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Tabacchi G, Garbagnati F, Wijnhoven TMA, Cairella G. Dietary assessment methods in surveillance systems targeted to adolescents: A review of the literature. Nutr Metab Cardiovasc Dis 2019; 29:761-774. [PMID: 31277974 DOI: 10.1016/j.numecd.2019.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 02/07/2023]
Abstract
AIMS The present paper aims to identify ongoing multinational surveillance systems (SURSYSs) assessing diet and nutrition targeted to adolescents, including European surveys involving multiple countries and similar initiatives conducted in non-European countries with developed economies, and to describe the dietary assessment methods used. DATA SYNTHESIS A total of 13 SURSYSs conducted in Europe, USA, Canada, Australia and New Zealand were identified. Dietary assessment methods commonly used include 24-h recalls (24H-Rs) and questionnaires or interviews. Food frequency questionnaires (FFQs) are used in combination with 24H-Rs in six SURSYSs: only FFQs are used in four SURSYSs; 24H-Rs only in one system and a 24H-R in combination with a general questionnaire/interview in one SURSYS. Eleven systems collect information also on some dietary habits and ten systems on other nutritional indicators such as anthropometric and/or biochemical measures. The FFQs used are not homogeneous and often include limited food or beverage items such as fruits and vegetables or sugar-sweetened beverages. In seven systems, foods specifically consumed by adolescents, such as fast food or snacks, are not assessed; instead, a total of seven systems collect data on supplement intake and just in very few cases on fats, legumes and/or water. CONCLUSIONS This study detected considerable variability across the systems identified, suggesting the need for a SURSYS targeted to adolescents that gathers as much as possible complete dietary information, with standardised methodology and regular periodicity. The detailed information provided by this review could be useful to national authorities for the choice of protocols to be applied in their own national surveys.
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Affiliation(s)
- Garden Tabacchi
- Department of Psychology, Pedagogy, Motor Exercise and Education, University of Palermo, Palermo, Italy.
| | | | - Trudy M A Wijnhoven
- Food and Agriculture Organization of the United Nations, Nutrition and Food Systems Division, Rome, Italy
| | - Giulia Cairella
- Department of Prevention - Local Health Service Rome 2, Rome, Italy
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Levy DT, Wijnhoven TMA, Levy J, Yuan Z, Mauer-Stender K. Potential health impact of strong tobacco control policies in 11 South Eastern WHO European Region countries. Eur J Public Health 2018; 28:693-701. [DOI: 10.1093/eurpub/cky028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- David T Levy
- Cancer Causes and Control, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Trudy M A Wijnhoven
- Division of Noncommunicable Diseases and Promoting Health through the Life-course, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Jeffrey Levy
- Cancer Causes and Control, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Zhe Yuan
- Cancer Causes and Control, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Kristina Mauer-Stender
- Division of Noncommunicable Diseases and Promoting Health through the Life-course, WHO Regional Office for Europe, Copenhagen, Denmark
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Mbulo L, Palipudi KM, Andes L, Morton J, Bashir R, Fouad H, Ramanandraibe N, Caixeta R, Dias RC, Wijnhoven TMA, Kashiwabara M, Sinha DN, Tursan d'Espaignet E. Secondhand smoke exposure at home among one billion children in 21 countries: findings from the Global Adult Tobacco Survey (GATS). Tob Control 2016; 25:e95-e100. [PMID: 26869598 DOI: 10.1136/tobaccocontrol-2015-052693] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/27/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Children are vulnerable to secondhand smoke (SHS) exposure because of limited control over their indoor environment. Homes remain the major place where children may be exposed to SHS. Our study examines the magnitude, patterns and determinants of SHS exposure in the home among children in 21 countries (19 low-income and middle-income countries and 2 high-income countries). METHODS Global Adult Tobacco Survey (GATS) data, a household survey of people 15 years of age or older. Data collected during 2009-2013 were analysed to estimate the proportion of children exposed to SHS in the home. GATS estimates and 2012 United Nations population projections for 2015 were also used to estimate the number of children exposed to SHS in the home. RESULTS The proportion of children younger than 15 years of age exposed to SHS in the home ranged from 4.5% (Panama) to 79.0% (Indonesia). Of the approximately one billion children younger than 15 years of age living in the 21 countries under study, an estimated 507.74 million were exposed to SHS in the home. China, India, Bangladesh, Indonesia and the Philippines accounted for almost 84.6% of the children exposed to SHS. The prevalence of SHS exposure was higher in countries with higher adult smoking rates and was also higher in rural areas than in urban areas, in most countries. CONCLUSIONS A large number of children were exposed to SHS in the home. Encouraging of voluntary smoke-free rules in homes and cessation in adults has the potential to reduce SHS exposure among children and prevent SHS-related diseases and deaths.
