A Meta-Analysis and an Evaluation of Trends in Obesity Prevalence among Children and Adolescents in Turkey: 1990 through 2015

Epidemiology of type 1 diabetes mellitus in children and adolescents: A 50-year, single-center experience

BACKGROUND

Global variations in epidemiology of type 1 diabetes mellitus (T1DM) exist. This study is designed to examine demographic and clinical features of T1DM over the past 3 decades as well as evolving trends in epidemiology over last 50 years.

METHODS

Clinical characteristics of 925 patients with T1DM over last 30 years (1990-2019) were evaluated and compared to previously published data of 477 patients diagnosed between 1969 and 1990 from one of the major referral centers for diabetes in Turkey.

RESULTS

Mean age at diagnosis decreased from 9.5 ± 4.0 to 7.1 ± 3.6 years within the past 50 years (p < .001). Age at diagnosis peaked at 12-14 years between 1969 and 1990, then fell to 10-11.9 years between 1990 and 1999, and to 4-5.9 years between 2000-2009 and 2010-2019 (p = .005). Although the percentage of patients diagnosed <6 years of age is gradually increasing, the percentage between the ages of 6 and 11.9 years is decreasing, and the percentage diagnosed ≥12 years remained stable. A total of 47.5% of patients had ketoacidosis, 38.2% had ketosis, and 14.3% had only hyperglycemia. 23% of patients had severe diabetic ketoacidosis (DKA), whereas 42% had moderate. Over last 3 decades, there has been no change in frequency of ketoacidosis at presentation, but there has been significant decline in severity (p = .865, and p < .001, respectively). Although the frequency of patients with mild DKA increased over time, frequency of patients with moderate DKA decreased; however, no significant difference was observed among patients with severe ketoacidosis. DKA was more frequent and severe in patients <6 years of age (p = .005, and p < .001, respectively).

CONCLUSION

Age at diagnosis shifted to younger ages in T1DM in the past 50 years. Half of patients had ketoacidosis at diagnosis and frequency of presentation with DKA did not decrease, but severity decreased slightly. Increase in prevalence of T1DM in the younger age group and the fact that half of patients present with DKA indicate that awareness should be increased in terms of early diagnosis and treatment.

Thyroid volume in Turkish school-age children living in an iodine-sufficient region

OBJECTIVES

We aimed to obtain local normative data on thyroid volume evaluated by ultrasonography and iodine status by measuring urine iodine levels in school-age children living in Aydın province.

METHODS

In this cross-sectional study, a sample comprising 1,553 cases was meticulously selected from a total cohort of 170,461 children aged 6-17, drawn from 21 distinct educational institutions located within the Aydın region, as participants in the investigation. Those with a known chronic disease or thyroid disease were excluded from the study. The children underwent physical examinations and ultrasonography imaging of the thyroid gland, and urine samples were collected to measure urinary iodine concentration (UIC).

RESULTS

The median UIC was 189.5 (IQR=134.4) μg/L, which was optimal according to WHO criteria. Thyroid volume was found to be 4.6 (IQR=3.5) mL in girls and 4.2 (IQR=4.0) mL in boys (p=0.883). The thyroid volumes in our study were found to be smaller when compared to the WHO. According to WHO age and body surface area criteria, thyroid volume was over 97 % in 0.9 % (n=15) of cases. Thyroid volume was found to have a positive correlation with age, height, weight, body mass index (BMI), and body surface area (BSA) in both genders (p<0.001). However, there was no significant correlation between thyroid volume and UIC.

CONCLUSIONS

This cross-sectional study provides normative data on thyroid volume and iodine status in school-age children in iodine-sufficient population, revealing a low prevalence of goiter and correlations between thyroid volume and anthropometric measures.

Cardiovascular Risk Factors in Adolescents with Type 1 Diabetes: Prevalence and Gender Differences

Objective

Cardiovascular diseases (CVD) are the most important cause of morbidity and mortality in patients with type 1 diabetes (T1D). Children with T1D have a similar or higher prevalence of being overweight (OW) or obese (Ob) compared to healthy peers. The aim of this study was to determine the prevalence of CVD risk factors in children and adolescents with T1D and the impact of obesity and sex differences on these factors.

Methods

Data of patients aged 10-21 years and who had been using intensive insulin therapy with a diagnosis of T1D for at least three years were evaluated. Patients were divided into normal weight (NW), OW and Ob groups based on body mass index percentiles. Risk factors for CVD (obesity, dyslipidemia, hypertension) were compared between groups, and impact of gender was also analyzed.

Results

Data of 365 patients (200 girls, 54.8%), were evaluated. Prevalence of OW/Ob was 25.9% and was significantly higher in girls (30.6% vs 20.1%, p<0.001). Rate of hypertension was highest in OW/Ob girls followed by OW/Ob boys, and similar in NW girls and boys (p=0.003). Mean low density lipoprotein cholesterol (LDL-c) and triglyceride (TG) levels were highest in OW/Ob girls, followed by OW/Ob boys, NW girls and NW boys, respectively (p<0.001 and p<0.001, respectively). Mean high density lipoprotein-cholesterol (HDL-c) levels were similar among groups. Rates of high LDL-c and TG were similar between OW/Ob girls and boys and higher than NW girls, followed by NW boys (p<0.001 and p<0.001, respectively). The rate of low HDL-c was similar in OW/Ob girls and boys, and higher than NW girls, followed by NW boys (p<0.001). Overall, girls were 1.9 times more likely than boys to have two or more risk factors for CVD. Factors associated with risk for CVD in multiple logistic regression analyses were being a girl, followed by higher daily insulin dose, higher hemoglobin A1c, and longer duration of diabetes (r=0.856; p<0.001).

Conclusion

In spite of the increased prevalence for obesity in both sexes, the trend for CVD risk factors was greater in Ob girls, followed by Ob boys and NW girls. Girls with T1D are more likely to be OW/Ob and to have CVD risk than boys, highlighting the need for early intervention and additional studies to elucidate the causes.

Evaluation of factors affecting body mass index of children with intellectual disability

This study was conducted to evaluate the BMI of the children with intellectual disability and the factors affecting their BMI. This descriptive and cross-sectional study was carried out between March 2016 and April 2016 in Turkey and consisted of 135 children. Children's anthropometric measurements were and their BMI values were calculated. Categorization of children by BMI percentile according to AAP reference values was performed. There was a significant difference between the BMI categories of the children (p < 0.05) and the education level of children's father (x2 = 8.960; p = 0.028), the degree of intellectual disability (x2 = 16.113; p = 0.008), the presence of other disabilities (x2 = 22.013; p = 0.000), type of disability (x2 = 21.359; p = 0.001), the nutrient intake (x2 = 38.935; p = 0.000) and the presence of nutritional problems (x2 = 7.687; p = 0.042). Father's education level, children's degree of disability, child's having presence of other disabilities, child's being dependent in the view of nutrient intake, and child's having nutritional problems were determined as factors affecting BMI.

