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Hayes A, Raghunandan R, Killedar A, Smith S, Cvejic E, Howell M, Petrou S, Lancsar E, Wong G, Craig J, Howard K. Reliability, acceptability, validity and responsiveness of the CHU9D and PedsQL in the measurement of quality of life in children and adolescents with overweight and obesity. Int J Obes (Lond) 2023:10.1038/s41366-023-01305-5. [PMID: 37072461 DOI: 10.1038/s41366-023-01305-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND The Paediatric Quality of life Inventory (PedsQLTM) Generic Core Scales and the Child Health Utilities 9 Dimensions (CHU9D) are two paediatric health-related quality of life (HRQoL) measures commonly used in overweight and obesity research. However, no studies have comprehensively established the psychometric properties of these instruments in the context of paediatric overweight and obesity. The aim of this study was to assess the reliability, acceptability, validity and responsiveness of the PedsQL and the CHU9D in the measurement of HRQoL among children and adolescents living with overweight and obesity. SUBJECTS/METHODS Subjects were 6544 child participants of the Longitudinal Study of Australian Children, with up to 3 repeated measures of PedsQL and CHU9D and aged between 10 and 17 years. Weight and height were measured objectively by trained operators, and weight status determined using World Health Organisation growth standards. We examined reliability, acceptability, known group and convergent validity and responsiveness, using recognised methods. RESULTS Both PedsQL and CHU9D demonstrated good internal consistency reliability, and high acceptability. Neither instrument showed strong convergent validity, but PedsQL appears to be superior to the CHU9D in known groups validity and responsiveness. Compared with healthy weight, mean (95%CI) differences in PedsQL scores for children with obesity were: boys -5.6 (-6.2, -4.4); girls -6.7 (-8.1, -5.4) and differences in CHU9D utility were: boys -0.02 (-0.034, -0.006); girls -0.035 (-0.054, -0.015). Differences in scores for overweight compared with healthy weight were: PedsQL boys -2.2 (-3.0, -1.4) and girls -1.3 (-2.0, -0.6) and CHU9D boys: no significant difference; girls -0.014 (-0.026, -0.003). CONCLUSION PedsQL and CHU9D overall demonstrated good psychometric properties, supporting their use in measuring HRQoL in paediatric overweight and obesity. CHU9D had poorer responsiveness and did not discriminate between overweight and healthy weight in boys, which may limit its use in economic evaluation.
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Affiliation(s)
- Alison Hayes
- University of Sydney School of Public Health, Sydney, NSW, Australia.
| | - Rakhee Raghunandan
- University of Sydney School of Public Health, Sydney, NSW, Australia
- Menzies Centre for Health Policy and Economics, University of Sydney, Sydney, NSW, Australia
| | - Anagha Killedar
- Menzies Centre for Health Policy and Economics, University of Sydney, Sydney, NSW, Australia
| | - Sarah Smith
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Erin Cvejic
- University of Sydney School of Public Health, Sydney, NSW, Australia
| | - Martin Howell
- Menzies Centre for Health Policy and Economics, University of Sydney, Sydney, NSW, Australia
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Emily Lancsar
- Department of Health Services Research and Policy, Australia National University, Canberra, ACT, Australia
| | - Germaine Wong
- University of Sydney School of Public Health, Sydney, NSW, Australia
| | - Jonathan Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Kirsten Howard
- University of Sydney School of Public Health, Sydney, NSW, Australia
- Menzies Centre for Health Policy and Economics, University of Sydney, Sydney, NSW, Australia
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Winn CON, Mackintosh KA, Eddolls WTB, Stratton G, Wilson AM, McNarry MA, Davies GA. Effect of high-intensity interval training in adolescents with asthma: The eXercise for Asthma with Commando Joe's® (X4ACJ) trial. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:488-498. [PMID: 34304826 PMCID: PMC8343006 DOI: 10.1016/j.jshs.2019.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/15/2019] [Accepted: 03/15/2019] [Indexed: 05/07/2023]
Abstract
BACKGROUND Higher levels of cardiorespiratory fitness are associated with reduced asthma severity and increased quality of life in those with asthma. Therefore, the purpose of this study was to evaluate the effectiveness of a 6-month high-intensity interval training (HIIT) intervention in adolescents with and without asthma. METHODS A total of 616 adolescents (334 boys; 13.0 ± 1.1 years, 1.57 ± 0.10 m, 52.6 ± 12.9 kg, mean ± SD), including 155 with asthma (78 boys), were recruited as part of a randomized controlled trial from 5 schools (4 control and 1 intervention). The 221 intervention participants (116 boys; 47 asthma) completed 6 months of school-based HIIT (30 min, 3 times per week, 10-30 s bouts at >90% age-predicted maximum heart rate with equal rest). At baseline, mid-intervention, post-intervention, and 3-month follow-up, measurements for 20-m shuttle run, body mass index (BMI), lung function, Pediatric Quality of Life Inventory, Paediatric Asthma Quality of Life Questionnaire, and Asthma Control Questionnaire were collected. Additionally, 69 adolescents (39 boys (of the 36 with asthma there were 21 boys)) also completed an incremental ramp test. For analysis, each group's data (intervention and control) were divided into those with and without asthma. RESULTS Participants with asthma did not differ from their peers in any parameter of aerobic fitness, at any time-point, but were characterized by a greater BMI. The intervention elicited a significant improvement in maximal aerobic fitness but no change in sub-maximal parameters of aerobic fitness, lung function, or quality of life irrespective of asthma status. Those in the intervention group maintained their BMI, whereas BMI significantly increased in the control group throughout the 6-month period. CONCLUSION HIIT represents an effective tool for improving aerobic fitness and maintaining BMI in adolescents, irrespective of asthma status. HIIT was well-tolerated by those with asthma, who evidenced a similar aerobic fitness to their healthy peers and responded equally well to a HIIT program.
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Affiliation(s)
- Charles O N Winn
- Swansea University Medical School, Singleton Campus, Swansea University, Swansea SA2 8PP, UK; Applied Sports Technology, Exercise and Medicine (A-STEM) Research Centre, College of Engineering, Bay Campus, Swansea University, Swansea SA1 8EN, UK
| | - Kelly A Mackintosh
- Applied Sports Technology, Exercise and Medicine (A-STEM) Research Centre, College of Engineering, Bay Campus, Swansea University, Swansea SA1 8EN, UK
| | - William T B Eddolls
- Applied Sports Technology, Exercise and Medicine (A-STEM) Research Centre, College of Engineering, Bay Campus, Swansea University, Swansea SA1 8EN, UK
| | - Gareth Stratton
- Applied Sports Technology, Exercise and Medicine (A-STEM) Research Centre, College of Engineering, Bay Campus, Swansea University, Swansea SA1 8EN, UK
| | - Andrew M Wilson
- Norwich Medical School, University of East Anglia, Norwich, England NR4 7TJ, UK
| | - Melitta A McNarry
- Applied Sports Technology, Exercise and Medicine (A-STEM) Research Centre, College of Engineering, Bay Campus, Swansea University, Swansea SA1 8EN, UK.
| | - Gwyneth A Davies
- Swansea University Medical School, Singleton Campus, Swansea University, Swansea SA2 8PP, UK.
