Behavioural determinants for obesity: a cross-sectional study among urban adolescents in India

Influences of role models and other factors on physical activity amongst 6 to 16 years overweight and obese students

Background

Physical activity is an essential aspect of living a healthy lifestyle, which offers a myriad of benefits for both the body and the mind. Nonetheless, a family history of obesity can pose significant challenges to achieving and maintaining a healthy weight, which is further exacerbated by the academic stress. Individuals who have a role model that prioritizes physical activity are more likely to develop positive and healthy habits in their lives.

Objectives

The study aimed to examine how role models affect physical activity and its impact on addressing challenges of family obesity history and academic stress in school children.

Methods

This cross-sectional study was conducted from October 2019 to April 2020 in three schools in Amritsar district selected by lottery method of simple random sampling. Out of 4226 students, 355 overweight and obese students were interviewed regarding their physical activity. An informed written assent and consent was taken from the children and guardians respectively. Mothers of 6 to 11-year-old students and students aged 12 to 16 were interviewed using a pre-designed, validated, semi-structured questionnaire.

Results

51.3% had a family history of obesity while 14.9% and 14.6% of parents of overweight students had hypertension and diabetes, respectively. Over half (52.7%) lacked interest in physical activity and almost 33.5% of males were inactive. Students who chose movie actors as role models (71.1%) and those who found their role models' information reliable (83.2%) were more likely to participate in physical activity. Of the 247 students who were knowledgeable about healthy living, a significant majority of 70.4% engaged in physical activity while 76% of overweight/obese students reported academic stress as a barrier.

Conclusions

Study shows majority engage in physical activity regardless of gender. Over 70% have family history of obesity and healthy lifestyle knowledge. Stress reduces physical activity and students with movie/sports/fitness role models have better activity levels. Reasons for not engaging included dislike for sports and lack of time.

Prevalence of overweight and obesity and associated demographic and health factors in India: Findings from Comprehensive National Nutrition Survey (CNNS)

BACKGROUND

Childhood obesity (5-9 years) in India is likely to contribute 11% to the global burden by 2030.

METHODS

Data from India's Comprehensive National Nutrition Survey (CNNS, 2016-2018) was used to assess the prevalence and key associated factors of overweight and obesity. Multivariable logistic regression models were applied to identify potential determinants associated with being overweight and obese.

RESULTS

Overweight prevalence (including obesity) varied from 1.6% (0-4 years) to 4.8% (10-19 years). The majority of states reported a higher proportion of adolescents overweight and obese, than younger age group 5-9 years. A significantly higher prevalence of children and adolescents with obesity was reported in higher wealth quintiles and residents of urban areas. The prevalence of overweight and obesity and associated demographic and health factors in India included: the presence of NCD risk factor (adolescents: 1.68, 95% CI [1.31-2.14]), micronutrient deficiency (5-9 years children: 1.72, 95% CI [1.30-2.28]), mother's education (5-9 years children: 4.84, 95% CI [2.92-8.03]; adolescents: 2.17, 95% CI [1.42-3.32]), wealth (adolescents: 1.92, 95% CI [1.16-3.19]), place of residence (5-9 years children: 1.68, 95% CI [1.39-2.03]; adolescents: 1.39, 95% CI [1.16-1.66]), child age (5-9 years children: 1.64, 95% CI [1.40-1.93], and screen-time (adolescents: 1.63, 95% CI [1.22-2.19].

CONCLUSION

The findings set out policy and research recommendations to pave the path for curtailing the increasing prevalence of overweight and obesity and achieving the World Health Assembly's Global Nutrition target of 'no increase in childhood overweight (Target 4) by 2025'.

Bone Mineral Density and Serum Bone Turnover Markers among Post-Menarchal Girls from Rural South India

Background

The data on the bone mineral density (BMD) and bone turnover markers (BTMs) in Indian adolescents are limited.

Objectives

To assess BMD at lumbar spine (LS, L1-L4) and femoral neck (FN) in South Indian post-menarchal girls and correlate it with dietary calcium intake (mg/day), physical activity score and post-menarchal years. The study also assessed serum BTMs and their correlation with chronological age in the study population.