Predictive markers of metabolically healthy obesity in children and adolescents: can AST/ALT ratio serve as a simple and reliable diagnostic indicator?

This study aimed to estimate the prevalence of metabolically healthy obesity (MHO) according to two different consensus-based criteria and to investigate simple, measurable predictive markers for the diagnosis of MHO. Five hundred and ninety-three obese children and adolescents aged 6-18 years were included in the study. The frequency of MHO was calculated. ROC analysis was used to estimate the predictive value of AST/ALT ratio, waist/hip ratio, MPV, TSH, and Ft4 cut-off value for the diagnosis of MHO. The prevalence of MHO was 21.9% and 10.2% according to 2018 and 2023 consensus-based MHO criteria, respectively. AST/ALT ratio cut-off value for the diagnosis of MHO was calculated as ≥ 1 with 77% sensitivity and 52% specificity using Damanhoury et al.'s criteria (AUC = 0.61, p = 0.02), and 90% sensitivity and 51% specificity using Abiri et al.'s criteria (AUC = 0.70, p = 0.01). Additionally, using binomial regression analysis, only the AST/ALT ratio is independently and significantly associated with the diagnosis of MHO (p = 0.03 for 2018 criteria and p = 0.04 for 2023 criteria).

CONCLUSION

The ALT/AST ratio may be a useful indicator of MHO in children and adolescents.

WHAT IS KNOWN

• Metabolically healthy obesity refers to people who are obese but do not have any of the standard cardio-metabolic risk factors. • Metabolically healthy obesity is not entirely harmless; the metabolic characteristics of individuals with this phenotype are less favorable than those of healthy lean groups. Moreover, it is not a constant state, and there may be a transition to metabolically unhealthy phenotypes over time.

WHAT IS NEW

• The prevalence of MHO is 21.9% and 10.2% according to 2018 and 2023 consensus-based metabolically healthy obesity criteria, respectively. • The ALT/AST ratio may be a useful indicator of metabolically healthy obesity in children and adolescents.

İlköğretim Çağındaki Çocuklarda Obezite Üzerinde Etkili Olan Bazı Faktörlerin İncelenmesi: İstanbul Örneği

Amaç: Çocukluk çağında obezite tüm dünyada artmaktadır. Bu çalışma ilköğretim çağındaki çocuklarda obezite üzerinde etkili olan bazı faktörlerin araştırılması amacıyla yapılmıştır.Yöntem: Çalışma İstanbul'da iki farklı okulda 621 ilköğretim öğrencisi üzerinde gerçekleştirilmiştir. Çocuklar 7-15 yaş grubunda olup rastgele örneklem yöntemi ile seçilmiştir. Çocuklara demografik özellikler, beslenme ve fiziksel aktivite ile ilgili sorulardan oluşan bir anket uygulanmış olup, bazı antropometrik ölçümleri alınmıştır. Çocukların Beden Kütle Indeksi (BKİ) değerleri Türk çocuklarının persentillerine göre sınıflandırılmıştır. Veriler SPSS 13.0 programı ile değerlendirilmiştir.Bulgular: Öğrencilerin %47,5’i kız, %52,5’i erkektir. BKİ sınıflandırmasında öğrencilerin %11,8'i obez bulunmuştur. Özel okuldaki öğrencilerde obezite prevalansı %17,3 devlet okulundaki öğrencilerde %6,6’dır (p&lt;0,05). Üniversite mezunu anne ve babaların çocuklarında, aile birey sayısı üç kişi olanlarda obezite oranı daha fazladır (p&lt;0,05). Beslenme alışkanlıklarına göre düzenli akşam yemeği tüketmeyenlerde ve sevinçli/mutlu olduğunda iştah değişimi olmayanlarda daha fazla obezite oranı görülmüştür (p&lt;0,05). Ayrıca, okula özel araba ile giden öğrencilerin obezite oranı en fazladır (%18,2; p&lt; 0,05).Sonuç: Çalışma sonucunda çocuklarda obezite oranı yüksek eğitim düzeyine sahip anne ve babaların çocuklarında, özel okula giden çocuklarda ve üç kişilik ailelerde yaşayanlarda daha yüksek bulunmuştur. Çocuklarda obezite gelişimini önlemek için okullarda düzenli olarak antropometrik ölçümlerin alınması, öğrencilere ve ebeveynlere sağlıklı beslenmeye yönelik eğitimlerin verilmesi faydalı olabilir.

İstanbul'da 6-15 Yaş Arası Çocuklarda Obezite Prevalansı

Amaç: Bu araştırma, İstanbul'un bir ilçesinde 6-15 yaş arası çocuklarda obezite prevalansını ve beslenme alışkanlıklarını değerlendirmeyi amaçlamaktadır.Yöntem: Bu araştırma, İstanbul'un Avcılar ilçesinde 19 ilköğretim okulunda 6-15 yaş arası 2452 öğrenci ile gerçekleştirilen kesitsel tipte bir araştırmadır. Çocukların beslenme alışkanlıkları ve besin tüketim sıklıkları hakkında yüz yüze anket uygulanmıştır. Çocukların boy uzunluğu, vücut ağırlığı, bel ve kalça çevresi ölçümleri alınmıştır. Çocuklar Z-skorlarına göre sınıflandırılmıştır. İstatistikler SPSS 21 programı kullanılarak yapılmıştır.Bulgular: Öğrencilerin toplam %47.8'i erkek, %52.2'si kızdır. Öğrencilerin yaşlarının ortalaması 9.47±2.21, ortalama BKİ ise 18.7±3.73 kg/m2’dir. Fazla kiloluluk ve obezite prevalansı sırasıyla %20.3 ve %13.2 bulunmuştur. 9 yaşındakilerin obezite prevalansı en yüksek düzeydedir ve erkeklerde kızlara göre daha fazla obezite görülmüştür (p&lt;0,001). Obez olan ve obez olmayan öğrenciler arasında ders çalışırken ve televizyon izlerken atıştırma ve bazı besinleri tüketme sıklığı açısından anlamlı fark bulunmuştur (p&lt;0.05).Sonuç: Her üç çocuktan birinin normalden fazla kilolu olduğu bulunmuştur. Ulusal ve uluslararası politikaların yanı sıra bölgesel ve yerel takipler ile gerekli önlemlerin alınması çocukluk çağı obezitesinin kontrolünde faydalı olabilir.

The association between vitamin B12, folate, homocysteine levels, and carotid intima-media thickness in children with obesity: a cross-sectional study

OBJECTIVES

We aimed to evaluate the association between vitamin B12, folate, homocysteine levels, and carotid intima-media thickness (CIMT) among children with obesity in whom vitamin deficiencies are more frequent.