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A bi-directional association between weight change and health-related quality of life: evidence from the 11-year follow-up of 9916 community-dwelling adults. Qual Life Res 2020; 29:1697-1706. [PMID: 31938964 DOI: 10.1007/s11136-020-02423-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To examine the prospective associations between body mass index (BMI) and health-related quality of life (HRQoL). METHODS Data were extracted from a longitudinal, nationally representative sample of 9916 men and women aged 18 years and over who were followed annually between 2006 and 2016 in the Household, Income and Labour Dynamics in Australia (HILDA) survey. HRQoL was assessed using the self-administered SF-36 questionnaire annually between 2006 (baseline) and 2016. BMI was calculated from self-reported height and weight and was classified into the following four categories of baseline BMI: underweight (< 18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2) and obese (≥ 30 kg/m2). We used linear mixed-effects regression models to investigate the associations between change in BMI (kg/m2) and concurrent changes in HRQoL scores over 11 years. RESULTS BMI gain was associated with deterioration of Physical Component Summary (PCS) (P < 0.001), but not with change in Mental component summary (MCS) over the 11-year period. BMI gain was inversely associated (P < 0.001) with five of the eight HRQoL domains (physical functioning, role physical, bodily pain, general health and vitality) with a significant graded association according to baseline BMI category. Over the 11-year study period, every unit increase in PCS was associated with a decrease of 0.02 (P < 0.001), 0.03 (P < 0.001) and 0.04 (P < 0.001) BMI units per year among participants who were normal, overweight and obese at baseline, respectively. Five of the eight domains of HRQoL (physical functioning, role physical, bodily pain, general health and vitality) were inversely associated with BMI (P < 0.001) with a significant graded association according to baseline BMI category. CONCLUSIONS Weight gain was not only associated with deterioration of HRQoL, and vice versa. The bi-directional association was stronger for physical than mental domains of HRQoL.
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Özalp Kızılay D, Yalın Sapmaz Ş, Şen S, Özkan Y, Cengiz Özyurt B, Ersoy B. Mental health of both child and parents plays a larger role in the health-related quality of life of obese and overweight children. J Pediatr Endocrinol Metab 2019; 32:1359-1367. [PMID: 31714889 DOI: 10.1515/jpem-2019-0401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/11/2019] [Indexed: 11/15/2022]
Abstract
Aims A decrease in health-related quality of life (HRQOL) measures among obese (OB) and overweight (OW) children has been shown in several studies, but knowledge about the variables affecting HRQOL impairments is missing. The aim of this study was to evaluate the relationship between HRQOL and sociodemographic characteristics, anthropometric measurements, metabolic parameters, mental symptoms and parental attitudes in a sample of OB/OW children. Methods Eighty-six OB/OW children, aged between 9 and 17 years, participated in the study. We performed sociodemographic questioning, anthropometric examinations and laboratory evaluations of the participants. HRQOL was assessed using the Pediatric Quality-of-Life Inventory (PedsQL), and levels of anxiety and depressive symptoms were measured using the Screen for Child Anxiety-Related Disorders (SCARED) questionnaire and the Children's Depression Inventory (CDI), respectively. Parental attitudes were assessed with the Parental Attitude Research Instrument (PARI) questionnaire. Results A statistically significant relationship was found between total scores of CDI and SCARED answered by children and the total and subscale scores of PedsQL. Scores of total quality of life subscale, physical functionality and emotional functionality subscales were significantly lower in children with a family history of mental illness. No relationship was found between PedsQL subscales, anthropometric and metabolic parameters. Conclusions Emotional problems and parental psychological distress are important factors in models of HRQOL in the OB/OW pediatric population.
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Affiliation(s)
- Deniz Özalp Kızılay
- Çiğli State Training Hospital, Department of Pediatrics, Division of Pediatric Endocrinology, Izmir, Turkey
| | - Şermin Yalın Sapmaz
- Department of Child Psychiatry, Celal Bayar University, School of Medicine, Manisa, Turkey
| | - Semra Şen
- Department of Pediatrics, Celal Bayar University, School of Medicine, Manisa, Turkey
| | - Yekta Özkan
- Department of Child Psychiatry, Celal Bayar University, School of Medicine, Manisa, Turkey
| | - Beyhan Cengiz Özyurt
- Department of Public Health, Celal Bayar University, School of Medicine, Manisa, Turkey
| | - Betül Ersoy
- Department of Pediatrics, Division of Pediatric Endocrinology, Celal Bayar University, School of Medicine, Manisa, Turkey
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Ortiz-Pinto MA, Ortiz-Marrón H, Rodríguez-Rodríguez A, Casado-Sánchez L, Cuadrado-Gamarra JI, Galán I. Parental perception of child health status and quality of life associated with overweight and obesity in early childhood. Qual Life Res 2019; 29:163-170. [PMID: 31583617 DOI: 10.1007/s11136-019-02313-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2019] [Indexed: 01/15/2023]
Abstract
PURPOSE The aim was to assess perceived health status and health-related quality of life (HRQL) according to persistence of and variation in weight status among children from the age of 4 to 6 years. METHODS Longitudinal study of 1883 participants in the ELOIN cohort (Madrid Region, Spain), with physical examination at ages 4 and 6 years. Perceived health status and HRQL were assessed using parent-reported Kidscreen-10 scores, with excess weight being defined on the basis of body mass index (BMI) using the WHO reference tables (z-BMI > 1 standard deviation), and abdominal obesity being defined on the basis of waist circumference (percentile ≥ 90) using the tables proposed by Fernández et al. Variation in these two parameters at age 6 years was associated with incident cases of suboptimal health by logistic regression, and with HRQL by linear regression. RESULTS Compared to children without excess weight or abdominal obesity in both periods, incident cases of excess weight or abdominal obesity had odds ratios (ORs) of suboptimal health of 2.41 (95% CI 1.21 to 4.80) and 2.99 (95% CI 1.31 to 6.84) respectively. In terms of HRQL, children with remission of excess weight had a higher Kidscreen-10 score: β coefficient = 2.02 (95% CI 0.36 to 3.68), whereas new cases of abdominal obesity had a lower Kidscreen-10 score: β = - 2.22 (95% CI - 4.40 to - 0.03). CONCLUSIONS Incident cases of excess weight and abdominal obesity had a higher risk of suboptimal health. Incident cases of abdominal obesity were also associated with worse HRQL.
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Affiliation(s)
- Maira Alejandra Ortiz-Pinto
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, c/Monforte de Lemos 5, 28029, Madrid, Spain.,Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPaz, Madrid, Spain.,Departamento de Salud Pública, Universidad del Norte, Barranquilla, Colombia
| | | | | | | | | | - Iñaki Galán
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, c/Monforte de Lemos 5, 28029, Madrid, Spain. .,Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPaz, Madrid, Spain.
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Weight Status, Physical Fitness, and Health-Related Quality of Life among Chinese Adolescents: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132271. [PMID: 31252581 PMCID: PMC6651867 DOI: 10.3390/ijerph16132271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/24/2019] [Accepted: 06/24/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE The impact of physical fitness (PF) on adolescents' health-related quality of life (HRQOL) is an important health issue in China. The purpose of this study was to identify whether body mass index (BMI), cardiorespiratory fitness (CRF), and musculoskeletal fitness (MSF) influences HRQOL among Chinese adolescents. METHOD The participants were 10,007 students (boys = 5276, 14.14 years ± 1.79; girls = 4829, 14.22 years ± 1.81) who were randomly selected from 30 secondary schools in Shandong, China. BMI, CRF, MSF, and HRQOL were measured and analyzed using ANCOVA and multiple regression. RESULTS BMI and physical fitness variables were partially associated with HRQOL in Chinese adolescents. ANCOVA showed a significant difference among BMI categories in terms of physical sense (PS), living convenience, and self-satisfaction (SS) for boys, but this difference was only seen with social activity opportunity (SAO) for girls. Multiple regression found that BMI was significantly associated with SAO. For boys, CRF was associated with the teacher and student relationship and SS, whereas MSF was only associated with PS. For girls, CRF was significantly linked with the parent and children relationship, learning capacity, and attitudes and self-perception (S-P), while MSF was associated with S-P. CONCLUSION Enforcing physical activity and enhancing PF will be a crucial pathway in improving adolescents' HRQOL in China.