Methods

This cross-sectional study included apparently healthy post-menarchal adolescent girls aged 12-16 years randomly selected from the community. Participants with vitamin D deficiency were excluded. The data on calcium intake and physical activity were obtained using validated questionnaires. All participants were evaluated with serum calcium, 25-hydroxy vitamin D, parathyroid hormone, N-terminal propeptide of type 1 collagen (P1NP) and Beta-CrossLaps (CTx) and BMD at LS and FN using dual X-ray absorptiometry (DXA).

Statistical Analysis

EpiData version 3.1 was used for the data entry. The data analysis was done using Statistical Package for Social Sciences (SPSS) version 21. Continuous variables were expressed as mean ± SD. Pearson's correlation coefficient (r) was calculated, and two-tailed Kendall's tau-b test was used for assessing correlation of all nonparametric measures.

Results

A total of 103 participants were screened, and data from 77 were analysed. There was a significant positive correlation of BMD at LS with chronological age (r: +0.235, P = 0.036), but not at FN. Positive correlation of BMD with increase in post-menarchal years was also noted at LS (r: +0.276, P = 0.015). There was no significant association of BMD with calcium intake and physical activity scores at both sites. There was a significant negative correlation of serum BTMs with age CTx (r: -0.596, P = 0.0001) and P1NP (r: -0.505, P = 0.0001).

Conclusion

This study provides insight into the reference BMD range at LS spine and FN in South Indian rural post-menarchal adolescent girls. BMD positively correlated, whereas BTMs negatively correlated with age. The study also provides the first Indian reference range for serum BTMs in this age group.

Prevalence of Excessive Weight and Underweight and Its Associated Knowledge and Lifestyle Behaviors among Urban Private School-Going Adolescents in New Delhi

With rapid urbanization and the Indian nutrition transition, Indian adolescents face a high risk of developing an energy imbalance. This study aims to assess the prevalence of excessive weight, underweight, and associated knowledge and lifestyle behaviors among private school-going adolescents in Delhi. A cross-sectional study was conducted in students (6th–7th grades) of eight randomly selected private schools in Delhi, India in 2019. A self-administered survey was used to assess students’ dietary-and-physical-activity-related knowledge and behavior. Anthropometric measurements (height, weight, and waist circumference) were also conducted. Out of 1567 participants, 7.2% were underweight, 61.3% normal, and 31.5% excess in weight. Underweight was associated with significantly more eating whilst studying for exams (relative risk ratio (RRR) 1.7 (1.0–2.9)). Excessive weight was associated with less incorrect knowledge on behaviors causing overweight (RRR 0.7 (0.5–0.9)), more often reading nutritional labels of packed food items (RRR 0.6 (0.4–0.9)), and less frequent vegetable-intake (RRR 0.7 (0.4–0.9)). Underweight students showed more suboptimal knowledge and unhealthy behaviors, whilst students with excessive weight showed more correct knowledge and healthy behaviors. This study highlights the immediate need for effective health-promoting interventions focused on the importance of healthy lifestyle at least in underweight adolescents.

Individual, Social and Environmental Correlates of Active School Travel among Adolescents in India

Active School Travel (AST) is an important domain for physical activity among adolescents; however, few studies in India have explored barriers or correlates of AST. This was a cross-sectional study of 324 adolescents aged 12-17 years recruited via households and schools from diverse areas of Chennai, India. Adolescents reported their mode of travel to school, neighbourhood correlates, and the barriers for AST. Adolescents were considered to be using AST to/from school if they walked/cycled ≥once/week during an average week. Half the adolescents usually performed AST (≥1 trip/week). School being too far was associated with 75% lower odds and parents not allowing their child to walk or cycle was associated with 82% lower odds of the adolescent performing AST to or from school at least once/week. AST among adolescents should be encouraged and there is considerable scope for improvement. Parental restriction and distance to school were the two strongest barriers for AST.

