Prevalence and risk factors for overweight and obesity in a population of Italian schoolchildren: a longitudinal study

Association between breastfeeding, parents' body mass index and birth weight with obesity indicators in children

Background

Childhood obesity is potentially affected by breastfeeding, parents’ body mass index and birth weight. Thus, this study aimed to verify the association between breastfeeding, parents’ body mass index and birth weight with obesity indicators in children.

Methods

This is a cross-sectional study, including data from 402 schoolchildren between 9 and 11 of age in the city of São Caetano do Sul, Brazil. Parents or guardians answered a questionnaire about breastfeeding (month), birth weight (kg), and parental body weight and height (parents’ body mass index [kg/m²] was calculated). Body mass index (kg/m²), waist circumference (cm) and body fat (%), determined via bio-impedance, were measured and used as obesity indicators. Multi-level linear regression models were used to assess the respective associations adjusted for the potential confounders.

Results

Considering body mass index of children, the overall prevalence of eutrophic, overweight and obese were 58.2%, 20.9% and 17.2%, respectively. Significant and positive correlations were observed between breastfeeding, maternal as well as paternal body mass index and the children’s body mass index, body fat and waist circumference. Birth weight was weakly and positively associated with body mass index and body fat but was not associated with waist circumference. After adjusting for school, sex, age, race/ethnicity, annual household income, sedentary time and moderate-to-vigorous physical activity, maternal body mass index and birth weight were positively associated with children’s body mass index (β: 0.228; 95%CI: 0.142; 0.314 and β: 0.001; 95%CI: 0.001; 0.002), body fat (β: 0.484; 95%CI: 0.297; 0.671 and β: 0.002; 95%CI: 0.001; 0.003) and waist circumference (β: 0.509; 95%CI: 0.304; 0.715 and β: 0.003; 95%CI: 0.001; 0.005). Breastfeeding was not associated with any obesity indicators.

Conclusion

Maternal body mass index and birth weight were associated with children’s obesity indicators. The perinatal environment, therefore, appears to be a critical contributor to childhood obesity and public policies need to address parental obesity in order to tackle childhood obesity.

Trial registration:

The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) is registered at (Identifier NCT01722500).

Breastfeeding in children born small for gestational age and future nutritional and metabolic outcomes: a systematic review

OBJECTIVE

To systematically review evidence related to nutritional and cardiometabolic outcomes in children born at term and small for gestational age and the association with breastfeeding.

SOURCE OF DATA

Two independent reviewers searched the MEDLINE, LILACS, SciELO, and Embase databases without time or language restrictions. The PRISMA tool was used, and studies that evaluated infants born at term and small for gestational age, breastfed, and with an evaluation of cardiometabolic outcomes were included. Studies with preterm infants, those that did not have information on breastfeeding, and those with lack of evaluation of the outcome variables were excluded. Also excluded were review articles, editorials, and series of cases.

SUMMARY OF DATA

Only seven articles were found that met the abovementioned criteria. There was a great variability in the type of evaluation, as well as in the age of these children. It was demonstrated that breastfeeding promoted growth without body composition alteration and without increased insulin resistance in children with exclusive breastfeeding, when compared to children receiving a higher calorie formula, except for one article that observed an increase in fat mass in exclusively breastfed children.

CONCLUSION

Breastfeeding seems to be a safe feeding practice for infants born at term and small for gestational age, showing no association with deleterious short-term outcomes. Breastfeeding stimulation in these populations seems to be a way of preventing the health problems associated with the high risk of chronic noncommunicable diseases and obesity.

Parent-reported prevalence and persistence of 19 common child health conditions

OBJECTIVE

To estimate prevalence and persistence of 19 common paediatric conditions from infancy to 14-15 years.

DESIGN

Population-based prospective cohort study.

SETTING

Australia.

PARTICIPANTS

Parallel cohorts assessed biennially from 2004 to 2014 from ages 0-1 and 4-5 years to 10-11 and 14-15 years, respectively, in the Longitudinal Study of Australian Children.

MAIN OUTCOME MEASURES

19 health conditions: 17 parent-reported, 2 (overweight/obesity, obesity) directly assessed. Two general measures: health status, special health care needs.

ANALYSIS

(1) prevalence estimated in 2-year age-bands and (2) persistence rates calculated at each subsequent time point for each condition among affected children.