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Wu H, Yin X, Chai X, Li Y, Wang G, Yang X, Sun Y, Ren S, Bi C, Li M, Liu Y. Research on Mental Sub-health of Chinese Han Adolescents with Different Nutritional Statuses. ANNALES MEDICO-PSYCHOLOGIQUES 2019. [DOI: 10.1016/j.amp.2018.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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8
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Psychosocial measures and weight change in a clinical paediatric population with obesity. Qual Life Res 2019; 28:1555-1564. [PMID: 30840194 DOI: 10.1007/s11136-019-02155-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Poor quality of life has been shown to occur in youth with obesity. This study aimed to assess associations between health-related quality of life, general mental health and general psychological distress measures, collectively termed psychosocial health questionnaires (PSH), with weight outcomes in a busy paediatric weight management service. METHODS A cross-sectional longitudinal clinical cohort, 'Childhood Overweight BioRepository of Australia (COBRA)', was used (n = 250, median age 11, range 2-18 year, mean BMI z-score 2.5 ± 0.2). Clinical data were collected and HRQOL questionnaires; Pediatric Quality of Life 4.0 (PedsQL), 'Sizing Me/Them Up' (SMU/STU), and psychological well-being questionnaires; strengths and difficulties questionnaire (SDQ) and Kessler 10 (K10) were completed by the child and primary caregiver. PSH results were compared to age- and sex-adjusted BMI z-score at baseline and follow-up. Direct logistic regression modelling was performed to assess the impact of PSH factors on the likelihood of successful weight reduction over a period of ≥ 12 months. RESULTS Mean self-report PSH scores were: 68.0 ± 15.28 (PedsQL, range 0-100), 64.8 ± 15.8, (SMU, range 0-100), 17.3 ± 4.4 (SDQ, range 0-40) and 20.0 ± 7.7 (K10, range 0-50). A significant negative correlation was observed between PSH scores and childhood obesity (baseline BMI z-scores (p < 0.01)). No correlations were observed between psychological well-being measures and BMI z-scores. Higher subscale scores of the PedsQL and SDQ, which measure impaired psychosocial health and more difficulties with hyperactivity and inattention, significantly predict weight loss in children with obesity after 12 months. CONCLUSION PSH questionnaires may be useful in identifying individuals who require additional support to achieve weight loss goals in a tertiary weight management service.
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Lycett K, McNamara C, Mensah FK, Burgner D, Kerr JA, Muller J, Wake M. Associations of mental health with cardiovascular risk phenotypes and adiposity in adolescence: A cross-sectional community-based study. J Paediatr Child Health 2018; 54:677-684. [PMID: 29779266 DOI: 10.1111/jpc.13943] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 03/21/2018] [Indexed: 12/20/2022]
Abstract
AIM Cardiovascular disease and mental illness commonly co-occur in later life, but it is unknown how early these associations arise. We aimed to determine the extent to which: (i) childhood mental health is associated with functional and structural cardiovascular risk phenotypes and adiposity in late childhood/adolescence, and (ii) associations between mental health and cardiovascular phenotypes may be explained by differential body mass index. METHODS This cross-sectional study drew on three longitudinal community-based cohort studies (two enriched for overweight/obesity) in metropolitan Melbourne, Australia, with harmonized follow-up in 2014. Mental health exposures included emotional and behavioural problems (Strength and Difficulties Questionnaire) and psychosocial health and general well-being (Pediatric Quality of Life Inventory (PedsQL)), which were assessed by self- and parent-proxy report. Cardiovascular risk phenotypes and adiposity measures included mean arterial pressure, pulse wave velocity, carotid artery intima-media thickness, retinal arterioleto-venule ratio, waist circumference, % body fat, and BMI z-score. We used multivariable linear regression models, adjusting for age, sex and neighbourhood disadvantage, to examine associations. RESULTS Of the 364 participants (mean age 14.7, standard deviation 2.0, years), 30% were overweight and 16% obese. All adiposity indicators were positively associated with higher behavioural/emotional problems and poorer psychosocial health and negatively associated with better ratings of positive general well-being, as reported by parents and children (all P ≤ 0.03). However, there was little evidence that cardiovascular functional or structural phenotypes varied by mental health. CONCLUSIONS By late childhood/adolescence, mental health is strongly associated with adiposity but not with cardiovascular structure or function. This suggests that the known relationship between these constructs may not develop until early or mid-adulthood.
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Affiliation(s)
- Kate Lycett
- Community Health Services Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Clare McNamara
- Community Health Services Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona K Mensah
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Clinical Epidemiology and Biostatistics Unit, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - David Burgner
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Jessica A Kerr
- Community Health Services Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Josh Muller
- Community Health Services Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Melissa Wake
- Community Health Services Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, Liggins Institute, University of Auckland, Auckland, New Zealand
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Evaristo S, Moreira C, Santos R, Lopes L, Abreu S, Agostinis-Sobrinho C, Oliveira-Santos J, Mota J. Associations between health-related quality of life and body mass index in Portuguese adolescents: LabMed physical activity study. Int J Adolesc Med Health 2018; 31:/j/ijamh.ahead-of-print/ijamh-2017-0066/ijamh-2017-0066.xml. [PMID: 29432203 DOI: 10.1515/ijamh-2017-0066] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/13/2017] [Indexed: 12/15/2022]
Abstract
Background In adolescence there are several biological and physiological changes associated with overweight and obesity. Objective The purpose of this study was to analyze the associations between health-related quality of life (HRQoL) and body mass index (BMI) in adolescents. Methods This is a cross-sectional analysis of 957 Portuguese adolescents (446 girls and 511 boys) aged 12-18 years. A series of variables were collected: (a) HRQoL was assessed using the KIDSCREEN-10 questionnaire; (b) socioeconomic status (SES) was measured using the Family Affluence Scale; (c) body composition (weigh, height) were measured and BMI was calculated and, (d) pubertal stage was assessed with Tanner stages; (e) the 20-m shuttle-run was used to estimate cardiorespiratory fitness. Regression models and mediation analysis were performed to assess the association between HRQoL and BMI. Results HRQoL was significantly higher in boys than girls (p < 0.05). The prevalence of overweight and obesity was 23.5% and 6.7% in girls, and 21.3% and 5% in boys, respectively. HRQoL was inversely and significantly associated with BMI in boys (B = -0.130; p < 0.05) and girls (B = -0.148; p < 0.05) after controlling for age, pubertal stage and SES. Cardiorespiratory fitness act as a full mediator variable on the relationship between BMI and HRQoL in adolescents (p < 0.05). Conclusion Our results suggest that cardiorespiratory fitness acted as a full mediator in the relationship between BMI and HRQoL, in adolescents. Public health policies targeting a wealthy weight and an improved physical fitness level could be a strategy of particular interest for improving the HRQoL of adolescents.
