Recent trends in childhood obesity and overweight in the transition countries of Eastern and Central Europe

The Role of Motivation and Physical Self-Concept in Accomplishing Physical Activity in Primary School Children

BACKGROUND

The goal of this research is to identify correlations of motivation and physical self-concept with physical activity among students of younger school age, as well as the level of prediction of motivation and physical self-concept with physical activity of students in physical education classes.

METHODS

The sample of respondents consisted of 411 students of the third and fourth grades from the territory of the Zlatibor district. A modified Self-Regulation Questionnaire was used to assess students' motivational orientations, while appropriate subscales of the Self-perception Profile for Children measuring instrument were used to assess physical self-concept. Physical activity is shown as volume and intensive physical activity (vigorous physical activity (VPA)), measured with a Suunto memory belt pedometer and heart-rate monitor.

RESULTS

Boys' motivational predictor variables accounted for 14% (volume) and 28% (VPA) of their physical activity in class, with intrinsic motivation, introjective regulation (just for the level of physical activity), and identified regulation as the most important determinants of physical activity. For girls, the identified regulation variable (from the system of motivational predictor variables) was shown to be the primary predictor variable on both criterion variables (R2 = 0.34 and 0.36).

CONCLUSION

The teaching of physical education for students of younger school age should be conceived by creating a motivational climate, in order to encourage physical activity.

Children's Physical Self-Concept, Motivation, and Physical Performance: Does Physical Self-Concept or Motivation Play a Mediating Role?

The present study aimed to examine the relations between physical self-concept, intrinsic and extrinsic motivation as well as physical performance of 1,082 children aged 7-8 years. The central objective of this study was to contrast a mediation model assuming physical self-concept as a mediator of the relations between both types of motivation and physical performance to a mediation model assuming both types of motivation as mediators of the relations between physical self-concept and physical performance. Physical self-concept and both types of motivation were measured by using self-reported questionnaires, while physical performance was measured with 10 motor skill tests. All tests were carried out during regular school hours (8-12 A.M.) by qualified test personnel. Beyond correlation analyses, structural equation modeling (SEM) was performed to find evidence for the predictive relations between the variables under study. Results showed that physical self-concept was significantly positively related to both types of motivation and physical performance (all p < 0.001). In contrast, results of SEM revealed that only physical self-concept (p < 0.001) and intrinsic motivation (p < 0.05) were significantly positively linked to physical performance. Furthermore, physical self-concept proved to significantly mediate the relations of both types of motivation to physical performance (p < 0.001), while only intrinsic motivation, but not extrinsic motivation, proved to significantly mediate the relation between physical self-concept and physical performance (p < 0.05). These results suggest that school-based or extracurricular interventions targeted at improving younger children's physical performance only by means of an increased level of physical activity or by external factors without supporting children's physical self-concept and intrinsic motivation may have less or no effects on their physical performance.

Changes in the incidence and prevalence of type 1 and type 2 diabetes among 2 million children and adolescents in Hungary between 2001 and 2016 - a nationwide population-based study

INTRODUCTION

The aim of the present study was to assess changes in the incidence and prevalence of type 1 diabetes (T1DM) and type 2 diabetes (T2DM) in children and adolescents in Hungary during the period 2001 to 2016 in order to provide nationwide population-based epidemiology data on diabetes in youths aged 0-18 years.

MATERIAL AND METHODS

This was a retrospective cohort study of Hungarian children and adolescents aged 18 years or younger. Pharmacologically treated diabetes cases were obtained through a population-based registry of the Hungarian National Health Insurance Fund. Time series analysis was used to evaluate the changing patterns of the incidence and prevalence for type 1 and type 2 diabetes covering a 16-year period.