Profiles of Active Transportation among Children and Adolescents in the Global Matrix 3.0 Initiative: A 49-Country Comparison

This article aims to compare the prevalence of active transportation among children and adolescents from 49 countries at different levels of development. The data was extracted from the Report Cards on Physical Activity for Children and Youth from the 49 countries that participated in the Global Matrix 3.0 initiative. Descriptive statistics and a latent profile analysis with active transportation, Human Development Index and Gini index as latent variables were conducted. The global average grade was a "C", indicating that countries are succeeding with about half of children and youth (47-53%). There is wide variability in the prevalence and in the definition of active transportation globally. Three different profiles of countries were identified based on active transportation grades, Human Development Index (HDI) and income inequalities. The first profile grouped very high HDI countries with low prevalence of active transport and low inequalities. The second profile grouped low and middle HDI countries with high prevalence of active transportation and higher inequalities. And the third profile was characterized by the relatively high prevalence of active transportation and more variability in the socioeconomic variables. Promising policies from countries under each profile were identified. A unified definition of active transportation and contextualized methods for its assessment are needed to advance in surveillance and practice.

Conflicts between adolescents and their caregivers living in slums of Mumbai, India in relation to junk food consumption and physical activity

Objective:

To explore influences on the diet and physical activity of adolescents living in Mumbai slums, from the perspectives of adolescents and their caregivers.

Design:

Three investigators from Mumbai conducted six focus group discussions.

Setting:

The study was conducted in suburban Mumbai slums.

Participants:

Thirty-six adolescents (aged 10–12 and 15–17 years) and twenty-three caregivers were recruited through convenience sampling.

Results:

The findings highlighted the complex negotiations between adolescent and caregivers surrounding adolescent junk food consumption and physical activity opportunities. Caregivers learned recipes to prepare popular junk foods to encourage adolescents to eat more home-cooked, and less ‘outside’, food, yet adolescents still preferred to eat outside. To adolescents, the social aspect of eating junk food with friends was an important and enjoyable experience. Caregivers felt that they had no control over adolescents’ food choices, whereas adolescents felt their diets were dictated by their parents. Adolescents wanted to be physically active but were encouraged to focus on their academic studies instead. Gender was also a key driver of physical activity, with girls given less priority to use outside spaces due to cultural and religious factors, and parental fears for their safety.

Conclusions:

These findings show that adolescents and caregivers have different agendas regarding adolescent diet. Adolescent girls have less opportunity for healthy exercise, and are more sedentary, than boys. Adolescents and caregivers need to be involved in designing effective interventions such as making space available for girls to be active, and smartphone games to encourage healthy eating or physical activity.

Relationship between diet and acculturation among South Asian children living in Canada

INTRODUCTION

Diet and South Asian ethnicity are both associated with early onset of cardiovascular risk factors. Among youth of South Asian origin, little is known about the role of culture in determining healthy dietary patterns. We aimed to assess dietary patterns and their relationships with acculturation to Western and traditional lifestyles among South Asian youth in Canada.

METHODS

The Research in Cardiovascular Health - Lifestyles, Environments and Genetic Attributes in Children and Youth (RICH LEGACY) study targeted South Asian children and adolescents aged 7-8 and 14-15 years in two Canadian cities. In this cross-sectional study, acculturation questionnaires and food frequency questionnaires were administered to assess the correlations between Western and traditional culture scores, immigration status (generation and length of residency) in Canada and intake frequency of various foods.

RESULTS

Among 759 youth, those who ate fruits and vegetables more often consumed dairy and whole grains more often (all r = 0.17-0.22, all p < 0.001), while those who ate fast food more often consumed meat, sweets and sugared drinks more often (all r 0.24-0.38, all p < 0.001). Traditional culture scores were weakly positively correlated with whole grain intake frequency (r = 0.12, p = 0.001), and negatively with meat intake frequency (r = -0.14, p < 0.001). Western culture scores positively correlated with high intake frequency of meat (r = 0.23, p < 0.001), fast food (r = 0.14, p < 0.001) and sweets (r = 0.14, p < 0.001).

DISCUSSION

Children who are more acculturated with Western lifestyle consumed foods associated with increased metabolic risk. However, whether this eating pattern translates into increased risk of obesity and cardiovascular diseases needs to be further explored.

Barriers and Enablers That Influence Overweight/Obesity/Obesogenic Behavior in Adolescents From Lower-Middle Income Countries: A Systematic Review

BACKGROUND

Overweight/obesity during adolescence in lower-middle income countries has become a public health problem with consequences in adulthood. Inadequate dietary habits, poor diet quality, sedentary behavior, and parental obesity have been reported.