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Affiliation(s)
- Sofia Evaristo
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
| | - Carla Moreira
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, R. Plácido Costa, 91, 4200 450Porto, Portugal, Phone: +351-22-5074786, Fax: +351-22-5500689
| | - Rute Santos
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal.,Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW,Australia
| | - Luís Lopes
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
| | - Sandra Abreu
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
| | - César Agostinis-Sobrinho
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
| | - José Oliveira-Santos
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
| | - Jorge Mota
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
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Michels N, Susi K, Marques-Vidal PM, Nydegger A, Puder JJ. Psychosocial Quality-of-Life, Lifestyle and Adiposity: A Longitudinal Study in Pre-schoolers (Ballabeina Study). Int J Behav Med 2017; 23:383-392. [PMID: 26809517 DOI: 10.1007/s12529-016-9537-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE In obesity prevention, understanding psychosocial influences in early life is pivotal. Reviews reported contradictory results and a lack of longitudinal studies focusing on underlying lifestyle factors. This study tested whether psychosocial Quality-Of-Life (QOL) was associated with pre-schoolers' lifestyle and adiposity changes over one school year and whether lifestyle moderated the latter. It was hypothesised that QOL might not impact adiposity in everybody but that this might depend on preceding lifestyle. METHOD Longitudinal data from 291 Swiss pre-schoolers (initially 3.9-6.3 years) was available. The following measures were used in longitudinal regressions: psychosocial QOL by PedsQL, adiposity (BMI z-score, waist, fat%), diet (food frequency), sedentary time and accelerometer-based activity. RESULTS Concerning lifestyle, low psychosocial QOL was only related to unfavourable changes in diet (less fruit β = 0.21 and more fat intake β = -0.28) and lower physical activity (β = 0.21). Longitudinal QOL-adiposity relations appeared only after moderation by lifestyle factors (beta-range 0.13-0.67). Low psychosocial QOL was associated with increased adiposity in children with an unhealthy diet intake or high sedentary time. By contrast, low psychosocial QOL was associated with decreasing adiposity in high fruit consumers or more physically active pre-schoolers. CONCLUSION Results emphasise the need for testing moderation in the QOL-adiposity relation. An unhealthy diet can be a vulnerability factor and high physical activity a protective factor in QOL-related adiposity. Consequently, QOL and lifestyle should be targeted concurrently in multi-factorial obesity prevention. The environment should be an 'activity encouraging, healthy food zone' that minimises opportunities for stress-induced eating. In addition, appropriate stress coping skills should be acquired.
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Affiliation(s)
- Nathalie Michels
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 4K3, Ghent, B-9000, Belgium.
| | - Kriemler Susi
- Institute for Social and Preventive Medicine, University of Zürich, Zürich, Switzerland
| | - Pedro M Marques-Vidal
- Department of Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Andreas Nydegger
- Department of Pediatrics, Pediatric Gastroenterology Unit, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Jardena J Puder
- Diabetes and Metabolism & Division of Pediatric Endocrinology, Service of Endocrinology, Diabetes and Obesity, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
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Hovsepian S, Qorbani M, Motlagh ME, Madady A, Mansourian M, Gorabi AM, Kelishadi R. Association of obesity and health related quality of life in Iranian children and adolescents: the Weight Disorders Survey of the CASPIAN-IV study. J Pediatr Endocrinol Metab 2017; 30:923-929. [PMID: 28809752 DOI: 10.1515/jpem-2016-0402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 07/03/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Considering the role of different ethnical, cultural and geographical factors in health related quality of life (HRQOL) as well as the perception of different populations regarding various weight disorders, we aimed to evaluate the association between body mass index (BMI) and HRQOL in Iranian children and adolescents. METHODS This cross-sectional study was part of the Weight Disorders Survey of the CASPIAN-IV study. During this study, students aged 6-18 years from urban and rural areas of 30 provinces of Iran were selected. HRQOL of the students was evaluated by using the Persian version of the Pediatric Quality of Life inventory (PedsQL™ 4.0™ 4.0) Generic Core Scales. The mean of total HRQOL and its subscales were compared in underweight, normal weight, overweight and obese students. RESULTS The mean of total HRQOL, physical functioning and psychological functioning scores in the total population were 83.31, 84.25 and 82.79, respectively. The mean of the total HRQOL score and the psychosocial score were significantly lower in underweight students aged 6-12 years than in other groups (p<0.05). The mean of the total HRQOL score and psychosocial score were significantly lower in obese students aged 13-18 years than in other groups (p<0.05). Overweight and obesity was negatively associated with total HRQOL, psychosocial and school functioning subscales (p<0.05). There was a significant negative association between emotional functioning and obesity (p<0.05). CONCLUSIONS The findings or this study support the importance of personal perception and cultural norm roles in HRQOL. Given the association between weight disorders and psychosocial health, it is suggested that social and cultural factors have a more crucial role in the HRQOL of children and adolescents.
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13
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Hunsberger M, Lehtinen-Jacks S, Mehlig K, Gwozdz W, Russo P, Michels N, Bammann K, Pigeot I, Fernández-Alvira JM, Thumann BF, Molnar D, Veidebaum T, Hadjigeorgiou C, Lissner L. Bidirectional associations between psychosocial well-being and body mass index in European children: longitudinal findings from the IDEFICS study. BMC Public Health 2016; 16:949. [PMID: 27608963 PMCID: PMC5017061 DOI: 10.1186/s12889-016-3626-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background The negative impact of childhood overweight on psychosocial well-being has been demonstrated in a number of studies. There is also evidence that psychosocial well-being may influence future overweight. We examined the bidirectional association between childhood overweight and psychosocial well-being in children from a large European cohort. The dual aim was to investigate the chronology of associations between overweight and psychosocial health indicators and the extent to which these associations may be explained by parental education. Methods Participants from the IDEFICS study were recruited from eight countries between September 2007 and June 2008 when the children were aged 2 to 9.9 years old. Children and families provided data on lifestyle, psychosocial well-being, and measured anthropometry at baseline and at follow-up 2 years later. This study includes children with weight, height, and psychosocial well-being measurements at both time points (n = 7,831). Psychosocial well-being was measured by the KINDL® and Strengths and Difficulties Questionnaire respectively. The first instrument measures health-related quality of life including emotional well-being, self-esteem, parent relations and social relations while the second measures well-being based on emotional symptoms, conduct problems and peer-related problems. Logistic regression was used for modeling longitudinal associations. Results Children who were overweight at baseline had increased risk of poor health-related quality of life (odds ratio (OR) = 1.23; 95 % confidence interval (CI):1.03–1.48) measured 2 years later; this association was unidirectional. In contrast to health-related quality of life, poor well-being at baseline was associated with increased risk of overweight (OR = 1.39; 95 % CI:1.03–1.86) at 2 year follow-up; this association was also only observed in one direction. Adjustment for parental education did not change our findings. Conclusion Our findings indicate that the association between overweight and psychosocial well-being may be bidirectional but varies by assessment measures. Future research should further investigate which aspects of psychosocial well-being are most likely to precede overweight and which are more likely to be consequences of overweight.