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Affiliation(s)
- Lazarous Mbulo
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Office of Smoking and Health, Global Tobacco Control Branch, Atlanta, Georgia, USA
| | - Krishna Mohan Palipudi
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Office of Smoking and Health, Global Tobacco Control Branch, Atlanta, Georgia, USA
| | - Linda Andes
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Office of Smoking and Health, Global Tobacco Control Branch, Atlanta, Georgia, USA
| | - Jeremy Morton
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Office of Smoking and Health, Global Tobacco Control Branch, Atlanta, Georgia, USA
| | - Rizwan Bashir
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Office of Smoking and Health, Global Tobacco Control Branch, Atlanta, Georgia, USA
| | - Heba Fouad
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Nivo Ramanandraibe
- Regional Office for Africa, World Health Organization, Brazzaville, Congo
| | - Roberta Caixeta
- Pan American Health Organization, World Health Organization, Washington DC, USA
| | - Rula Cavaco Dias
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Trudy M A Wijnhoven
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Mina Kashiwabara
- Regional Office for the Western Pacific, World Health Organization, Manila, Philippines
| | - Dhirendra N Sinha
- Regional Office for South-East Asia, World Health Organization, New Delhi, India
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Lissner L, Wijnhoven TMA, Mehlig K, Sjöberg A, Kunesova M, Yngve A, Petrauskiene A, Duleva V, Rito AI, Breda J. Socioeconomic inequalities in childhood overweight: heterogeneity across five countries in the WHO European Childhood Obesity Surveillance Initiative (COSI-2008). Int J Obes (Lond) 2016; 40:796-802. [PMID: 27136760 PMCID: PMC4856730 DOI: 10.1038/ijo.2016.12] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 11/17/2015] [Accepted: 12/09/2015] [Indexed: 11/23/2022]
Abstract
Background: Excess risk of childhood overweight and obesity occurring in socioeconomically disadvantaged families has been demonstrated in numerous studies from high-income regions, including Europe. It is well known that socioeconomic characteristics such as parental education, income and occupation are etiologically relevant to childhood obesity. However, in the pan-European setting, there is reason to believe that inequalities in childhood weight status may vary among countries as a function of differing degrees of socioeconomic development and equity. Subjects and Methods: In this cross-sectional study, we have examined socioeconomic differences in childhood obesity in different parts of the European region using nationally representative data from Bulgaria, the Czech Republic, Lithuania, Portugal and Sweden that were collected in 2008 during the first round of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative. Results: Heterogeneity in the association between parental socioeconomic indicators and childhood overweight or obesity was clearly observed across the five countries studied. Positive as well as negative associations were observed between parental socioeconomic indicators and childhood overweight, with statistically significant interactions between country and parental indicators. Conclusions: These findings have public health implications for the WHO European Region and underscore the necessity to continue documenting socioeconomic inequalities in obesity in all countries through international surveillance efforts in countries with diverse geographic, social and economic environments. This is a prerequisite for universal as well as targeted preventive actions.
