13.4 kg/23 years and height increments between 1.3 and 7.2 cm/23 years were indicated. Usually, there were significant height increments between 1993 and 2016 in both genders. However, there were no significant differences in height between 2003 and 2016 for all age groups. Furthermore, there were significant differences in BMI measurements in all age and gender groups between 1993 and 2016.

CONCLUSIONS

The secular ascending trend in height seems to stop between 2003 and 2016; however, increments in weight and mean BMI tend to continue in Turkish primary school children and adolescents.

Trends in overweight and obesity prevalence in Tuscan schoolchildren (2002-2012)

Objective

The aim of the present study was to examine the prevalence and time trends in childhood overweight including obesity and obesity among Tuscan children from 2002 to 2012.

Design

Cross-sectional study at five time points (Tuscan Nutritional Surveillance Surveys conducted in the years of 2002, 2006, 2008, 2010 and 2012). Trained personnel directly measured the height and weight of the subjects. BMI was assessed by means of the International Obesity Task Force (IOTF) and WHO cut-offs.

Setting

Representative sample of children in the Tuscany region (Italy).

Subjects

Children (n 7183) aged between 7·5 and 9·5 years (3711 boys and 3472 girls).

Results

With respect to the estimation of the absolute prevalence level of childhood overweight, a discrepancy was observed between the two criteria. In all surveys, more boys than girls were overweight (including obesity). Trend analysis showed a significant decrease in the prevalence of overweight including obesity and obesity in Tuscan children from 2002 to 2012 (32·0 % v. 25·8 %, P<0·001 on using IOTF criteria and 37·7 % v. 34·3 %, P<0·001 on using WHO criteria for overweight including obesity; and 10·0 % v. 6·7 %, P<0·001 on using IOTF criteria and 12·5 % v. 11·3 %, P=0·035 on using WHO criteria for obesity).

Conclusions

The present study is the first report from an Italian region showing a significant decrease in childhood obesity and overweight in the last 10 years. This reduction is probably a result of regional and local actions that have taken place in many sectors of society. However, efforts should be made to lower the prevalence of childhood obesity and overweight further.

Changes in total and central adiposity and body fat distribution among 7-10-year-old schoolchildren in Brazil

OBJECTIVE

To describe changes in total and central adiposity and body fat distribution in children over a 5-year period by investigating variations in BMI, waist circumference (WC), waist-to-height ratio (WHtR) and skinfold thicknesses (SFT).

DESIGN

A school-based sample of children from 2nd to 5th grades of elementary schools participated in two cross-sectional studies in 2002 (n 2936) and 2007 (n 1232).

SETTING

Public and private schools of Florianopolis, Brazil.

SUBJECTS

Schoolchildren aged 7-10 years had their weight, height, WC and SFT measured according to standard procedures. Body fat distribution was assessed by triceps, subscapular, suprailiac and medial calf skinfold measurements. Changes in BMI, WC, WHtR and SFT were analysed, adjusting for type of school and monthly family income.

RESULTS

Adjusted mean differences between 2002 and 2007 for BMI and WC were always positive and of similar magnitude between boys and girls. However, a statistically significant increase was observed only for BMI (raw and Z-score values) in boys. WHtR remained stable in both sexes. Adjusted median values for SFT also increased in boys and girls, except for triceps skinfold. BMI, WC and SFT tended to increase across age classes in both sexes. The relative change observed for the median central skinfolds (subscapular and suprailiac) was greater than that of peripheral skinfolds (triceps and medial calf).

CONCLUSIONS

The subcutaneous adipose tissue (SFT) appeared to increase at a faster rate than total adiposity (BMI). The increase in central SFT indicates that the relative change is due primarily to a rise in central adiposity.

Weight and height centiles of Argentinian children and adolescents: a comparison with WHO and national growth references

BACKGROUND

Studies in several countries comparing the performance of WHO references and their own national growth standards reported differences that could affect screening and growth monitoring.

AIM

To estimate weight and height centiles on a sample of Argentinian children and adolescents and compare selected centiles with WHO and national growth references.

SUBJECTS AND METHODS

A cross-sectional school survey was conducted on 6239 boys and girls aged 5-18. Data were collected between 2005-2009 in Santa Rosa, Argentina. Smoothed weight and height centiles were estimated by the LMS method and compared with WHO 2007 and Argentinian (ARG) growth references.

RESULTS

Weight centiles were higher than those of WHO and ARG. Height centiles were above the ARG and below the WHO ones. The greatest differences with ARG were seen before puberty and then declined up to age 18. In contrast, differences with WHO increased from puberty onwards.

CONCLUSION

Compared with the ARG reference, linear growth of these schoolchildren shows a secular acceleration without substantial improvements in the adult height. In relation to WHO, the results suggest that around the adolescent growth spurt differences in linear growth between populations became larger, limiting the clinical usefulness of international growth references in adolescents.

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.