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Affiliation(s)
- Monica Hunsberger
- Section for Epidemiology and Social Medicine (EPSO), The Sahlgrenska Academy, University of Gothenburg, Box 453, 40530, Gothenburg, Sweden.
| | | | - Kirsten Mehlig
- Section for Epidemiology and Social Medicine (EPSO), The Sahlgrenska Academy, University of Gothenburg, Box 453, 40530, Gothenburg, Sweden
| | - Wencke Gwozdz
- Department of Intercultural Communication and Management, Copenhagen Business School, POR/18.B-1.118, Copenhagen, Denmark
| | - Paola Russo
- Institute of Food Sciences, CNR Via Roma 64-83100, Avellino, Italy
| | | | - Karin Bammann
- Institute for Public Health and Nursing Research, Faculty of Human and Health Sciences (FB 11), University of Bremen, Grazer Str. 2a, 28359, Bremen, Germany
| | - Iris Pigeot
- Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany.,Leibniz Institute for Prevention Research and Epidemiology, BIPS, Achterstr. 30, 28359, Bremen, Germany
| | - Juan Miguel Fernández-Alvira
- Centro Nacional de Investigaciones Cardiovasculares Carlos III Madrid, Spain and GENUD (Growth, Exercise, Nutrition and Development) Research group, University of Zaragoza, Madrid, Spain
| | - Barbara Franziska Thumann
- Leibniz Institute for Prevention Research and Epidemiology, BIPS, Achterstr. 30, 28359, Bremen, Germany
| | - Dénes Molnar
- Department of Pediatrics, Medical Faculty, University of Pécs, H-7623, Pécs, József A. u. 7, Hungary
| | - Toomas Veidebaum
- National Institute for Health and Development, Hiiu 42, 11619, Tallinn, Estonia
| | | | - Lauren Lissner
- Section for Epidemiology and Social Medicine (EPSO), The Sahlgrenska Academy, University of Gothenburg, Box 453, 40530, Gothenburg, Sweden
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Abstract
Prevalence rates of childhood obesity have risen steeply over the last 3 decades. Given the increased national focus, the frequency of this clinical problem, and the multiple mental health factors that coexist with it, make obesity a public health concern. The complex relationships between mental health and obesity serve to potentiate the severity and interdependency of each. The purpose of this review is to create a contextual connection for the 2 conditions as outlined by the research literature and consider treatment options that affect both health problems.
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Affiliation(s)
- Leigh Small
- Family and Community Health Nursing Department, Virginia Commonwealth University School of Nursing, 1100 East Leigh Street, PO Box 980567, Richmond, VA 23298, USA.
| | - Alexis Aplasca
- Pediatrics and Psychiatry, Children's Hospital of Richmond/Virginia Treatment Center for Children, Virginia Commonwealth University School of Medicine, 515 North 10th Street, Richmond, VA 23298, USA
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Wynne C, Comiskey C, McGilloway S. The role of body mass index, weight change desires and depressive symptoms in the health-related quality of life of children living in urban disadvantage: Testing mediation models. Psychol Health 2015; 31:147-65. [DOI: 10.1080/08870446.2015.1082560] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Parkinson KN, Adamson AJ, Basterfield L, Reilly JK, Le Couteur A, Reilly JJ. Influence of adiposity on health-related quality of life in the Gateshead Millennium Study cohort: longitudinal study at 12 years. Arch Dis Child 2015; 100:779-83. [PMID: 26038309 DOI: 10.1136/archdischild-2014-307498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 05/11/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To examine whether adiposity is associated with an impaired quality of life (an individual's perception of their life) in general population samples in early adolescence. DESIGN AND METHODS Relationships between a direct measure of adiposity (fat mass index from bioimpedance) and a proxy measure (waist circumference), and a generic (KIDSCREEN-27) and a weight-specific measure of health-related quality of life (HRQoL, Impact of Weight on Quality of Life-Kids (IWQOL-Kids)) were examined in a longitudinal population-based cohort of young adolescents aged 12 years (n=519). The effects of change in adiposity over time (from 7 years and 9 years) were also examined (n=331-445 in longitudinal analyses). RESULTS Impairment in HRQoL was associated with current adiposity but it was not predicted by earlier adiposity. At 12 years, higher adiposity was associated with lower Physical Well-Being on KIDSCREEN-27, and with lower Total Scores on the weight-specific IWQOL-Kids instrument, the latter particularly in girls. CONCLUSIONS Health and education professionals need to be aware in their clinical practice that higher adiposity impairs HRQoL in general populations of young adolescents. Further research would be useful to determine whether or not children of primary school age self-reporting lower HRQoL are more likely to develop higher adiposity later in adolescence or early adulthood.
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Affiliation(s)
- Kathryn N Parkinson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Ashley J Adamson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Basterfield
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Jessica K Reilly
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Ann Le Couteur
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - John J Reilly
- Physical Activity for Health Group, School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
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17
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Bolton K, Kremer P, Rossthorn N, Moodie M, Gibbs L, Waters E, Swinburn B, de Silva A. The effect of gender and age on the association between weight status and health-related quality of life in Australian adolescents. BMC Public Health 2014; 14:898. [PMID: 25183192 PMCID: PMC4158070 DOI: 10.1186/1471-2458-14-898] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 08/21/2014] [Indexed: 01/06/2023] Open
Abstract
Background Evidence suggests an inverse relationship between excess weight and health-related quality of life (HRQoL) in children and adolescents, however little is known about whether this association is moderated by variables such as gender and age. This study aimed to investigate these relationships. Methods Participants were secondary school students (818 females, 52% and 765 males, 48%) from 23 secondary schools in Victoria, Australia. Age ranged from 11.0 to 19.6 years (mean age 14.5 years). The adolescent version of the Assessment of Quality of Life (AQoL) Instrument (AQoL-6D) which is a self-reported measure of adolescent quality of life was administered and anthropometric measures (height and weight) were taken. Assessment of weight status was categorized using the Body Mass Index (BMI). Results HRQoL was associated with gender and age, but not weight status or socio-economic status; with males and younger adolescents having higher HRQoL scores than their female and older adolescent counterparts (both p < 0.05). There was also a significant interaction of weight status by gender whereby overweight females had poorer HRQoL (-.06 units) relative to healthy weight females (p < 0.05). Conclusions This study contributes to the evidence base around factors associated with adolescent HRQoL and reveals that gender and age are important correlates of HRQoL in an Australian adolescent population. This knowledge is critical to inform the design of health promotion initiatives so they can be tailored to be gender- and age-specific. Trial registration Australian Clinical Trials Registration Number
12609000892213.
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Affiliation(s)
- Kristy Bolton
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Geelong, Australia.
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Cui W, Zack MM, Wethington H. Health-related quality of life and body mass index among US adolescents. Qual Life Res 2014; 23:2139-50. [PMID: 24526296 PMCID: PMC4600603 DOI: 10.1007/s11136-014-0646-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2014] [Indexed: 01/08/2023]
Abstract
PURPOSE To examine the magnitude of differences in health-related quality of life (HRQOL) by body mass index (BMI) in a population-based sample of United States adolescents overall and by sex, and to provide national prevalence estimates of reported HRQOL outcomes for not only obese and overweight but also underweight adolescents. METHODS From the 2001 through 2010 cross-sectional National Health and Nutrition Examination Surveys, we estimated the percentages of four HRQOL outcomes-self-rated health, physically unhealthy days, mentally unhealthy days, and activity limitation days-in four BMI categories-obese, overweight, normal weight, and underweight-of approximately 6,000 US adolescents aged 12-17 years. We also estimated the percentages for boys and girls separately. RESULTS Substantial gaps in self-rated health exist between normal-weight adolescents and those who are obese and overweight, but not underweight. Eighteen percent (95% CI 15-22) of obese adolescents reported fair or poor health compared to only 5% (95% CI 4-7) of normal-weight adolescents. Thirty-seven percent (95% CI 33-42) of obese adolescents reported excellent or very good health, compared to 65% (94% CI 63-67) of normal-weight adolescents. However, all BMI groups reported similar percentages of physically unhealthy days, mentally unhealthy days, and activity limitation days. The associations between HRQOL and BMI groups did not vary by sex. Boys generally reported significantly better self-rated health and mental health than girls. Specifically, obese boys reported better self-rated health, mental health, and fewer activity limitation days than obese girls. CONCLUSIONS Substantially, significant differences in some domains of HRQOL are found between above normal-weight and normal-weight US adolescents. This relationship between BMI and HRQOL is robust and observed among both boys and girls.