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Affiliation(s)
- L Lissner
- Section for Epidemiology and Community Medicine (EPSO), Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - T M A Wijnhoven
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, Copenhagen Ø, Denmark
| | - K Mehlig
- Section for Epidemiology and Community Medicine (EPSO), Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - A Sjöberg
- Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - M Kunesova
- Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic
| | - A Yngve
- School of Hospitality, Culinary Arts and Meal Science, Örebro University, Grythyttan, Sweden
| | - A Petrauskiene
- Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - V Duleva
- Department of Food and Nutrition, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - A I Rito
- Instituto Nacional de Saúde Dr Ricardo Jorge, Lisbon, Portugal
| | - J Breda
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, Copenhagen Ø, Denmark
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Börnhorst C, Wijnhoven TMA, Kunešová M, Yngve A, Rito AI, Lissner L, Duleva V, Petrauskiene A, Breda J. WHO European Childhood Obesity Surveillance Initiative: associations between sleep duration, screen time and food consumption frequencies. BMC Public Health 2015; 15:442. [PMID: 25924872 PMCID: PMC4440513 DOI: 10.1186/s12889-015-1793-3] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 04/22/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Both sleep duration and screen time have been suggested to affect children's diet, although in different directions and presumably through different pathways. The present cross-sectional study aimed to simultaneously investigate the associations between sleep duration, screen time and food consumption frequencies in children. METHODS The analysis was based on 10 453 children aged 6-9 years from five European countries that participated in the World Health Organization European Childhood Obesity Surveillance Initiative. Logistic multilevel models were used to assess associations of parent-reported screen time as well as sleep duration (exposure variables) with consumption frequencies of 16 food items (outcome variables). All models were adjusted for age, sex, outdoor play time, maximum educational level of parents and sleep duration or screen time, depending on the exposure under investigation. RESULTS One additional hour of screen time was associated with increased consumption frequencies of 'soft drinks containing sugar' (1.28 [1.19;1.39]; odds ratio and 99% confidence interval), 'diet/light soft drinks' (1.21 [1.14;1.29]), 'flavoured milk' (1.18 [1.08;1.28]), 'candy bars or chocolate' (1.31 [1.22;1.40]), 'biscuits, cakes, doughnuts or pies' (1.22 [1.14;1.30]), 'potato chips (crisps), corn chips, popcorn or peanuts' (1.32 [1.20;1.45]), 'pizza, French fries (chips), hamburgers'(1.30 [1.18;1.43]) and with a reduced consumption frequency of 'vegetables (excluding potatoes)' (0.89 [0.83;0.95]) and 'fresh fruits' (0.91 [0.86;0.97]). Conversely, one additional hour of sleep duration was found to be associated with increased consumption frequencies of 'fresh fruits' (1.11 [1.04;1.18]) and 'vegetables (excluding potatoes)' (1.14 [1.07;1.23]). CONCLUSION The results suggest a potential relation between high screen time exposure and increased consumption frequencies of foods high in fat, free sugar or salt whereas long sleep duration may favourably be related to children's food choices. Both screen time and sleep duration are modifiable behaviours that may be tackled in childhood obesity prevention efforts.
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Affiliation(s)
- Claudia Börnhorst
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Achterstrasse 30, 28359, Bremen, Germany.
| | - Trudy M A Wijnhoven
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100, Copenhagen Ø, Denmark.
| | - Marie Kunešová
- Obesity Management Centre, Institute of Endocrinology, Narodni 8, 11694, Prague 1, Czech Republic.
| | - Agneta Yngve
- School of Hospitality, Culinary Arts and Meal Science, Örebro University, Campus Grythyttan, P.O. Box 1, SE, 712 02, Grythyttan, Sweden.
| | - Ana I Rito
- National Health Institute Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016, Lisbon, Portugal.
| | - Lauren Lissner
- Section for Epidemiology and Social medicine (EPSO), Department of Public Health and Community Medicine, University of Gothenburg, P.O. Box 454, SE, 405 30, Gothenburg, Sweden.
| | - Vesselka Duleva
- Department of Food and Nutrition, National Center of Public Health and Analyses, 15 Akad. Ivan Evstatiev Geshov Blvd, 1431, Sofia, Bulgaria.
| | - Ausra Petrauskiene
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Eiveniu str. 4, 50009, Kaunas, Lithuania.
| | - João Breda
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100, Copenhagen Ø, Denmark.