RESULTS

During the study period, 6,138 and 1,997 new T1DM and T2DM cases were observed, respectively. Newly diagnosed T2DM cases accounted for 24.5% of all incident diabetes cases. Incidence of T1DM increased from 16/100,000 to 23/100,000 (R ² = 0.7681; p < 0.0001). The male-to-female ratio among newly diagnosed T1DM patients did not change over the study period. Prevalence of T1DM rose from 114/100,000 to 209/100,000 (R ² = 0.9909; p < 0.0001). The prevalent T1DM cases showed significant male predominance in every year (p < 0.05). Incidence of T2DM decreased from 8/100,000 to 5/100,000 (R ² = 0.4977; p < 0.0014). The overall prevalence of T2DM did not change significantly. Prevalent T2DM cases showed significant female predominance in every year (p < 0.0001). A significant decrease in male-to female ratio was observed among newly diagnosed T2DM cases over the study period (p < 0.0001).

CONCLUSIONS

According to these population-based Hungarian data of children and adolescents with diabetes, T1DM is still the most common form and its frequency continues to rise, affecting more males than females. A high proportion of patients have T2DM, affecting more females than males, but the occurrence of medically treated cases is not increasing. The decrease in male-to-female ratio in newly diagnosed T2DM cases needs further investigations.

Status of nutrition and cardiovascular system in children from the south Moravian region of the Czech Republic: a pilot study

Nutritional status, its assessment and its influence on numerous diseases is currently still being discussed. The aim of this study was to determine the current state of nutrition by various research methods in school children. Also, to verify the accuracy of body mass index (BMI) determination in school environment and to compare the nutritional status in two different types of school. We used a quantitative questionnaire method in 64 children from schools in the South Moravian Region. We have verified the weight and height measurement in the same group by sophisticated instruments. We have determined the basic parameters of the cardiovascular system (non-invasive continuously blood pressure recording; mutual spectral analysis for estimation of baroreflex sensitivity; applanation tonometry and cardiac polygraphy for arterial stiffness evaluation). The indicative questionnaire method encountered a problem with the weight of almost 40 % of the population approached - both obesity (14.3 %) and malnutrition (25.2 %). Cardiovascular parameters were in physiological range for the given age categories. We found increased values in BMI, % of body fat and heart rate in children from countryside type of school, respectively. We concluded that obesity/malnutrition are both common phenomena in the children population in the Czech Republic.

The Relationship between Body Fat Percentage and Some Anthropometric and Physical Fitness Characteristics in Pre- and Peripubertal Boys

The main aim of this study was to compare anthropometric and physical fitness indicators of boys of the same chronical age but with different fat percentages. Subjects were Hungarian boys aged 9⁻13 years (N = 6919). Anthropometry was measured according the guidelines of the International Biological Program. Relative body fat was estimated by Drinkwater⁻Ross's method (1980); Conrad's growth type of physique was also estimated (1963). Physical fitness was tested with 30 m dash (s), standing long jump (cm), fistball throw (m), and 1200 m run (s). Subjects of each cohort were grouped into seven subgroups with fat percentage ranges of 4%. Differences between subgroups were tested by one-way ANOVA. In the case of a significant F-test, Tukey's post-hoc tests were used. The level of effective random error was set at 5% in all significance tests (p < 0.05). Except for the three groups with low fat percentages, values of body weight, stature, body mass index, and plastic and metric indexes were significantly higher; results of 30 m, 1200 m running, and standing long jump were worse in all groups with higher fat percentages. An interesting finding of the current study is that body fat percentage also influenced the physical fitness of non-overweight and obese children as well when using merely the 4% ranges in grouping by fatness. The lower the fat the better the physical fitness was in this sample of pre- and peripubertal boys.

The Reform of School Catering in Hungary: Anatomy of a Health-Education Attempt

School lunch nutrition standards are an important carrier of messages on healthy eating and an efficient way of changing the nutritional behaviour of new generations. Many countries in Europe have a compulsory system of school meals; the Hungarian government also wanted to take action in order to improve the nutrition requirements of the school catering service. The Hungarian Ministry of Human Resources established some limits in the school catering system. However, increasing public pressure forced the legislating organ to considerably modify this regulation. The aim of this study is to analyse the causes of this failure, based on a conceptual framework of institutional economics and a strategic modelling of different institutes by examining the results of 72 interviews (33 experts, 26 parents and 13 teachers) conducted with representatives of different stakeholders. The results highlight the lack of preparation for the introduction of the new regulatory framework, as well as the inefficient communication between the different stakeholders. In order to support children in eating healthfully, a complex nutrition education program and continuous dialogue is needed between teachers, parents, catering staff and the government.