METHODS

Herein, 100 children with obesity (58 girls) were included (age, 5-18 years). Height, weight, body mass index (BMI), waist circumference (WC), puberty stage, blood pressure, and biochemical values were collected from medical records; standard deviations (SDS) and percentiles were calculated. Obesity was defined as BMI SDS of >+2SDS. Vitamin B12 and folate levels of <300 pg/mL and <4.8 ng/mL, respectively, were considered deficient. A radiologist quantified measurements from the carotid artery.

RESULTS

Mean patient age was 12.52 ± 3.63 years. The mean weight SDS, BMI SDS, and WC/height were +3.37 ± 0.93, +2.93 ± 0.55, and 0.65 ± 0.05, respectively. In pubertal cases, insulin (p<0.001), the homeostatic model assessment for insulin resistance (HOMA-IR) (p=0.001) and homocysteine (p=0.002) levels were higher; vitamin B12 (p<0.001) and folate (p<0.001) levels were lower than those in prepubertal ones. WC and HOMA-IR correlated with CIMT; however, homocysteine levels were not correlated with CIMT.

CONCLUSIONS

In our study, pubertal cases had lower vitamin B12 and folate levels as well as higher homocysteine levels. Although no correlation was identified between homocysteine levels and CIMT, this condition may be related to our study group comprising children, who had a shorter duration of obesity than those in adults. As CIMT was higher in children/adolescents with increased WC, it is proposed that they need central obesity more frequently and carefully follow-up.

Research of socioeconomic status and school-based health screening results of study with children after two years of COVID-19 pandemic

Aim: Schools are the most effective environments for health screenings for children and adolescents. The aim of school health screenings is to contribute to the protection and maintenance of children's health status by early diagnosis and treatment of diseases. We aimed to reveal the health screening findings of children whose lifestyles changed during the pandemic period, and to compare according to socioeconomic status. Material and Method: Students from three different schools which were grouped as low, middle and high socioeconomic status were included. Hearing test, visual acuity examination, orthopedic examination, blood pressure measurements, height, weight and anthropometric measurements were performed. Descriptive statistical methods were used in the evaluation of the data. Results: 1322 students with parental consent were included in our study. 667 (50.5%) of the students were female, mean age was 11.4±1.1, and mean body mass index score was 19.6±4.0. When body mass index scores were evaluated, 202 (15.3%) students were overweight and 189 (14.3%) were obese. Visual acuity defect was found in 257 (19.4%) of the students and hearing loss in 309 (23.4%). As a result of orthopedic examination and blood pressure measurements, 67 (5.1%) scoliosis and 131 (9.9%) high blood pressure were determined. The rate of hypertension was found to be significantly higher in school students with high socioeconomic status compared to the others (p

Cutaneous manifestations of obesity in Turkish children: A comparative study

BACKGROUND

Cutaneous changes in obese adults have been investigated in numerous studies, but this issue has not been adequately investigated in children.

OBJECTIVES

We aimed to determine the prevalence of skin manifestations in children with obesity by comparing them to normal-weight children.

METHODS

A cross-sectional study was conducted between June 2017 and January 2019 in which 82 children with obesity and 86 normal-weight healthy control children were enrolled. Study participants had detailed full-body skin examinations performed by the same dermatologist; mycological and Wood's lamp examinations were performed when necessary. Sociodemographic and anthropometric measurements of the participants were recorded.

RESULTS

Striae distensae were the most common skin manifestation in children with obesity; striae were significantly higher in the obese than in the control group (72% vs. 26.7%, p < .001). The anatomical distribution of the striae distensae in the groups differed significantly. Striae distensae were most commonly observed on the buttocks in the control group, while the thighs were the most common site in the obese group. Acanthosis nigricans (63.4% vs. 3.5%, p < .001), acrochordons (17.1% vs. 1.2%, p < .001), keratosis pilaris (32.9% vs. 17.4%, p = .021), intertrigo (11% vs. 0%, p = .001), folliculitis (31.7% vs. 5.8%, p < .001), seborrheic dermatitis (12.2% vs. 3.5%, p = .035) and facial erythema (7.3% vs. 0%, p = .012) were found to be statistically significantly more common in the obese group compared to the control group.

CONCLUSIONS

Obesity in children is associated with numerous cutaneous manifestations. Further study is needed to identify whether weight loss can reduce skin manifestations in obese children.

Trends in Obesity and Obesity-Related Risk Factors among Adolescents in Korea from 2009 to 2019

This study was conducted to identify the trends in obesity prevalence among adolescents and changes in the risk factors related to obesity. The study analyzed secondary data obtained from Korean Youth Risk Behavior Web-based Surveys conducted from 2009 to 2019. The Korean Youth Risk Behavior Web-based Survey is an annual survey of a nationwide representative sample of enrolled students aged 13–18 years in middle and high schools in Korea. Linear and trend analyses showed that the prevalence of obesity increased by 0.47% on average annually; this increase was statistically significant. Healthy food intake decreased significantly, but the prevalence of unhealthy food intake and the prevalence of skipping breakfast increased significantly. Vigorous-intensity physical activity, physical activity for over 60 min a day, and muscle-strengthening exercise for more than 3 days a week increased significantly, but so did the adolescents’ sedentary time. Therefore, health care providers and public policymakers need to actively manage adolescent obesity, which has been continuously increasing since 2009. In addition, long-term trends in obesity-related risk factors such as physical activity and dietary behaviors need to be considered in the development of obesity management strategies.

Profile of hypertension in Turkey: from prevalence to patient awareness and compliance with therapy, and a focus on reasons of increase in hypertension among youths

Hypertension is one of the most common noncommunicable chronic diseases and is an important risk factor for vascular complications. The prevalence of hypertension is very high worldwide, and it is still increasing in low- and middle-income countries. Although some improvements were reported in high-income countries in recent years, there is still much to do to overcome hypertension and its complications. Identically, hypertension is a severe public health issue in Turkey. Approximately one third of the adult population has got hypertension but almost half is unaware of the disease. Children and youths are also affected by the burden of hypertension. Increased body mass index and obesity frequently accompany hypertension in children and adolescents. Major contributors to the disease burden appears to be consumption of high amounts of dietary sodium, lack of appropriate physical activity, increasing weight and obesity. In the last decades, an improvement at disease awareness has been achieved but blood-pressure control rates are still low in Turkey. Traditional and natural products, including lemon juice and garlic, are very popular among patients with concerns regarding medications' side effects. Patients' adherence to therapy differs between regions and increases in parallel with high education level. Decreasing daily salt intake has been shown to reduce the prevalence of hypertension substantially and to prevent cardiovascular and cerebrovascular deaths in a cost effective manner in projection studies. Finally, improving education of patients, which has positive effects on disease awareness, treatment adherence, and blood-pressure control rates, should be considered.