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Kahlmeier S, Wijnhoven TMA, Alpiger P, Schweizer C, Breda J, Martin BW. National physical activity recommendations: systematic overview and analysis of the situation in European countries. BMC Public Health 2015; 15:133. [PMID: 25879680 PMCID: PMC4404650 DOI: 10.1186/s12889-015-1412-3] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 01/13/2015] [Indexed: 12/03/2022] Open
Abstract
Background Developing national physical activity (PA) recommendations is an essential element of an effective national approach to promote PA. Methods Systematic overview and analysis of national PA recommendations across the European Region of the World Health Organization (WHO). The WHO European national information focal points provided information which was complemented through online searches and input from other experts. Results Information received until summer 2012 from 37 countries was analyzed. Sixteen countries did not have national recommendations while 21 countries did. For 17 countries, the source document was accessible. Seventeen recommendations referred to adults, 14 to young people and 6 to older adults. Most national recommendations for children and young people are quite similar: 12 countries recommend at least 60 minutes of moderate- to vigorous-intensity PA each day, in line with the WHO global recommendation. Three countries recommend longer durations and one a lower one. In some countries, slight variations were found regarding the recommended intensity and minimum bouts. Only one country was fully in line with the WHO recommendations. Two countries have issued separate recommendations for pre-school children. For adults, most countries still follow the 1995 United States recommendations of “at least 30 minutes on 5 days a week”. Three countries were fully in line with the WHO recommendations. Four countries give specific recommendations on reducing weight, avoiding weight gain or continuing weight maintenance. The six identified national PA recommendations for older adults are mainly similar to those for adults but underline that particularly for this age group also less activity has important health benefits; four countries also recommend balance training. Conclusions About half of the countries for which information was available and likely less than 40% of all 53 countries in the WHO European Region have developed national PA recommendations. Further investment is needed to address this important step towards a comprehensive PA promotion approach. Much remains to be done for the 2010 WHO recommendations to be fully reflected in national documents across all parts of the Region and all age groups. In addition, avoiding extended periods of inactivity and overweight are only addressed by a minority of countries yet.
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Affiliation(s)
- Sonja Kahlmeier
- Physical Activity and Health Unit, Epidemiology, Biostatistics, and Prevention Institute (EBPI), University of Zurich, Seilergraben 49, 8001, Zurich, Switzerland.
| | - Trudy M A Wijnhoven
- Nutrition, Physical Activity and Obesity, Division of Noncommunicable Diseases and Promoting Health through the Life-Course, World Health Organization (WHO) Regional Office for Europe, UN City, Marmorvej 51, DK-2100, Copenhagen Ø, Denmark.
| | - Patrick Alpiger
- Physical Activity and Health Unit, Epidemiology, Biostatistics, and Prevention Institute (EBPI), University of Zurich, Seilergraben 49, 8001, Zurich, Switzerland.
| | - Christian Schweizer
- Environment and Health, Division of Communicable Diseases, Health Security and Environment, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100, Copenhagen Ø, Denmark.
| | - João Breda
- Nutrition, Physical Activity and Obesity, Division of Noncommunicable Diseases and Promoting Health through the Life-Course, World Health Organization (WHO) Regional Office for Europe, UN City, Marmorvej 51, DK-2100, Copenhagen Ø, Denmark.
| | - Brian W Martin
- Physical Activity and Health Unit, Epidemiology, Biostatistics, and Prevention Institute (EBPI), University of Zurich, Seilergraben 49, 8001, Zurich, Switzerland.
