Energy-Dense Snack Food Intake in Adolescence: Longitudinal Relationship to Weight and Fatness

Maternal depression, stress and feeding styles: towards a framework for theory and research in child obesity

Against the background of rising rates of obesity in children and adults in the USA, and modest effect sizes for obesity interventions, the aim of the present narrative review paper is to extend the UNICEF care model to focus on childhood obesity and its associated risks with an emphasis on the emotional climate of the parent-child relationship within the family. Specifically, we extended the UNICEF model by applying the systems approach to childhood obesity and by combining previously unintegrated sets of literature across multiple disciplines including developmental psychology, clinical psychology and nutrition. Specifically, we modified the extended care model by explicitly integrating new linkages (i.e. parental feeding styles, stress, depression and mother's own eating behaviour) that have been found to be associated with the development of children's eating behaviours and risk of childhood obesity. These new linkages are based on studies that were not incorporated into the original UNICEF model, but suggest important implications for childhood obesity. In all, this narrative review offers important advancements to the scientific understanding of familial influences on children's eating behaviours and childhood obesity.

What factors are associated with frequent unhealthy snack-food consumption among Australian secondary-school students?

OBJECTIVE

To examine demographic and behavioural correlates of unhealthy snack-food consumption among Australian secondary-school students and the association between their perceptions of availability, convenience and intake with consumption.

DESIGN

Cross-sectional survey of students' eating, physical activity and sedentary behaviours using validated instruments administered via an online questionnaire.

SETTING

Australian secondary schools across all states/territories.

SUBJECTS

Secondary-school students aged 12-17 years participating in the 2009-10 National Secondary Students' Diet and Activity (NaSSDA) survey (n 12 188).

RESULTS

Approximately one in five students (21 %) reported consuming unhealthy snack foods ≥14 times/week ('frequent snackers'). After adjusting for all covariates, older students and those with a BMI of ≥25 kg/m² were less likely to be frequent snackers, while students who reported high fast-food and high sugar-sweetened beverage consumption and those who watched television for >2 h/d were more likely to snack frequently. Furthermore, after adjusting for all covariates and demographic factors, students who agreed that snack foods are usually available at home, convenient to buy and that they eat too many snack foods were more likely to be snacking frequently. Conversely, students who agreed that fruit is a convenient snack were less likely to be frequent snackers.

CONCLUSIONS

Frequent unhealthy snack-food consumption appears to cluster with other poor health behaviours. Perceptions of availability and convenience are factors most readily amenable to change, and findings suggest interventions should focus on decreasing the availability of unhealthy snack foods in the home and promoting healthier options such as fruit as convenient snacks.

Risk Factors Associated with Overweight among Adolescents in Serbia

INTRODUCTION

The pandemic of obesity in adolescents is one of the challenges of public health.

AIM

The aim of this study was to examine the association of overweight with demographic, socioeconomic and lifestyle factors among Serbian adolescents.

METHOD

A cross-sectional study of 2139 adolescents aged 10 to 19 years was carried out. Data used in this study were from the 2006 Health Survey. In accordance with the international sex- and age-specific Body Mass Index cut-off points, all participants were classified as being normal weight or overweight, including obese. The association between the risk factors and overweight were examined using a multivariate logistic regression model.

RESULTS

The study showed that 28.9% of boys and 17.0% of girls were overweight, while 14.5% of boys and 8.1% of girls were obese. Boys were more likely to be overweight/obese, compared with girls. Being younger (p< 0.01 for 14 to 15 years) and (p< 0.01, for 16 to 19 years), engaging in physical activities that last less than 7 hours a week, in such a manner that they breathe quickly and become sweaty, (p< 0.01) and skipping breakfast (p< 0.05) were risk factors significantly associated with overweight among adolescents. No significant association was found with wealth index.

CONCLUSION

These findings should be an integral part of further preventive interventions, especially oriented towards younger adolescents, who are physically inactive, have a habit of skipping breakfast and are boys.

Sugar-sweetened and artificially-sweetened beverages in relation to obesity risk

The goal of this review was to critically evaluate the scientific evidence in humans on the potential effect of sweetened beverages on weight gain and risk of obesity in youth and adults. Two categories of these beverages were reviewed. Sugar-sweetened beverages (SSBs) include soft drinks, colas, other sweetened carbonated beverages, and fruit drinks with added sugar. Artificially sweetened beverages (ASBs), also referred to as non-nutritive sweetened beverages, are marketed and used as a replacement for SSBs for those who want to reduce sugar and caloric intake. The totality of evidence to date demonstrates a pattern across observational and experimental studies of an increased risk of weight gain and obesity with higher intake of SSBs. However, it remains difficult to establish the strength of the association and the independence from other potentially confounding factors. The primary reason for unclear conclusions regarding the robustness of any effect of SSBs is due to the heterogeneity and methodologic limitations of both observational and experimental studies on this topic. Although some observational studies have suggested that ASBs may cause increased risk of obesity and cardiometabolic diseases, there is no clear mechanism for this pathway, and the epidemiologic studies are highly inconsistent. An important issue with the observational studies on ASBs and obesity or disease risk is reverse causality bias, with higher-quality studies demonstrating this possibility. The field needs higher-quality experimental studies in humans, with relevant direct comparisons between sweetened beverages and their sweetened solid-food alternatives.

Neglect: failure to thrive and obesity

Medical providers need to monitor growth at every visit. Weight status is influenced by genetics, medical conditions, socioeconomic status, and family environment. Screening for food security and psychosocial risk factors is an integral tool to identify families at risk for nutritional deficits and child maltreatment. Nutritional rehabilitation is best accomplished in an outpatient, multidisciplinary setting. Medical neglect should be considered in failure to thrive and obesity when there is a serious risk of harm from identified medical complications, additional or worsening medical complications occurring despite a multidisciplinary approach, and/or non-adherence with the treatment plan.

Impact of snacking pattern on overweight and obesity risk in a cohort of 11- to 13-year-old adolescents

OBJECTIVES

The association between snacking habits and overweight in adolescents is unclear. We evaluated the relation between snacking patterns and overweight/obesity in a cohort of 11- to 13-year-old Italian adolescents.

METHODS

The dietary habits of 400 randomly selected adolescents were evaluated; those with body mass index ≥ 85 th percentile were considered as overweight/obese. Participants were classified based on the percentage of caloric intake from snacks (<15%, 15%-20%, >20%), snacking frequency (1, 2, ≥ 3), and timing of consuming the most caloric snack (morning, afternoon, evening).

RESULTS

A minority of participants (13/400, 3.3%) did not consume any snacks; 5/13 (38.5) of them were overweight/obese. Among snackers (387/400), overweight/obesity prevalence was 10.4%, 14.4%, 20.5%, respectively, in those consuming <15%, 15% to 10%, and >20% of their energy intake from snacks. In a Poisson regression model, the overweight/obesity relative risks (RRs) were 1.35 (95% confidence interval [CI] 0.58-3.15) and 2.32 (1.10-4.89) for 15% to 20% and >20% calories/day from snacks, respectively. Overweight/obesity prevalence (from 9.6% to 22.6%) was correlated with snacking frequency (RR 2.20, 95% CI 0.92-5.27, and RR 4.17, 95% CI 1.60-10.9, for 2 and ≥ 3 snacks per day, respectively). The most caloric snacks were consumed in the morning (180/387) and afternoon (179/387); 28.6% of the predominantly evening snackers (28/387) were overweight/obese (RR 3.12, 95% CI 1.17-8.34).

CONCLUSIONS

Increased snacking calories, frequency, and evening snacking are independently associated with overweight/obesity in Italian middle-school adolescents.

Evaluating the effect of energy-dense foods consumption on preschool children's body mass index: a prospective analysis from 2 to 4 years of age

PURPOSE

The aim of this study was to study the association between the consumption of energy-dense foods at 2 years and body mass index (BMI) at 4 years, using a cross-lagged panel design.

