Associations between energy intake, daily food intake and energy density of foods and BMI z-score in 2-9-year-old European children

Purpose

The aim of this study was to investigate the associations between proxy-reported energy intake, daily food intake and energy density of foods and body mass index (BMI) z-score in 2–9-year-old European children.

Methods

From 16,225 children who participated in the identification and prevention of dietary- and lifestyle-induced health effects in children and infants (IDEFICS) baseline examination, 9,782 children with 24-h proxy dietary information and complete covariate information were included in the analysis. Participating children were classified according to adapted Goldberg cutoffs: underreports, plausible energy reports and overreports. Energy intake, daily food intake and energy density of foods excluding noncaloric beverages were calculated for all eating occasions. Effect of energy intake, daily food intake and energy density of foods on BMI z-score was investigated using multilevel regression models in the full sample and subsample of plausible energy reports. Exposure variables were included separately; daily food intake and energy intake were addressed in a combined model to check for interactions.

Results

In the group of plausible energy reports (N = 8,544), energy intake and daily food intake were significantly positively associated with BMI z-score. Energy density of foods was not associated with BMI z-score. In the model including energy intake, food intake and an interaction term, only energy intake showed a significantly positive effect on BMI z-score. In the full sample (N = 9,782), only energy intake was significantly but negatively associated with BMI z-score.

Conclusion

Proxy-reporters are subject to misreporting, especially for children in the higher BMI levels. Energy intake is a more important predictor of unhealthy weight development in children than daily food intake.

Markers of insulin resistance are associated with fatness and fitness in school-aged children: the European Youth Heart Study

AIMS/HYPOTHESIS

Our aim was to examine the association between markers of insulin resistance and: (1) body fat and waist circumference, taking into account cardiorespiratory fitness in school-aged children; and (2) cardiorespiratory fitness at differing levels of body fat and waist circumference.

SUBJECTS AND METHODS

This was a cross-sectional study of 873 children aged 9.6 +/- 0.4 years from Estonia and Sweden. Weight, height and waist circumference were measured. Body fat was expressed as the sum of five skinfold thicknesses. Cardiorespiratory fitness was estimated by a maximal cycle-ergometer test. The studied markers of insulin resistance were fasting insulin and glucose, and homeostasis model assessment (HOMA).

RESULTS

HOMA and fasting insulin were positively associated with body fat and waist circumference after adjusting for cardiorespiratory fitness, age, pubertal status and study location. HOMA and fasting insulin were negatively associated with cardiorespiratory fitness in children in the third (highest) tertile of body fat and waist circumference after controlling for sex, age, pubertal status and study location. Fasting glucose was negatively associated with cardiorespiratory fitness in children in the third (highest) tertile of waist circumference, but it was not associated when body fat was taken into account.

CONCLUSIONS/INTERPRETATION

In school-aged children, HOMA and fasting insulin are significantly associated with body fat and waist circumference. In addition, cardiorespiratory fitness explains a significant proportion of the HOMA and fasting insulin variance in those children with high levels of body fat and waist circumference. The findings suggest that the deleterious consequences ascribed to high fatness could be counteracted by having high levels of cardiorespiratory fitness.

Allergic sensitization among adults in Tallinn, Estonia

BACKGROUND

The prevalence of allergic sensitization has increased worldwide during recent years.

OBJECTIVE

The aim of the study was to estimate the prevalence of allergic sensitization and to evaluate the influence of age, gender, number of siblings, pet keeping in childhood, and residential area before the age of five on allergic sensitization among adolescents and adults aged 17-66 years in the capital of Estonia, Tallinn. A cross-sectional study was carried out between March 1997 and December 1998.

METHODS

The sensitization to 15 inhalant allergens was assessed. The associations between sensitization based on skin prick tests (SPTs), symptoms based on a structured interview, and possible risk factors were estimated. A random sample of 516 subjects was included in the study analysis.

RESULTS

The prevalence of allergic sensitization was 34.5%, while it was 39.3% in subjects aged 20-44 years. The most prevalent sensitization was against the German cockroach, 15.5%, and it was particularly high among adolescents. It was followed by mugwort, dog, two storage mites species, and cat dander. Subjects with wheezing during the last 12 months, attacks of shortness of breath, wheezing due to furred animals, and allergic rhinitis or conjunctivitis had a significantly higher prevalence of positive SPT.

CONCLUSION

We found a surprisingly high prevalence of allergic sensitization among adults in Tallinn. Our results suggest that the cockroach allergen should be included in the investigation panel in order to reach a true prevalence of allergic sensitization in Estonia. Further, the pattern of allergic sensitization in Estonia appears to be different from published data about allergic sensitization in Scandinavia.