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Affiliation(s)
- Wanjun Cui
- Division of Population Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS F-78, Atlanta, GA, 30341, USA,
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Shrivastava A, Murrin C, Kelleher CC. Preschoolers' parent-rated health disparities are strongly associated with measures of adiposity in the Lifeways cohort study children. BMJ Open 2014; 4:e005328. [PMID: 25052171 PMCID: PMC4120306 DOI: 10.1136/bmjopen-2014-005328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To examine the relationship between lifecourse factors from preschoolers' microecosystem and their parent-reported (mother-reported) health (PRH), following them prospectively from preconception to age 5 years. To investigate if preschoolers' body mass index (BMI) and waist circumference were associated with preschoolers' PRH when controlled for lifecourse predictors. DESIGN Lifeways cross-generation cohort study. SETTING Ireland. PARTICIPANTS Of 1082 families, 62% mothers responded on a health and lifestyle questionnaire at follow-up. Food frequency, BMI and waist circumference were measured. There were 547 family data sets available for analysis of children's PRH. MAIN OUTCOME MEASURE Mother-reported children's PRH at age 5. Associations with child's individual and familial exposures from preconception to age 5 years examined using logistic regression. RESULTS In univariate analysis, relatively positive rating of children's PRH were associated with children's lower intake of fats (OR (95% CI) 2.2 (1.1 to 4.3)), higher intake of fruits/vegetables (OR (95% CI) 2.2 (1.1 to 4.3)); as well as familial socioeconomic characteristics {higher household income (OR (95% CI) 3.0 (1.6 to 5.9)), non-entitlement to means-tested healthcare (OR (95% CI) 2.1 (1.0 to 4.3)), mothers' higher education (OR (95% CI) 1.9 (1.0 to 3.6))}, psychosocial characteristics {father's participation in study (OR (95% CI) 2.1 (1.0 to 4.3)), mothers' perceiving better support from partner (OR (95% CI) 2.3 (1.2 to 4.3)), children (OR (95% CI) 1.9 (1.0 to 3.7)) or relatives (OR (95% CI) 2.2 (1.1 to 4.1))}, parents' lifestyle {mothers' lower intake of energy (OR (95% CI) 2.2 (1.1 to 4.3)), fathers' non-smoking status (OR (95% CI) 2.2 (1.1 to 4.4))} and parents' health {mothers' self-rated health relatively positive (OR (95% CI) 5.1 (2.6 to 9.9)), fathers' self-rated health relatively positive (OR (95% CI) 3.0 (1.5 to 6.0))}. In multivariable analysis (χ(2)=34.2, df=21, N=303, R(2 )= 0.26, p<0.05), one of the two strong predictors of children's relatively positive PRH was child not being obese by International Obesity Task Force classification (OR (95% CI) 5.5 (1.4 to 21.0)), observed also using BMI (kg/m(2); OR (95% CI) 0.73 (0.58 to 0.93)) or waist circumference (cm; OR (95% CI) 0.89 (0.81 to 0.98)) as continuous variables. The other significant predictor was mothers' self-rated health relatively positive (OR (95% CI) 4.2 (1.5 to 12.2)). CONCLUSIONS Preschoolers' health is adversely associated with obesity and this is independent of lifecourse and social and environmental inequalities. The findings suggest that reducing childhood obesity and improving maternal health may be useful ways to improve child's global health.
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Affiliation(s)
- Aakash Shrivastava
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin 4, Republic of Ireland
| | - Celine Murrin
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin 4, Republic of Ireland
| | - Cecily C Kelleher
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin 4, Republic of Ireland
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Casey MM, Harvey JT, Telford A, Eime RM, Mooney A, Payne WR. Effectiveness of a school-community linked program on physical activity levels and health-related quality of life for adolescent girls. BMC Public Health 2014; 14:649. [PMID: 24966134 PMCID: PMC4080584 DOI: 10.1186/1471-2458-14-649] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/19/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND This study evaluated the effectiveness of a school-community program on Health-Related Quality of Life (HRQoL; the primary outcome), physical activity (PA), and potential mediators of PA among adolescent girls living in low-socioeconomic rural/regional settings. METHOD The study was a cluster-randomized controlled trial. Twelve communities with the requisite sports clubs and facilities were paired according to relevant criteria; one of each pair was randomly assigned to the intervention or control condition. Eight schools per condition were randomly selected from these communities and the intervention was conducted over one school year (2011). Female students in grades 7-9 in intervention schools participated in two 6-session PA units - a sport unit (football or tennis) and a recreational unit (leisure centre-based). These were incorporated into physical education (PE) curriculum and linked to PA opportunities for participation outside school. Students were surveyed at baseline and endpoint, self-reporting impact on primary and secondary outcome measures (HRQoL, PA) and PA mediators (e.g. self-efficacy). Linear mixed models for two-group (intervention, control) and three-group (completers, non-completers, control) analyses were conducted with baseline value, age and BMI as covariates, group as a fixed effect and school as random cluster effect. RESULTS Participants completing baseline and endpoint measures included: 358 intervention (baseline response rate 33.7%, retention rate 61.3%) and 256 control (14.1% and 84.0%). Adjustment for age and BMI made no substantive difference to outcomes, and there were no cluster effects. For HRQoL, after adjustment for baseline scores, the intervention group showed significantly higher scores on all three PedsQL scores (physical functioning: M ± SE = 83.9 ± 0.7, p = .005; psychosocial: 79.9 ± 0.8, p = .001; total score: 81.3 ± 0.7, p = .001) than the control group (80.9 ± 0.8; 76.1 ± 0.9 and 77.8 ± 0.8). The three-group analysis found intervention non-completers had significantly higher PedsQL scores (84.0 ± 0.8, p = .021; 80.4 ± 0.9, p = .003; 81.7 ± 0.8, p = .002;) than controls (80.9 ± 0.8, 76.1 ± 0.9 and 77.8 ± 0.8). There were no significant differences for any PA measure. Intervention completers had significantly higher scores than non-completers and controls for some mediator variables (e.g. self-efficacy, behavioural control). CONCLUSION Positive outcomes were achieved from a modest school-community linked intervention. The school component contributed to maintaining HRQoL; students who completed the community component derived a range of intra-personal and inter-personal benefits. TRIAL REGISTRATION ACTRN12614000446662. April 30th 2014.