METHODS

The present study included 589 children evaluated at 2 and 4 years of age, as part of the birth cohort generation XXI. Information was obtained by face-to-face interviews. Consumption of energy-dense foods (salty snacks, soft drinks, cakes, and sweets) was measured using a food frequency questionnaire. Children's weight and height were measured by standard procedures, and BMI standard deviation scores (BMI z-scores) were calculated according to the World Health Organization. Linear regression and cross-lagged panel design models were fitted to estimate the associations between the consumption of energy-dense foods and BMI z-scores (controlled for maternal age, education and prepregnancy BMI, and children's exact age at 2 years).

RESULTS

The consumption of energy-dense foods at 2 years was significantly associated with their consumption at 4 years (β = 0.522, 95% CI 0.432-0.612). Children's BMI z-scores at 2 years were associated with posterior BMI z-scores (β = 0.747, 95% CI 0.688-0.806). In the cross-lagged analysis, consumption of energy-dense foods at 2 years had no effect on subsequent BMI z-scores (β = -0.030, 95% CI -0.095 to 0.035) and BMI z-scores at 2 years were not significantly associated with the consumption of energy-dense foods at 4 years (β = -0.012, 95% CI -0.086 to 0.062).

CONCLUSIONS

Consumption of energy-dense foods and BMI tracked over time, but the consumption of energy-dense foods at 2 years was not associated with BMI z-scores at 4 years.

Dietary and oral hygiene habits of active athletes and adolescents attending ordinary junior high schools

BACKGROUND

Active sports require sufficient energy intake. How do young athletes meet this need? The aim of this study was to investigate self-reported health and oral behaviors of young athletes and to compare them with a population-based sample of ordinary adolescents.

DESIGN

A computer-based questionnaire on oral hygiene habits and dietary habits was conducted in two junior high schools with special classes for athletes in 2011. Adolescents of similar age (n=1230) attending ordinary classes had responded the same questionnaire earlier in the city of Oulu (in 2004) and in Kajaani, Finland (in 2006-2007). Answers to individual questions as well as sum scores of the answers were analyzed. The answers of the athletes and ordinary adolescents were analyzed by gender using cross-tabulation and chi-square testing.

RESULTS

The mean sum score of the athletes indicated their more favorable health behavior compared with the other adolescents. They also ate more frequently the four daily than the others; in addition, they ate the school lunch as an entity which it was intended. However, the athlete boys consumed more fizzy/soft drinks and ate chocolate more often than the rest. The athletes also brushed their teeth more frequently than ordinary adolescents. Oral health behavior of the girls was better than that of the boys.

CONCLUSIONS

Health behavior of the young athletes is better than that of other adolescents. Continuous oral health education should be targeted to all adolescents; growing boys should be target group of information on healthy sources of energy.

Sugar-sweetened beverage consumption and central and total adiposity in older children: a prospective study accounting for dietary reporting errors

OBJECTIVE

To determine the prospective relationship between changes in sugar-sweetened beverage (SSB) intake and central adiposity in older children.

DESIGN

Dietary intakes of children were obtained by 3 d food records at ages 10 and 13 years. Waist circumference (WC) and weight and height to determine BMI were measured at 10 and 13 years and total body fat mass (TBFM) at 13 years by dual-energy X-ray absorptiometry. Analyses were conducted using multivariable linear regression. Reporting errors were measured and participants were categorized as under-, plausible and over-reporters of dietary intakes.

SETTING

Community-based British cohort of children participating in the Avon Longitudinal Study of Parents and Children.

RESULTS

Among 2455 older children, increased SSB consumption from ages 10 to 13 years was associated with higher WC (standardized β=0.020, P=0.19), BMI (β=0.028, P=0.03) and TBFM (β=0.017, P=0.20) at 13 years. Effects were strengthened among plausible dietary reporters (n 1059): WC (β=0.097, P<0.001), BMI (β=0.074, P<0.001) and TBFM (β=0.065, P=0.003). The association between change in SSB and WC was weakened, but remained statistically significant after accounting for BMI (β=0.042, P=0.02) and TBFM (β=0.048, P=0.01).

CONCLUSIONS

Higher consumption of SSB from ages 10 to 13 years was associated with a larger WC at age 13 years independent of differences in total adiposity. Accounting for dietary reporting errors strengthened associations. Our findings further support recommendations to limit intakes of SSB to reduce excess weight gain in children and suggest that SSB have an additional deleterious effect on central adiposity.

Systematic review of the evidence for an association between sugar-sweetened beverage consumption and risk of obesity

A systematic review of the evidence for an association between sugar-sweetened beverages and risk of obesity was conducted. This review focused specifically on the role of sugar-sweetened beverages in obesity risk, taking into account energy balance. For the purpose of this review, scientific conclusions could not be drawn from the intervention studies that evaluated the relationship between sugar-sweetened beverage intake and obesity risk. Results of observational studies that examined the relationship between sugar-sweetened beverage intake and obesity risk that were adjusted for energy intake and physical activity were inconsistent for each of the three age groups evaluated (children, adolescents, and adults). From this review, evidence for an association between sugar-sweetened beverage intake and obesity risk is inconsistent when adjustment for energy balance is made.

Is there an association between food portion size and BMI among British adolescents?

The prevalence of obesity has increased simultaneously with the increase in the consumption of large food portion sizes (FPS). Studies investigating this association among adolescents are limited; fewer have addressed energy-dense foods as a potential risk factor. In the present study, the association between the portion size of the most energy-dense foods and BMI was investigated. A representative sample of 636 British adolescents (11–18 years) was used from the 2008–2011 UK National Diet and Nutrition Survey. FPS were estimated for the most energy-dense foods (those containing above 10·5 kJ/g (2·5 kcal/g)). Regression models with BMI as the outcome variable were adjusted for age, sex and misreporting energy intake (EI). A positive association was observed between total EI and BMI. For each 418 kJ (100 kcal) increase in EI, BMI increased by 0·19 kg/m2(95 % CI 0·10, 0·28;P< 0·001) for the whole sample. This association remained significant after stratifying the sample by misreporting. The portion sizes of a limited number of high-energy-dense foods (high-fibre breakfast cereals, cream and high-energy soft drinks (carbonated)) were found to be positively associated with a higher BMI among all adolescents after adjusting for misreporting. When eliminating the effect of under-reporting, larger portion sizes of a number of high-energy-dense foods (biscuits, cheese, cream and cakes) were found to be positively associated with BMI among normal reporters. The portion sizes of only high-fibre breakfast cereals and high-energy soft drinks (carbonated) were found to be positively associated with BMI among under-reporters. These findings emphasise the importance of considering under-reporting when analysing adolescents' dietary intake data. Also, there is a need to address adolescents' awareness of portion sizes of energy-dense foods to improve their food choice and future health outcomes.

Adherence to a snacking dietary pattern and soda intake are related to the development of adiposity: a prospective study in school-age children

OBJECTIVE

Snacking has been related to increased prevalence of overweight among school-age children in cross-sectional studies. It is uncertain, however, whether snacking influences the development of adiposity over time.

DESIGN

We examined whether adherence to a snacking dietary pattern was associated with greater increases in children's BMI, subscapular:triceps skinfold thickness ratio and waist circumference over a median 2·5-year follow-up. Dietary patterns were identified through principal component analysis of an FFQ administered at recruitment in 2006. Anthropometric follow-up was conducted annually. Linear mixed-effects models were used to estimate rates of change in each indicator according to quartiles of adherence to the snacking pattern. We also examined change in BMI, subscapular:triceps skinfold thickness ratio and waist circumference in relation to intake of the food items in the snacking pattern.

SUBJECTS

Children (n 961) 5-12 years of age.

SETTING

Public schools in Bogotá, Colombia.

