1
|
Hermeling L, Steinacker JM, Kobel S. Beyond correlates: the social gradient in childhood overweight. Arch Public Health 2024; 82:3. [PMID: 38195594 PMCID: PMC10775653 DOI: 10.1186/s13690-023-01232-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Health (in)equity has a high priority on research and policy agendas. Even though it is known that inequalities in overweight prevalence accumulate with age and are already existent among children below the age of six, research on this topic is scarce. In this young age group, parents play an important role in preventing overweight and associated adverse consequences. This study examines the magnitude of parental misclassification of child weight status and its correlates, focussing on the factors that determine social status and equity. METHODS Preschool children's weight and height was measured objectively. Parents gave information on their socioeconomic background. Family education was dichotomised into tertiary and non-tertiary educational level, according to CASMIN. Binary logistic regression, adjusted for parental BMI, was applied to detect odds of childhood overweight. RESULTS Data on family educational level and anthropometrics were available from 643 children (4.5 ± 0.82 years, 52.7% male) and their parents of which 46.5% (n = 299) had a tertiary educational background. The groups (tertiary vs. non-tertiary educational level) differ significantly in overweight prevalence (3.7% vs. 11.9%, p ≤ 0.001). Odds of overweight were two times higher in children with non-tertiary educational background (OR: 2.123, CI: 1.010-4.461, p < 0.05), adjusted for parental BMI. CONCLUSION Children from families with low educational background have an elevated risk of overweight, already at a very young age. Education in general (not explicitly health education) seems to play a tremendous role in the prevention of overweight and obesity and should therefore be implied in policies enhancing health equity. TRIAL REGISTRATION DRKS-ID: DRKS00010089.
Collapse
Affiliation(s)
- Lina Hermeling
- Division of Sports- and Rehabilitation Medicine, Centre of Medicine, Ulm University Hospital, Ulm, Germany
| | - Jürgen M Steinacker
- Division of Sports- and Rehabilitation Medicine, Centre of Medicine, Ulm University Hospital, Ulm, Germany
| | - Susanne Kobel
- Division of Sports- and Rehabilitation Medicine, Centre of Medicine, Ulm University Hospital, Ulm, Germany.
| |
Collapse
|
2
|
Kösling C, Schäfer L, Hübner C, Sebert C, Hilbert A, Schmidt R. Food-Induced Brain Activity in Children with Overweight or Obesity versus Normal Weight: An Electroencephalographic Pilot Study. Brain Sci 2022; 12:brainsci12121653. [PMID: 36552113 PMCID: PMC9775366 DOI: 10.3390/brainsci12121653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Although increased food cue reactivity is evidenced to be crucial to the development and maintenance of pediatric obesity, virtually nothing is known about the underlying neurophysiological aspects of food cue reactivity in children with obesity. Therefore, this study aimed at investigating neural characteristics in children with overweight or obesity using electroencephalography (EEG). METHODS Electrophysiological brain activity was measured using EEG frequency band analysis in n = 9 children with overweight or obesity versus n = 16 children with normal weight (8-13 years) during the presentation of high- and low-calorie food pictures and images of appealing non-food stimuli. RESULTS Children with overweight or obesity showed significantly increased relative central beta band activity induced by high-calorie foods and appealing non-food stimuli compared to children with normal weight. Beyond significant effects of the scalp region on EEG activity, non-significant effects of stimulus category or weight status were seen for theta and alpha frequency bands. CONCLUSIONS This study demonstrated elevated beta band activity in children with overweight or obesity when viewing high-calorie food stimuli. Beta band activity may, thus, be a valuable target for neuromodulatory interventions in children with overweight or obesity.
Collapse
|
3
|
Kobel S, Wartha O, Dreyhaupt J, Feather KE, Steinacker JM. Intervention effects of a school-based health promotion programme on children’s nutrition behaviour. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01726-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Aim
The programme “Join the Healthy Boat” promotes amongst other things a healthy diet in primary school children. In order to evaluate the programme’s effectiveness, this study longitudinally investigated children’s nutrition behaviour.
Subject and methods
A total of 1564 children (7.1 ± 0.6 years) participated in a cluster-randomised study. Teachers delivered lessons including behavioural contracting and budgeting. Nutritional behaviours of parents and child were assessed via parental report. Anthropometrics were measured on site.
Results
After one year, children in the intervention group (IG) showed a significant reduction in the consumption of pure juices (p ≤ 0.001). Soft drink consumption reduced in both groups, although with a trend towards a slightly greater reduction in the IG. Children with fathers of normal weight as well as first graders showed a significant reduction of soft drink consumption in the IG (p = 0.025 and p = 0.022 respectively). Fruit and vegetable intake increased significantly for first graders (p = 0.050), children from families with a high parental education level (p = 0.023), and for children with an overweight father (p = 0.034). Significant group differences were found for fruit and vegetable intake of children with migration background (p = 0.01) and children of parents with a high school degree could be observed (p = 0.019).
Conclusion
This shows that the programme appeals to a wider range of children, and is therefore more likely to compensate for differences due to origin or other social inequalities, which also shows that active parental involvement is vital for successful interventions.
Collapse
|
4
|
The Impact of Physical Activity at School on Children's Body Mass during 2 Years of Observation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063287. [PMID: 35328972 PMCID: PMC8949997 DOI: 10.3390/ijerph19063287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 02/01/2023]
Abstract
(1) Background: Children's overweight and obesity are a growing public health problem. The aim of this study was to assess the influence of physical activity (PA) at school on body mass of children aged 10-12 during 2 years of observation. (2) Methods: Primary school children (n = 245, 48% girls and 52% boys) took part in the study. Children were divided in two groups, (1) of standard PA and (2) of elevated PA at school corresponding to 4 and 10 h of physical education lessons (PE) a week, respectively. Weight, height, and body mass index (BMI) were measured starting from the 4th grade and ending at the 6th grade of school. (3) Results: The number of children with excessive body weight (overweight and obese) increased by ¼ in children of standard PA while slightly decreased in children of elevated PA. Many more children of elevated PA changed body mass category from overweight to healthy weight than those of standard PA. Girls, especially of standard PA, had more often excessive body weight compared to boys. (4) Conclusions: Increasing time of physical activity at school by elevation of the number of PE lessons favorably affects the body mass of children.
Collapse
|
5
|
Al-Kataan MA, Fawzi MM. Obesity and Mitochondrial Function in Children: A case–control study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES: Childhood obesity has increased over the past years worldwide. Therefore, changes in mitochondrial function as the risk factors of obesity in children need to consider.
AIM: The study aimed to evaluate the connection between obesity and mitochondrial function in obese children.
PATIENTS AND METHODS: This study was a case–control study conducted in the primary school children in Mosul city. The study included 100 children, with an age ranged from 6 to 12 years. Fifty child with obesity (BMI ≥ 95th percentile) for children enrolled in this work and compared to 50 control with BMI <95th percentile. Mitochondrial function assessed by measurement of serum lactic acid, lactate/pyruvate ratio, and L-carnitine and mt-DNA copy number.
RESULTS: Serum lactate and the lactate/pyruvate ratio were significantly higher in obese children than in the control group, while serum pyruvate levels in children with obesity are not significantly different from those in the control group. Serum levels of L-carnitine and mt-DNA copy number significantly reduced in obese children comparison to the control group.
CONCLUSION: Changes of mitochondrial function may be involved in obesity of children.