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Wijnhoven TMA, van Raaij JMA, Sjöberg A, Eldin N, Yngve A, Kunešová M, Starc G, Rito AI, Duleva V, Hassapidou M, Martos E, Pudule I, Petrauskiene A, Sant'Angelo VF, Hovengen R, Breda J. WHO European Childhood Obesity Surveillance Initiative: School nutrition environment and body mass index in primary schools. Int J Environ Res Public Health 2014; 11:11261-85. [PMID: 25361044 PMCID: PMC4245612 DOI: 10.3390/ijerph111111261] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 10/14/2014] [Accepted: 10/20/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Schools are important settings for the promotion of a healthy diet and sufficient physical activity and thus overweight prevention. OBJECTIVE To assess differences in school nutrition environment and body mass index (BMI) in primary schools between and within 12 European countries. METHODS Data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) were used (1831 and 2045 schools in 2007/2008 and 2009/2010, respectively). School personnel provided information on 18 school environmental characteristics on nutrition and physical activity. A school nutrition environment score was calculated using five nutrition-related characteristics whereby higher scores correspond to higher support for a healthy school nutrition environment. Trained field workers measured children's weight and height; BMI-for-age (BMI/A) Z-scores were computed using the 2007 WHO growth reference and, for each school, the mean of the children's BMI/A Z-scores was calculated. RESULTS Large between-country differences were found in the availability of food items on the premises (e.g., fresh fruit could be obtained in 12%-95% of schools) and school nutrition environment scores (range: 0.30-0.93). Low-score countries (Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania) graded less than three characteristics as supportive. High-score (≥0.70) countries were Ireland, Malta, Norway, Portugal, Slovenia and Sweden. The combined absence of cold drinks containing sugar, sweet snacks and salted snacks were more observed in high-score countries than in low-score countries. Largest within-country school nutrition environment scores were found in Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania. All country-level BMI/A Z-scores were positive (range: 0.20-1.02), indicating higher BMI values than the 2007 WHO growth reference. With the exception of Norway and Sweden, a country-specific association between the school nutrition environment score and the school BMI/A Z-score was not observed. CONCLUSIONS Some European countries have implemented more school policies that are supportive to a healthy nutrition environment than others. However, most countries with low school nutrition environment scores also host schools with supportive school environment policies, suggesting that a uniform school policy to tackle the "unhealthy" school nutrition environment has not been implemented at the same level throughout a country and may underline the need for harmonized school policies.
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Affiliation(s)
- Trudy M A Wijnhoven
- Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.
| | - Joop M A van Raaij
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands.
| | - Agneta Sjöberg
- Department of Food and Nutrition and Sport Science, University of Gothenburg, P.O. Box 300, SE-405 30 Gothenburg, Sweden.
| | - Nazih Eldin
- Health Promotion Department, Health Service Executive, Railway Street, Navan, County Meath, Ireland.
| | - Agneta Yngve
- School of Hospitality, Culinary Arts and Meal Science, Örebro University, Campus Grythyttan, P.O. Box 1, SE-712 60 Grythyttan, Sweden.
| | - Marie Kunešová
- Obesity Management Centre, Institute of Endocrinology, Narodni 8, 11694 Prague 1, Czech Republic.
| | - Gregor Starc
- Faculty of Sport, University of Ljubljana, Gortanova 22, 1000 Ljubljana, Slovenia.
| | - Ana I Rito
- Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.
| | - Vesselka Duleva
- Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.
| | - Maria Hassapidou
- Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.
| | - Eva Martos
- Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.
| | - Iveta Pudule
- Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.
| | - Ausra Petrauskiene
- Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.
| | - Victoria Farrugia Sant'Angelo
- Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.
| | - Ragnhild Hovengen
- Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.
| | - João Breda
- Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.