RESULTS

After adjustment for age, sex, total energy intake and socio-economic status, children in the highest quartile of adherence to the snacking pattern had a 0·09 kg/m2 per year higher BMI gain than children in the lowest quartile (P trend = 0·05). A similar association was observed for mean change in subscapular:triceps skinfold thickness ratio (highest v. lowest quartile difference = 0·012/year; P = 0·03). Of the food items in the snacking pattern, soda intake was positively and significantly associated with change in BMI (P trend = 0·01) and waist circumference (P trend = 0·04) in multivariable analysis.

CONCLUSIONS

Our results indicate that snacking and soda intake are associated with development of adiposity in school-age children.

Fundraising, celebrations and classroom rewards are substantial sources of unhealthy foods and beverages on public school campuses

OBJECTIVE

The emphasis in school nutrition policy has been on vending and competitive items. Our study was designed to characterize and quantify the amount and source of other foods and beverages on school campuses.

DESIGN

A cross-sectional observational study was conducted using a specially designed objective nutrition observation system.

SETTING

One low-income school district in southern California with six elementary and two middle schools.

SUBJECTS

Data were not collected from individual children. A total of 4033 students, 42 % of whom were Hispanic/Latino, 26 % African American and 21 % non-Hispanic white, were observed across school settings.

RESULTS

Data were collected continuously from 9 January 2008 to 16 June 2010. Healthy foods had, per serving, total energy ≤732 kJ (≤175 kcal), total fat content ≤35 %, total saturated fat ≤10 %, sugar less ≤15 g, sodium <200 mg and trans-fat ≤0·5 g. Healthy beverages were only 100 % juice or water, and unflavoured non-fat, 1 %, 2 % milk and soya or rice milk. The system had high inter-rater reliability (r = 0·78 to 0·99), percentage agreement (83 % to 100 %) and test-retest reliability (r = 0·81 to 0·98). Significantly more unhealthy foods and beverages than healthy items were observed on all campuses (P < 0·001). An average of 1·26 (sd 0·46) items per student per week was found with an average of 0·86 (sd 0·34) unhealthy items per child per week.

CONCLUSIONS

There were substantial amounts of unhealthy foods and beverages brought onto campuses for classroom rewards, celebrations and fundraising that should be targeted for intervention.

Effect of television viewing on food and nutrient intake among adolescents

OBJECTIVE

Among the behaviors associated with food intake, exposure to television is particularly important given the number of adolescents exposed. Also, increased time spent watching television has been associated with physical inactivity and with less desirable dietary intake among adolescents. The aim of this study was to examine the association between television viewing and dietary intake among 13-y-old adolescents.

METHODS

A cross-sectional evaluation was carried out in the 2003-2004 school year, including adolescents born in 1990 and enrolled in the schools of Porto, Portugal. Time spent watching TV was collected by self-administered questionnaires and dietary intake was evaluated using a food frequency questionnaire. Included in the analysis were 1436 adolescents.

RESULTS

Spending more than 120 min per day watching TV was significantly associated with higher intake of total fat and polyunsaturated fat and with lower intake of magnesium, in both sexes. Additionally, in girls, spending more than 120 min per day watching TV was associated with lower intake of complex carbohydrates, fiber, total vitamin A, folate, vitamin C, calcium, iron, phosphorus, and potassium. In boys, higher intake of saturated fat and cholesterol was found among those spending more time watching TV.

CONCLUSIONS

We found that television viewing is associated with higher consumption of foods containing more fats and sugars and a lower consumption of fruits and vegetables. Consequently, adolescents who watched more television had a higher intake of total fat and polyunsaturated fat and a lower intake of minerals and vitamins. This dietary behavior among adolescents may have long-term health implications, not only limited to obesity.

Relationship between raised BMI and sugar sweetened beverage and high fat food consumption among children

OBJECTIVE

Longitudinal evidence of relationships between unhealthy diets and BMI in children is crucial for appropriately targeting obesity prevention activities. The objective was to determine the relationship between frequency of consumption of sugar sweetened beverages (SSBs) and high fat foods (HFFs) and body weight in Australian children aged from 4 to 10 years.

METHODS

Data from 4,164 children participating in four waves (wave 1, 2004; wave 2, 2006; wave 3, 2008; and wave 4, 2010) of the Longitudinal Study of Australian Children were analyzed. A multi-level growth model tested relationships between consumption of SSB and HFF and BMI z-scores.

RESULTS

BMI z-scores were associated with daily consumption of HFF, SSB and maternal BMI independent of BMI z-scores at wave 1 (baseline); with each additional occurrence of SSB and HFF consumption intake per day, BMI z-score increased by 0.015 U (P < 0.01) and 0.014 U (P < 0.001), respectively. With each additional maternal BMI unit, BMI z-score increased by 0.032 (P < 0.001).

CONCLUSIONS

Higher BMI z-scores were strongly associated with the consumption of SSBs and HFFs. Future efforts to prevent obesity should consider urgent action to address the impact of the consumption of SSBs and HFFs in childhood.

Snacking patterns, diet quality, and cardiovascular risk factors in adults

Background

The relationship of snacking patterns on nutrient intake and cardiovascular risk factors (CVRF) in adults is unknown. The aim of this study was to examine the associations of snacking patterns with nutrient intake, diet quality, and a selection of CVRF in adults participating in the 2001-2008 National Health and Nutrition Examination Survey.

Methods

24-hour dietary recalls were used to determine intake and cluster analysis was used to identify the snacking patterns. Height and weight were obtained and the health indices that were evaluated included diastolic and systolic blood pressure, high density lipoprotein-cholesterol, low density lipoprotein cholesterol, triacylglycerides, blood glucose, and insulin.

Results

The sample was participants (n = 18,988) 19+ years (50% males; 11% African-Americans; 72% white, 12% Hispanic-Americans, and 5% other). Cluster analyses generated 12 distinct snacking patterns, explaining 61% of the variance in snacking. Comparisons of snacking patterns were made to the no snack pattern. It was found that miscellaneous snacks constituted the most common snacking pattern (17%) followed by cakes/cookies/pastries (12%) and sweets (9%). Most snacking patterns were associated with higher energy intakes. Snacking patterns cakes/cookies/pastries, vegetables/legumes, crackers/salty snacks, other grains and whole fruit were associated with lower intakes of saturated fatty acids. Added sugars intakes were higher in the cakes/cookies/pastries, sweets, milk desserts, and soft drinks patterns. Five snack patterns (cakes/cookies/pastries, sweets, vegetable/legumes, milk desserts, soft drinks) were associated with lower sodium intakes. Several snack patterns were associated with higher intakes of potassium, calcium, fiber, vitamin A, and magnesium. Five snacking patterns (miscellaneous snacks; vegetables/legumes; crackers/salty snacks; other grains; and whole fruit) were associated with better diet quality scores. Alcohol was associated with a lower body mass index and milk desserts were associated with a lower waist circumference. No snack patterns were associated with other CVRF studied.

Conclusions

Overall, several snacking patterns were associated with better diet quality than those consuming no snacks. Yet, the majority of the snacking patterns were not associated with CVRF. Education is needed to improve snacking patterns in terms of nutrients to limit in the diet along with more nutrient-dense foods to be included in snacks.

Meals and snacking, diet quality and energy balance

The present obesity "epidemic" has been attributed to a growing trend for snacking. Snacking may contribute to excess energy intake and weight gain through different ways, for example: context/environment of eating, frequency of consumption and quality of food choices. The present article reviews data and hypotheses about the role of snacks in diet quality and body weight control. One obvious difficulty in this field is the diversity of definitions and approaches used in cross-sectional, longitudinal, and intervention studies. A brief paragraph reviews the prevalence of snacking in various countries and its recent evolution. The literature addressing the contribution of snacks to daily energy and nutrient intake presents two contrasting pictures. In many reports, snacking appears to facilitate the adjustment of energy intake to needs, and to contribute carbohydrates, rather than fats, to the diet, in addition to valuable micronutrients. Such results are usually reported in healthy, normal-weight children and adults. By contrast, snacking often appears to contribute much energy but little nutrition in the diet of other consumers, particularly obese children and adults. In addition to selecting energy-dense foods, eating in the absence of hunger in response to external non-physiological cues, in an irregular fashion, in contexts (e.g. while watching television) that do not favor attention to the act of eating, might be crucial factors determining the nutritional effects of snacking. While efforts should be continued to harmonize definitions and minimize the influence of under-reporting, interventions aimed at decreasing detrimental snacking should address both food-related aspects and behavioral components.