OBJECTIVE

To describe management of obesity-like food habits and behavior of adolescents from lower-middle income countries with respect to what keeps them using this diet (barriers) and what helps them avoid it (enablers).

METHODS

Systematic review of the literature related to obesity and food intake of adolescents conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA).

RESULTS

We classified 11 eligible studies describing the barriers to and enablers of the management of obesity-like food intake and obesity lifestyle. The dual burdens of malnutrition and increased urbanization have been observed. There is preference for processed food, dietary habits, and obesity-like food intake and sedentary behavior. Barriers to managing body weight gain included mostly consumption of fast-food and snack food, less vegetable and fruit intake, skipping meals, and sedentary behavior. Enablers of managing body weight gain included changes in nutritional habits, perception of the consumption of healthy food, physical activity, and engagement in programs to change lifestyle.

CONCLUSION

The globalization of the fast food industry has provided an obesogenic environmental stimulus for adolescents in lower-middle income countries.

Influence of lifestyle factors on Body Mass Index in preschoolers in Behbahan city, southwest Iran, 2016

Background and aim

The body mass index (BMI) of Iranian preschoolers is noticeably increasing. Thus, studying the factors influencing BMI in preschool children is crucial. The purpose of this study was to identify the effects of lifestyle factors on BMI of preschool children, residing in Behbahan city, southwest Iran, in 2016.

Methods

A total of 120 preschool children, aged 4 to 6 years, participated in this cross-sectional study. Multi-stage random sampling was done. Using researcher-developed questionnaires whose validity and reliability was confirmed, demographic and lifestyle data were obtained, as the questionnaires were completed by the subject's mothers. Lifestyle factors included physical activity, fruit and vegetable consumption, sugar-free beverage intake, and screen time. Multiple logistic regression was conducted to analyze the influence of lifestyle-related behaviors on BMI. Data were analyzed by means of the SPSS 22 software and p<0.05 was resulted as the meaningful level of statistics.

Results

The average BMI values for children was 15.13±1.90 kg/m2. A total of 88.3% of children did not receive 5 cups of fruits and vegetables each day. Also, 12.5% consumed more than one serving of sweetened beverages per day. Only 2.5% engaged in 60 minutes of structured physical activity every day and 40% did not limit screen-time viewing to 2 hours per day or less. The findings indicated that the physical activity and screen time affected the BMI (p<0.05), and the duration of physical activity had inverse relationship with obesity, and screen time was directly related to obesity.

Conclusion

Understanding the factors affecting the BMI of preschool children can inform the development of interventions to impact children's weight-related behavior and it can be used as the basis for future healthy body weight policies. Efforts to lower the obesity rate of preschoolers should be focused on the lifestyle behaviors, especially on the physical activity and screen time.

Demographic determinants of obesity, and adherence to dietary and physical activity guidelines among 4 to 6-year-old children in Behbahan city, southwest Iran, 2016

Background and aim

The world is experiencing an alarming increase in prevalence of childhood obesity. The aim of this study was to determine the demographic determinants of obesity and adherence to dietary and physical activity guidelines among children aged 4 to 6 years old in Behbahan city, southwest Iran, in 2016.

Methods

This cross-sectional study was conducted on 120 preschool children aged 4 to 6 years old in Behbahan city, southwest Iran, in 2016. Multi-stage random sampling was done. The weight and height of the children were measured with standard methods. The demographic and behavioral factors data were collected in self report questionnaires which were completed by the children’s mothers. The Chi-square test, Independent-samples t-tests, One-way analysis of variances and logistic regression analysis were used for data analysis. SPSS software (version 22) was employed.

Results

This study showed that 88.3% of the children did not meet the guideline of 5 servings per day of fruit and vegetables. Only 2.5% met the guideline of 60 minutes of structured physical activity every day. Sex and mother’s occupation status were associated with adhering to screen time guideline. This study found a significant difference in the mean of screen time between sexes. Boys were more likely to meet the screen time guideline. A significant association between adhering to physical activity guidelines and mother’s occupation status was revealed. Significant statistical relationship between demographic factors and BMI categories was not illustrated. Demographic covariates were not significantly related to adherence to dietary and physical activity guidelines.