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Wijnhoven TMA, van Raaij JMA, Spinelli A, Starc G, Hassapidou M, Spiroski I, Rutter H, Martos É, Rito AI, Hovengen R, Pérez-Farinós N, Petrauskiene A, Eldin N, Braeckevelt L, Pudule I, Kunešová M, Breda J. WHO European Childhood Obesity Surveillance Initiative: body mass index and level of overweight among 6-9-year-old children from school year 2007/2008 to school year 2009/2010. BMC Public Health 2014; 14:806. [PMID: 25099430 PMCID: PMC4289284 DOI: 10.1186/1471-2458-14-806] [Citation(s) in RCA: 170] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 07/29/2014] [Indexed: 12/02/2022] Open
Abstract
Background The World Health Organization (WHO) Regional Office for Europe has established the Childhood Obesity Surveillance Initiative (COSI) to monitor changes in overweight in primary-school children. The aims of this paper are to present the anthropometric results of COSI Round 2 (2009/2010) and to explore changes in body mass index (BMI) and overweight among children within and across nine countries from school years 2007/2008 to 2009/2010. Methods Using cross-sectional nationally representative samples of 6−9-year-olds, BMI, anthropometric Z-scores and overweight prevalence were derived from measured weight and height. Significant changes between rounds were assessed using variance and t-tests analyses. Results At Round 2, the prevalence of overweight (including obesity; WHO definitions) ranged from 18% to 57% among boys and from 18% to 50% among girls; 6 − 31% of boys and 5 − 21% of girls were obese. Southern European countries had the highest overweight prevalence. Between rounds, the absolute change in mean BMI (range: from −0.4 to +0.3) and BMI-for-age Z-scores (range: from −0.21 to +0.14) varied statistically significantly across countries. The highest significant decrease in BMI-for-age Z-scores was found in countries with higher absolute BMI values and the highest significant increase in countries with lower BMI values. The highest significant decrease in overweight prevalence was observed in Italy, Portugal and Slovenia and the highest significant increase in Latvia and Norway. Conclusions Changes in BMI and prevalence of overweight over a two-year period varied significantly among European countries. It may be that countries with higher prevalence of overweight in COSI Round 1 have implemented interventions to try to remedy this situation. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-806) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Trudy M A Wijnhoven
- Division of Noncommunicable Diseases and Life-course, World Health Organization Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen, Ø, Denmark.
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Wijnhoven TMA, van Raaij JMA, Spinelli A, Rito AI, Hovengen R, Kunesova M, Starc G, Rutter H, Sjöberg A, Petrauskiene A, O'Dwyer U, Petrova S, Farrugia Sant'angelo V, Wauters M, Yngve A, Rubana IM, Breda J. WHO European Childhood Obesity Surveillance Initiative 2008: weight, height and body mass index in 6-9-year-old children. Pediatr Obes 2013; 8:79-97. [PMID: 23001989 DOI: 10.1111/j.2047-6310.2012.00090.x] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 07/08/2012] [Accepted: 07/17/2012] [Indexed: 11/29/2022]
Abstract
UNLABELLED What is already known about this subject Overweight and obesity prevalence estimates among children based on International Obesity Task Force definitions are substantially lower than estimates based on World Health Organization definitions. Presence of a north-south gradient with the highest level of overweight found in southern European countries. Intercountry comparisons of overweight and obesity in primary-school children in Europe based on measured data lack a similar data collection protocol. What this study adds Unique dataset on overweight and obesity based on measured weights and heights in 6-9-year-old children from 12 European countries using a harmonized surveillance methodology. Because of the use of a consistent data collection protocol, it is possible to perform valid multiple comparisons between countries. It demonstrates wide variations in overweight and obesity prevalence estimates among primary-school children between European countries and regions. BACKGROUND Nutritional surveillance in school-age children, using measured weight and height, is not common in the European Region of the World Health Organization (WHO). The WHO Regional Office for Europe has therefore initiated the WHO European Childhood Obesity Surveillance Initiative. OBJECTIVE To present the anthropometric results of data collected in 2007/2008 and to investigate whether there exist differences across countries and between the sexes. METHODS Weight and height were measured in 6-9-year-old children in 12 countries. Prevalence of overweight, obesity, stunting, thinness and underweight as well as mean Z-scores of anthropometric indices of height, weight and body mass index were calculated. RESULTS A total of 168 832 children were included in the analyses and a school participation rate of more than 95% was obtained in 8 out of 12 countries. Stunting, underweight and thinness were rarely prevalent. However, 19.3-49.0% of boys and 18.4-42.5% of girls were overweight (including obesity and based on the 2007 WHO growth reference).The prevalence of obesity ranged from 6.0 to 26.6% among boys and from 4.6 to 17.3% among girls. Multi-country comparisons suggest the presence of a north-south gradient with the highest level of overweight found in southern European countries. CONCLUSIONS Overweight among 6-9-year-old children is a serious public health concern and its variation across the European Region highly depends on the country. Comparable monitoring of child growth is possible across Europe and should be emphasized in national policies and implemented as part of action plans.