Which dimensions of food-related lifestyle are likely to be associated with obesity in Italy?

OBJECTIVE

To compare obese v. non-obese consumers in terms of their general food-related lifestyles and to explore possible food-related factors affecting obesity in Italy.

DESIGN

The data were collected using a self-completion questionnaire. Data included sociodemographic information, measures of the Food-Related Lifestyle scale (FRL) and self-reported weight and height. A logistic regression model was fitted for the sample with obesity as the dependent variable and sociodemographic characteristics and FRL dimensions as the independent variables.

SETTING

The survey was carried out in Italy between October and November 2010.

SUBJECTS

One thousand respondents were recruited with equal quotas for men v. women. The sample was representative of the Italian population in term of age groups and geographic areas. The participants were over 18 years of age and were solely or jointly responsible for the family's food shopping.

RESULTS

Our analyses revealed that sociodemographic, economic and cultural variables affect the increasing rate of obesity in Italy. Obese respondents appeared to find more enjoyment from shopping and interest in cooking compared with non-obese ones. Moreover, they were more likely to find self-fulfilment in foods. However, obese respondents appeared to be less interested in the nutritional content of foods, suggesting their weak involvement in nutritional aspects when they eat. In fact, the obese respondents gave preference to snacks over meals.

CONCLUSIONS

The outcome of the study would suggest that in targeted interventions for public health purposes in order to address obesity, attention should be placed on the role that food plays in obese consumers' lives.

Obesity in children with autism spectrum disorder

Research suggests that the prevalence of obesity in children with autism spectrum disorder (ASD) is at least as high as that seen in typically developing children. Many of the risk factors for children with ASD are likely the same as for typically developing children, especially within the context of today's obesogenic environment. The particular needs and challenges that this population faces, however, may render them more susceptible to the adverse effects of typical risk factors, and they may also be vulnerable to additional risk factors not shared by children in the general population, including psychopharmacological treatment, genetics, disordered sleep, atypical eating patterns, and challenges for engaging in sufficient physical activity. For individuals with ASD, obesity and its sequelae potentially represent a significant threat to independent living, self-care, quality of life, and overall health.

Social, dietary and lifestyle factors associated with obesity among Bahraini adolescents

The main purpose of this study was to explore some of the social, dietary and lifestyle factors that could be related to the risk of obesity among adolescents in Bahrain. A multistage stratified method was used to select secondary school students (15-18years old) from governmental schools in Bahrain. The total sample selected was 735 (339 males and 396 females). A pre-validated self-report questionnaire was used to obtain information on socio-demographics, food and the lifestyle habits of adolescents. Weight and height were taken and percentiles of Body Mass Index for age and gender were used to classify the adolescents as non-obese and obese (overweight and obese), using NHANES-1 growth standard. In general, the prevalence of overweight and obesity was 29.5% and 36.8% among males and females, respectively. The risk of obesity was not consistent among male and female adolescents. Mothers' education was found to be a risk factor for obesity among both males and females (p=0.0167 and p=0.007, respectively). Bringing food from home to school (odds ratio (OR)=0.54, confidence interval (CI) 0.35-0.81) was protective factor for obesity among females but not among males. Fathers' education (p=0.0167), rank among siblings (p=0.009), place where breakfast is eaten (p=0.0398), eating between lunch and dinner (p=0.0152), fruit intake (p=0.042), sweet intake (p=0.0192), size of burger (p=0.002) and hours of watching television per day (p=0.004) were significantly associated with the risk of obesity among males, but not among females. Various social, dietary and lifestyle factors were found to contribute to obesity among adolescents in Bahrain. These factors should be considered in school health policy in the country.

Effects of energy-dense nutrient-poor snacks on the incidence of metabolic syndrome: a prospective approach in Tehran Lipid and Glucose Study

OBJECTIVES

Increased consumption of energy-dense, nutrient-poor snacks is one of the major, growing concerns in relation to the alarming trend of overweight, obesity, and metabolic disorders worldwide. The aim of this study was to investigate whether consumption of energy-dense snacks could affect the occurrence of metabolic syndrome after 3 y of follow-up in adults.

METHODS

This longitudinal study was conducted within the framework of the Tehran Lipid and Glucose Study between 2006 and 2008 and 2009 and 2011, on 1466 adults, ages 19 to 70 y. The usual intake of participants was measured using a validated semiquantitative food frequency questionnaire at baseline. Biochemical and anthropometric measurements were assessed at baseline and 3 y later. Multiple logistic regression models were used to estimate the occurrence of metabolic syndrome (MetS) in each quartile of energy-dense snacks.

RESULTS

Participants in the highest quartile of energy-dense snack consumption were significantly younger (33.8 versus 43.1 y; P < 0.01). There were non-significant increased risks for MetS in the highest quartile of biscuits and cakes (odds ratio [OR], 1.13; 95% confidence interval [CI], 0.77-1.66), and candies and chocolates (OR, 1.31; 95% CI, 0.88-1.94). The risk for MetS in participants with highest consumption of salty snacks increased more than 50% (OR, 1.56; 95% CI, 1.01-2.40). Consumption of soft drinks had a borderline effect on the risk for MetS. More than 361 kcal/d from total energy-dense snacks independently increased the occurrence of MetS in the fourth compared the first quartile category (OR, 1.53; 95% CI, 1.03-2.29).

CONCLUSION

The findings of this study demonstrated that higher consumption of energy-dense snacks could be a dietary risk factor for development of MetS.

Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis

BACKGROUND

The relation between sugar-sweetened beverages (SSBs) and body weight remains controversial.

OBJECTIVE

We conducted a systematic review and meta-analysis to summarize the evidence in children and adults.

DESIGN

We searched PubMed, EMBASE, and Cochrane databases through March 2013 for prospective cohort studies and randomized controlled trials (RCTs) that evaluated the SSB-weight relation. Separate meta-analyses were conducted in children and adults and for cohorts and RCTs by using random- and fixed-effects models.

RESULTS

Thirty-two original articles were included in our meta-analyses: 20 in children (15 cohort studies, n = 25,745; 5 trials, n = 2772) and 12 in adults (7 cohort studies, n = 174,252; 5 trials, n = 292). In cohort studies, one daily serving increment of SSBs was associated with a 0.06 (95% CI: 0.02, 0.10) and 0.05 (95% CI: 0.03, 0.07)-unit increase in BMI in children and 0.22 kg (95% CI: 0.09, 0.34 kg) and 0.12 kg (95% CI: 0.10, 0.14 kg) weight gain in adults over 1 y in random- and fixed-effects models, respectively. RCTs in children showed reductions in BMI gain when SSBs were reduced [random and fixed effects: -0.17 (95% CI: -0.39, 0.05) and -0.12 (95% CI: -0.22, -0.2)], whereas RCTs in adults showed increases in body weight when SSBs were added (random and fixed effects: 0.85 kg; 95% CI: 0.50, 1.20 kg). Sensitivity analyses of RCTs in children showed more pronounced benefits in preventing weight gain in SSB substitution trials (compared with school-based educational programs) and among overweight children (compared with normal-weight children).

CONCLUSION

Our systematic review and meta-analysis of prospective cohort studies and RCTs provides evidence that SSB consumption promotes weight gain in children and adults.

Carbohydrate nutrition and development of adiposity during adolescence

OBJECTIVE

To examine the prospective association between glycemic index, glycemic load (GL) of diets and intakes of carbohydrates, sugars, fiber, and the main carbohydrate containing food groups (e.g., soft drinks) with changes in percent body fat, body mass index (BMI), and waist circumference among adolescents.