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Affiliation(s)
- Meghan M Casey
- School of Health Sciences, Federation University Australia, Ballarat, Australia
| | - Jack T Harvey
- School of Health Sciences, Federation University Australia, Ballarat, Australia
| | - Amanda Telford
- School of Medical Sciences, Discipline of Exercise Sciences, RMIT University, Melbourne, Australia
| | - Rochelle M Eime
- School of Health Sciences, Federation University Australia, Ballarat, Australia
- Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, Australia
| | - Amanda Mooney
- School of Education, Faculty of Arts & Education, Deakin University, Melbourne, Australia
| | - Warren R Payne
- Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, Australia
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Chen G, Ratcliffe J, Olds T, Magarey A, Jones M, Leslie E. BMI, health behaviors, and quality of life in children and adolescents: a school-based study. Pediatrics 2014; 133:e868-74. [PMID: 24590749 DOI: 10.1542/peds.2013-0622] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To explore the relationship between weight status (BMI) and health-related quality of life in children and adolescents through application of the Child Health Utility 9D, a new generic preference-based instrument. METHODS Data were collected from primary and high school students in rural and metropolitan regions of South Australia. Consenting participants (2588 in grades 4-6 and 765 in grades 9-10) were weighed and measured and categorized as underweight, healthy weight, overweight, or obese according to International Obesity Taskforce BMI cutoff points (primary outcome). Participants also completed a questionnaire including the Child Health Utility 9D and standardized measures of physical activity, sedentary behavior, sleep patterns, and eating behavior (secondary outcomes). Descriptive and multivariate linear regression analyses were undertaken to calculate mean utility differences. RESULTS In comparison with healthy-weight primary school students, adjusted mean utilities were lower for overweight (-0.016, P = .02) or obese (-0.039, P = .001) students. For high school students, the adjusted mean utilities were also lower for overweight and obese students but were nonsignificant (-0.018, P > .10). Physical activity, sedentary behavior, sleep patterns, and eating behavior were all found to be significantly associated with utilities. CONCLUSIONS Irrespective of BMI, young people engaging in more physical activities or less sedentary behavior, and having healthier sleep patterns or eating behavior exhibited higher utilities. Associations between utilities and sleep patterns or eating behavior were stronger than the associations with BMI. Future economic evaluations for obesity interventions should more formally investigate the relationship between changes over time in weight status and health-related quality of life for children and adolescents.
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Affiliation(s)
- Gang Chen
- Flinders Health Economics Group, and
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Wynne C, Comiskey C, Hollywood E, Quirke MB, O'Sullivan K, McGilloway S. The relationship between body mass index and health-related quality of life in urban disadvantaged children. Qual Life Res 2014; 23:1895-905. [PMID: 24473990 DOI: 10.1007/s11136-014-0634-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The study's aim was to establish, for children living in urban disadvantage, the nature and extent of the relationship between body mass index (BMI) and health-related quality of life (HRQoL), including the role of individual and family factors in influencing this relationship. METHODS Within the context of a longitudinal design, 255 children aged 7-12 years (50 % male) self-reported their HRQoL (Kidscreen-27) and had their height and weight measured at year one and two. One parent/guardian for each child was also assessed at year one with the OSLO Social Support Scale and Hospital Anxiety and Depression Scale. Regression analysis was also conducted. RESULTS BMI was weakly inversely associated with 'total HRQoL' (r = -.15, p < .05), 'physical well-being' and 'autonomy and parent relations'. Significant differences were found between normal weight and obese children on all but the latter dimension. Neither weight group, however, fell below the average European HRQoL range. BMI predicted physical well-being a year later and vice versa, whilst autonomy and parent relations also predicted BMI a year later. In terms of 'overweight' children (38 %), those approaching adolescence had poorer physical and school well-being than younger children, and those whose parents had moderate-to-severe levels of depression fared worse on school well-being than children whose parents were not depressed. CONCLUSION The findings suggest that obesity programmes could aim to prevent/reduce obesity and optimise HRQoL in urban disadvantaged preadolescent children whilst also targeting parental mental health difficulties. Future research should examine mediators of the effect of BMI on HRQoL.
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Buttitta M, Iliescu C, Rousseau A, Guerrien A. Quality of life in overweight and obese children and adolescents: a literature review. Qual Life Res 2013; 23:1117-39. [PMID: 24249217 DOI: 10.1007/s11136-013-0568-5] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of the study is to present a literature review on quality-of-life (QOL) assessment in overweight or obese children and adolescents in order to identify the most affected dimensions and better understand associated factors. METHODS The ERIC, FRANCIS, MEDLINE, PsycARTICLES, PsycINFO, and Academic Search Premier databases were searched for articles reporting cross-sectional QOL studies in obese children and adolescents published in English before January 2013. The reference lists of retained articles were also screened. RESULTS Among the 34 articles retained for the analysis, only three did not report lower QOL among obese youth. Clinical populations appeared to be more affected than the general population. Several variables were associated with QOL such as self-image, bullying, bodily pain, quality of food intake, physical activity, screen time, parents' educational level, and weight status. CONCLUSIONS Identifying variables associated with lower QOL in obese children and adolescents offers new perspectives for prevention and care. Further research is needed to better elucidate these findings. Better understanding QOL is a key element essential for the treatment for childhood and adolescent obesity.
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Petersen S, Moodie M, Mavoa H, Waqa G, Goundar R, Swinburn B. Relationship between overweight and health-related quality of life in secondary school children in Fiji: results from a cross-sectional population-based study. Int J Obes (Lond) 2013; 38:539-46. [PMID: 24232500 DOI: 10.1038/ijo.2013.212] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 09/03/2013] [Accepted: 11/04/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the relationship between excess weight (overweight and obesity) and health-related quality of life (HRQoL) in a sample of secondary school children in Fiji, by gender, age and ethnicity. METHODS The study comprised 8947 children from forms 3-6 (age 12-18 years) in 18 secondary schools on Viti Levu, the main island of Fiji. Body mass index (BMI) was calculated from measured height and weight, and weight status was classified according to the International Obesity Task Force recommendations. HRQoL was measured by the self-report version of the Pediatric Quality of Life Inventory 4.0. RESULTS HRQoL was similar in children with obesity and normal weight. Generally, this was replicated when analyzed separately by gender and ethnicity, but age stratification revealed disparities. In 12-14-year-old children, obesity was associated with better HRQoL, owing to better social and school functioning and well-being, and in 15-18-year olds with poorer HRQoL, owing to worse physical, emotional and social functioning and well-being (Cohen's d 0.2-0.3). Children with a BMI in the overweight range also reported a slightly lower HRQoL than children with a BMI in the normal weight range, but although statistically significant, the size of this difference was trivial (Cohen's d <0.2). DISCUSSION The results suggest that, overall there is no meaningful negative association between excess weight and HRQoL in secondary school children in Fiji. This is in contradiction to the negative relationship between excess weight and HRQoL shown in studies from other countries and cultures. The assumption that a large body size is associated with a lower quality of life cannot be held universally. Although a generally low HRQoL among children in Fiji may be masking or overriding the potential effect of excess weight on HRQoL, socio-economic and/or socio-cultural factors, may help to explain these relationships.
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Affiliation(s)
- S Petersen
- 1] Deakin Health Economics, Faculty of Health, Deakin University, Melbourne, Victoria, Australia [2] WHO Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Melbourne, Victoria, Australia [3] Child and Adolescent Psychiatry, Clinical Sciences, Umeå University, Umeå, Sweden
| | - M Moodie
- 1] Deakin Health Economics, Faculty of Health, Deakin University, Melbourne, Victoria, Australia [2] WHO Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - H Mavoa
- WHO Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - G Waqa
- Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases (C-POND), Fiji School of Medicine, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - R Goundar
- Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases (C-POND), Fiji School of Medicine, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - B Swinburn
- 1] WHO Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Melbourne, Victoria, Australia [2] School of Population Health, University of Auckland, Auckland, New Zealand
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van Grieken A, Veldhuis L, Renders CM, Landgraf JM, Hirasing RA, Raat H. Impaired parent-reported health-related quality of life of underweight and obese children at elementary school entry. Qual Life Res 2013; 22:917-28. [PMID: 22695828 PMCID: PMC3636439 DOI: 10.1007/s11136-012-0211-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE Examine the health-related quality of life of 5-6-year-old underweight, overweight and obese children. METHODS Our cross-sectional study included 3,227 parent-child dyads from the "Be active, eat right" study. Parents completed questionnaires regarding child and parental characteristics. Health-related quality of life of the child was measured using the Child Health Questionnaire Parent Form 28. Children were classified normal weight, overweight, obese, severely obese, and underweight according to the international age and gender BMI cutoff points. Bootstrap analyses were performed for general linear models corrected for potential confounding variables. RESULTS Severely obese children (β, -2.60; 95% CI, -4.80 to -0.57, p < 0.01) and underweight children (β, -1.11; 95% CI, -1.85 to -0.39, p < 0.01) had lower parent-reported scores on the physical summary scale. On the physical functioning profile scale parents of overweight and severely obese children also reported statistically significant lower scores (p < 0.05 and p < 0.01, respectively).There were no significant differences regarding the psychosocial summary scale scores between the different weight categories. CONCLUSION Underweight and overweight children experience impaired health-related quality of life on the physical functioning domain. Physicians, teachers and parents should be aware of the possible negative impact on health-related quality of life in underweight and overweight 5-6-year-old children.