Vitamin D Insufficiency in Overweight and Obese Children and Adolescents

Excessive body weight and obesity in childhood and adolescence are becoming more and more important unfavorable factors that entail extremely adverse consequences and require close attention of physicians of any specialty. Along with the high prevalence of obesity and metabolic syndrome in pediatric patients, children and adolescents in the majority of countries are diagnosed with vitamin D deficiency. Among the non-calcaemic effects of vitamin D, a significant role is played by its impact on the hormonal regulation of glucose metabolism and the synthesis of adipokines by fat tissue. The review presents literature data indicative of a close pathogenic relationship between vitamin D insufficiency and impaired tissue insulin sensitivity. It demonstrates the role of vitamin D insufficiency in immune reactions resulting in development of subclinical inflammation in fat tissue infiltrated with macrophages and lymphocytes. It also shows the role of adipokines, immune system cells and pro-inflammatory cytokines produced by them in the pathogenesis of obesity, as well as the function of vitamin D as an endocrine and paracrine regulator of the process of inflammation in adipose tissue. The relationships between the principal adipokines (leptin, adiponectin, resistin) are revealed in the presence of normal vitamin D content and in vitamin D deficiency. The carbohydrate and lipid metabolism parameters in overweight children and adolescents with vitamin D insufficiency are analyzed. A high prevalence of vitamin D insufficiency in overweight and obese children and adolescents (increasing along with the severity of obesity) is demonstrated. The review also presents the current recommendations for the correction of vitamin D insufficiency and underlines the need for higher cholecalciferol doses to achieve serum calcifediol targets in overweight and obese children and adolescents.

Socioeconomic differences in childhood BMI trajectories in Belarus

Objective

To examine associations of parental socioeconomic position with early-life offspring body mass index (BMI) trajectories in a middle-income country.

Subjects

Overall, 12,385 Belarusian children born 1996–97 and enrolled in a randomised breastfeeding promotion trial at birth, with 3–14 measurements of BMI from birth to 7 years.

Methods

Cohort analysis in which exposures were parental education (common secondary or less; advanced secondary or partial university; completed university) and occupation (manual; non-manual) at birth, and the outcome was BMI z-score trajectories estimated using multilevel linear spline models, controlling for trial arm, location, parental BMI, maternal smoking status and number of older siblings.

Results

Infants born to university-educated mothers were heavier at birth than those born to secondary school-educated mothers [by 0.13 BMI z-score units (95% confidence interval, CI: 0.07, 0.19) for girls and 0.11 (95% CI: 0.05, 0.17) for boys; equivalent for an infant of average birth length to 43 and 38 g, respectively]. Between the ages of 3–7 years children of the most educated mothers had larger BMI increases than children of the least educated mothers. At age 7 years, after controlling for trial arm and location,  children of university-educated mothers had higher BMIs than those born to secondary school-educated mothers by 0.11 z-score (95% CI: 0.03, 0.19) among girls and 0.18 (95% CI: 0.1, 0.27) among boys, equivalent to differences in BMI for a child of average height of 0.19 and 0.26 kg/m², respectively. After further controlling for parental BMI, these differences attenuated to 0.08 z-score (95% CI: 0, 0.16) and 0.16 z-score (95% CI: 0.07, 0.24), respectively, but changed very little after additional adjustment for number of older siblings and mother’s smoking status. Associations were similar when based on paternal educational attainment and highest household occupation.

Conclusions

In Belarus, consistent with some middle-income countries, higher socioeconomic position was associated with greater BMI trajectories from age 3 onwards.

Effectiveness of social marketing strategies to reduce youth obesity in European school-based interventions: a systematic review and meta-analysis

CONTEXT

The use of social marketing to modify lifestyle choices could be helpful in reducing youth obesity. Some or all of the 8 domains of the National Social Marketing Centre's social marketing benchmark criteria (SMBC) are often used but not always defined in intervention studies.