DESIGN AND METHODS

Students aged 12 at baseline (n = 856) were examined both in 2004-2005 and 2009-2011. A semiquantitative food frequency questionnaire was administered. Anthropometric parameters were measured and defined using standardized protocols.

RESULTS

After multivariable adjustment, in girls, each 1-SD increase in dietary GL was associated with concurrent 0.77 kg/m2 and 1.45 cm increase in BMI and waist circumference, respectively (both P = 0.01). Conversely, each 1-SD increase in dietary fiber intake was associated with a concurrent 0.44 kg/m2 decrease in mean BMI in girls (P = 0.02) and 1.45 cm decrease in waist circumference in boys (P = 0.002). Girls who consumed soft drinks once or more per day versus those who never/rarely consumed soft drinks, had a 4.45% increase in percent body fat after 5 years (Ptrend = 0.01).

CONCLUSIONS

High-GL foods might adversely influence development of body composition, particularly in girls, whereas fiber-rich diets could limit excess weight during adolescence.

Evidence mapping: methodologic foundations and application to intervention and observational research on sugar-sweetened beverages and health outcomes

BACKGROUND

Evidence maps are a new method that systematically characterize the range of research activity in broad topic areas and are used to guide research priority setting, systematic reviews, and meta-analyses.

OBJECTIVE

We expanded evidence mapping methods by demonstrating their usefulness as a tool for organizing epidemiologic research on sugar-sweetened beverage (SSB) intake and health outcomes: obesity, type 2 diabetes, metabolic syndrome, and coronary heart disease/stroke.

DESIGN

We performed a search of the PubMed, Scopus, and Cochrane databases and a hand search of references. Studies selected were reviews and longitudinal studies (intervention and cohort) published between 1 January 1966 and 31 October 2012.

RESULTS

We identified and mapped 77 studies (18 review and 59 primary research articles); most of the research focused on obesity (n = 47). For all outcomes, >30% (n = 18) of the primary research studies we identified were not referenced in published reviews. We found considerable variability among primary research studies of SSBs and the 4 health outcomes in terms of designs, definitions of SSBs, and definitions of outcomes, which renders these studies difficult to interpret collectively. For example, we counted 14 different definitions of weight/obesity in 29 observational cohort studies, and ≤6 studies reported the use of the same outcome measure.

CONCLUSIONS

Establishing field standards in the study of SSB intake and health outcomes would facilitate interpretation across research studies and thereby increase the utility of systematic reviews/meta-analyses and ultimately the efficiency of research efforts. Rapid publication of new data suggests the need for regular updates and caution when reading reviews.

Factors associated with development of excessive fatness in children and adolescents: a review of prospective studies

The purpose of this review was to examine the factors that predict the development of excessive fatness in children and adolescents. Medline, Web of Science and PubMed were searched to identify prospective cohort studies that evaluated the association between several variables (e.g. physical activity, sedentary behaviour, dietary intake and genetic, physiological, social cognitive, family and peer, school and community factors) and the development of excessive fatness in children and adolescents (5-18 years). Sixty-one studies met the eligibility criteria and were included. There is evidence to support the association between genetic factors and low physical activity with excessive fatness in children and adolescents. Current studies yielded mixed evidence for the contribution of sedentary behaviour, dietary intake, physiological biomarkers, family factors and the community physical activity environment. No conclusions could be drawn about social cognitive factors, peer factors, school nutrition and physical activity environments, and the community nutrition environment. There is a dearth of longitudinal evidence that examines specific factors contributing to the development of excessive fatness in childhood and adolescence. Given that childhood obesity is a worldwide public health concern, the field can benefit from large-scale, long-term prospective studies that use state-of-the-art measures in a diverse sample of children and adolescents.

Association between sweet drink intake and adiposity in Danish children participating in a long-term intervention study

BACKGROUND

In some previous studies direct associations between intake of soft drinks, sugar-sweetened beverages and adiposity have been reported. The majority of these studies were, however, conducted in the USA and it is uncertain if the results are applicable to non-US countries.

OBJECTIVE

To assess the association between sweet drink intake at age 6 and 9 years and the subsequent 3- to 7-year changes in body mass index (BMI) and sum of four skin-folds (Σ4SF).

METHODS

Information on sweet drink intake (7 days food record) and physical activity (accelerometer) was obtained at age 6 years (n = 366) [Correction made here after initial online publication.] and 9 years (n = 269). Weight, height and Σ4SF were measured at age 6, 9 and 13 years. Additional information on socio-economic status, maternal BMI and pubertal status was obtained.

RESULTS

No associations were observed between sweet drink intake at age 6 years and change in BMI or logΣ4SF from age 6 to 9 years or 6 to 13 years. Also, no associations were observed between change in sweet drink intake from age 6 to 9 years and subsequent change in BMI or logΣ4SF from age 9 to 13 years. A weak direct association was observed between sweet drink intake at age 9 years and change in logΣ4SF from age 9 to 13 years (per 100 g ∼ 3.38 fl oz) (β: 0.014, 95% confidence interval [CI]: -0.001 to 0.029, P = 0.06), while no association was seen for BMI. In supplementary analyses a similar association was observed for soft drinks (β: 0.087, 95% CI: 0.048 to 0.126, P = 0.001) but only in the intervention group.

CONCLUSION

We observed associations between intake of sweet drinks and soft drinks and change in skin-fold thickness in a group of Danish children. However, as the associations did not remain significant when multiple testing was considered or was only significant among children from the intervention group, the results do not confirm or refute the direct association reported in previous studies.

The obesogenic effect of high fructose exposure during early development

Obesogens are compounds that disrupt the function and development of adipose tissue or the normal metabolism of lipids, leading to an increased risk of obesity and associated diseases. Evidence for the adverse effects of industrial and agricultural obesogens, such as tributyltin, bisphenol A and other organic pollutants is well-established. Current evidence suggests that high maternal consumption of fat promotes obesity and increased metabolic risk in offspring, but less is known about the effects of other potential nutrient obesogens. Widespread increase in dietary fructose consumption over the past 30 years is associated with chronic metabolic and endocrine disorders and alterations in feeding behaviour that promote obesity. In this Perspectives, we examine the evidence linking high intakes of fructose with altered metabolism and early obesity. We review the evidence suggesting that high fructose exposure during critical periods of development of the fetus, neonate and infant can act as an obesogen by affecting lifelong neuroendocrine function, appetite control, feeding behaviour, adipogenesis, fat distribution and metabolic systems. These changes ultimately favour the long-term development of obesity and associated metabolic risk.

Inconsistent associations between sweet drink intake and 2-year change in BMI among Victorian children and adolescents

OBJECTIVE

The aim of this study was to examine whether baseline (T1) or 2-year change in sweet drink intake in children and adolescents was associated with age- and gender-standardized body mass index (BMIz) at time two (T2), 2 years later.

METHODS

Data on 1465 children and adolescents from the comparison groups of two quasi-experimental intervention studies from Victoria, Australia were analysed. At two time points between 2003 and 2008 (mean interval: 2.2 years) height and weight were measured and sweet drink consumption (soft drink and fruit juice/cordial) was assessed.

RESULTS

No association was observed between T1 sweet drink intake and BMIz at T2 among children or adolescents. Children from higher socioeconomic status families who reported an increased intake of sweet drinks at T2 compared with T1 had higher mean BMIz at T2 (β: 0.13, P = 0.05). There was no evidence of a dose-response relationship between sweet drink intake and BMIz. In supplementary analyses, we observed that more frequent usual consumption of fruit juice/cordial was associated with a higher BMIz at T2 among children.

CONCLUSION

This study showed limited evidence of an association between sweet drink intake and BMIz. However, the association is complex and may be confounded by both dietary and activity behaviours.

Is what Filipino children eat between meals associated with body mass index?