Children-Dietary Inflammatory Index (C-DII), cardiometabolic risk, and inflammation in adolescents: a cross-sectional study

OBJECTIVES

There is limited evidence about the inflammatory potential of diet and cardiometabolic risk in children. The aim of this study was to evaluate the association between the Children's Dietary Inflammatory Index (C-DII) with cardiometabolic risk factors in Turkish adolescents from 10 to 17 years.

METHODS

Participants aged 10-17 years, who completed a 24-h dietary recall, from which C-DII scores were calculated, were include in this cross-sectional study. Lipid profile, glycemic parameters, high-sensitivity C-reactive protein (hs-CRP), liver enzymes, thyroid-stimulating hormone (TSH), and uric acid were analyzed in blood samples. Sociodemographic characteristics and sedentary behavior were assessed using a semi-structured questionnaire. We compared the distributions of anthropometric, biochemical, and blood pressure measurement levels associated with cardiometabolic risk factors by the median of C-DII with linear regression.

RESULTS

The mean sample C-DII was -0.16 ± 2.31 and ranged from -3.22 to +4.09. Higher median C-DII scores, indicating a more pro-inflammatory diet among children, were associated with higher blood pressure and body mass index (BMI). However, the C-DII was modestly directly associated with fasting insulin, fasting blood glucose, and waist circumference. The area under the receiver operating curve of C-DII in predicting hs-CRP was found to be quite high (0.864, 95% CI: 0.795-0.933).

CONCLUSIONS

Consuming a pro-inflammatory diet in adolescence was associated with alterations in cardiometabolic risk factors, especially with systolic blood pressure, diastolic blood pressure, and BMI.

Prevalence of arterial hypertension among Ukrainian students: the comparison of European and American guidelines

INTRODUCTION

Arterial hypertension (HTN) among children is progressively increasing. These concerns have led to an update of the guidelines about childhood hypertension by the European Society of Hypertension (ESH) in 2016 and the American Academy of Pediatrics (AAP) in 2017, and their thresholds for HTN differ. The current research aims to compare the prevalence of hypertension in Ukrainian teenagers using 2 different guidelines and to check the impact of gender, age, and excess weight on hypertension.

MATERIAL AND METHODS

The sample includes 540 Ukrainian students of 2 secondary urban schools, aged 10-17 years. Blood pressure and anthropometrical measurements were taken and compared with percentile tables.

RESULTS

The prevalence of abnormal BP (11.3% and 15.2%) and HTN (1.9% and 4.1%) was determined with ESH and AAP guidelines, respectively, and they strongly depended on which definitions and criteria were used. Boys were much more predisposed to abnormal BP. Comparing both guidelines, there was no significant difference in HTN prevalence in children aged 10-12 years; nevertheless, AAP recognized HTN almost twice as often in teenagers aged ≥ 13 years. Excess body weight was identified in 17.2% of the school-age children, twice as frequently as in males.

CONCLUSIONS

The results have shown a higher prevalence of HTN in teenagers and children with excessive weight more significant in boys and between children with positive markers of abdominal obesity due to both guidelines, without a significant difference in prevalence after re-classification; however, AAP recommendations might be preferable.

Structural equation model of physical activity in Turkish schoolchildren: an application of the integrated behavioural model

OBJECTIVES

Childhood obesity is increasingly prevalent in the developing world including Turkey. This study examined constructs of the integrated behavioural model associated with physical activity in a sample of schoolchildren in Ankara, Turkey using structural equation modelling.

DESIGN

Cross-sectional survey by probability sampling.

SETTING

Fifteen schools of different socioeconomic strata in Ankara, Turkey with grade 4 students.

PARTICIPANTS

2066 (969 girls and 1097 boys) grade 4 schoolchildren and their parents selected using a probability-based sampling frame.

PRIMARY OUTCOME MEASURES

Three primary outcomes were used: moderate-to-vigorous physical activity, team sport participation, sedentary behaviour.

RESULTS

Data were collected from 2066 fourth-grade children from schools of three socioeconomic strata. Missing data were imputed using multiple imputation. To examine the integrated behavioural model, a structural equation model containing latent constructs for physical activity outcome expectancies, self-efficacy, home environment and social norms were fitted with the three outcomes above. Adequate model fit was achieved in the structural equation model (χ²=1821.97, df=872, p<0.001, Comparative Fit Index=0.91, Tucker Lewis Index=0.91, root mean square error of approximation=0.02, standardised root mean square residual=0.04). All scale items were significantly associated with their respective latent constructs (all p<0.001). Several significant pathways between latent constructs and outcomes of interest were observed (p<0.05). Self-efficacy was positively associated with moderate-to-vigorous physical activity (p<0.001) and team sport participation (p<0.001) and negatively associated with sedentary behaviour (p<0.001). Negative outcome expectancies were negatively associated with moderate-to-vigorous physical activity (p<0.01) and sedentary behaviour (p<0.01) while positive outcome expectancies were positively associated with team sport behaviour (p<0.001) and negatively associated with sedentary behaviour (p<0.05). Home support was positively associated with moderate-to-vigorous physical activity (p<0.01) and team sport participation (p<0.05). Finally, physical activity social norms were negatively associated with sedentary behaviour only (p<0.05).

CONCLUSIONS

This study supported the extension to Turkish children of the integrated behavioural model in relation to physical activity behaviours. Results illustrate multiple targets for interventions to increase physical activity.

Children's Power of Food Scale: Turkish validity and reliability study

Objective:

The aim of the present study was to validate the Turkish version of the Children’s Power of Food Scale (C-PFS-T) after translation of the original version.

Design:

The data were collected via face-to-face interviews using the C-PFS-T and a socio-demographic information form. BMI was calculated by dividing body weight by the square of the height. After the adaptation of the scale to Turkish language, validity and reliability analysis were conducted for the C-PFS-T.

Setting:

Gülhane Training and Research Hospital Department of Child Health and Diseases Nutrition and Diet Unit in Ankara.

Participants:

This research was conducted with volunteer children and adolescents between the ages of 9 and 16 years (n 268).

Results:

It was concluded that the 15-item C-PFS-T was collected under three factors as in the original version of the child version. Cronbach’s α coefficient was found to be 0·878 for the scale. The confirmatory factor analysis results showed the acceptability and applicability of adapting the version of the C-PFS-T in terms of χ²/df (= 3·816), adjusted goodness-of-fit index (AGFI = 0·931), root mean square error of approximation (RMSEA = 0·082) and goodness-of-fit index (GFI = 0·852) fit indices. C-PFS-T total score’s median value of obese group wasn’t substantially different from normal weight group.Conclusions:

It was concluded that the Turkish version of the C-PFS, which provides an assessment of the hedonic hunger status of children and adolescents with fifteen items and threesubdimensions, has sufficient reliability and validity to be applied to these subjects.