RESULTS

10 090 children participated in Wave 1 and 6717 in all waves. From age 2, more than 60% of children were experiencing at least one health condition at any age. Distinct prevalence patterns by age-bands comprised eight conditions that steadily rose (overweight/obesity, obesity, injury, anxiety/depression, frequent headaches, abdominal pain, autism spectrum disorder, attention-deficit hyperactivity disorder). Six conditions fell with age (eczema, sleep problems, day-wetting, soiling, constipation, recurrent tonsillitis), three remained stable (asthma, diabetes, epilepsy) and two peaked in mid-childhood (dental decay, recurrent ear infections). Conditions were more likely to persist if present for 2 years; persistence was especially high for obesity beyond 6-7 (91.3%-95.1% persisting at 14-15).

CONCLUSIONS

Beyond infancy, most Australian children are experiencing at least one ongoing health condition at any given time. This study's age-specific estimates of prevalence and persistence should assist families and clinicians to plan care. Conditions showing little resolution (obesity, asthma, attention-deficit hyperactivity disorder) require long-term planning and management.

Persistence and Variation in Overweight and Obesity Among the Pre-school Population of the Community of Madrid After 2 Years of Follow-up. The ELOIN Cohort

INTRODUCTION AND OBJECTIVES

The childhood obesity epidemic is a worldwide public health problem which starts at very early ages. The aim of this study was to determine the persistence of and variation in overweight and obesity among a cohort of children followed up from 4 to 6 years of age.

METHODS

The data were drawn from the ELOIN (Longitudinal Childhood Obesity Study), a population-based cohort in the Community of Madrid, Spain. A total of 2435 children were involved. Weight and height were objectively measured and standardised at 4 (2012-2013) and 6 years of age (2014-2015) by 31 purpose-trained pediatricians. Three reference criteria were used: the World Health Organization (WHO-2006), International Obesity Task Force (IOTF-2000), and Spanish tables of the Orbegozo Foundation 2004, were used to define "absence of excess weight", overweight and obesity.

RESULTS

According to the above three classification criteria, between the ages of 4 and 6 years the prevalence of overweight increased from 5.7%-16.5% (range of the 3 criteria) to 8.9%-17.0%, and obesity increased from 3.0%-5.4% to 6.1%-10.1%. Three out of every 4 obese children at age 4 years persisted with obesity at age 6 years, whereas 20.6%-29.3% who were overweight became obese. A total of 8.0% to 16.1% of children maintained "excess weight" (overweight/obesity), 7.9% to 11% were new cases, and 2.2% to 5.9% showed remission.

CONCLUSIONS

Excess weight increased between the ages of 4 and 6 years. Important variations were observed in weight status susceptible to intervention during well-child visits.

Early-life exposures predicting onset and resolution of childhood overweight or obesity

OBJECTIVES

To determine which of multiple early-life exposures predict onset or resolution of overweight/obesity during a 9-year period.

METHODS

Design: longitudinal cohort from three harmonised community-based cohorts enriched for overweight and obesity. Early-life exposures: child-gestational age; delivery; birth weight; breast feeding; solids introduction; baseline body mass index (BMI); waist circumference; diet; activity; global, physical and psychosocial health. Mother-baseline BMI; education; age; neighbourhood disadvantage; concern for child's weight. Outcome: change in BMI category. Analyses: adjusted logistic regression.

RESULTS

On average, the 363 children (57% retention) were 6 and 15 years old at baseline and follow-up. Children were classified as 'never' overweight/obese (38%), 'resolving' overweight/obese (15%), 'becoming' overweight/obese (8%) or 'always' overweight/obese (39%). Compared with 'never overweight/obese' children, odds of 'becoming overweight/obese' were greater with higher child (OR 2.33, 95% CI 1.02 to 5.29) and maternal BMI (OR 1.18, CI 1.07 to 1.31), and lower with higher maternal education (OR 0.09, CI 0.02 to 0.34). Compared with 'always overweight/obese' children, odds of 'resolving overweight/obese' were lower with higher maternal BMI (OR 0.87, CI 0.78 to 0.97), and higher with better child physical health (OR 1.06, CI 1.02 to 1.10) and higher maternal age (OR 1.11, CI 1.01 to 1.22) and education (OR 4.07, CI 1.02 to 16.19).

CONCLUSIONS

Readily available baseline information (child/maternal BMI, maternal age, education and child health) were the strongest predictors of both onset and resolution of overweight/obesity between the primary school and adolescent years. Perinatal, breastfeeding and lifestyle exposures were not strongly predictive. Results could stimulate development of algorithms identifying children most in need of targeted prevention or treatment.

Metabolic syndrome is strictly associated with parental obesity beginning from childhood

OBJECTIVE

We aimed to identify potential correlates or risk factors for metabolic syndrome (MetS) in a cohort of schoolchildren. We quantified the prevalence of MetS, analysed the clustering of MetS components and described the distribution of metabolic parameters not included in MetS definition.