Collapse
|
6
|
Pop TL, Maniu D, Rajka D, Lazea C, Cismaru G, Ştef A, Căinap SS. Prevalence of Underweight, Overweight and Obesity in School-Aged Children in the Urban Area of the Northwestern Part of Romania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105176. [PMID: 34068152 PMCID: PMC8152956 DOI: 10.3390/ijerph18105176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/02/2021] [Accepted: 05/08/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION During the last three decades, there has been an excess weight epidemic due to changes in nutrition and lifestyle. Few data on the prevalence of overweight and obesity in children in Romania were published, without a single study representative at the national level. There are reports on the higher level of overweight and obesity in urban areas compared to rural ones. This study aimed to estimate the prevalence of underweight, overweight, obesity and severe obesity in children enrolled in schools from the urban area. MATERIAL AND METHODS For this cross-sectional study, children from 177 schools from the urban area of five counties from the northwestern part of Romania were included after the parents signed written informed consent. Anthropometric data were recorded (weight, height) based on World Health Organization (WHO) recommendations and Body-Mass-Index (BMI), and the z-score for BMI were calculated. The nutritional status was estimated using three reference criteria: WHO, International Obesity Task Force (IOTC) and the Center for Disease Control and Prevention (CDC). RESULTS We analyzed data of 21,650 children (48.19% boys) age between 7 and 18 years. The prevalence of overweight was 13.8%, 16.2% and 20.3%, of obesity was 10.7%, 10.0% and 5.7% and of severe obesity was 5.1%, 1.2% and 1.6% (using WHO, CDC and IOTF cut-offs). Underweight was present in 5.2% (WHO), 6% (CDC) and 2.6% (IOTF). The highest prevalence of overweight (including obesity) was found in children aged 10 years, and the lowest in adolescents at 18 years. Boys have a higher prevalence of excess weight than girls. Using IOTF cut-offs, the prevalence of obesity and severe obesity was lower than using WHO criteria. CONCLUSIONS The prevalence of overweight (including obesity) in children from the urban area of Western Romania was recorded at alarming levels, higher in boys and at the pre-puberty ages. There are significant differences based on the reference system used. It is important to correctly choose the reference for the definition of overweight and obesity to have the correct estimation of the target for public health measures.
Collapse
Affiliation(s)
- Tudor Lucian Pop
- 2nd Pediatric Discipline, Mother and Child Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
- 2nd Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania
- Romanian Society of Social Pediatrics, 400177 Cluj-Napoca, Romania
- Correspondence: (C.L.); (T.L.P.)
| | - Dana Maniu
- Faculty of Physics, Babes-Bolyai University, 400084 Cluj-Napoca, Romania;
| | - Daniela Rajka
- Society of Physicians from Children and Youth Communities, 400427 Cluj-Napoca, Romania;
| | - Cecilia Lazea
- 1st Pediatric Discipline, Mother and Child Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 40012 Cluj-Napoca, Romania
- 1st Pediatric Clinic, Emergency Clinical Hospital for Children, 400470 Cluj-Napoca, Romania
- Correspondence: (C.L.); (T.L.P.)
| | - Gabriel Cismaru
- Cardiology-Rehabilitation Discipline, Internal Medicine Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
- Cardiology Department, Rehabilitation Hospital, 400347 Cluj-Napoca, Romania
| | - Adrian Ştef
- Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
- “Nicolae Stancioiu” Heart Institute, 400001 Cluj-Napoca, Romania
| | - Simona Sorana Căinap
- 2nd Pediatric Discipline, Mother and Child Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
- 2nd Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania
- Romanian Society of Social Pediatrics, 400177 Cluj-Napoca, Romania
| |
Collapse
|
7
|
Intervention Effects of the Health Promotion Programme "Join the Healthy Boat" on Objectively Assessed Sedentary Time in Primary School Children in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239029. [PMID: 33287418 PMCID: PMC7730991 DOI: 10.3390/ijerph17239029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/16/2020] [Accepted: 11/26/2020] [Indexed: 12/11/2022]
Abstract
Sedentary behaviour (SB) in children is related to negative health consequences that can track into adulthood. The programme "Join the Healthy Boat" promotes reduced screen time and a less sedentary lifestyle in schoolchildren. This study investigated the effects of the programme on children's SB. For one year, teachers delivered the programme. A total of 231 children (7.0 ± 0.6 years) participated in the cluster-randomised study; there were 154 one year later at follow-up. Children's SB was assessed using multi-sensor accelerometery, screen time via parental questionnaire. Effects were analysed using (linear) mixed effects regression models. At baseline, children spent 211 (±89) min daily in SB, at follow-up 259 (±109) min/day with no significant difference between the intervention (IG) and control group (CG). SB was higher during weekends (p < 0.01, for CG and IG). However, at follow-up, daily screen time decreased in IG (screen time of >1 h/day: baseline: 33.3% vs. 27.4%; follow-up: 41.2% vs. 27.5%, for CG and IG, respectively). This multi-dimensional, low-threshold intervention for one year does not seem to achieve a significant reduction in children's SB, although screen time decreased in IG. Therefore, it should be considered that screen time cannot be the key contributor to SB and should not solely be used for changing children's SB. However, if screen time is targeted, interventions should promote the replacement of screen time with active alternatives.
Collapse
|
8
|
Role of Parents in Body Mass Reduction in Children with Obesity-Adherence and Success of 1-Year Participation in an Intervention Program. ACTA ACUST UNITED AC 2020; 56:medicina56040168. [PMID: 32283681 PMCID: PMC7230971 DOI: 10.3390/medicina56040168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 12/15/2022]
Abstract
Background and Objectives: Obesity in children and adolescents results in a number of serious health-related consequences necessitating early treatment. Support from family members and family-focused lifestyle interventions can improve effectiveness of the treatment. The aim of the study was to assess the effects of parental characteristics and family-based dietary habits on the adherence and success of a body mass reduction program in children with obesity included in a lifestyle intervention program after 1 year. Materials and Methods: The program included dietetic, psychosocial, and endocrine counseling given to individuals either alone or in groups and was conducted by a multidisciplinary team (consisting of endocrinologists, nurses, psychologists, social counselors, dietitians, and physiotherapists). A total of 113 children aged 10-17 years (mean age 12.9 ± 2.0; 60 girls, 53 boys) were included in the program. After 1 year of participation, the rate of adherence and success were assessed. The effect of the participants' general characteristics, including anthropometric data, as well as parental characteristics (marital status, employment, education, body mass index (BMI), duration of breastfeeding) and the circumstances of meal consumption (eating at home or outside, fast food consumption), was analyzed. Results: The most important factors predicting body mass reduction success were baseline BMI (p < 0.0001) and waist-hip ratio (WHR) (p = 0.04), but they did not predict body mass reduction adherence. Conclusions: The meal consumption habits and support from family members may be among the determinants of adherence to a body mass reduction program for preadolescents and adolescents with obesity. However, the results of the presented study suggested that baseline BMI and WHR are the most important determinants of the body mass reduction success.
Collapse
|
9
|
Interaction Effects of Child Weight Status and Parental Feeding Practices on Children's Eating Disorder Symptomatology. Nutrients 2019; 11:nu11102433. [PMID: 31614777 PMCID: PMC6835784 DOI: 10.3390/nu11102433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/05/2019] [Accepted: 10/10/2019] [Indexed: 12/22/2022] Open
Abstract
(1) Background: Research on parental feeding practices and non-normative eating behavior including loss of control (LOC) eating and eating disorder psychopathology indicated separate associations of these variables with child weight status, especially in early childhood. This study cross-sectionally examined interaction effects of restriction, monitoring, pressure to eat, and children's weight status on disordered eating in children aged 8-13 years. (2) Methods: A population-based sample of N = 904 children and their mothers completed the Eating Disorder Examination Questionnaire for Children and the Child Feeding Questionnaire. Child anthropometrics were objectively measured. Hierarchical linear and logistic regression analyses were conducted for cross-sectionally predicting global eating disorder psychopathology and recurrent LOC eating by feeding practices and child weight status for younger (8-10 years) and older (11-13 years) ages. (3) Results: Restriction x Child weight status significantly predicted global eating disorder psychopathology in younger children and recurrent LOC eating in older children. Monitoring x Child weight status significantly predicted eating disorder psychopathology in older children. A higher versus lower child weight status was associated with adverse eating behaviors, particularly in children with mothers reporting high restriction and monitoring. (4) Conclusions: Detrimental associations between higher child weight status and child eating disorder symptomatology held especially true for children whose mothers strongly control child food intake.