Passive smoking and respiratory symptoms in the FinEsS Study

The aim of the present study was to examine the relationship between reported environmental tobacco smoke (ETS) exposure and respiratory symptoms. In 1996, a postal questionnaire was randomly distributed in three areas of Estonia to a population-based sample, of which 4,995 females and 1,822 males had never smoked. The main outcome measures were current respiratory symptoms and the amount of reported ETS exposure outside the home. ETS exposure at home was more common in females (31% versus 19%), while exposure outside of the home was more common in males (53% versus 7%). Females reported more symptoms from tobacco smoke than males (37.7% versus 21.6%). If ETS exposure outside of the home exceeded 5 h daily, the risk for wheeze (odds ratio (OR) 2.67, 95% confidence interval (CI) 1.98-3.61) and physician-diagnosed asthma (OR 1.79, 1.02-3.16) were increased. ETS exposure outside of the home was shown to be strongly related to almost all respiratory symptoms in a dose/response manner. ETS exposure at home did not show significantly elevated ORs for any respiratory symptoms. This study shows that females seem to be more troubled by environmental smoke exposure than males and provides further evidence of the serious health hazards associated with environmental smoke exposure. Indeed, the findings of this study support a ban on smoking in the workplace and public areas.

Risk factors for pulmonary tuberculosis in Estonia

OBJECTIVE

To determine the risk factors for pulmonary tuberculosis incidence in Estonia.

DESIGN

In a case-control study, the cases were 248 adult tuberculosis patients treated in a hospital in Tallinn between January 1999 and June 2000, and the controls were 248 persons sampled from the Population Registry and matched to cases by sex, year of birth and county of residence. A questionnaire was administered to collect information on potential risk factors. Logistic regression was used to calculate odds ratios and 95% confidence intervals.

RESULTS

The main risk factors for tuberculosis were marital status other than married, educational level less than higher, low income, having been in prison, not having own place of residence, current unemployment, current smoking, alcohol consumption, shortage of food, and contact with tuberculosis patients. Place of birth was not a risk factor. Risk of tuberculosis decreased for overweight persons whose individual economic situation had improved during the last year.

CONCLUSIONS

The pattern of risk factors for pulmonary tuberculosis in Estonia was somewhat different from that in Western European countries; a large percentage of the patients were men, but were not elderly, and immigration and drug abuse did not increase the risk. Major risk factors were related to poverty and low socio-economic status.

Prevalence and risk factors for asthma and chronic bronchitis in the capitals Helsinki, Stockholm, and Tallinn

The aim of this part of the FinEsS-studies was to assess whether differences existed in prevalence of asthma, chronic bronchitis, and respiratory symptoms between three Baltic capitals, and to examine risk factor profiles for respiratory conditions. In 1996, a postal survey was performed in these cities with a response rate of 72% in Stockholm, 76% in Helsinki, and 68% in Tallinn. The prevalence of physician-diagnosed asthma was 76% in Stockholm, 6.2% in Helsinki, and 2.3% in Tallinn, while respiratory symptoms were most common in Tallinn. The prevalence of physician-diagnosed chronic bronchitis was 10.6% in Tallinn, 3.4% in Helsinki, and 3.0% in Stockholm. Risk factor analyses revealed a significantly increased risk for those living in Tallinn compared to that of Stockholm for wheezing conditions, OR 1.56-1.69, longstanding cough, OR 1.92 (1.74-2.13), attacks of shortness of breath during the previous 12 months, OR 1.35 (1.20-1.52), and chronic productive cough, OR 1.49 (1.28-1.74). Subjects having symptoms common in asthma were more likely to have physician-diagnosed asthma in Stockholm and Helsinki than in Tallinn, while subjects having bronchitis symptoms had more often physician-diagnosed chronic bronchitis in Tallinn. Prevalence of respiratory symptoms was higher in Tallinn than in Stockholm and Helsinki, while physician-diagnosed asthma was more common in Stockholm and Helsinki. The prevalence of physician-diagnosed chronic bronchitis was three times as high in Tallinn as in Helsinki or Stockholm. Our results also suggest large differences in diagnostic practices between the three countries, while the differences between the capitals in true prevalence of disease may be small.

Asthma, chronic bronchitis and respiratory symptoms among adults in Estonia according to a postal questionnaire

Epidemiological studies indicate a lower prevalence of asthma in Eastern than Western Europe. This study of the prevalence of asthma, chronic bronchitis, and respiratory symptoms was performed in three different regions of Estonia, a state incorporated in the Soviet Union until 1991. A postal questionnaire was sent to a random sample of 24,307 of the population aged 15-64 years. The response rate was 77.6%. The prevalence of physician-diagnosed asthma was 2.0% or considerably lower than in Northern and Western European countries. The prevalence of wheezing last 12 months, 21.7%, recurrent wheeze, 13.3%, and attacks of shortness of breath, 12.5%, were similar or even higher compared with prevalence rates found in the Nordic countries. The prevalence of physician-diagnosed chronic bronchitis was 10.7%, and was higher among women than in men, although the proportion of current smokers among men, 57%, was considerably greater than in women, 28%. A possible explanation to the high prevalence of respiratory symptoms also among non-smoking women may be exposure to environmental tobacco smoke in small, crowded Estonian homes. Diagnostic criteria based on the Soviet-time definitions is discussed as a possible explanation to the low prevalence of physician-diagnosed asthma and high prevalence of chronic bronchitis in Estonia compared with other Northern European countries.