DESIGN

Population-based, cross-sectional study.

PATIENTS AND MEASUREMENTS

A total of 489 children (6·7-13 years) representing the 92·6% of the whole school population between the 1st year of primary school and the 2nd year of junior high school living in a centre of southern Italy. Weight, height, waist circumference, blood pressure (BP), laboratory parameters (indexes of glucose metabolism, lipid profile and uric acid), anamnestic and parental information, lifestyle and dietary habits were collected. Dietary habits data were available only for 353 children.

RESULTS

MetS prevalence was 9·8%. Of 48 children with MetS, 38 (79·2%) were simultaneously positive for abdominal obesity and elevated BP. In children with MetS, the prevalence of insulin resistance, high insulin, high non-HDL(high-density lipoprotein) cholesterol and high uric acid was higher than in children without MetS. In 6·7-10-year-old children, only the presence of parental history of obesity [odds ratio (OR) = 4·3, 95% CI = 1·8-10·2] was higher in those with MetS than in those without. In 10·1-13-year-old children, the presence of parental history of obesity, the habits of no walking/cycling to school, long screen time and no breakfast consumption were higher in children with MetS than in those without, but only parental history of obesity (adjusted OR = 3·8, 95% CI = 1·7-8·4) remained significantly related to MetS in multivariate logistic regression.

CONCLUSIONS

Parental obesity was strictly associated with MetS in all children and should be considered in clinical practice. In older children, wrong lifestyle and dietary habits were related to parental obesity.

Risk of childhood overweight or obesity associated with excessive weight gain during pregnancy: a meta-analysis

PURPOSE

Several investigations have shown that the risk of childhood overweight and obesity may be associated with excessive gestational weight gain (GWG), but the study samples were limited and results were mixed; hence we conducted this meta-analysis to assess the explicit association between them and present evidence.

METHODS

We searched PubMed, EMbase, Ovid, Web of knowledge and Cochrane library for relevant studies. Bibliographies from retrieved articles were also manually searched. Cohort studies that presented results by OR or RR with 95 % CI for the association of maternal excessive GWG and child overweight/obesity were included. The pooled estimates were calculated by fixed-effect model or random-effect model according to the heterogeneity.

RESULTS

Twelve cohort studies were identified, and the combined OR of excessive GWG and childhood overweight/obesity was 1.33 (95 % CI 1.18-1.50) with evidence of heterogeneity (P = 0.000, I (2) = 71.1 %). Adjustment of maternal BMI, investigation area, age of children, research type, and omission of any single study had little effect on the pooled estimate. After eliminating the effect of publication bias by trim and fill analyses, the result still remained statistically significant (OR 1.21, 95 % CI 1.05-1.40).

CONCLUSIONS

This meta-analysis suggests that the risk of childhood overweight/obesity is significantly associated with excessive gestational weight gain.

Birth weight and long-term overweight risk: systematic review and a meta-analysis including 643,902 persons from 66 studies and 26 countries globally

BACKGROUND

Overweight is among the major challenging health risk factors. It has been claimed that birth weight, being a critical indicator of prenatal developmental conditions, is related to long-term overweight risk. In order to check this important assumption of developmental and preventive medicine, we performed a systematic review and comprehensive meta-analysis.

METHODS AND FINDINGS

Relevant studies published up to January 2011 that investigated the relation between birth weight and later risk of overweight were identified through literature searches using MEDLINE and EMBASE. For meta-analysis, 66 studies from 26 countries and five continents were identified to be eligible, including 643,902 persons aged 1 to 75 years. We constructed random-effects and fixed-effects models, performed subgroup-analyses, influence-analyses, assessed heterogeneity and publication bias, performed meta-regression analysis as well as analysis of confounder adjusted data. Meta-regression revealed a linear positive relationship between birth weight and later overweight risk (p<0.001). Low birth weight (<2,500 g) was found to be followed by a decreased risk of overweight (odds ratio (OR) =0.67; 95% confidence interval (CI) 0.59-0.76). High birth weight (>4,000 g) was associated with increased risk of overweight (OR=1.66; 95% CI 1.55-1.77). Results did not change significantly by using normal birth weight (2,500-4,000 g) as reference category (OR=0.73, 95% CI 0.63-0.84, and OR=1.60, 95% CI 1.45-1.77, respectively). Subgroup- and influence-analyses revealed no indication for bias/confounding. Adjusted estimates indicate a doubling of long-term overweight risk in high as compared to normal birth weight subjects (OR=1.96, 95% CI 1.43-2.67).