Collapse
|
10
|
Schienkiewitz A, Damerow S, Schaffrath Rosario A. [Just method effects? Prevalences of underweight, overweight and obesity in children and adolescents according to the weighting factors and reference system used]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1235-1241. [PMID: 31529187 DOI: 10.1007/s00103-019-03011-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) is an important data source for assessing the occurrence of underweight, overweight and obesity in children and adolescents in Germany. However, to assess trends over time, it must be considered that methodological changes in the calculation of prevalences have been necessary and that the reference system has been revised. OBJECTIVE Are the effects of the methodological changes in weighting factors and reference systems so important that they significantly influence the available prevalence estimates and statements on trends over time? MATERIALS AND METHODS The data are based on valid measurements of body height and weight from the KiGGS baseline survey (2003-2006, 7531 boys and 7215 girls) and from KiGGS Wave 2 (2014-2017, 1762 boys and 1799 girls). The participants were aged between 3 and 17 years. Prevalences (%, 95% CI) of underweight, overweight and obesity for the KiGGS baseline survey were calculated depending on the reference system and different weighting factors used. RESULTS The statements on the temporal trend in the prevalence of underweight, overweight, and obesity remain valid even when methodological changes are taken into account. Only among 16- and especially 17-year-old girls, can a noticeable difference due to the altered reference system be noted. DISCUSSION With regard to the trend examined here, the methodological changes can be neglected, as long as no small subgroups are analysed. However, this conclusion cannot be generalised; the effects of methodological changes must be re-examined for each study question.
Collapse
Affiliation(s)
- Anja Schienkiewitz
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Nordufer 20, 13353, Berlin, Deutschland.
| | - Stefan Damerow
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Nordufer 20, 13353, Berlin, Deutschland
| | - Angelika Schaffrath Rosario
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Nordufer 20, 13353, Berlin, Deutschland
| |
Collapse
|
11
|
Kobel S, Wartha O, Lämmle C, Dreyhaupt J, Steinacker JM. Intervention effects of a kindergarten-based health promotion programme on obesity related behavioural outcomes and BMI percentiles. Prev Med Rep 2019; 15:100931. [PMID: 31321204 PMCID: PMC6612931 DOI: 10.1016/j.pmedr.2019.100931] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 06/11/2019] [Accepted: 06/27/2019] [Indexed: 01/22/2023] Open
Abstract
In recent decades, prevalence of childhood overweight has increased worldwide and became a public health concern. One reason is children's insufficient engagement in physical activity (PA) which may lead to deficient motor skills, which are interdependent. Therefore, early health promotion such as the kindergarten-based health promotion programme "Join the Healthy Boat" is necessary. In order to evaluate the programme's effectiveness on children's BMI percentiles (BMIPCT), PA and endurance capacity, a randomised controlled trial including intervention (IG) and control group (CG) was conducted. 973 kindergarten children (3.6 ± 0.6 years; 47.1% male) in 57 kindergartens were assessed at baseline and 558 of them at follow-up. Anthropometrics and endurance capability (3-minute-run) were assessed on site. PA behaviour and socio-economic data were assessed using parental report. Linear regression models were used to determine intervention effects for all health outcomes, adjusting for baseline values, age, gender, BMIPCT and socio-economic variables. After one year, a significant positive intervention effect on children's BMIPCT was found (p ≤ 0.04). Children in the IG spent significantly more days in sufficient PA than children in the CG (3.1 ± 2.1 days vs. 2.5 ± 1.9 days; p ≤ 0.005). Children in the IG performed significantly better in the three minute endurance run than their counterparts in the CG (305.8 ± 46.2 m vs. 286.9 ± 43.2 m; p ≤ 0.001). This teacher-centred health promotion using a low-dose bottom-up approach with action alternatives achieved significant positive effects in the reduction of BMIPCT and significant increases in endurance capacity and daily PA. The programme is therefore ideal for integrating health promotion more intensively into the everyday life of children.
Collapse
Affiliation(s)
- Susanne Kobel
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, D-89075 Ulm, Germany
| | - Olivia Wartha
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, D-89075 Ulm, Germany
| | - Christine Lämmle
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, D-89075 Ulm, Germany
| | - Jens Dreyhaupt
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Jürgen M. Steinacker
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, D-89075 Ulm, Germany
| |
Collapse
|
12
|
Kobel S, Kesztyüs D, Steinacker JM. [Teacher-Based Health Promotion in Primary School Children in Baden-Württemberg: Effects on Endurance Performance and Incidence of Abdominal Obesity]. DAS GESUNDHEITSWESEN 2019; 82:901-908. [PMID: 31311060 DOI: 10.1055/a-0921-7076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Health promotion has to start early. Many prevention programmes lack proof of effectiveness. A programme that promotes an active and healthy lifestyle for primary school children in Baden-Württemberg is "Join the Healthy Boat". AIM The effect of this one-year school-based intervention on endurance performance and incidence of paediatric abdominal obesity was investigated in a large cluster randomised study. METHODS Data of 1739 children (7.1±0.6 years) were available at baseline and follow-up. Background variables were assessed via parent questionnaires. Endurance performance (6-minute run) and anthropometric data were collected on-site. Children with waist-to-height-ratio (WHtR) ≥ 0.5 were classified as being abdominally obese. The difference in endurance capacity and the incidence of abdominal obesity between baseline and follow-up were calculated and analysed in simple and hierarchical regression models taking into account the school effect. RESULTS Adjusted for gender and grade level, the difference in completed meters in the intervention group after one year was significantly greater (70.5±128.6 vs. 59.2±106.6 m, n=1708). However, after taking into account data clustering of schools, the significance was lost. Odds for the development of abdominal obesity in the intervention group were more than halved after adjustment for gender, grade, baseline WHtR and no-breakfasts (odds ratio=0.48, 95% CI [0.25; 0.94], n=1535). CONCLUSION Children should learn to make healthy choices from an early age. With the prevention of abdominal obesity as an indicator, this intervention is characterised as an effective health promotion.
Collapse
Affiliation(s)
- Susanne Kobel
- Sport- und Rehabilitationsmedizin, Universitätsklinikum Ulm, Ulm
| | | | | |
Collapse
|
13
|
Body mass index and height in 11- to 16-year-old Austrian students attending two different school types with divergent socioeconomic backgrounds. Wien Klin Wochenschr 2019; 131:337-346. [PMID: 30937540 PMCID: PMC6647492 DOI: 10.1007/s00508-019-1479-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 03/06/2019] [Indexed: 12/02/2022]
Abstract
Background In developed countries high socioeconomic status (SES) is associated with lower body mass index (BMI) and greater height compared with low SES. Aim To investigate differences in BMI/height in adolescent students from two different school types with divergent SES backgrounds. Methods A total of 4579 students (2313 female), aged 11–16 years, attending either low SES vocation-directed secondary schools (VSS) or high SES secondary academic schools (AHS) were compared. Potential differences were investigated using ANCOVA models including sex, school type, geographical region and degree of urbanicity. Results At all ages between 11 and 16 years the BMI of students attending VSS was significantly higher than that of students attending AHS (mean +0.87kg/m2). The AHS students were on average taller (mean +0.93cm; p<0.001), without statistically significant age-specific differences. The taller height contributed to lower BMI by approximately 25%. Short stature, overweight and obesity were 2.3-fold, 1.8-fold and 2.5-fold, respectively more frequent in VSS than in AHS students. The BMI was higher in students in Vienna than in communities with >100,000 (p<0.001) and 20,000-100,000 (p=0.045) but similar to communities with <20,000 inhabitants. Conclusion These findings suggest that differences in BMI and height between students reflect early SES-based grouping into school types according to the academic level of the schools they attend.