OBJECTIVE

The aim of this review is to assess the effectiveness of European school-based interventions to prevent obesity relative to the inclusion of SMBC domains in the intervention.

DATA SOURCES

The PubMed, Cochrane, and ERIC databases were used.

STUDY SELECTION

Nonrandomized and randomized controlled trials conducted from 1990 to April 2014 in participants aged 5 to 17 years were included.

DATA EXTRACTION

After the study selection, the 8 domains of the SMBC were assessed in each included study.

RESULTS

Thirty-eight publications were included in the systematic review. For the meta-analysis, randomized controlled trials (RCTs) reporting body mass index or prevalence of overweight and obesity were considered. Eighteen RCTs with a total of 8681 participants included at least 5 SMBC. The meta-analysis showed a small standardized mean difference in body mass index of -0.25 (95%CI, -0.45 to -0.04) and a prevalence of overweight and obesity odds ratio of 0.72 (95%CI, 0.5-0.97).

CONCLUSION

Current evidence indicates that the inclusion of at least 5 SMBC domains in school-based interventions could benefit efforts to prevent obesity in young people. PROSPERO registration number: CRD42014007297.

A youth-led social marketing intervention to encourage healthy lifestyles, the EYTO (European Youth Tackling Obesity) project: a cluster randomised controlled0 trial in Catalonia, Spain

Background

The encouragement of healthy lifestyles for obesity prevention in young people is a public health priority. The European Youth Tackling Obesity (EYTO) project is a multicentric intervention project with participation from the United Kingdom, Portugal, the Czech Republic and Spain. The general aim of the EYTO project is to improve lifestyles, including nutritional habits and physical activity practice, and to prevent obesity in socioeconomically disadvantaged and vulnerable adolescents. The EYTO project works through a peer-led social marketing intervention that is designed and implemented by the adolescents of each participating country. Each country involved in the project acts independently. This paper describes the “Som la Pera” intervention Spanish study that is part of the EYTO project.

Methods/Design

In Spain, the research team performed a cluster randomised controlled intervention over 2 academic years (2013–2015) in which 2 high-schools were designated as the control group and 2 high-schools were designated as the intervention group, with a minimum of 121 schoolchildren per group.

From the intervention group, 5 adolescents with leadership characteristics, called “Adolescent Challenge Creators” (ACCs), were recruited. These 5 ACCs received an initial 4 h training session about social marketing principles and healthy lifestyle theory, followed by 24 sessions (1.30 h/session) divided in two academic years to design and implement activities presented as challenges to encourage healthy lifestyles among their peers, the approximately 180–200 high-school students in the intervention group. During the design of the intervention, it was essential that the ACCs used the 8 social marketing criteria (customer orientation, behaviour, theory, insight, exchange, competition, segmentation and methods mix). The expected primary outcomes from the Spanish intervention will be as follows: increases in the consumption of fruits and vegetables and physical activity practice along with reductions in TV/computer/game console use. The secondary outcomes will be as follows: increased breakfast consumption, engagement with local recreation and reduced obesity prevalence. The outcomes will be measured by the Health Behaviour in School-aged Children Study (HBSC) survey at baseline and at the end of the intervention.

In the control group, no intervention was implemented, but the outcome measurements were collected in parallel with the intervention group.

Discussion

This study described a new methodology to improve lifestyles and to address adolescent obesity.

Trial registration

ClinicalTrials.gov: NCT02157402. Registered 03 June 2014.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1920-1) contains supplementary material, which is available to authorized users.

Establishing Normative Reference Values for Standing Broad Jump Among Hungarian Youth

PURPOSE

The purpose of this study was to examine age and sex trends in anaerobic power assessed by a standing broad jump and to determine norm-referenced values for youth in Hungary.