Time trends of overweight and obesity among schoolchildren in Kuwait over a 13-year period (2007-2019): repeated cross-sectional study

OBJECTIVES

This study aimed to examine age-specific trends in the prevalence of overweight and obesity in schoolchildren in Kuwait over a 13-year period (2007 to 2019) using the WHO, the Centers for Disease Control and Prevention (CDC) and the International Obesity Taskforce (IOTF) definitions.

DESIGN

Using cross-sectional approach, Kuwait Nutrition Surveillance System (KNSS) objectively measured weight and height of schoolchildren over a 13-year period. Log-binomial regression models were used to examine age-specific trends of obesity and overweight over the study period.

SETTING

Public primary, middle and high schools in all provinces of Kuwait.

PARTICIPANTS

Schoolchildren aged 5-19 years (n 172 603).

RESULTS

According to the WHO definition, the prevalence of overweight and obesity in schoolchildren, respectively, increased from 17·73 % and 21·37 % in 2007 to 20·19 % and 28·39 % in 2019 (Pfor trend < 0·001). There is evidence that the obesity in females (but not males) has levelled off in the period 2014-2019 according to the three definitions of obesity, which is corroborated by a similar trend in the mean of BMI-for-age Z-score.

CONCLUSION

The prevalence of obesity and overweight in schoolchildren in Kuwait has risen over the last 13 years and trends are similar across all definitions. Obesity is no longer increasing at the same pace and there is evidence that the prevalence of obesity in females has plateaued. The current level of childhood overweight and obesity is too high and requires community-based and school-based interventions.

Integration of FGF21 Signaling and Metabolomics in High-Fat Diet-Induced Obesity

Sex differences in obesity have been well established, but the metabolic mechanism underlying these differences remains unclear. In the present study, we determined the expression levels of endogenous fibroblast growth factor 21 (FGF21) and its related receptors in male and female mice that were fed a high-fat diet (HFD) for 12 weeks. We also analyzed the metabolic changes in serum and livers using a nuclear magnetic resonance-based metabolomics approach. Reverse transcription polymerase chain reaction and western blotting results revealed that the levels of FGFR1, FGFR2, and co-factor β-klotho were upregulated in female mice to alleviate FGF21 resistance induced by HFD. The metabolomics results demonstrated that the serum and liver metabolic patterns of HFD-fed male mice were significantly separated from those of the female HFD-fed group and the normal diet group. Furthermore, low-density lipoprotein/very low density lipoprotein and betaine levels were associated with the resistance of exogenous HFD in female mice. These findings imply that sex-based differences in metabolism and susceptibility to obesity might be mediated by the FGF21 signaling pathway.

The prevalence and risk factors for overweight/obesity among Turkish children with neurodevelopmental disorders

OBJECTIVE

To compare the prevalence and correlates of overweight (OW) and obesity (OB) between autism spectrum disorder (ASD), intellectual disability (ID), and attention deficit-hyperactivity disorder (ADHD) and to investigate which variables significantly contribute to OW/OB in each group.

METHODS

Of 267 cases (96 with ASD, 80 with ID, and 91 with ADHD) aged 2-18 years, body mass index (BMI) percentiles, birth weight, food reward usage, weekly screen and physical activity time, and psychotropics used were recorded.

RESULTS

OB (OB + OW) prevalence was 22.9 % (36.4 %) in ASD; 22.5 % (40 %) in ID; and 17.6 % (27.5 %) in ADHD. Although the ADHD group had the highest rate of stimulant usage (χ2 = 69.605, p < 0.001), physical activity attendance (χ2 = 49.751, p < 0.001), and the lowest anti-psychotic (χ2 = 69.142, p < 0.001), and anti-depressant usage (χ2 = 7.219, p < 0.001) than ID/DD or ASD, BMI percentile of the participants did not differ between the groups (H(2) = 1.652, p = 0.43). In hierarchical logistic regression analysis, in ASD, food reward (OR = 4.65, 95 %Cl = 1.25-17.19) and the number of psychotropics used (OR = 2.168, 95 %Cl = 1.07-4.36) were significantly related to the risk of OW/OB. In ADHD, each drugs administered and a 1-kilogram elevation in birth weight was associated with a 4.09 and 2.82 increased risk for OW/OB.

CONCLUSION

OW/OB is prevalent in children with neurodevelopmental disorders regardless of their diagnosis. Our findings showed that food rewards put a higher risk for OW/OB in ASD than administering a psychotropic. It could be better to use other positive reinforcements other than edible ones to prevent OW/OB in these children.

What is the relationship between obesity and new circadian rhythm parameters in Turkish children and adolescents? A case-control study

BACKGROUND

Although the relationship between circadian rhythm parameters and obesity in children and adolescents is recognized, there are few studies on this topic. The concept of sleep-corrected social jetlag (SJLsc) has been formulated recently, but its relationship with childhood obesity has not yet been established. Therefore, we thought that SJL might play an important role in the etiology of obesity. Accordingly, we aimed to compare circadian rhythm parameters between obese and normal-weight children and adolescents.

METHODS

Seventy-nine obese and eighty-two normal-weight children and adolescents aged between 8 and 17 years participated in this case-control study, which took place in the Mardin province of Turkey. Data were collected with a sociodemographic information form, the Childhood Chronotype Questionnaire, and anthropometric measurements.

RESULTS

The average ages of the obese participants and controls were 12.3 ± 2.3 and 12.4 ± 2.2 years, respectively. Obese young people had greater evening preference, longer sleep debt duration, SJL duration and SJLsc duration, and higher Morningness-Eveningness Scale (MeScale) scores; and shorter mean sleep duration (p<0.005). In regression analyses, BMI z scores were significantly correlated with all circadian rhythm parameters, except SJLsc duration, while WC z scores were significantly correlated with all circadian rhythm parameters, except mean sleep duration. After adjustment, the high MeScale scores (OR: 1.142, p<0.05) and the presence of psychiatric disorder in the mother (OR: 15.075, p<0.05) were associated with obesity.

CONCLUSIONS

Circadian rhythm parameters can play an important role in the etiology of obesity. Future studies with larger samples and fewer confounding factors are needed to clarify the etiological factors.