Conclusion

In preventive programs of obesity among 4 to 6-year-old children key lifestyle behaviors and demographic factors need to be considered.

Food environment and policies in private schools in Kolkata, India

School food policies and services have the potential to influence the food practices and eating behaviours of adolescents which in turn may affect their lifestyles and health in adulthood. The aim of this qualitative investigation was to describe the opinions of adolescents, their parents, nutrition educators and school principals about the prevailing food environment and canteen policies in Indian schools. Fifteen adolescents aged 14-15 years, 15 parents, 12 teachers and 10 principals from 10 private schools in Kolkata, India participated in semi-structured interviews. The interview questions were primarily based on the existing literature related to school food environments and policies. Audio recordings were transcribed verbatim and assessed thematically. Throughout the 52 interviews, a number of inadequacies of the school food environment and policies were revealed. These included the absence of written food policies, the widespread supply of unhealthy foods, inadequate provision of healthy foods, misleading messages about food communicated by school authorities, lack of cleanliness in the school canteen and the high cost of canteen food. Current school food environments do not appear to promote healthy eating among adolescents. Therefore, it is important to upgrade the quality of food services in Indian schools through adoption of healthy eating policies.

Association between full service and fast food restaurant density, dietary intake and overweight/obesity among adults in Delhi, India

Background

The food environment has been implicated as an underlying contributor to the global obesity epidemic. However, few studies have evaluated the relationship between the food environment, dietary intake, and overweight/obesity in low- and middle-income countries (LMICs). The aim of this study was to assess the association of full service and fast food restaurant density with dietary intake and overweight/obesity in Delhi, India.

Methods

Data are from a cross-sectional, population-based study conducted in Delhi. Using multilevel cluster random sampling, 5364 participants were selected from 134 census enumeration blocks (CEBs). Geographic information system data were available for 131 CEBs (n = 5264) from a field survey conducted using hand-held global positioning system devices. The number of full service and fast food restaurants within a 1-km buffer of CEBs was recorded by trained staff using ArcGIS software, and participants were assigned to tertiles of full service and fast food restaurant density based on their resident CEB. Height and weight were measured using standardized procedures and overweight/obesity was defined as a BMI ≥25 kg/m².

Results

The most common full service and fast food restaurants were Indian savory restaurants (57.2%) and Indian sweet shops (25.8%). Only 14.1% of full service and fast food restaurants were Western style. After adjustment for age, household income, education, and tobacco and alcohol use, participants in the highest tertile of full service and fast food restaurant density were less likely to consume fruit and more likely to consume refined grains compared to participants in the lowest tertile (both p < 0.05). In unadjusted logistic regression models, participants in the highest versus lowest tertile of full service and fast food restaurant density were significantly more likely to be overweight/obese: odds ratio (95% confidence interval), 1.44 (1.24, 1.67). After adjustment for age, household income, and education, the effect was attenuated: 1.08 (0.92, 1.26). Results were consistent with further adjustment for tobacco and alcohol use, moderate physical activity, and owning a bicycle or motorized vehicle.

Conclusions

Most full service and fast food restaurants were Indian, suggesting that the nutrition transition in this megacity may be better characterized by the large number of unhealthy Indian food outlets rather than the Western food outlets. Full service and fast food restaurant density in the residence area of adults in Delhi, India, was associated with poor dietary intake. It was also positively associated with overweight/obesity, but this was largely explained by socioeconomic status. Further research is needed exploring these associations prospectively and in other LMICs.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4598-8) contains supplementary material, which is available to authorized users.

Prevalence and correlates of achieving recommended physical activity levels among children living in rural South Asia-A multi-centre study

Background

We report the prevalence of recommended physical activity levels (RPALs) and examine the correlates of achieving RPALs in rural South Asian children and analyse its association with anthropometric outcomes.