METHOD

A sample of 2,427 Hungarian youth (1,360 boys and 1,067 girls) completed the standing broad jump twice, and the highest distance score was recorded. Quantile regression was used to fit standing broad jump trends across linear and quadratic functions of age. Statistical significance was determined with bootstrap confidence intervals and the Wald test with p < .05. Age-by-sex specific centiles were generated and the 50th percentile was used to describe the overall patterns.

RESULTS

Standing broad jump scores increased steadily in boys from age 11 through 18 years with a discrete plateau at the end of adolescence. Girls' standing broad jump scores of those who performed above the median increased with age and plateaued later in the adolescence. Both linear and quadratic age terms were statistically significant predictors of standing broad jump trends across age (p < .05), but the relations varied depending on the percentile. The 50th percentile values resulted in 147.0 cm, 162.0 cm, 175.0 cm, 186.0 cm, 195.0 cm, 202.0 cm, 207.0 cm, and 210.0 cm for boys aged 11 to 18 years old, respectively, and 140.0 cm, 143.9 cm, 147.3 cm, 150.0 cm, 152.1 cm, 153.7 cm, 154.6 cm, and 155.0 cm for girls aged 11 to 18 years old, respectively.

CONCLUSIONS

This study provides normative reference charts that take into account age and sex differences in standing broad jump performance. The proposed reference values can be used to interpret standing broad jump scores in Hungarian youth.

Establishing Normative Reference Values for Handgrip Among Hungarian Youth

PURPOSE

The purpose of this study was to examine age- and sex-related variation in handgrip strength and to determine reference values for the Hungarian population.

METHOD

A sample of 1,086 Hungary youth (aged 11-18 years old; 654 boys and 432 girls) completed a handgrip strength assessment using a handheld dynamometer. Quantile regression was used to compute separate models for boys and girls and included a linear, cubic, and quadratic term for age to account for nonlinear patterns. These terms were tested for statistical significance using the Wald statistical test with p < .05. Age- and sex-specific centiles were generated and the 50th percentile was used to describe the overall patterns in handgrip strength.

RESULTS

The linear, cubic, and quadratic terms for age fitted the data well for boys (p < .05), while both linear and quadratic terms for age were statistically significant for girls (p < .05). The 50th percentile values resulted in 21.4 kg, 21.7 kg, 25.0 kg, 30.0 kg, 35.4 kg, 40.0 kg, 42.6 kg, and 42.0 kg for boys aged 11 to 18 years old, respectively. The same percentile resulted in 20.0 kg, 19.5 kg, 19.6 kg, 20.3 kg, 21.6 kg, 23.5 kg, 26.1 kg, and 29.2 kg for girls aged 11 to 18 years old, respectively.

CONCLUSIONS

Muscle strength as determined by handgrip has distinct age-related patterns in boys and girls. We have accounted for biological age differences and developed norm-referenced values that can be used to interpret handgrip assessment scores obtained from school-aged children in Hungary.

THE BIOLOGICAL STATUS OF CHILDREN LIVING IN DISADVANTAGED REGIONS OF HUNGARY

The aim of this study was to find out whether differences exist in the physical development, nutritional status and psychosomatic status of children living in deprived regions of Hungary compared with the Hungarian national reference values. The Hungarian government’s decree No. 24/2003 created a complex indicator of social and economic conditions by which the country’s regions were graded into deprived and non-deprived regions. This study examined 3128 children (aged 3–18 years) living in the deprived regions and their biological status was compared with the national reference values (2nd Hungarian National Growth Study). Children’s body development was assessed via some absolute body dimensions. Nutritional status was estimated by BMI with children being divided into ‘underweight’, ‘normal’, ‘overweight’ and ‘obese’ categories. For children aged 7–18 years a standard symptoms list was used to characterize psychosomatic status. The subjects were asked to rate their health status as excellent, good, fair or poor. The body development of children living in these deprived regions was significantly retarded compared with the national references in the age groups 7–9 years and 14–17 years for boys and in the age groups 4–6 and 14–17 for girls. The prevalence of underweight was significantly higher in children and adolescents living in deprived regions (boys: 4.8%; girls: 5.9%) than the national references (boys: 2.9%; girls: 4.0%), while the prevalence of overweight and obese children did not differ between deprived regions (boys: 20.2%; girls: 19.8%) and the national references (boys: 21.5%; girls: 19.1%). Children and adolescents living in the deprived regions rated their health status worse, and experienced more psychosomatic complaints (abdominal discomfort and fear), than the national references. Although the majority of body dimensions of children in deprived regions were close to the 50th centile of the Hungarian national references, a sizeable minority (31%) were 0.20SD or more away from the median value, which has implications as to how social, medical and public welfare policy can be shaped.