Traditional Societal Practices Can Avert Poor Dietary Habits and Reduce Obesity Risk in Preschool Children of Mothers with Low Socioeconomic Status and Unemployment

Healthy nutritional habits are of vital importance for good health and quality of life for all individuals in all life stages. Nutritional habits shaped in early childhood set the foundation for future dietary practices applied through lifespan, hence informing risk towards chronic diseases. A key contributor to child health is maternal impact. A healthy childhood status translates into increased lifespan, health, and life-quality, as well as better family and social interactions and improved academic performance. These conditions can contribute to a healthier and more vibrant workforce, and thus extend positive impact on the economic and overall development of a country. Evidence related to maternal impact on childhood dietary habits is limited in Turkey, an emerging economy with notable disparities and a significant segment (approximately one third) of its 83 million population under the age of 30. Hence, the aim of this study was to investigate the relationship between the socioeconomic status (SES) of mothers on the dietary habits of their preschool children. A pilot cross-sectional observational study was conducted involving the mothers of 109 preschool children aged 4-6 years. Data on the nutritional status of children were collected through a food frequency questionnaire and a 24-h recall interview, while sociodemographic information was also collected, and statistical analyses conducted. An unexpected finding regarding the lack of association between the socioeconomic and employment status of mothers and the nutritional intakes of their children was observed. Interestingly, it appears that more traditional societal and nutritional practices typically undertaken in the case of lower SES, especially in more traditional settings like the case of Turkey, appear to extend a protective effect as per the nutritional habits and ensuing obesity risk in the case of children of women with lower SES. Another way to interpret our finding is that the difference in education and SES is not adequate to produce a significant effect in terms of children dietary intake. This is an interesting finding that warrants further study. Additionally, such studies serve to increase awareness about the importance of healthy nutritional practices in preschool children and the critical role of the mother on their nutritional status, particularly in the Turkish idiosyncratic setting.

The current review of adolescent obesity: the role of genetic factors

Obesity, a complex, multi-factor and heterogeneous condition, is thought to result from the interaction of environmental and genetic factors. Considering the result of adolescence obesity in adulthood, the role of genetic factors comes to the fore. Recently, many genome-wide association studies (GWAS) have been conducted and many loci associated with adiposity have been identified. In adolescents, the strongest association with obesity has been found in single nucleotide polymorphisms (SNP) in the FTO gene. Besides FTO, GWAS showed consistent effects between variants in MC4R, TMEM18, TNNI3K, SEC16B, GNPDA2, POMC and obesity. However, these variants may not have similar effects for all ethnic groups. Although recently genetic factors are considered to contribute to obesity, relatively little is known about the specific loci related to obesity and the mechanisms by which they cause obesity.

Obesity is associated with severe clinical course in children with Henoch-Schonlein purpura

BACKGROUND

We aimed to evaluate the role of obesity on the clinical course and response to treatment in patients with Henoch-Schonlein purpura (HSP).

METHODS

Data charts of children with HSP followed in a tertiary hospital between 2000 and 2018 were reviewed retrospectively. Persistent purpura was defined as skin involvement persisting for ≥ 30 days. Mild nephropathy was defined as the presence of microscopical hematuria and/or non-nephrotic proteinuria, while severe nephropathy as nephrotic proteinuria, nephritic syndrome, and/or kidney insufficiency. Obese and non-obese patients were compared for demographic, clinical, and laboratory parameters.

RESULTS

There were 199 patients (M/F, 104/95; median (IQR) presenting age 7.1 (5.0-9.2) years; follow-up period 17.5 (6-50) months). Obese patients (n = 35 (17.6%)) had significantly higher rate of persistent purpura (46% vs 21%), severe renal involvement (58% vs 31%), high-grade renal histopathological lesions (83% vs 39%), hypertension (29% vs 9%), and increased erythrocyte sedimentation rate (79% vs 56%). Obese patients also showed delayed improvement of cutaneous (25 vs 14 days), articular (12.5 vs 10.0 days), and kidney (280 vs 57 days) symptoms. Obese children used steroids for significantly longer period of time (236 vs 40 days). Furthermore, need for immunosuppressive medications were higher in obese patients (40% vs 9%).

CONCLUSIONS

Obese children with HSP had higher erythrocyte sedimentation rate, hypertension, and severe renal involvement; showed delayed improvement of skin, joint, and kidney findings; and need more immunosuppressive medications and a longer period of steroid treatment. These findings may be associated with the effect of adipose tissue on inflammation.

Food addiction: A key factor contributing to obesity?

Background:

People may develop addiction to hyperpalatable foods, which may be a cause of obesity. This study aimed to determine the prevalence of obesity among adolescents and the effect of food addiction on obesity.

Materials and Methods:

In this cross-sectional study, food addiction and obesity status of high school students were investigated. Among 17,000 10^th and 11^th grade students, assuming the design effect as 2.0, with obesity prevalence of 10%, with 3% error, and 95% confidence interval, at least 752 participants were included. Obesity was the dependent variable, whereas sociodemographic characteristics, body image, eating habits, and food addiction were the independent variables. Food addiction was assessed using the Yale Food Addiction Scale. Obesity was determined by age- and sex-specific body mass index (BMI) percentiles for adolescents < 18 years of age and BMI ≥ 30.0 for those aged ≥ 18. Data were collected through face-to-face interviews. Statistical analyses were performed using SPSS 25.0. After adjustment for age, sex, and other variables, the effect of food addiction on obesity was determined through logistic regression. P <0.05 was deemed statistically significant.

Results:

Among adolescents (n = 874), 18.9% were food addict, 25.1% were overweight, and 12.1% were obese. After adjusted for age, sex, and other variables, food addiction significantly increased the risk of obesity (odds ratio: 1.9; 95% confidence interval: 1.167–3.335). Having a fragmented family, working mother, overweight father, and participants not knowing their weight correctly significantly increased obesity.

Conclusion:

While quarter of the adolescents had weight problems, one-fifth suffered from food addiction. After adjusting for confounders, food addiction significantly increased obesity. Identifying individuals with food addiction, providing treatment to overcome that, paying special attention to adolescents with obese parents or living in fragmented families, and providing support to both parents and adolescents could be useful in tackling obesity.

The relationship between adolescents' nutrition literacy and food habits, and affecting factors

OBJECTIVE

The current study aimed to investigate the relationship between nutrition literacy (NL) and food habits (FH) in adolescents, and the factors affecting the relationship.

DESIGN

The study used a cross-sectional design. The data were collected using socio-demographic information forms, the Adolescent Nutrition Literacy Scale (ANLS) and the Adolescent Food Habit Checklist (AFHC). The socio-demographic characteristics of adolescents were analysed using descriptive statistics, and the factors affecting NL and FH were determined using the t test, Mann-Whitney U test and ANOVA. The correlation between ANLS and AFHC scores was tested with correlation analysis, and linear regression analysis was employed to predict the change in the NL of adolescents at the level of FH.

SETTING

The study was conducted in the city of Izmir in Turkey.

PARTICIPANTS

The study consisted of a total of 467 adolescents.

RESULTS

There was a statistically significant relationship between NL of adolescents and their gender, education level of the father, grade, BMI values and daily lifestyle behaviours (DLB), as well as between their FH and DLB. There was a positive and significant relationship between ANLS and AFHC. The ANLS and its subscales were found to have a statistically significant effect on AFHC. According to the linear regression analysis, the nutritional habits of adolescents were found to be significantly affected by NL (β = 0·357).

CONCLUSIONS

As ANLS scores increased, AFHC scores were determined to increase as well. This finding shows that the FH of adolescents have changed positively with increase in their NL.