The study aimed to assess the association between childhood obesity and snacking. A total of 396 students in grades 4 to 6 enrolled in an elementary school in the Philippines were the participants in this study. Demographic profile; anthropometric measures of height, weight, body mass index; and information about snacking were gathered. Obese group had statistically more servings of sweetened drinks and low-quality snacks. Female obese subjects have statistically more servings at nighttime and greater total snack servings. For the whole cohort, the odds ratio of being overweight with high total snack servings was 2.12 (95% confidence interval = 1.25-3.62) whereas the odds ratio of being obese with calories obtained from snacking was 2.08 (95% confidence interval = 1.01-4.26). Nighttime snacks and bad-quality foods should be minimized. Moreover, reducing food portions at any snack time will protect children from being overweight.

Estimating trajectories of energy intake through childhood and adolescence using linear-spline multilevel models

BACKGROUND

Methods for the assessment of changes in dietary intake across the life course are underdeveloped.

METHODS

We demonstrate the use of linear-spline multilevel models to summarize energy-intake trajectories through childhood and adolescence and their application as exposures, outcomes, or mediators. The Avon Longitudinal Study of Parents and Children assessed children's dietary intake several times between ages 3 and 13 years, using both food frequency questionnaires (FFQs) and 3-day food diaries. We estimated energy-intake trajectories for 12,032 children using linear-spline multilevel models. We then assessed the associations of these trajectories with maternal body mass index (BMI), and later offspring BMI, and also their role in mediating the relation between maternal and offspring BMIs.

RESULTS

Models estimated average and individual energy intake at 3 years, and linear changes in energy intake from age 3 to 7 years and from age 7 to 13 years. By including the exposure (in this example, maternal BMI) in the multilevel model, we were able to estimate the average energy-intake trajectories across levels of the exposure. When energy-intake trajectories are the exposure for a later outcome (in this case offspring BMI) or a mediator (between maternal and offspring BMI), results were similar, whether using a two-step process (exporting individual-level intercepts and slopes from multilevel models and using these in linear regression/path analysis), or a single-step process (multivariate multilevel models). Trajectories were similar when FFQs and food diaries were assessed either separately, or when combined into one model.

CONCLUSIONS

Linear-spline multilevel models provide useful summaries of trajectories of dietary intake that can be used as an exposure, outcome, or mediator.

Swim training of monosodium L-glutamate-obese mice improves the impaired insulin receptor tyrosine phosphorylation in pancreatic islets

The goal of the present study was to investigate changes on glucose homoeostasis and of the insulin receptor (IR) and insulin receptor substrate-1 (IRS-1) signalling in pancreatic islets from MSG-obese mice submitted to or not submitted to swim training. Swim training of 90-day-old MSG mice was used to evaluate whether signalling pathways of the IR and IRS-1 in islets are involved with the insulin resistance and glucose intolerance observed in this obese animal model. The results showed that IR tyrosine phosphorylation (pIR) was reduced by 42 % in MSG-obese mice (MSG, 6.7 ± 0.2 arbitrary units (a.u.); control, 11.5 ± 0.4 a.u.); on the other hand, exercise training increased pIR by 76 % in MSG mice without affecting control mice (MSG, 11.8 ± 0.3; control, 12.8 ± 0.2 a.u.). Although the treatment with MSG increased IRS-1 tyrosine phosphorylation (pIRS-1) by 96 % (MSG, 17.02 ± 0.6; control, 8.7 ± 0.2 a.u.), exercise training also increased it in both groups (control, 13.6 ± 0.1; MSG, 22.2 ± 1.1 a.u.). Current research shows that the practice of swim training increases the tyrosine phosphorylation of IRS-1 which can modulate the effect caused by obesity in insulin receptors.

Parent perceptions of neighborhood safety and children's physical activity, sedentary behavior, and obesity: evidence from a national longitudinal study

We examined the relationship between parent-perceived neighborhood safety and children's physical activity, sedentary behavior, body mass, and obesity status using 9 years of longitudinal data (1999-2007) on a cohort of approximately 19,000 US kindergartners from the Early Childhood Longitudinal Study. Children's height and weight measurements and parent perceptions of neighborhood safety were available in kindergarten and in the first, third, fifth, and eighth grades. Dependent variables included age- and gender-specific body mass index percentile, obesity status, and parent- or child-reported weekly physical activity and television-watching. Pooled cross-sectional and within-child longitudinal regression models that controlled for child, family, and school characteristics were fitted. Both cross-sectional and longitudinal models indicated that children whose parents perceived their neighborhoods as unsafe watched more television and participated in less physical activity, although the magnitude of this association was much weaker in longitudinal models. However, there was no significant association between parent-perceived neighborhood safety and children's body mass index.

A review of snacking patterns among children and adolescents: what are the implications of snacking for weight status?

Given the growing contribution of snacks to dietary intake and the need for effective strategies to reduce obesity, it is important to consider whether snacking behaviors contribute to high BMI in childhood. This review summarizes US research that has addressed trends in snacking behavior and its contribution to dietary intake, as well as research describing snack food availability in settings where youth spend their time. In addition, it comprehensively reviews studies conducted in the United States and internationally that have examined associations of snacking behavior with weight. Research published between January, 2000, and December, 2011, was identified by searching PubMed and MEDLINE databases, and by examining bibliographies of relevant studies. Recent analyses of trends in dietary intake have shown there were significant increases in the contribution of energy-dense, nutrient-poor foods to snacking kilocalories over the past few decades. Although snacks can contribute to intake of key nutrients, frequent snacking has been associated with higher intake of total energy and energy from added and total sugars. Assessments in schools and retail stores have further indicated that energy-dense, nutrient-poor snacks are widely available in settings where youth spend their time. The majority of studies either found no evidence of a relationship between snacking behavior and weight status or found evidence indicating that young people who consumed more snacks were less likely to be obese; however, additional research is needed to address various methodological limitations. Recommendations for future research are provided to address knowledge gaps and inform the development of interventions.

Infrequent breakfast consumption is associated with higher body adiposity and abdominal obesity in Malaysian school-aged adolescents

Unhealthy dietary pattern increases the risk of obesity and metabolic disorders in growing children and adolescents. However, the way the habitual pattern of breakfast consumption influences body composition and risk of obesity in adolescents is not well defined. Thus, the aim of the present study was to assess any associations between breakfast consumption practices and body composition profiles in 236 apparently healthy adolescents aged 12 to 19 years. A self-administered questionnaire on dietary behaviour and lifestyle practices and a dietary food frequency questionnaire were used. Body composition and adiposity indices were determined using standard anthropometric measurement protocols and dual energy χ-ray absorptiometry (DXA). Mean age of the participants was 15.3±1.9 years. The majority of participants (71.2%) fell in the normal body mass index (BMI) ranges. Breakfast consumption patterns showed that only half of the participants (50%) were consuming breakfast daily. Gender-specific multivariate analyses (ANCOVA) showed that in both boys and girls, those eating breakfast at least 5 times a week had significantly lower body weight, body mass index (BMI), BMI z-scores, waist circumference, body fat mass and percent body fat (%BF) compared to infrequent breakfast eaters, after adjustment for age, household income, pubertal status, eating-out and snacking practices, daily energy intakes, and daily physical activity levels. The present findings indicate that infrequent breakfast consumption is associated with higher body adiposity and abdominal obesity. Therefore, daily breakfast consumption with healthy food choices should be encouraged in growing children and adolescents to prevent adiposity during these critical years of growth.

Association of nutrient-dense snack combinations with calories and vegetable intake

BACKGROUND

With other factors such as general diet and insufficient exercise, eating non-nutrient dense snack foods such as potato chips contributes to childhood obesity. We examined whether children consumed fewer calories when offered high-nutrient dense snacks consisting of cheese and vegetables than children who were offered non-nutrient dense snacks (ie, potato chips).

METHODS

Two hundred one children (115 girls) entering the third to sixth grades were randomly assigned to 1 of 4 snacking conditions: (1) potato chips only, (2) cheese-only, (3) vegetables only, and (4) cheese and vegetables. Children were allowed to eat snacks freely provided while watching 45-minute TV programs. Satiety was measured before they started eating snacks, in the middle of the study, and 20 minutes after they finished eating the snacks. Parents completed a questionnaire regarding their family environment.