Collapse
|
14
|
Holzmann SL, Dischl F, Schäfer H, Groh G, Hauner H, Holzapfel C. Digital Gaming for Nutritional Education: A Survey on Preferences, Motives, and Needs of Children and Adolescents. JMIR Form Res 2019; 3:e10284. [PMID: 30758290 PMCID: PMC6391648 DOI: 10.2196/10284] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 10/04/2018] [Accepted: 11/25/2018] [Indexed: 12/19/2022] Open
Abstract
Background Use of novel information and communication technologies are frequently discussed as promising tools to prevent and treat overweight and obesity in children and adolescents. Objective This survey aims to describe the preferences, motives, and needs of children and adolescents regarding nutrition and digital games. Methods We conducted a survey in 6 secondary schools in the southern region of Germany using a 43-item questionnaire. Questions referred to preferences, motives, and needs of children and adolescents regarding nutrition and digital games. In addition, knowledge regarding nutrition was assessed with 4 questions. We collected self-reported sociodemographic and anthropometric data. Descriptive statistical analyses were performed using SPSS. Results In total, 293 children and adolescents participated in the study, with ages 12-18 years (137 girls, 46.8%), weight 30.0-120.0 (mean 60.2 [SD 13.2]) kg, and height 1.4-2.0 (mean 1.7 [SD 0.1]) m. A total of 5.5% (16/290) correctly answered the 4 questions regarding nutrition knowledge. Study participants acquired digital nutritional information primarily from the internet (166/291, 57.0%) and television (97/291, 33.3%), while school education (161/291, 55.3%) and parents or other adults (209/291, 71.8%) were the most relevant nondigital information sources. Most participants (242/283, 85.5%) reported that they regularly play digital games. More than half (144/236, 61.0%) stated that they play digital games on a daily basis on their smartphones or tablets, and almost 70% (151/282, 66.5%) reported playing digital games for ≤30 minutes without any interruption. One-half of respondents (144/280, 51.4%) also stated that they were interested in receiving information about nutrition while playing digital games. Conclusions This survey suggests that nutrition knowledge in children and adolescents might be deficient. Most children and adolescents play digital games and express interest in acquiring nutritional information during digital gameplay. A digital game with a focus on sound nutrition could be a potential educational tool for imparting nutrition knowledge and promoting healthier nutrition behaviors in children and adolescents.
Collapse
Affiliation(s)
- Sophie Laura Holzmann
- Institute for Nutritional Medicine, Else Kroener-Fresenius-Center for Nutritional Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Munich, Germany
| | - Felicitas Dischl
- Institute for Nutritional Medicine, Else Kroener-Fresenius-Center for Nutritional Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Munich, Germany
| | - Hanna Schäfer
- Research Group Social Computing, Department of Informatics, Technical University of Munich, Garching, Germany
| | - Georg Groh
- Research Group Social Computing, Department of Informatics, Technical University of Munich, Garching, Germany
| | - Hans Hauner
- Institute for Nutritional Medicine, Else Kroener-Fresenius-Center for Nutritional Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Munich, Germany.,Nutritional Medicine Unit, Institute for Food and Health, Technical University of Munich, Freising, Germany
| | - Christina Holzapfel
- Institute for Nutritional Medicine, Else Kroener-Fresenius-Center for Nutritional Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Munich, Germany
| |
Collapse
|
15
|
Kobel S, Wartha O, Dreyhaupt J, Kettner S, Steinacker JM. Cross-sectional associations of objectively assessed sleep duration with physical activity, BMI and television viewing in German primary school children. BMC Pediatr 2019; 19:54. [PMID: 30744602 PMCID: PMC6369549 DOI: 10.1186/s12887-019-1429-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 02/07/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The global incidence of overweight and obesity has increased dramatically among children and adolescents over the past decades. Insufficient sleep duration and physical inactivity are known risk factors for overweight and obesity in children. To engage children in a healthier lifestyle knowledge about associations of sleep duration and behavioural aspects in children are vital. Therefore, this study investigated the mentioned associations in German primary school children. METHODS Data of 308 first and second graders (7.1 ± 0.6 years) was used; children's anthropometric data were taken during a school visit. Children's physical activity (PA) and sleep duration were assessed objectively (Actiheart©, CamNtech Ltd., Cambridge, UK); children's daily television time and socio-demographic data were collected via parental questionnaire. Linear mixed-effects regression models as well as logistic regressions were used to determine associations of PA, television viewing, age, gender, BMI z-scores and socio-economic variables on sleep duration. RESULTS In linear regression models young age and not having a migration background were significantly associated with long sleep duration (p < 0.001). In logistic regressions, long night time sleep (≥10:08 h; compared to medium and short sleep duration) was significantly associated with not reaching the PA guideline (OR 0.60 [0.36;0.99]), daily television viewing of less than one hour (OR 0.44 [0.24;0.80]), young age (OR 0.38 [0.21;067]), a high parental education level (OR 0.52 [0.27;0.99]) and the lack of migration background (OR 0.21 [0.10;0.48]). However, if controlling for age, gender, parental education level and migration background, reaching the PA guideline stayed no longer significantly associated with a tertiary sleep level. CONCLUSIONS Children in the highest sleep category showed a negative association with reaching the PA guideline and a positive association with daily television viewing. This therefore adds to previously primarily subjectively assessed associations of sleep and risk factors for obesity (related behaviours) with a detailed insight based on objective data. Hence, interventions trying to decrease children's BMI and television viewing should also aim at extending children's night-time sleep and inform parents about the importance of sufficient sleep during childhood. TRIAL REGISTRATION DRKS-ID: DRKS00000494 .
Collapse
Affiliation(s)
- Susanne Kobel
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, D-89075 Ulm, Germany
| | - Olivia Wartha
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, D-89075 Ulm, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Ulm University, Schwabstr. 13, D-89075 Ulm, Germany
| | - Sarah Kettner
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, D-89075 Ulm, Germany
| | - Jürgen M. Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Centre, Leimgrubenweg 14, D-89075 Ulm, Germany
| |
Collapse
|
16
|
Forster F, Weinmann T, Gerlich J, Schlotz W, Weinmayr G, Genuneit J, Windstetter D, Vogelberg C, von Mutius E, Nowak D, Radon K. Work-related stress and incident asthma and rhinitis: results from the SOLAR study. Int Arch Occup Environ Health 2019; 92:673-681. [PMID: 30656403 DOI: 10.1007/s00420-019-01402-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 01/13/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study analyzes the association of work-related stress with incident asthma and rhinitis in young adults with a special focus on gender-specific differences. METHODS Incident asthma, wheezing and rhinitis were measured in a cohort of 2051 young German adults (aged 16-18 years at baseline) recruited by the prospective population-based SOLAR study (Study of Occupational Allergy Risks). Work-related stress was measured by the Trier Inventory for the Assessment of Chronic Stress (TICS). Two TICS scales, work overload and work discontent, were analysed. Logistic regression was conducted to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS In females, the odds for incident asthma were found to be 17% higher for each increase of the work discontent score by one point (OR 1.17, 95% CI 1.04-1.31). In males, no association was statistically significant. Incident rhinitis showed no association with any exposure variable. CONCLUSION This study shows a link between work-related stress and incident asthma which seems to be confined to women. This study adds evidence about the association of work-related stress and asthma in young adults and can contribute to prevention for that particular age group.
Collapse
Affiliation(s)
- Felix Forster
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany. .,Institute for Medical Informatics, Biometry, and Epidemiology, LMU Munich, Munich, Germany. .,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany.
| | - Tobias Weinmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany.,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany.,Munich Center of Health Sciences (MC-Health), Munich, Germany
| | - Jessica Gerlich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany.,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany.,Munich Center of Health Sciences (MC-Health), Munich, Germany
| | - Wolff Schlotz
- Max Planck Institute of Empirical Aesthetics, Frankfurt am Main, Germany
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Doris Windstetter
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany.,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany
| | - Christian Vogelberg
- Paediatric Department, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Erika von Mutius
- Dr. v. Haunersches Kinderspital, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany.,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany.,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany.,Munich Center of Health Sciences (MC-Health), Munich, Germany
| |
Collapse
|
17
|
Schmidt R, Sebert C, Kösling C, Grunwald M, Hilbert A, Hübner C, Schäfer L. Neuropsychological and Neurophysiological Indicators of General and Food-Specific Impulsivity in Children with Overweight and Obesity: A Pilot Study. Nutrients 2018; 10:nu10121983. [PMID: 30558260 PMCID: PMC6316789 DOI: 10.3390/nu10121983] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 02/07/2023] Open
Abstract
Impulsivity, particularly towards food, is a potential risk factor for increased energy intake and the development and maintenance of obesity in children. However, neuropsychological and neurophysiological indicators of general and food-specific impulsivity and their association with children's weight status are poorly understood. This pilot study examined electroencephalography (EEG) frequency band profiles during eyes-closed and eyes-open resting state in n = 12 children with overweight or obesity versus n = 22 normal-weight controls and their link to child- and parent-reported and experimentally assessed impulsivity of children (e.g., risk-taking behavior, approach-avoidance behavior towards food). The main results indicated that children with overweight/obesity versus normal weight showed significantly increased delta and decreased alpha band activity during eyes-closed resting state. Across the total sample, EEG slow-wave band activity was particularly linked to self- and parent-reported impulsivity and greater risk-taking behavior, but not to approach behavior towards food, after controlling for children's age and weight status. The identification of specific EEG patterns in children with excess weight may provide a new basis for developing neurophysiological diagnostic and treatment approaches for childhood obesity. Future studies with larger samples and longitudinal designs are needed to replicate the present findings and test their stability over time.