The Effect of Diet-Exercise Trainings Provided to Overweight and Obese Teenagers through Creative Drama on Their Knowledge, Attitude, and Behaviors

BACKGROUND

This study was conducted in Turkey as an empirical study in randomized, controlled, and time series design for the purpose of evaluating the effects of the Diet-Exercise trainings with creative drama method provided to overweight/obese teenagers.

METHODS

This study was designed to highlight the effect of interactive education provided to slightly overweight/obese teenagers through creative drama on modifiable factors that caused obesity. Seventy-six overweight/obese teenagers studying at sixth and seventh grades of upper primary education were included in the study (38 participants in the Study Group and 38 participants in the Control Group). Training courses that were designed based on creative drama method were implemented in five sessions with teenager groups (n = 12-13); and the mothers were also trained in a session in this study (for the Study Group).

RESULTS

At the end of the study, it was determined that the knowledge, attitude, the order of the meals, and healthy diet-exercise behavior points of the teenagers in the Study Group increased; and the difference between the Study Group and the Control Group was significant (p < 0.05). The BMI, body weight, and waist/height rate of the teenagers in the Study Group decreased at a significant level after the study was completed (p < 0.05); and significant increases were determined in the waist circumference and body weight measurements of the Control Group (p < 0.05).

CONCLUSIONS

As a conclusion, overweight/obese teenagers may be reached with school-based educational programs, and they may be made to acquire positive attitudes and behaviors through diet and exercises designed with interactive methods like creative drama.

Evaluation of upper arm muscle and fat area of children and adolescents from Ankara, Turkey

Arm anthropometry is a commonly used method for determining the nutritional status of children and adolescents. The purpose of the study is to evaluate the arm anthropometry of 1484 children and adolescents (760 boys and 724 girls) aged between 6–17 years. The sample groups are selected who are living in Ankara to establish local reference values. In order to determine upper Arm Muscle Area (AMA) and upper Arm Fat Area (AFA), height, weight, upper arm circumference and triceps skinfold thickness measurements were taken in accordance with International Biological Program (IBP) protocols. Smoothed percentiles of AMA and AFA were obtained. Body mass index was calculated with weight and height measurements (kg/m2). Fat mass (FM) and fat free mass (FFM) were measured using bio-impedance analyzer. According to the obtained results, arm muscle area values were higher in boys and arm fat area was higher in girls. In addition, sex difference in these variables increased with age. There was a high positive correlation between body mass index (BMI) and AMA, AFA. It has been found that there is a difference in AMA and AFA values for Ankara children compared to previous studies in Turkey.

The relationship between body mass index and renal length in obese children

BACKGROUND

Obesity in the pediatric population is a severe public health problem and is associated with various comorbidities. Renal length is an important clinical parameter for the diagnosis and follow-up of renal diseases. The aim of this study was to determine the relationship between renal length (measured ultrasonographically) and body mass index (BMI) in obese children, and to develop nomograms for renal length according to BMI.

METHODS

Renal ultrasound was performed in 368 children without renal disease. Each child's age, gender, weight, height, and BMI (kg/m²) were recorded. The children were divided into three groups according to BMI percentiles: obese group: BMI ≥ 95th percentile; overweight group: BMI 85th-94th percentile; normal weight group: BMI 5th-84th percentile.

RESULTS

Weight, height, BMI, and right and left renal length differed significantly between the three groups (p = 0.001). There were significant correlations between renal length with age, weight, height, and BMI. Measurement of renal length was independently associated with BMI, age, and height. BMI was used to create renal length nomograms for obese children, based on multiple regression analysis (R² = 0.32 and p = 0.0001). Mean renal length was highest in the obese group (96.9 ± 13.4 mm) and lowest in the normal weight group (88.3 ± 12.9 mm).

CONCLUSIONS

Ultrasonographic measurement of the renal length according to BMI in children can be a useful method in evaluating these children. Smaller-than-normal kidneys can easily remain undiagnosed in obese and overweight children and this nomogram offers an additional method to evaluate the renal size in obese children.

New guidelines for the diagnosis, evaluation, and treatment of pediatric hypertension

Childhood hypertension has become a significant public health problem due to increased prevalence in recent decades. High blood pressure causes increased mortality and morbidity in childhood, precedes adult hypertension, and causes increased cardiovascular events in adulthood. These concerns have led to an update of guidelines about childhood hypertension by the European Society of Hypertension in 2016 and the American Academy of Hypertension in 2017. This review highlights the important developments in these guidelines and recent literature about childhood hypertension in terms of diagnosis, prevalence, risk factors, diagnostic tools, prevention and management.

Physio-psychosocial and Metabolic Parameters of Obese Adolescents: Health-Promoting Lifestyle Education of Obesity Management

The aim of the study was to determine the effect of health-promoting lifestyle education on the physio-psychosocial and metabolic parameters of obese adolescents. This quasi-experimental study was conducted at a city center in Turkey through a pretest and a post-test (n = 73). Following the collection of the first assessment data from the study and control groups, an 8-week education program was applied to students in the study group. The study found that the BMI values and obesity-related risk factors of study group decreased, the means of the self-esteem scale and total ALS and sub-scale scores increased, and the pretest and post-test inter-group difference was significant (p < 0.05). The study found a decrease in cholesterol, LDL, Hb1Ac and Triglyceride levels in the study group and an increase in HDL levels. The study concluded that health-promoting lifestyle education for obese adolescents contributed to improving their physio-psychosocial and metabolic parameters.

Turkish Psychometric Properties of the Predictor Scales Affecting Adolescent Obesity

Adolescent obesity is one of the most important public health problems today. Identifying factors that affect obesity in adolescents and developing programs to prevent obesity are very important. This research aims to test Turkish psychometric properties of the scales to predict adolescent obesity (Healthy Lifestyle Choices Scale, Perceived Healthy Lifestyle Difficulty Scale, Activity Knowledge Scale, Nutrition Knowledge Scale, Healthy Lifestyle Attitude Scale, Healthy Lifestyle Belief Scale). The psychometric properties of the Scales were tested test-re-test reliability, the Cronbach's alpha coefficient, the item-total correlation, and the Confirmatory Factor Analysis. The relationship between the Scales was measured using the Spearman's correlation analysis. The level of internal consistency of the scales to predict adolescent obesity was found good. The goodness of fit values of the Belief Scale were measured as significantly high (χ2 = 177.24, df = 0.99, χ2/df = 1.79 (p < .001), Comparative Fit Index = 0.91, Goodness of Fit Index = 0.91, Normed Fit Index = 0.92, Incremental Fit Index = 0.92, Root Mean Square Residual = 0.05, Root Mean Square Error of Approximation Residual = 0.05). The psychometric analyses of the Scales were found to be very similar to the results of the original scales. There was a positive correlation between the Choice, Attitude, Belief, Nutrition and Activity Knowledge Scale, and a negative correlation with the Perceived Difficulty scale. The scales which measure adolescent obesity were accepted as valid and reliable measuring tools. This study will be an important resource for researchers working on the adolescent health and obesity.