CONCLUSIONS

Findings demonstrate that low birth weight is followed by a decreased long-term risk of overweight, while high birth weight predisposes for later overweight. Preventing in-utero overnutrition, e.g., by avoiding maternal overnutrition, overweight and/or diabetes during pregnancy, might therefore be a promising strategy of genuine overweight prevention, globally.

Self discipline and obesity in Bangkok school children

Background

Childhood obesity has become an important public health problem in Thailand. This study aimed to determine the relationship between self discipline and obesity in Bangkok school children.

Methods

A case control study was conducted. 140 cases (obese children) and 140 controls (normal weight children) were randomly chosen from grades 4-6 students in 4 Bangkok public schools. Questionnaire responses regarding general characteristics and child self-discipline were obtained from children and their parents.

Results

Self discipline in eating habits, money management and time management were reported at significantly lower levels among the obese group (p < 0.05). After controlling all other variables, it was revealed that the ranking of factors associated with obesity by adjusted odds ratio (OR) were low self-discipline in managing expenses (3.1), poor home environment (3.0,), moderate self-discipline in time management (2.9), television viewing time ≥2 hours/day (2.6), an obese father (2.2), and an obese mother (1.9).

Conclusions

It was recommended that parents and teachers participate in child self-discipline guidance, particularly with regard to eating habits, money management and time management in a supportive environment that both facilitates prevention of obesity and simultaneously develops a child's personal control.

Breast-feeding and growth in children until the age of 3 years: the Generation R Study

Breast-feeding has been suggested to be associated with lower risks of obesity in older children and adults. We assessed whether the duration and exclusiveness of breast-feeding are associated with early postnatal growth rates and the risks of overweight and obesity in preschool children. The present study was embedded in a population-based prospective cohort study from early fetal life onwards, among 5047 children and their mothers in The Netherlands. Compared with children who were breast-fed, those who were never breast-fed had a lower weight at birth (difference 134 (95 % CI - 190, - 77) g). No associations between breast-feeding duration and exclusivity with growth rates before the age of 3 months were observed. Shorter breast-feeding duration was associated with an increased gain in age- and sex-adjusted standard deviation scores for length, weight and BMI (P for trend < 0·05) between 3 and 6 months of age. Similar tendencies were observed for the associations of breast-feeding exclusivity with change in length, weight and BMI. Breast-feeding duration and exclusivity were not consistently associated with the risks of overweight and obesity at the ages of 1, 2 and 3 years. In conclusion, shorter breast-feeding duration and exclusivity during the first 6 months tended to be associated with increased growth rates for length, weight and BMI between the age of 3 and 6 months but not with the risks of overweight and obesity until the age of 3 years.

Trimming the fat: identification of risk factors associated with obesity in a pediatric emergency department

OBJECTIVE

The purpose of this study was to assess which knowledge deficits and dietary habits in an urban pediatric emergency department (ED) population are risk factors for obesity.

METHODS

This cross-sectional study in an urban pediatric ED used a modified version of the Diet and Health Knowledge Survey, an in-person interview questionnaire, to collect data on demographics, dietary knowledge, and practices. All patients aged 2 to 17 years were enrolled in the study over a 4-month period. Subjects were excluded if they were in extremis, pregnant, incarcerated, institutionalized, considered an emancipated minor, or consumed only a modified consistency diet.

RESULTS

One hundred seventy-nine subjects were enrolled in this study. Based on body mass index, the prevalence of obesity in our study population was 24%. Parents with obese children answered a mean of 62.9% (95% confidence interval, 60.4%-65.5%) of knowledge questions correctly, whereas all others scored 60.3% (95% confidence interval, 58.3%-62.3%) correctly. Based on the univariate analysis, 10 predictors met inclusion criteria into logistic regression analysis: screen time (P = 0.03), race (P = 0.08), sex (P = 0.04), parental education (P = 0.08), parental estimation that child is overweight (P < 0.0001), parental estimation that child is underweight (P = 0.003), trimming fat from meat (P = 0.06), soft-drink consumption (P = 0.03), exercise (P = 0.07), and chip consumption (P = 0.04). In a multivariate analysis, only male sex, regularly trimming fat from meat, and parental assessment of obesity were independently associated with obesity.

CONCLUSIONS

Knowledge deficiencies regarding healthy nutrition among parents in an urban pediatric ED population were not significantly associated with having obese children; however, specific habits were. Emergency physicians may provide a valuable role in identification and brief behavioral intervention in high-risk populations during the current epidemic of childhood obesity.