Collapse
Affiliation(s)
- Ricarda Schmidt
- Integrated Research and Treatment Center Adiposity Diseases, Department of Medical Psychology and Medical Sociology and Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, 04103 Leipzig, Germany.
| | - Caroline Sebert
- Integrated Research and Treatment Center Adiposity Diseases, Department of Medical Psychology and Medical Sociology and Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, 04103 Leipzig, Germany.
| | - Christine Kösling
- Integrated Research and Treatment Center Adiposity Diseases, Department of Medical Psychology and Medical Sociology and Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, 04103 Leipzig, Germany.
| | - Martin Grunwald
- Haptic-Research Laboratory, Paul-Flechsig-Institute for Brain Research, University of Leipzig, 04103 Leipzig, Germany.
| | - Anja Hilbert
- Integrated Research and Treatment Center Adiposity Diseases, Department of Medical Psychology and Medical Sociology and Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, 04103 Leipzig, Germany.
| | - Claudia Hübner
- Integrated Research and Treatment Center Adiposity Diseases, Department of Medical Psychology and Medical Sociology and Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, 04103 Leipzig, Germany.
| | - Lisa Schäfer
- Integrated Research and Treatment Center Adiposity Diseases, Department of Medical Psychology and Medical Sociology and Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, 04103 Leipzig, Germany.
| |
Collapse
|
18
|
Bohn B, Stachow R, Gellhaus I, Matthias J, Lichtenstern H, Holl RW. Heterogeneity in sociodemographic characteristics and cardiovascular risk factors at the initiation of a lifestyle intervention for obesity within Germany: an APV multicenter study on 40,942 children and adolescents. CHILD AND ADOLESCENT OBESITY 2018. [DOI: 10.1080/2574254x.2018.1547070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Barbara Bohn
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Rainer Stachow
- Rehabilitation Clinic for Children and Adolescents, Fachklinik Sylt, Westerland, Germany
| | - Ines Gellhaus
- Consensus Group Obesity Education for Children and Adolescents (KgAS), Paderborn, Germany
| | | | | | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| |
Collapse
|
19
|
Prinz N, Schwandt A, Becker M, Denzer C, Flury M, Fritsch M, Galler A, Lemmer A, Papsch M, Reinehr T, Rosenbauer J, Holl RW. Trajectories of Body Mass Index from Childhood to Young Adulthood among Patients with Type 1 Diabetes-A Longitudinal Group-Based Modeling Approach Based on the DPV Registry. J Pediatr 2018; 201:78-85.e4. [PMID: 29937081 DOI: 10.1016/j.jpeds.2018.05.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/05/2018] [Accepted: 05/09/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To identify distinct longitudinal patterns of body mass index (BMI) z score in type 1 diabetes from childhood to young adulthood and secondly to determine sex differences as well as associated clinical covariates. STUDY DESIGN A total of 5665 patients with type 1 diabetes (51% male) with follow-up from 8 to 20 years of age from the multicenter diabetes prospective registry DPV were studied (baseline diabetes duration ≥1 years, BMI z score aggregated per year of life). Latent class growth modeling (SAS: PROC TRAJ) was applied to analyze BMI z score over time. RESULTS Six distinct BMI z score trajectories were identified (group 1: 7% of patients, group 2: 22%, group 3: 20%, group 4: 16%, group 5: 25%, and group 6: 10%). Group 1, 2, 5, and 6 had an almost stable BMI z score, either in the low, near-normal, high stable, or chronic overweight range. Group 3 (60% girls) increased their BMI during puberty, whereas group 4 (65% boys) had a BMI decrease. Similar patterns were observed for girls only, whereas boys followed nearly stable trajectories without fluctuation over time. Between the near-normal and the other groups, significant differences (P < .05) in sex ratio, migration background, mental health, height z score, glycated hemoglobin A1c, diabetes treatment, dyslipidemia, hypertension, and smoking were observed. CONCLUSIONS In youth with type 1 diabetes, a great heterogeneity of BMI z score trajectories exists that highlight the importance of personalized sex-specific intervention programs for subjects at risk for unfavorable BMI development.
Collapse
Affiliation(s)
- Nicole Prinz
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - Anke Schwandt
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Marianne Becker
- Department of Pediatrics, Diabetes & Endocrinology Care Clinique Pédiatrique, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg
| | - Christian Denzer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Endocrinology and Diabetes, Interdisciplinary Obesity Unit, University Medical Center Ulm, Ulm, Germany
| | - Monika Flury
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Endocrinology and Diabetes, Medical University Carl Gustav Carus, Dresden, Germany
| | - Maria Fritsch
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Angela Galler
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Sozialpädiatrisches Zentrum, Abteilung Interdisziplinär, Pediatric Endocrinology and Diabetology, Berlin, Germany
| | - Andreas Lemmer
- Department of Pediatrics and Adolescent Medicine, Helios Clinical Center, Erfurt, Germany
| | - Matthias Papsch
- Department of Pediatrics and Adolescent Medicine, Marienhospital GmbH, Gelsenkirchen, Germany
| | - Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Hospital for Children and Adolescents, University of Witten/Herdecke, Datteln, Germany
| | - Joachim Rosenbauer
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| |
Collapse
|
20
|
Wulff H, Wagner P. Media Use and Physical Activity Behaviour of Adolescent Participants in Obesity Therapy: Impact Analysis of Selected Socio-Demographic Factors. Obes Facts 2018; 11:307-317. [PMID: 30064131 PMCID: PMC6189527 DOI: 10.1159/000490178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 05/18/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To address the challenge of juvenile obesity, effective therapeutic concepts focusing on lifestyle changes are necessary. A relevant aspect is the media use, which is associated with nutrition and physical activity patterns and is influenced by socio-demographic factors. To optimise obesity therapy, the use of media depending on these socio-demographic factors needs to be analysed to adjust the aims, content and methods of interventions as well as to harness the potential of media use in obesity therapy. The question considered in this research is: What media and physical activity patterns show 11- to 17-year-old obesity therapy participants in dependence on socio-demographic factors? METHODS A national multicentre study was conducted in 2015. A questionnaire was used to survey 432 participants' aged 13.75 ± 1.4 years. Standardised instruments were used to assess the variables: physical activity, media use and socio-demographic factors. RESULTS The participants were 1-hour physically active for 3.9 ± 1.9 days/week, 14.1% daily. Televisions, mobile phones and computers were available in all socio-demographic groups and used for 2 h/day. Socio-demographic differences emerged in the duration of media use (h/day). Girls were found to use mobile phones for longer (2.49 vs. 1.90; p < 0.01) and spend less time on game consoles than boys (0.55 vs. 1.65; p < 0.01). CONCLUSION Compared to current recommendations, the sample shows reduced physical activity and increased media use, which vary between the groups. Hence, differentiated therapy approaches appear recommendable. Future research needs to evaluate, how media (despite its risks) can facilitate therapy, training and aftercare concepts.