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Affiliation(s)
- Amy van Grieken
- Department of Public Health, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Ul-Haq Z, Mackay DF, Fenwick E, Pell JP. Meta-analysis of the association between body mass index and health-related quality of life among children and adolescents, assessed using the pediatric quality of life inventory index. J Pediatr 2013; 162:280-6.e1. [PMID: 22959137 DOI: 10.1016/j.jpeds.2012.07.049] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 05/22/2012] [Accepted: 07/24/2012] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To explore the relationships between body mass index and overall, physical, and psychosocial health-related quality of life (HRQoL) in children and adolescents. STUDY DESIGN A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Medline, Embase, PsycINFO, and the Web of Knowledge were searched for relevant articles. Inclusion was restricted to participants under 20 years of age, assessed using the Pediatric Quality of Life Inventory. Random-effects meta-analysis, meta-regression, and cumulative meta-analysis were conducted. Heterogeneity was assessed using the I(2) statistic, and potential publication and small study bias were evaluated using funnel plots and the Egger test. RESULTS Eleven eligible studies provided 35 estimates of effect size, derived from a total of 13210 study participants. Based on self-reports, children and adolescents with above-normal body mass index had significantly lower total, physical, and psychosocial HRQoL, with a clear dose relationship across all categories. In obese children and adolescents, the overall score was reduced by 10.6 points (95% CI, 14.0-7.2; P < .001). Parents reported the same pattern but a larger effect size. The total parental score for obese children and adolescents was reduced by 18.9 points (95% CI, 26.6-11.1; P < .001). No significant publication or small study bias was observed. CONCLUSION Parents overestimate the impact of obesity on the HRQoL of their children. Nonetheless, obese children and adolescents have significantly reduced overall, physical, and psychosocial HRQoL.
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Affiliation(s)
- Zia Ul-Haq
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Alff F, Markert J, Zschaler S, Gausche R, Kiess W, Blüher S. Reasons for (non)participating in a telephone-based intervention program for families with overweight children. PLoS One 2012; 7:e34580. [PMID: 22509327 PMCID: PMC3317994 DOI: 10.1371/journal.pone.0034580] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 03/06/2012] [Indexed: 12/15/2022] Open
Abstract
Objective Willingness to participate in obesity prevention programs is low; underlying reasons are poorly understood. We evaluated reasons for (non)participating in a novel telephone-based obesity prevention program for overweight children and their families. Method Overweight children and adolescents (BMI>90th percentile) aged 3.5–17.4 years were screened via the CrescNet database, a representative cohort of German children, and program participation (repetitive computer aided telephone counseling) was offered by their local pediatrician. Identical questionnaires to collect baseline data on anthropometrics, lifestyle, eating habits, sociodemographic and psychosocial parameters were analyzed from 433 families (241 participants, 192 nonparticipants). Univariate analyses and binary logistic regression were used to identify factors associated with nonparticipation. Results The number of overweight children (BMI>90th percentile) was higher in nonparticipants than participants (62% vs. 41.1%,p<0.001), whereas the number of obese children (BMI>97th percentile) was higher in participants (58.9% vs.38%,p<0.001). Participating girls were younger than boys (8.8 vs.10.4 years, p<0.001). 87.3% and 40% of participants, but only 72.2% and 24.7% of nonparticipants, respectively, reported to have regular breakfasts (p = 0.008) and 5 regular daily meals (p = 0.003). Nonparticipants had a lower household-net-income (p<0.001), but higher subjective physical wellbeing than participants (p = 0.018) and believed that changes in lifestyle can be made easily (p = 0.05). Conclusion An important reason for nonparticipation was non-awareness of their child's weight status by parents. Nonparticipants, who were often low-income families, believed that they already perform a healthy lifestyle and had a higher subjective wellbeing. We hypothesize that even a low-threshold intervention program does not reach the families who really need it.
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Affiliation(s)
- Franziska Alff
- Department of Women and Child Health, Hospital for Children and Adolescents, University Hospital of Leipzig, Leipzig, Germany
| | - Jana Markert
- Department of Women and Child Health, Hospital for Children and Adolescents, University Hospital of Leipzig, Leipzig, Germany
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, University of Leipzig, Leipzig, Germany
| | - Silke Zschaler
- Department of Women and Child Health, Hospital for Children and Adolescents, University Hospital of Leipzig, Leipzig, Germany
| | - Ruth Gausche
- CrescNet gGmbH, University of Leipzig, Leipzig, Germany
| | - Wieland Kiess
- Department of Women and Child Health, Hospital for Children and Adolescents, University Hospital of Leipzig, Leipzig, Germany
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, University of Leipzig, Leipzig, Germany
| | - Susann Blüher
- Department of Women and Child Health, Hospital for Children and Adolescents, University Hospital of Leipzig, Leipzig, Germany
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, University of Leipzig, Leipzig, Germany
- * E-mail:
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Al-Akour NA, Khader YS, Khassawneh MY, Bawadi H. Health-related quality of life of adolescents with overweight or obesity in the north of Jordan. Child Care Health Dev 2012; 38:237-43. [PMID: 21615771 DOI: 10.1111/j.1365-2214.2011.01248.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies showed that overweight and obesity in children and adolescents are associated with impaired health-related quality of life (QOL). The objective of this study was to describe health-related QOL among Jordanian adolescents who were overweight or obese. METHODS This is a cross-sectional study conducted among Jordanian students aged between 13 and 18 years in three educational directorates in Irbid City in the north of Jordan. Using simple random sampling, two male schools and two female schools were selected from the list of each directorate to represent all schools in north of Jordan. In each selected school, all adolescents aged 13-18 years were visited in their classes and were invited to participate in the study. Of the total number of 1561 subjects, 1433 (91.8%) agreed to participate in the study. The short-form 15-item Pediatric Quality of Life Inventory version 4.00 was used to measure health-related QOL among participants. Body mass index (BMI) was calculated and interpreted according to the BMI-for-age growth charts of the Center for Disease Control and Prevention guidelines. RESULTS This study included 707 boys and 726 girls; 17.6% of participants were overweight and 7.8% were obese. For boys and girls, adolescents who were overweight or obese had significantly lower average scores for psychosocial health summary scale and physical functioning scale. Female gender, age of 16-18 years, fathers' education of high school or less and unemployed fathers (for social functioning and physical functioning) were significantly associated with decreased average scores of all scales and subscales of Pediatric Quality of Life Inventory. CONCLUSIONS Compared with healthy adolescents, adolescents who were overweight or obese reported significantly lower health-related QOL in all domains. Girls reported greater effect of overweight and obesity on their health-related QOL.
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Affiliation(s)
- N A Al-Akour
- Maternal-Child Health Nursing, School of Nursing, Jordan University of Science and Technology, Irbid, Jordan.
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