Methods

This analysis on rural South Asian children aged 5–14 years (n = 564) is a part of the Chronic Disease Risk Factor study conducted at three sites in India (Chennai n = 146; Goa n = 218) and Bangladesh (Matlab; n = 200). Data on socio-demographic and lifestyle factors (physical activity (PA); diet) were collected using an interviewer-administered questionnaires, along with objective anthropometric measurements. Multivariate logistic regression models were used to examine whether RPALs (active travel to school (yes/no); leisure-time PA ≥ 1 h/day; sedentary-activity ≤ 2 h/day) were associated with socio-demographic factors, diet and other forms of PA. Multivariate linear regression models were used to investigate associations between RPALs and anthropometrics (BMI- and waist z-scores).

Results

The majority of children (71.8 %) belonged to households where a parent had at least a secondary education. Two-thirds (66.7 %) actively travelled to school; 74.6 % reported ≥1 h/day of leisure-time PA and 55.7 % had ≤2 h/day of sedentary-activity; 25.2 % of children reported RPALs in all three dimensions. Older (10–14 years, OR = 2.0; 95 % CI: 1.3, 3.0) and female (OR = 1.7; 95 % CI: 1.1, 2.5) children were more likely to travel actively to school. Leisure-time PA ≥ 1 h/day was more common among boys (OR = 2.5; 95 % CI: 1.5, 4.0), children in Matlab, Bangladesh (OR = 3.0; 95 % CI: 1.6, 5.5), and those with higher processed-food consumption (OR = 2.3; 95 % CI: 1.2, 4.1). Sedentary activity ≤ 2 h/day was associated with younger children (5–9 years, OR = 1.6; 95 % CI: 1.1, 2.4), children of Goa (OR = 3.5; 95 % CI: 2.1, 6.1) and Chennai (OR = 2.5; 95 % CI: 1.5, 4.3) and low household education (OR = 2.1; 95 % CI: 1.1, 4.1). In multivariate analyses, sedentary activity ≤ 2 h/day was associated with lower BMI-z-scores (β = −0.3; 95 % CI: −0.5, −0.08) and lower waist-z-scores (β = −1.1; 95 % CI: −2.2, −0.07).

Conclusion

Only one quarter of children in these rural areas achieved RPAL in active travel, leisure and sedentary activity. Improved understanding of RPAL in rural South Asian children is important due to rapid socio-economic transition.

What influences urban Indian secondary school students' food consumption? - A qualitative study

Indian adolescents' over reliance on foods such as nutrient-poor snacks, sugar-sweetened beverages and take-away foods puts them at significant risk of obesity and several diet-related chronic diseases. Therefore, the factors that influence their dietary behaviours need to be better understood in order to develop effective nutrition promotion strategies. The purpose of this qualitative inquiry was to investigate adolescents', parents', teachers', and school principals' perceptions of the main influences on adolescent eating behaviours. Fifteen adolescents aged 14-15 years, 15 parents, 12 teachers and 10 principals from 10 private English-speaking schools in Kolkata, India, participated in semi-structured interviews. The digitally-recorded conversations were transcribed verbatim and analysed thematically. The 52 interviews revealed a number of factors that may influence adolescents' eating habits including parent and peer influences, home and school food environments, and the mass media. Emerging evidence suggests that future health and nutrition promotion interventions need to target the different influences on Indian teenagers' food consumption.

Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update

This systematic review is an update examining the relationships between objectively and subjectively measured sedentary behaviour and health indicators in children and youth aged 5–17 years. EMBASE, PsycINFO, and Medline were searched in December 2014, and date limits were imposed (≥February 2010). Included studies were peer-reviewed and met the a priori-determined population (apparently healthy children and youth, mean age: 5–17 years), intervention (durations, patterns, and types of sedentary behaviours), comparator (various durations, patterns, and types of sedentary behaviours), and outcome (critical: body composition, metabolic syndrome/cardiovascular disease risk factors, behavioural conduct/pro-social behaviour, academic achievement; important: fitness, self-esteem) study criteria. Quality of evidence by outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework. Due to heterogeneity, a narrative analysis was conducted. A total of 235 studies (194 unique samples) were included representing 1 657 064 unique participants from 71 different countries. Higher durations/frequencies of screen time and television (TV) viewing were associated with unfavourable body composition. Higher duration/frequency of TV viewing was also associated with higher clustered cardiometabolic risk scores. Higher durations of TV viewing and video game use were associated with unfavourable behavioural conduct/pro-social behaviour. Higher durations of reading and doing homework were associated with higher academic achievement. Higher duration of screen time was associated with lower fitness. Higher durations of screen time and computer use were associated with lower self-esteem. Evidence ranged from “very low” to “moderate” quality. Higher quality studies using reliable and valid sedentary behaviour measures should confirm this largely observational evidence.