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Affiliation(s)
- T M A Wijnhoven
- Noncommunicable Diseases and Health Promotion, World Health Organization Regional Office for Europe, Copenhagen Ø, Denmark.
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10
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Béghin L, Huybrechts I, Ortega FB, Coopman S, Manios Y, Wijnhoven TMA, Duhamel A, Ciarapica D, Gilbert CC, Kafatos A, Widhalm K, Molnar D, Moreno LA, Gottrand F. Nutritional and pubertal status influences accuracy of self-reported weight and height in adolescents: the HELENA Study. Ann Nutr Metab 2013; 62:189-200. [PMID: 23485769 DOI: 10.1159/000343096] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 08/31/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS The aim of this study was to assess factors that have an effect on the accuracy of self-reported weight and height in adolescents. METHODS Weight and height of 3,865 European adolescents aged 12.5 to 17.5 years were self-reported via specific questionnaire. Then real weight and height were measured using accurate equipment and standardized protocols. Differences (D) between self-reported and measured weight and height were calculated, and factors that could have influenced the accuracy of self-reported weight and height were assessed. Data were analyzed using ANOVA, Student's t test and multivariate regression. RESULTS Adolescents underestimated their weight (D = -0.81 kg; n = 2,968) and overestimated their height (D = +0.74 cm; n = 3,308). Obese girls underestimated their weight (D = -4.70 kg) and overestimated their height (D = +0.22 cm) to a greater extent (p < 0.05) than obese boys (D = -3.13 kg and +0.14 cm for weight and height, respectively). Underestimation of weight (D = -1.25 kg) and overestimation of height (D = +0.15 cm) were only significant for girls who had finished puberty (Tanner stage 5). Socioeconomic status, nutritional knowledge, physical fitness, physical activity level, food choice and preference, and healthy eating behaviour had no significant influence on the accuracy of self-reported weight and height. CONCLUSION Our data confirms that self-reports of weight and height made by adolescents are inaccurate and demonstrate that inaccuracy is strongly influenced by nutritional status, pubertal status and gender.
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Affiliation(s)
- Laurent Béghin
- U955 INSERM, IFR114, Faculty of Medicine, Université Lille Nord de France, Lille, France.
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11
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Rito A, Wijnhoven TMA, Rutter H, Carvalho MA, Paixão E, Ramos C, Claudio D, Espanca R, Sancho T, Cerqueira Z, Carvalho R, Faria C, Feliciano E, Breda J. Prevalence of obesity among Portuguese children (6-8 years old) using three definition criteria: COSI Portugal, 2008. Pediatr Obes 2012; 7:413-22. [PMID: 22899658 DOI: 10.1111/j.2047-6310.2012.00068.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Revised: 04/17/2012] [Accepted: 04/19/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Previous studies place Portugal among the five countries with the highest prevalence of childhood obesity in Europe. This paper describes the prevalence of thinness, overweight and obesity in Portuguese children of 6-8 years of age, based on the first data collection from Childhood Obesity Surveillance Initiative Portugal, which took place during the 2007/2008 school year. METHODS This study uses a semi-longitudinal design with repeated cross-sectional national representative samples. Specific prevalence of overweight (including obesity) and obesity was determined using three different diagnostic criteria. Across the seven geographic regions, 3765 children were enrolled from 181 schools; 50.3% of participants were males. RESULTS Using the International Obesity Task Force reference, the prevalence of thinness, overweight and obesity were 4.8%, 28.1% and 8.9%, respectively; using the Center for Disease Control and Prevention reference they were 2.1%, 32.2% and 14.6%, respectively; and according to the World Health Organization reference, they were 1.0%, 37.9% and 15.3%, respectively. Univariate analysis showed a higher risk of obesity in older children, in boys and in the Azores region. The islands of Madeira and the Azores were the regions with the highest prevalence of overweight at 39.4% and 46.6%, respectively, and Algarve was the one with the lowest (21.4%). CONCLUSION These findings demonstrate the need for urgent action in Portugal and provide policy-makers with comprehensive and detailed information to assist with this.