RESULTS

Children consumed 72% fewer calories when eating a combined snack compared with when they were served potato chips, P < .001. Children who ate the combination snack needed significantly fewer calories to achieve satiety than those who ate potato chips, P < .001. The effects of the snack conditions on caloric intake were more pronounced among overweight or obese children (P = .02) and those from low-involvement families (P = .049)

CONCLUSIONS

The combination snack of vegetables and cheese can be an effective means for children to reduce caloric intake while snacking. The effect was more pronounced among children who were overweight or obese and children from low-involvement families.

Differences in lifestyle behaviors, dietary habits, and familial factors among normal-weight, overweight, and obese Chinese children and adolescents

Background

Pediatric obesity has become a global public health problem. Data on the lifestyle behaviors, dietary habits, and familial factors of overweight and obese children and adolescents are limited. The present study aims to compare health-related factors among normal-weight, overweight, and obese Chinese children and adolescents.

Methods

We conducted a cross-sectional study consisted of 4262 children and adolescents aged 5–18 years old from rural areas of the northeast China. Anthropometric measurements and self-reported information on health-related variables, such as physical activities, sleep duration, dietary habits, family income, and recognition of weight status from the views of both children and parents, were collected by trained personnel.

Results

The prevalence rates of overweight and obesity were 15.3 and 6.4%, respectively. Compared to girls, boys were more commonly overweight (17.5% vs. 12.9%) and obese (9.5% vs. 3.1%). Approximately half of the parents with an overweight or obese child reported that they failed to recognize their child’s excess weight status, and 65% of patients with an overweight child reported that they would not take measures to decrease their child’s body weight. Obese children and adolescents were more likely to be nonsnackers [odds ratio (OR): 1.348; 95% confidence interval (CI): 1.039–1.748] and to have a family income of 2000 CNY or more per month (OR: 1.442; 95% CI: 1.045–1.99) and less likely to sleep longer (≥7.5 h) (OR: 0.475; 95% CI: 0.31–0.728) than the normal-weight participants.

Conclusions

Our study revealed a high prevalence of overweight and obesity in a large Chinese pediatric population. Differences in sleep duration, snacking, family income, and parental recognition of children’s weight status among participants in different weight categories were observed, which should be considered when planning prevention and treatment programs for pediatric obesity.

Consumption patterns of sweet drinks in a population of Australian children and adolescents (2003-2008)

Background

Intake of sweet drinks has previously been associated with the development of overweight and obesity among children and adolescents. The present study aimed to assess the consumption pattern of sweet drinks in a population of children and adolescents in Victoria, Australia.

Methods

Data on 1,604 children and adolescents (4–18 years) from the comparison groups of two quasi-experimental intervention studies from Victoria, Australia were analysed. Sweet drink consumption (soft drink and fruit juice/cordial) was assessed as one day’s intake and typical intake over the last week or month at two time points between 2003 and 2008 (mean time between measurement: 2.2 years).

Results

Assessed using dietary recalls, more than 70% of the children and adolescents consumed sweet drinks, with no difference between age groups (p = 0.28). The median intake among consumers was 500 ml and almost a third consumed more than 750 ml per day. More children and adolescents consumed fruit juice/cordial (69%) than soft drink (33%) (p < 0.0001) and in larger volumes (median intake fruit juice/cordial: 500 ml and soft drink: 375 ml). Secular changes in sweet drink consumption were observed with a lower proportion of children and adolescents consuming sweet drinks at time 2 compared to time 1 (significant for age group 8 to <10 years, p = 0.001).

Conclusion

The proportion of Australian children and adolescents from the state of Victoria consuming sweet drinks has been stable or decreasing, although a high proportion of this sample consumed sweet drinks, especially fruit juice/cordial at both time points.

Lifestyle factors associated with overweight and obesity among Saudi adolescents

Background

A better understanding of the relationships between obesity and lifestyle factors is necessary for effective prevention and management of obesity in youth. Therefore, the objective of this study was to evaluate the associations between obesity measures and several lifestyle factors, including physical activity, sedentary behaviors and dietary habits among Saudi adolescents aged 14–19 years.

Methods

This was a school-based cross-sectional study that was conducted in three cities in Saudi Arabia (Al-Khobar, Jeddah and Riyadh). The participants were 2906 secondary school males (1400) and females (1506) aged 14–19 years, who were randomly selected using a multistage stratified cluster sampling technique. Measurements included weight, height, body mass index (BMI), waist circumference, waist/height ratio (WHtR), screen time (television viewing, video games and computer use), physical activity (determined using a validated questionnaire), and dietary habits (intake frequency per week). Logistic regression was used to examine the associations between obesity and lifestyle factors.

Results

Compared with non-obese, obese males and females were significantly less active, especially in terms of vigorous activity, had less favorable dietary habits (e.g., lower intake of breakfast, fruits and milk), but had lower intake of sugar-sweetened drinks and sweets/chocolates. Logistic regression analysis showed that overweight/obesity (based on BMI categories) or abdominal obesity (based on WHtR categories) were significantly and inversely associated with vigorous physical activity levels (aOR for high level = 0.69, 95% CI 0.41–0.92 for BMI and 0.63, 95% CI 0.45–0.89 for WHtR) and frequency of breakfast (aOR for < 3 days/week = 1.44; 95% CI 1.20–1.71 for BMI and 1.47; 95% CI 1.22–1.76 for WHtR) and vegetable (aOR for < 3 days/week = 1.29; 95% CI 1.03–1.59 for WHtR) intakes, and consumption of sugar-sweetened beverages (aOR for < 3 days/week = 1.32; 95% CI 1.08–1.62 for BMI and 1.42; 95% CI 1.16–1.75 for WHtR).

Conclusions

The present study identified several lifestyle factors associated with obesity that may represent valid targets for the prevention and management of obesity among Saudi adolescents. Primary prevention of obesity by promoting active lifestyles and healthy diets should be a national public health priority.

Optimising women's diets. An examination of factors that promote healthy eating and reduce the likelihood of unhealthy eating

The majority of nutrition promotion research that has examined the determinants of unhealthy or healthy dietary behaviours has focused on factors that promote consumption of these foods, rather than factors that may both promote healthy eating and buffer or protect consumption of unhealthy foods. The purpose of this paper is to identify factors that both promote healthy eating and also reduce the likelihood of eating unhealthily amongst women. A community sample of 1013 Australian women participated in a cross-sectional self-report survey that assessed factors associated with diet and obesity. Multiple logistic regressions were used to examine the associations between a range of individual, social and environmental factors and aspects of both healthy and unhealthy eating, whilst controlling for key covariates. Results indicated that women with high self efficacy for healthy eating, taste preferences for fruit and vegetables, family support for healthy eating and the absence of perceived barriers to healthy eating (time and cost) were more likely to consume components of a healthy diet and less likely to consume components of a unhealthy diet. Optimal benefits in overall diet quality amongst women may be achieved by targeting factors associated with both healthy and unhealthy eating in nutrition promotion efforts.

Less frequent eating predicts greater BMI and waist circumference in female adolescents

BACKGROUND

Little is known about the effect of eating frequency on adiposity.

OBJECTIVE

The study aim was to assess the prospective relation of an objective measure of eating frequency with adiposity in girls from ages 9-10 to 19-20 y.

DESIGN

By using data from 3-d diet records collected from 2372 girls in the National Heart, Lung, and Blood Institute Growth and Health Study, meal, snack, and total eating frequencies aggregated over the first 2 study years were examined in relation to 10-y change in BMI and waist circumference (WC).