Collapse
Affiliation(s)
- Hagen Wulff
- *Hagen Wulff, Institute of Exercise and Public Health, University of Leipzig, Jahnallee 59, 04109 Leipzig, Germany,
| | | |
Collapse
|
21
|
Hoffmann B, Kettner S, Wirt T, Wartha O, Hermeling L, Steinacker JM, Kobel S. Sedentary time among primary school children in south-west Germany: amounts and correlates. ACTA ACUST UNITED AC 2017; 75:63. [PMID: 29046786 PMCID: PMC5637270 DOI: 10.1186/s13690-017-0230-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 08/28/2017] [Indexed: 11/21/2022]
Abstract
Background Sedentary behaviour in children is related to different health consequences such as overweight and cardio-metabolic diseases that can track into adulthood. Previous studies have shown that children spend hours being sedentary, but no data of sedentary time (ST) among German children has been available, yet. Therefore, this study investigated objectively measured amounts and correlates of ST in a sample of German primary school children. Methods Children’s physical activity (PA) was objectively assessed for 6 days using a multi-sensor device (Actiheart®; CamNtech, Cambridge, UK). Activity levels were categorized on the basis of energy expenditure (MET) into sedentary, light PA (LPA), and moderate to vigorous PA (MVPA). ST excluding sleeping hours was assessed for 231 children (7.1 ± 0.6 years, male: 45.9%) and analysed for independent groups. Examined factors (parental education, household income, and migration background) were assessed by parental questionnaire. Children’s weight, height and gender were collected in schools. Weight status was calculated on the basis of BMI percentiles. Results On average, children spent 3.5 ± 1.5 h daily being sedentary, excluding sleeping hours. Significantly higher ST was found in girls (t = −4.6; p < 0.01), in children with migration background (t = −6.9; p < 0.01), at the weekend (t = −2.8; p < 0.01), and among inactive children (t = 6.8; p < 0.01). Additionally, significant correlations with ST in this sample were identified for MVPA (B = −0.99; [−1.09;-0.88], p < 0.01), LPA (B = −0.89; [−0.97;-0.82], p < 0.01), migration background (B = −17.64; [5.24;30.04], p < 0.01), gender (B = −13.48; [−25.94;-1.01], p < 0.05) and household income (B = −4.80; [−9.07; −0.53], p < 0.05). Conclusion Girls, children with migration background, and inactive children were identified as potential risk groups. A higher income was associated with less ST. In general, ST was higher at the weekend. Furthermore, as PA was found to be negatively correlated to ST, these activities may replace each other. Therefore, these findings should be considered in future health interventions. Trial registration German Clinical Trials Register (DRKS), DRKS-ID: DRKS00000494 DATE: 25/08/2010.
Collapse
Affiliation(s)
- Belinda Hoffmann
- Division of Sports- and Rehabilitation Medicine, Center of Medicine, Ulm University Hospital, Leimgrubenweg 14, 89075 Ulm, Germany
| | - Sarah Kettner
- Division of Sports- and Rehabilitation Medicine, Center of Medicine, Ulm University Hospital, Leimgrubenweg 14, 89075 Ulm, Germany
| | - Tamara Wirt
- Division of Sports- and Rehabilitation Medicine, Center of Medicine, Ulm University Hospital, Leimgrubenweg 14, 89075 Ulm, Germany
| | - Olivia Wartha
- Division of Sports- and Rehabilitation Medicine, Center of Medicine, Ulm University Hospital, Leimgrubenweg 14, 89075 Ulm, Germany
| | - Lina Hermeling
- Division of Sports- and Rehabilitation Medicine, Center of Medicine, Ulm University Hospital, Leimgrubenweg 14, 89075 Ulm, Germany
| | - Jürgen M Steinacker
- Division of Sports- and Rehabilitation Medicine, Center of Medicine, Ulm University Hospital, Leimgrubenweg 14, 89075 Ulm, Germany
| | - Susanne Kobel
- Division of Sports- and Rehabilitation Medicine, Center of Medicine, Ulm University Hospital, Leimgrubenweg 14, 89075 Ulm, Germany
| | | |
Collapse
|
22
|
|
23
|
Nagl K, Hermann JM, Plamper M, Schröder C, Dost A, Kordonouri O, Rami-Merhar B, Holl RW. Factors contributing to partial remission in type 1 diabetes: analysis based on the insulin dose-adjusted HbA1c in 3657 children and adolescents from Germany and Austria. Pediatr Diabetes 2017; 18:428-434. [PMID: 27416952 DOI: 10.1111/pedi.12413] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/24/2016] [Accepted: 06/07/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Insulin dose-adjusted hemoglobin A1c (HbA1C, IDAA1c) correlates well with stimulated C-peptide levels, but has not yet been evaluated in a large cohort of patients with Type 1 diabetes (T1D). METHODS We investigated prevalence of partial remission (PREM) defined by IDAA1c ≤9 in 3657 in children with new-onset T1D who were continuously followed over 6 years. We evaluated the predictors of PREM using the multicenter database from the DPV (Diabetes Patienten Verlaufsdokumentation) registry. RESULTS PREM occurred in 71% of patients. Median duration was 9 (0-21) months. Compared to children <5 years at T1D onset, those aged 5-10 and ≥10 years had twice the chance of developing PREM (OR: 2.08, CI: 1.67-2.60; P < .001 and OR: 2.16, CI: 1.70-2.75; P < .001). Boys were more likely to develop PREM than girls (OR 1.41, CI: 1.18-1.69; P = .0002). Further predictors for PREM were: ketoacidosis, autoantibodies, and HbA1c at T1D onset. These results were confirmed by quantile regression analysis with duration of PREM as dependent variable. CONCLUSION This research on a large cohort provides insight into epidemiologic characteristics of PREM in T1D defined by IDAA1c. As IDAA1c does not discriminate between insulin sensitivity and secretion, available data cannot resolve whether the sex-difference in PREM reflects innate higher insulin resistance in girls, or better beta-cell recovery in boys. Further research is needed to clarify the usefulness and performance of IDAA1c in clinical practice.
Collapse
Affiliation(s)
- Katrin Nagl
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Austria
| | - Julia M Hermann
- Epidemiology and Medical Biometry, University of Ulm, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | | | | | - Axel Dost
- Department of Pediatrics, University Hospital Jena, Germany
| | | | - Birgit Rami-Merhar
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Austria
| | - Reinhard W Holl
- Epidemiology and Medical Biometry, University of Ulm, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| |
Collapse
|
24
|
Steenbock B, Zeeb H, Rach S, Pohlabeln H, Pischke CR. Design and methods for a cluster-controlled trial conducted at sixty-eight daycare facilities evaluating the impact of "JolinchenKids - Fit and Healthy in Daycare", a program for health promotion in 3- to 6-year-old children. BMC Public Health 2017; 18:6. [PMID: 28693454 PMCID: PMC5504810 DOI: 10.1186/s12889-017-4551-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/28/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The prevention of overweight and obesity during infancy is a highly relevant public health topic given the significant impact of childhood obesity on acute and chronic diseases, general health, and well-being in later stages of life. Apart from the family setting, daycare facilities (DFs) represent a key setting for health promotion among children under the age of six years. "JolinchenKids - Fit and Healthy in Daycare" is a multi-component program promoting physical activity (PA), healthy eating, and mental well-being in 3- to 6-year-old preschoolers at DFs, originally designed by the German health insurance AOK. To evaluate program effectiveness, a cluster-controlled trial involving 68 DFs is currently conducted. The objective of this article is to describe the background, study design, and aims of this trial. METHODS/DESIGN Sixty-eight DFs across Germany will be recruited to take part in the study, half of them serving as intervention DFs and half of them as delayed intervention control DFs (which receive the program upon completion of the study). At each DF, height, weight, and body composition, as well as motor skills, will be assessed in twenty 3- to 6-year-old children. Children's eating and PA habits, and mental well-being will be assessed via parental questionnaires. A subsample of children (i.e., at 24 DFs which are randomly selected within a geographic region) will be asked to wear accelerometers at their wrists to objectively measure PA over the course of seven days. To compare changes in body composition, motor skills, eating and PA habits, and mental well-being of children at intervention DFs with those observed among children at delayed intervention control DFs over one year, all measurements will take place at baseline and twelve months after the launch of the program at all DFs. DISCUSSION This study investigates the influence of a health promotion program in the daycare setting on various outcomes, including body composition and objectively measured PA, in a nationwide sample of 3- to 6-year-old preschoolers. This study will provide evidence regarding the effectiveness of a multi-component program for health promotion in this setting and may provide insights into new strategies for preventing obesity in early life. TRIAL REGISTRATION German Clinical Trials Register DRKS00011065 (Date of registration 16-09-2016).