Cross-regional analysis of multiple factors associated with childhood obesity in India: a national or local challenge?

OBJECTIVE

To investigate obesogenic co-causing factors, promoting rise of weight in children, associated to local differences in India.

METHODS

Overall 1,680 children, aged 3-11 and balanced by gender, were recruited in school contexts distributed in seven major Indian cities. All children were weighted and measured in order to calculate their BMI. A validated cultural specific questionnaire was administered to children's parents for assessing socio-demographic data, eating habits, physical activity, etc. Furthermore children's brand awareness scores were computed in order to analyze their affiliation towards food-based advertisement. Descriptive statistics of frequencies, duration and intensity of the various factors were performed. Chi-square tests or Wilcoxon signed rank test were used for evaluating significance of differences in factors distribution across Indian cities.

RESULTS

Four factors, promoting rise of children's weight, were individuated as associated to urban differences, namely meal times consumed in the family, parents' BMI, brand awareness and physical activity. These aspects exercised a significant impact on children's body size in Kolkata and Chennai. Hyderabad and Mumbai, instead, were the cities where religion played some role in influencing children's weight gain.

CONCLUSIONS

Such findings underline the need to frame obesity as a situated phenomenon rather than a national problem. Health policies, implemented in treating and preventing obesity, should be therefore specifically focused on locally situated peculiarities.

Measuring brand awareness as a component of eating habits in Indian children: the development of the IBAI questionnaire

OBJECTIVE

To develop an instrument that allows one to estimate the Indian children's brand awareness of alimentary products.

METHODS

The IBAI (International Brand Awareness Instrument), an age specific tool composed of 12 sheets with images reporting brand logos of alimentary products, has been adjusted for the Indian context in order to investigate on infants' cognitive skills of recalling and recognizing. The IBAI was piloted in a sample of 100 children aged from 3 to 10 y and enrolled in New Delhi schools.

RESULTS

Children aged 7-10 y showed an higher brand awareness as compared to those of 3-6 y.

CONCLUSIONS

The IBAI instrument may be a component for further analysis of the influence of food marketing on child's diet, foods' choices and preferences within the Indian social and cultural macro-context. Findings suggest that children over 6 y are particularly gullible by brands and TV promoted advertising. Prevention through information should, therefore be offered to school aged children and their parents, involving teachers, nutritionists and experts in developmental psychology also.

Influence of dietary pattern, physical activity, and I148M PNPLA3 on steatosis severity in at-risk adolescents

Evidence relating dietary patterns to obesity and related disorders such as non-alcoholic fatty liver disease (NAFLD) is limited in pediatric age. Aim of this study was to analyze the association between dietary patterns, obesity and development of severe steatosis and the metabolic syndrome in a series of children and adolescents referred for suspected NAFLD, and the interaction with the rs738409 I148M PNPLA3 polymorphism. Two hundred patients (112 females) had completed a food frequency and demographic questionnaire. Nearly 58 % were obese, and 32 % were overweight. Mild, moderate, and severe fatty liver was present in 60 (30 %), 87 (44 %), and 51 (26 %) participants, respectively. A great proportion of overweight/obese children and adolescents reported a correct dietary pattern. At multivariate ordinal regression analysis considering demographic, anthropometric, genetic, and behavioral determinants, the major determinant of steatosis severity was PNPLA3 I148M genotype (p < 0.0001), followed by older age (p = 0.017), higher waist circumference (p = 0.016), and less time spent practising physical exercise (p = 0.034). Furthermore, there was a significant interaction between PNPLA3 I148M and intake of sweetened beverages (p = 0.033) and of vegetables (p = 0.038). In conclusion, although dietary pattern was reportedly correct in at-risk overweight adolescents with NAFLD, we report a novel interaction between PNPLA3 I148M and dietary components with the severity of steatosis.