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Affiliation(s)
- A Rito
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal.
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12
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Abstract
This study aims to improve comparability of available data within the World Health Organization (WHO) European Region taking into account differences related to the aging of the population. Surveys were included if they were conducted on adults aged 25-64 years between 1985 and 2010 in the WHO European Region. Overweight/obesity prevalences were adjusted to the European standard population aged 25-64. Data were entered for each of the 5-year categories between 1981 and 2010. Measured height and weight data were available for males in 16 and females in 24 of the 53 countries. The 50-64-year-olds had higher prevalence of overweight and obesity as compared to the 25-49-year-olds. This pattern occurs in every country, by male and female, in almost all surveys. Age-standardized overweight prevalence was higher among males than females in all countries. Trend data showed increases in most countries. Age-standardized maps were based on self-reported data because of insufficient availability of measured data. Results showed more countries with available data as well as the higher category of obesity in the later surveys. Measured values are needed and age adjustment is important in documenting emerging overweight and obesity trends, independent of demographic changes, in the WHO European Region.
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Affiliation(s)
- C M Doak
- Institute of Health Sciences, VU University and VU Medical Centre, Amsterdam, the Netherlands.
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Doets EL, de Wit LS, Dhonukshe-Rutten RAM, Cavelaars AEJM, Raats MM, Timotijevic L, Brzozowska A, Wijnhoven TMA, Pavlovic M, Totland TH, Andersen LF, Ruprich J, Pijls LTJ, Ashwell M, Lambert JP, van ’t Veer P, de Groot LCPGM. Current micronutrient recommendations in Europe: towards understanding their differences and similarities. Eur J Nutr 2008; 47 Suppl 1:17-40. [DOI: 10.1007/s00394-008-1003-5] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
OBJECTIVE To describe child growth monitoring practices worldwide in preparation for the construction and application of a new international growth reference. STUDY DESIGN A questionnaire was sent to Ministries of Health in 202 countries requesting information on growth charts used in national programs, reference populations, classification systems, problems encountered, and actions taken against growth faltering. Countries also provided hard copies of charts in current use. This information was entered and analyzed in Microsoft Access. RESULTS Responses were received from 178 (88%) countries, 154 of which included growth charts (n=806). Two thirds of the charts covered preschool age. All countries used weight-for-age, over half relying on this index alone. The reference most commonly used (68%) was the National Center for Health Statistics/World Health Organization population, with regional variations, where most European countries used local standards. Sixty-three percent of charts classified child growth on percentiles, whereas about one fifth used z scores. Problems reported were both conceptual (eg, interpreting growth trajectories) and practical (eg, lack of equipment). CONCLUSIONS The survey demonstrates that growth charts are used universally in pediatric care. The information gathered on current use and interpretation of growth charts provides important guidance for constructing and applying the new reference.
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Affiliation(s)
- Mercedes de Onis
- Department of Nutrition, World Health Organization, 1211 Geneva 27, Switzerland.
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Brouwer ID, Wijnhoven TMA, Burema J, Hoorweg JC. Household fuel use and food consumption: Relationship and seasonal effects in central Malawi. Ecol Food Nutr 1996. [DOI: 10.1080/03670244.1996.9991488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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