Collapse
Affiliation(s)
- Berit Steenbock
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Stefan Rach
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Hermann Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Claudia R Pischke
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| |
Collapse
|
25
|
'Knowing what Matters in diabetes: Healthier below 7': results of the campaign's first 10 years (part 2), participants without known diabetes history. Cardiovasc Endocrinol 2017; 6:48-54. [PMID: 28392974 PMCID: PMC5367513 DOI: 10.1097/xce.0000000000000109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/16/2016] [Indexed: 11/30/2022] Open
Abstract
Type 2 diabetes represents a major problem in many societies. Early detection and, even better, prevention could help to reduce the burden of the disease. Therefore, increased awareness of disorders of glucose metabolism is important. During the campaign ‘Knowing what Matters in diabetes: Healthier below 7’, in the last few years, more than 31 000 shopping mall visitors in Germany were voluntarily checked for their potential diabetes risk.
Collapse
|
26
|
Kobel S, Lämmle C, Wartha O, Kesztyüs D, Wirt T, Steinacker JM. Effects of a Randomised Controlled School-Based Health Promotion Intervention on Obesity Related Behavioural Outcomes of Children with Migration Background. J Immigr Minor Health 2017; 19:254-262. [PMID: 27388441 PMCID: PMC5332505 DOI: 10.1007/s10903-016-0460-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Children with migration background (MB) appear to be at higher risk of developing obesity, therefore, prevention is necessary to avoid possible health inequalities. This study investigated a 1-year intervention with focus on increasing physical activity (PA) and fruit and vegetable intake (FVI), decreasing screen media use (SMU) and soft drink consumption (SDC) in children with MB. 525 children (7.1 ± 0.7 years) with MB who participated in the cluster-randomised study were assessed at baseline and after 1 year. Daily SMU, PA behaviours, SDC and FVI were assessed using a parental questionnaire. After one year, significant effects were found in the intervention group for FVI (p ≤ 0.035). Partially strong tendencies but no significant differences were found for PA and SDC. Although the effects are small, the intervention seems to reach children with MB. An intervention lasting longer than one year might result in more changes.
Collapse
Affiliation(s)
- Susanne Kobel
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, 89075, Ulm, Germany.
| | - Christine Lämmle
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, 89075, Ulm, Germany
| | - Olivia Wartha
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, 89075, Ulm, Germany
| | - Dorothea Kesztyüs
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, 89075, Ulm, Germany
| | - Tamara Wirt
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, 89075, Ulm, Germany
| | - Jürgen M Steinacker
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, 89075, Ulm, Germany
| |
Collapse
|
27
|
Differential Influences of Parenting Dimensions and Parental Physical Abuse during Childhood on Overweight and Obesity in Adolescents. CHILDREN-BASEL 2017; 4:children4030017. [PMID: 28272353 PMCID: PMC5368428 DOI: 10.3390/children4030017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 11/22/2022]
Abstract
Besides other explanatory variables, parenting styles and parental violence might also be responsible for setting a path towards overweight/obesity in childhood. While this association has consistently been observed for adults, findings for adolescents still remain scarce and inconsistent. Therefore, the goal of this study is to add evidence on this topic for children and adolescents. Analyses are based on a sample of 1729 German, ninth-grade students. To analyze associations between parenting dimensions and weight status, non-parametric conditional inference trees were applied. Three gender-specific pathways for a heightened risk of overweight/obesity were observed: (1) female adolescents who report having experienced severe parental physical abuse and medium/high parental warmth in childhood; (2) male adolescents who report having experienced low or medium parental monitoring in childhood; and (3) this second pathway for male adolescents is more pronounced if the families receive welfare. The importance of promoting parenting styles characterized by warmth and a lack of physical abuse is also discussed. This is one of only a few studies examining the association of parenting dimensions/parental physical abuse and weight status in adolescence. Future studies should include even more parenting dimensions, as well as parental physical abuse levels, in order to detect and untangle gender-specific effects on weight status.
Collapse
|
28
|
Parental feeding practices in families with children aged 2–13 years: Psychometric properties and child age-specific norms of the German version of the Child Feeding Questionnaire (CFQ). Appetite 2017; 109:154-164. [DOI: 10.1016/j.appet.2016.11.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/03/2016] [Accepted: 11/28/2016] [Indexed: 01/24/2023]
|
29
|
Deux N, Schlarb AA, Martin F, Holtmann M, Hebebrand J, Legenbauer T. Overweight in adolescent, psychiatric inpatients: A problem of general or food-specific impulsivity? Appetite 2017; 112:157-166. [PMID: 28131756 DOI: 10.1016/j.appet.2017.01.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 01/18/2017] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
Adolescent psychiatric patients are vulnerable to weight problems and show an overrepresentation of overweight compared to the healthy population. One potential factor that can contribute to the etiology of overweight is higher impulsivity. As of yet, it is unclear whether it is a general impulse control deficit or weight-related aspects such as lower impulse control in response to food that have an impact on body weight. As this may have therapeutic implications, the current study investigated differences between overweight and non-overweight adolescent psychiatric inpatients (N = 98; aged 12-20) in relation to trait impulsivity and behavioral inhibition performance. The Barratt Impulsiveness Scale and two go/no-go paradigms with neutral and food-related stimulus materials were applied. Results indicated no significant differences concerning trait impulsivity, but revealed that overweight inpatients had significantly more difficulties in inhibition performance (i.e. they reacted more impulsively) in response to both food and neutral stimuli compared to non-overweight inpatients. Furthermore, no specific inhibition deficit for high-caloric vs. low-caloric food cues emerged in overweight inpatients, whereas non-overweight participants showed significantly lower inhibition skills in response to high-caloric than low-caloric food stimuli. The results highlight a rather general, non-food-specific reduced inhibition performance in an overweight adolescent psychiatric population. Further research is necessary to enhance the understanding of the role of impulsivity in terms of body weight status in this high-risk group of adolescent inpatients.
Collapse
Affiliation(s)
- Natalie Deux
- Clinic for Child and Adolescent Psychiatry, LWL University Hospital Hamm of the Ruhr-University Bochum, Germany.
| | - Angelika A Schlarb
- University of Bielefeld, Department for Psychology and Sports, Clinical Psychology and Psychotherapy for Children and Adolescents, Bielefeld, Germany
| | - Franziska Martin
- Clinic for Child and Adolescent Psychiatry, LWL University Hospital Hamm of the Ruhr-University Bochum, Germany
| | - Martin Holtmann
- Clinic for Child and Adolescent Psychiatry, LWL University Hospital Hamm of the Ruhr-University Bochum, Germany
| | - Johannes Hebebrand
- Clinic for Child and Adolescent Psychiatry, LVR Hospital Essen of the University of Duisburg-Essen, Germany
| | - Tanja Legenbauer
- Clinic for Child and Adolescent Psychiatry, LWL University Hospital Hamm of the Ruhr-University Bochum, Germany
| |
Collapse
|
30
|
[Media use and physical activity patterns of adolescent participants in obesity therapy: Analysis of the impact of selected sociodemographic factors]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 59:284-91. [PMID: 26689417 DOI: 10.1007/s00103-015-2289-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
To meet the challenge of obesity, effective therapeutic concepts for adolescents focusing on lifestyle changes are necessary. Particularly relevant are nutrition and physical activity patterns associated with media use, which can be influenced by sociodemographic factors. For the optimization of obesity therapy approaches, it is essential to analyze these sociodemographic factors to adjust the aims, content, and methods of interventions, and to use the potential of media in treatment concepts. Thus, the research question is: what are the media and physical activity patterns of 11- to 17-year-old participants in obesity therapy, depending on sociodemographic factors? The national multicenter study was conducted from 2012 to 2013. A questionnaire was administered to 564 participants aged 13.4 ± 1.6 (mean ± standard deviation) years. Standardized instruments were used to assess the variables physical activity, media use, and sociodemographic factors. Participants were physically active for 1 h on 3.3 ± 1.8 days per week, 8.5 % daily. Televisions, mobile phones, and computers were available in all sociodemographic groups and were used for 2 h per day. Sociodemographic differences can be seen in the extent of media usage (h/day). These differences can be found between girls and boys concerning their usage of mobile phones (2.49 vs. 1.90; p < 0.001), between 11- to 13- and 14- to 17-year-old children concerning their usage of game consoles (0.55 vs. 1.65; p = 0.007), and in the correlation analysis of media usage and physical activity. Compared with existing literature, the survey results reveal reduced activity and increased media use, which vary among the groups. Thus, differentiated therapy approaches appear to be reasonable. Future research needs to evaluate to what extent media, despite the risks, can contribute to the methodological support of therapy, training, and aftercare concepts.