Country-level and individual correlates of overweight and obesity among primary school children: a cross-sectional study in seven European countries

BACKGROUND

The present study aims to estimate childhood overweight and obesity prevalence and their association with individual and population-level correlates in Eastern and Western European countries.

METHODS

Data were obtained from the School Children Mental Health in Europe, a cross-sectional survey conducted in 2010 in Italy, Germany, the Netherlands, Romania, Bulgaria, Lithuania and Turkey. The sample consists of 5,206 school children aged 6 to 11 years old. Information on socio-demographics, children's height and weight, life-style and parental attitude were reported by the mothers. Country-level indicators were obtained through several data banks. Overweight and obesity in children were calculated according to the international age and gender-specific child Body Mass Index cut-off points. Multivariable logistic regression models included socio-demographic, lifestyle, mothers' attitude, and country-level indicators to examine the correlates of overweight.

RESULTS

Overall prevalence was 15.6% (95% CI = 19.3-21.7%) for overweight and 4.9% (95% CI = 4.3-5.6%) for obesity. In overweight (including obesity), Romanian children had the highest prevalence (31.4%, 95% CI = 28.1-34.6%) and Italian the lowest (10.4%, 95% CI = 8.1-12.6%). Models in the pooled sample showed that being younger (aOR = 0.93, 95% = CI 0.87-0.97), male (aOR = 1.24, 95% CI = 1.07-1.43), an only child (aOR = 1.40, 95% CI = 1.07-1.84), spending more hours per week watching TV (aOR = 1.01, 95% CI =1.002-1.03), and living in an Eastern Country were associated with greater risk of childhood overweight (including obesity). The same predictors were significantly associated with childhood overweight in the model conducted in the Eastern region, but not in the West. Higher Gross Domestic Product and Real Domestic Product, greater number of motor and passenger vehicles, higher percentage of energy available from fat, and more public sector expenditure on health were also associated with lower risk for childhood overweight after adjusting for covariables in the pooled sample and in the east of Europe, but not in the West.

CONCLUSIONS

Prevalence rates of overweight and obesity in school children is still high, especially in Eastern regions, with some socio-demographic factors and life-styles associated with being overweight. It is also in the Eastern region itself where better macro-economic indicators are related with lower rates of childhood overweight. This represents a public health concern that deserves special attention in those countries undertaking economic and political transitions.

SECULAR GROWTH AND MATURATION CHANGES IN HUNGARY IN RELATION TO SOCIOECONOMIC AND DEMOGRAPHIC CHANGES

This paper analyses the secular changes in the body development patterns of Hungarian children between the 1910s and the beginning of the 2000s in relation to socioeconomic and demographic changes in the country. Individual growth data of children were available from two national growth studies (1983-86, 2003-06), while sample-size weighted means of children's body dimensions were collected through regional studies between the 1920s and 1970s. Gross domestic product, Gini index, life expectancy at birth and under-5 mortality rate were used to assess the changes in economic status, income inequalities of the society and the population's general health status, respectively. Secular changes in food consumption habits were also examined. The positive Hungarian secular changes in socioeconomic status were associated with a continuous increase in children's body dimensions. The negative socioeconomic changes reflected only in wartime and post-war periods of children's growth, and the considerable socioeconomic changes at the beginning of the 1990s did not appear to influence the positive trend in children's growth. The positive secular trend in stature and body mass did not level off at the beginning of the 2000s: the socioeconomic conditions that support optimal growth and maturation could improve in Hungary.