RESULTS

Eating frequency was lower in black and older girls than in white and younger girls (P < 0.0001). In whites, lower initial snack and total eating frequencies were related to greater 10-y increases in BMI (P = 0.023 and 0.012, respectively) and WC (P = 0.030 and 0.015, respectively). In blacks, lower initial meal and snack frequencies were related to greater increases in BMI (P = 0.004 and 0.022, respectively) and WC (P = 0.052 and 0.005, respectively). Also, in blacks, lower initial total eating frequency was related to greater increases in WC (P = 0.010). After adjustment for baseline adiposity measure, race, parental education, physical activity, television and video viewing, total energy intake, and dieting for weight loss, lower initial total eating frequency remained related to greater 10-y increases in BMI (P = 0.013) and WC (P = 0.036).

CONCLUSIONS

A lower eating frequency predicts a greater gain in adiposity in adolescent females. Intervention trials are needed to test if changing the frequency of eating can affect obesity risk.

Selected eating behaviours and excess body weight: a systematic review

The relationship between obesity and the intake of macronutrients and specific foods is uncertain. Thus, there is growing interest in some eating behaviours because they may reflect the joint effect of several foods and nutrients and, thus, increase the likelihood of finding a link to obesity. This study examined the association between selected eating behaviours and excess weight in the general population throughout a systematic review of publications written in English, Spanish or Portuguese identified in a PubMed search up to 31 December 2010. We included 153 articles, 73 of which have been published since 2008. Only 30 studies had a prospective design; of these, 15 adjusted for sociodemographic variables, physical activity and energy or food intake. Moreover, definitions of eating behaviours varied substantially across studies. We found only small or inconsistent evidence of a relationship between excess weight and skipping breakfast, daily eating frequency, snacking, irregular meals, eating away from home, consumption of fast food, takeaway food intake, consumption of large food portions, eating until full and eating quickly. In conclusion, this review highlights the difficulty in measuring human behaviour, and suggests that a more systematic approach is needed for capturing the effects of eating behaviours on body weight.

Evidence-based guideline of the German Nutrition Society: carbohydrate intake and prevention of nutrition-related diseases

The relative contribution of nutrition-related chronic diseases to the total disease burden of the society and the health care costs has risen continuously over the last decades. Thus, there is an urgent necessity to better exploit the potential of dietary prevention of diseases. Carbohydrates play a major role in human nutrition - next to fat, carbohydrates are the second biggest group of energy-yielding nutrients. Obesity, type 2 diabetes mellitus, dyslipoproteinaemia, hypertension, metabolic syndrome, coronary heart disease and cancer are wide-spread diseases, in which carbohydrates could have a pathophysiologic relevance. Correspondingly, modification of carbohydrate intake could have a preventive potential. In the present evidence-based guideline of the German Nutrition Society, the potential role of carbohydrates in the primary prevention of the named diseases was judged systematically. The major findings were: a high carbohydrate intake at the expense of total fat and saturated fatty acids reduces the concentrations of total, LDL and HDL cholesterol. A high carbohydrate consumption at the expense of polyunsaturated fatty acids increases total and LDL cholesterol, but reduces HDL cholesterol. Regardless of the type of fat being replaced, a high carbohydrate intake promotes an increase in the triglyceride concentration. Furthermore, a high consumption of sugar-sweetened beverages increases the risk of obesity and type 2 diabetes mellitus, whereas a high dietary fibre intake, mainly from whole-grain products, reduces the risk of obesity, type 2 diabetes mellitus, dyslipoproteinaemia, cardiovascular disease and colorectal cancer at varying evidence levels. The practical consequences for current dietary recommendations are presented.

Effects of breastfeeding and low sugar-sweetened beverage intake on obesity prevalence in Hispanic toddlers

BACKGROUND

Few studies have examined the independent and additive effects of breastfeeding (BF) and sugar-sweetened beverage (SSB) intake in early life on overweight and obesity prevalence.

OBJECTIVE

The objective was to assess the effects of BF and SSB intake on the prevalence of overweight and obesity in Hispanic toddlers.

DESIGN

Nutrition data were collected via phone surveys with caregivers of 1483 Hispanic children (2-4 y of age) from the Los Angeles County Women, Infants, and Children (WIC) program. BF history at 2-4 y of age was categorized as follows: no BF, >1 wk to <6 mo BF, 6 to <12 mo BF, and ≥12 mo BF. SSB intake at 2-4 y of age was categorized as follows: high SSB (≥2 SSBs/d), mid SSB (1 SSB/d), and no SSB. The height and weight of the children were measured by WIC staff and stored in the Integrated Statewide Information System. Binary logistic regressions assessed the effects of BF and SSB categories on overweight and obesity prevalence.

RESULTS

In comparison with the no-BF participants, the odds of obesity were lower in the ≥12-mo-BF participants (OR: 0.55; 95% CI: 0.37, 0.83; P = 0.004). In comparison with high-SSB participants, the odds of obesity were lower in the no-SSB participants (OR: 0.69; 95% CI: 0.47, 1.00; P = 0.047). In comparison with the combined no-BF/high-SSB participants, the odds of obesity were lower in the ≥12-mo BF/no-SSB participants (OR: 0.39; 95% CI: 0.19, 0.80; P = 0.01).

CONCLUSION

The results suggest that BF for ≥1 y and low SSB intake during the toddler years can have profound effects on reducing the prevalence of obesity in Hispanic toddlers.

Longitudinal associations between key dietary behaviors and weight gain over time: transitions through the adolescent years

Previous studies have yielded inconsistent results when documenting the association between key dietary factors and adolescent weight change over time. The purpose of this study was to examine the extent to which changes in adolescent sugar-sweetened beverage (SSB), diet soda, breakfast, and fast-food consumption were associated with changes in BMI and percent body fat (PBF). This study analyzed data from a sample of 693 Minnesota adolescents followed over 2 years. Random coefficient models were used to examine the relationship between dietary intake and BMI and PBF and to separate cross-sectional and longitudinal associations. Adjusting for total physical activity, total energy intake, puberty, race, socioeconomic status, and age, cross-sectional findings indicated that for both males and females, breakfast consumption was significantly and inversely associated with BMI and PBF, and diet soda intake was significantly and positively associated with BMI and PBF among females. In longitudinal analyses, however, there were fewer significant associations. Among males there was evidence of a significant longitudinal association between SSB consumption and PBF; after adjustment for energy intake, an increase of one serving of SSB per day was associated with an increase of 0.7 units of PBF among males. This study adds to previous research through its methodological strengths, including adjustment for physical activity and energy intake assessed using state-of-the-art methods (i.e., accelerometers and 24-h dietary recalls), as well as its evaluation of both BMI and PBF. Additional research is needed to better understand the complex constellation of factors that contribute to adolescent weight gain over time.

Dietary patterns are associated with physical growth among school girls aged 9-11 years

The purpose of this study was to identify dietary patterns among Korean elementary school girls based on the change in body mass index (BMI), body fat, bone mineral density (BMD), and bone mineral content (BMC) during 22 months and to explore the characteristics of dietary patterns identified. Girls aged 9-11 years were recruited and 3-day dietary data were collected four times. Subjects with a diet record of 8 or more days and anthropometric data measured at baseline and 22 months later were included (n = 198). Reduced rank regression was utilized to derive dietary patterns using a change in BMI, body fat, and calcaneus BMD and BMC as response variables. Two dietary patterns were identified: the "Egg and Rice" dietary pattern and "Fruit, Nuts, Milk Beverage, Egg, Grain" (FNMBEG) dietary pattern. Subjects who had high score on the FNMBEG pattern consumed various food groups, including fruits, nuts and seeds, and dairy products, whereas subjects in the "Egg and Rice" dietary pattern group did not. Both dietary patterns showed a positive association with change in BMI and body fat. However, subjects who had a higher score on the "Egg and Rice" dietary pattern had less of a BMC increase, whereas subjects who had a higher score on the FMBEG dietary pattern had more increased BMC over 22 months after adjusting for age, body and bone mass, and Tanner stage at baseline. Our results provide evidence that a well-balanced diet contributes to lean body mass growth among young girls.