The impact of nutrition literacy on the food habits among young adults in Turkey

BACKGROUND/OBJECTIVES

Youth is the crucial stage between childhood and adulthood during which an individual acquires new behavior and practices including dietary habits, that may be influenced by his peers, social circle, nutrition knowledge level and other factors. The increase in awareness of young adults is of special importance from the perspective of health and prevention of obesity related chronic diseases. To measure the nutrition literacy level of university students using the Turkish version of Adolescent Nutrition Literacy Scale (ANLS). We evaluated their food habits using the Adolescent Food Habit Checklist (AFHC) tool and analysed it, if the eating habits were affected by nutrition literacy level.

SUBJECTS/METHODS

A cross-sectional descriptive study was conducted on randomly selected 276 students studying in the Faculty of Health Sciences of Istanbul Aydin University, Turkey. Data was collected by means of ANLS and AFHC tools by face to face interview method. SPSS statistical sofware (IBM SPSS Statistics 19) was used to analyse the obtained data.

RESULTS

Participants comprised of 47.1% males and 52.9% females with mean age of 20.0 ± 1.60 years. Mean body mass index (BMI) was determined as 22.4 ± 3.76 (23.6 ± 3.63 males 21.3 ± 3.57 females). Functional, interactive and critical nutritional literacy scores for male participants were 22.49 ± 5.71, 17.45 ± 4.84, and 28.28 ± 7.13 respectively (total 64.98 ± 10.15). For females the values were 24.66 ± 5.13, 20.17 ± 4.28, and 32.20 ± 5.65 (total 69.72 ± 8.59) respectively. For all the three sub-categories of nutrition literacy, the scores acquired by females were significantly higher than males (P < 0.001). In the AFHC tool, the mean score acquired by males were 9.26 ± 4.18 whereas for females it was 10.37 ± 3.40 significantly higher as compared to males (P = 0.007).

CONCLUSIONS

The food habits of female participants were better than males; in accordance with their nutrition literacy status. It may be concluded that food habits are influenced by nutrition literacy and therefore stress much be given to increase the nutrition awareness among children youth as well as adults.

Remarkable Increase in the Prevalence of Overweight and Obesity Among School Age Children in Antalya, Turkey, Between 2003 and 2015

OBJECTIVE

Childhood obesity (OB) is an acknowledged global problem with increasing prevalence reported around the world. We conducted this study with the aim of determining the local trend in OB and overweight (OW) prevalence in the last decade and to observe the alteration of OB and OW prevalence by age group. An additional aim was to construct new age- and gender-specific body mass index (BMI) reference percentile charts for Turkish children living in the city center of Antalya.

METHODS

This cross-sectional study included 1687 school aged children. International Obesity Task Force guidelines were used to determine the OB and OW prevalence. OW was defined as a BMI between 85^th and 95^th percentile, and OB >95^th percentile. The data were compared with a previous study carried out in the same region in 2003. The least mean square method was used to construct the BMI reference percentile charts.

RESULTS

The prevalence rates for OB and OW were 9.8% and 23.2%, respectively, with a combined OW/OB rate of 33%. OB prevalence was higher in boys than girls (p<0.05). The prevalence of combined OW/OB was highest at age 9-10 years. The prevalence of OB has increased 2.9 times during twelve years in this location.

CONCLUSION

Comparing the current findings with rates of OW and OB in the previous decade, childhood OB in Antalya has reached alarming levels. Urgent measures integrated into the national education system should be taken to prevent OB. In addition more surveillance studies should be planned to show the future trend of OB prevalence nationally.

Nutritional status and related factors of schoolchildren in Çorum, Turkey

OBJECTIVE

We aimed to determine nutritional status and related factors among schoolchildren in Çorum, Central Anatolia, Turkey.

DESIGN

Schoolchildren's height and weight were measured to calculate BMI and BMI Z-scores. Height, weight and BMI Z-scores were analysed and nutritional status classified according to the WHO.

SETTING

Central Anatolia, Turkey.ParticipantsSchoolchildren aged 5-17 years (n 1684) participated in study.

RESULTS

Of children, 4·2% were stunted, 6·9% thin, 13·8% overweight and 6·6% were obese. Proportions of stunting, thinness and overweight/obesity were significantly higher in children aged &gt;10 years (78·6, 75·0 and 64·9%, respectively) than in those aged ≤10 years (21·4, 25·0 and 35·1%, respectively; all P &lt;0·001). Median (range) birth weight and breast-feeding duration in children with stunting (2750 (1400-3600)g; 10 (0-36) months) were significantly lower and shorter, respectively, than those of normal height (3200 (750-5500)g; 15 (0-72) months) and tall children (3500 (2500-4900)g; 18 (0-36) months; P &lt;0·001, &lt;0·001, 0·011 and 0·016, respectively). The same relationship was observed in thin children (3000 (1000-4500)g; 12 (0-36) months) compared with normal-weight (3200 (750-5500)g; 15 (0-72) months) and overweight/obese children (3300 (1200-5500)g; 16 (0-48) months; P=0·026, &lt;0·001, 0·045 and 0·011, respectively).

CONCLUSIONS

Overweight and obesity are health problems that must be addressed in schoolchildren. Adolescents also have a risk of double malnutrition. Promoting normal birth weight and encouraging long duration of breast-feeding are important to support normal growth in children.

Pediatric laparoscopic sleeve gastrectomy in Turkey: Short-term results

BACKGROUND

Obesity is one of the most rapidly increasing health problems in children. Laparoscopic sleeve gastrectomy (LSG) is one of the best treatment options and is feasible and safe in children. The aim of this study was to present the short-term results of a laparoscopic sleeve gastrectomy series in children.

METHODS

Children who underwent LSG in 2014-2017 were included in the study. Charts were investigated retrospectively and short-term weight loss was analyzed.

RESULTS

Patients who had surgery in 2014-2017 were included in the study. There were six girls and two boys, and the median age was 15 years (range, 11-18 years). Mean weight was 159.25 ± 19.78 kg, and mean body mass index was 61.05 ± 8.5 kg/m² . Mean operation time was 70 min (range, 65-90 min), mean hospital stay was 5.1 days (range, 3-7 days), and mean follow up was 19.2 months (range, 1-43 months). Of these patients, five had hypertension and were under medication and two of these five also had hyperinsulinemia. One of the five children had Bardet-Biedl syndrome and one had bronchial asthma. After operation, medication was stopped in four of the eight children. At the time of writing, six patients were doing well without postoperative complications, or the need for reoperation.

CONCLUSION

Even though the follow-up period was short and the number of patients was small, LSG was a feasible and promising surgical method for morbidly obese children. A multidisciplinary approach and lifelong behavior therapy are key steps for success.