Collapse
|
31
|
Bohn B, Wiegand S, Kiess W, Reinehr T, Stachow R, Oepen J, Langhof H, Hermann T, Widhalm K, Wabitsch M, Gellhaus I, Holl R. Changing Characteristics of Obese Children and Adolescents Entering Pediatric Lifestyle Intervention Programs in Germany over the Last 11 Years: An Adiposity Patients Registry Multicenter Analysis of 65,453 Children and Adolescents. Obes Facts 2017; 10:517-530. [PMID: 29131049 PMCID: PMC5741166 DOI: 10.1159/000479631] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 07/17/2017] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To examine whether characteristics of children and adolescents who start lifestyle intervention (LI) for obesity in Germany changed over the last decade. METHODS 65,453 subjects (<21 years) from the APV database (Adiposity Patients Registry) with a BMI ≥ 90th percentile were included (years 2005-2015). Logistic regression models (confounders: age, sex, migration background) were created for overweight, obesity, extreme obesity, and obesity-related comorbidities. Comorbidities were further adjusted for weight category. Results were stratified by inpatient or outpatient care. RESULTS Extreme obesity was found to be more frequent at the onset of LI (2005: 11.6; 2015: 12.7%) with a similar trend in subgroups (p < 0.001). Obesity increased (2005: 50.3%; 2015: 55.1%), and overweight decreased (2005: 34.1%; 2015: 29.0%) in the whole study population. Trends were similar for inpatient or outpatient care (all p < 0.001). Hypertension increased from 45.7% to 49.2% in the whole study population, and similar data were obtained in the subgroup of inpatients (both p < 0.0001). Dyslipidemia increased in all patients (2005: 21.9%; 2015: 28.0%) and in inpatients (2005: 20.2%; 2015: 25.7%; both p < 0.0001). Abnormal carbohydrate metabolism rose in all patients (from 5.2 to 6.4%; p = 0.0002) without significant trends in subgroups. CONCLUSION During the last decade, children and adolescents presented with higher BMI SDS at the onset of LI and the proportion with obesity-related comorbidities increased. Particularly the presence of comorbidities differed between outpatients and inpatients.
Collapse
Affiliation(s)
- Barbara Bohn
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
- *Dr. biol. hum. Barbara Bohn; M.Sc. Public Health Nutrition, Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, 89081 Ulm, Germany,
| | - Susanna Wiegand
- Department of Pediatric Endocrinology and Diabetology, Charité University Medicine, Berlin, Germany
| | - Wieland Kiess
- University Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Children's Hospital; University of Witten/Herdecke, Datteln, Germany
| | - Rainer Stachow
- Specialized Clinic Sylt, Rehabilitation Clinic for Children and Adolescents, Westerland, Germany
| | - Johannes Oepen
- Rehabilitation Clinic for Children and Adolescents, Viktoriastift Bad Kreuznach, Bad Kreuznach, Germany
| | | | - Thomas Hermann
- Specialized Rehabilitation Clinic Prinzregent Luitpold, Scheidegg/Allgäu, Germany
| | - Kurt Widhalm
- Division of Clinical Nutrition, Obesity and Lipid Disorders, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Martin Wabitsch
- Division of Pediatric Endocrinology and Diabetes, University Hospital for Children and Adolescents, Ulm, Germany
| | - Ines Gellhaus
- Consensus Group Obesity Education for Children and Adolescents (KgAS), Paderborn, Germany
| | - Reinhard Holl
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
| |
Collapse
|
32
|
Predictors and determinants for weight reduction in overweight and obese children and adolescents. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2016; 118-119:31-39. [PMID: 27987566 DOI: 10.1016/j.zefq.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 06/03/2016] [Accepted: 06/07/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Worldwide, overweight and obesity are known as posing serious health risks. Successful methods for weight reduction have remained elusive. This multicenter non-randomised trial aimed to identify parameters and determinants of long-term weight reduction. PATIENTS AND METHODS A total of 143/159 overweight and obese children and adolescents (90 %) completed the prospective multicenter trial (age 13.9±2.4 years, BMI 31.2±5.4kg/m2, BMI-SDS 2.51±0.57). During a 6-week rehabilitation period the patients participated in a structured treatment and teaching program (STTP). Following in-patient treatment the children and adolescents were monitored over a period of 24 months (physical examination, measurements of BMI, BMI-SDS, body composition, carotid intima-media thickness, laboratory parameters, blood pressure, standardized questionnaires to assess socio-demographic and socio-economic parameters, eating behavior, well-being, quality of life, intelligence, intrafamilial conflicts, self-efficacy, resilience, sense of coherence, stress management, social support, actual body shape). RESULTS 66% of the children and adolescents had abnormal laboratory parameters as well as higher blood pressure and/or an increased carotid intima-media thickness. The mean carotid intima-media thickness was 0.53±0.09mm (range 0.40 to 0.80); 15% of the patients showed normal range values (< 0.45mm), 40% a slightly elevated (≥ 0.45 to ≤ 0.50mm) and 45% an elevated (> 0.50mm) thickness. After the inpatient treatment lasting 40.4±4.1 (range 28 to 49) days, children and adolescents reached a mean weight reduction of 5.52±3.94 (0.4 to 13.3) kg (p<0.01) that was accompanied by a reduction in body fat mass. Using multivariate analyses, the most important psychological factors associated with long-term weight reduction were identified (R-square=0.53): well-being (β=-0.543), resilience (β=0.434), and sense of coherence (β=0.315). CONCLUSION The different parameters (i. e., well-being, resilience, sense of coherence) have demonstrated their utility, and strategies should be developed allowing an adaption of these into the STTPs.
Collapse
|
33
|
Warschburger P, Kroeller K, Haerting J, Unverzagt S, van Egmond-Fröhlich A. Empowering Parents of Obese Children (EPOC): A randomized controlled trial on additional long-term weight effects of parent training. Appetite 2016; 103:148-156. [DOI: 10.1016/j.appet.2016.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/02/2016] [Accepted: 04/07/2016] [Indexed: 10/22/2022]
|
34
|
Beyond intima-media-thickness: Analysis of the carotid intima-media-roughness in a paediatric population. Atherosclerosis 2016; 251:164-169. [DOI: 10.1016/j.atherosclerosis.2016.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/01/2016] [Accepted: 06/08/2016] [Indexed: 11/21/2022]
|
35
|
Abstract
Zusammenfassung:
In Deutschland ist mehr als die Hälfte der Erwachsenen übergewichtig, fast ein Viertel ist adipös. Als Risikofaktor für viele Erkrankungen geht Übergewicht mit einer hohen individuellen Krankheitslast und, infolge dessen, erhöhten Versorgungskosten und Produktivitätsverlusten einher. Aufgrund der hohen Krankheitslast und weiten Verbreitung gehört Übergewicht zu den relevantesten Risikofaktoren in Deutschland. Der Beitrag konzentriert sich auf die gesundheitsökonomischen Folgen des Übergewichtes.
Collapse
Affiliation(s)
- Thomas Lehnert
- Universitätsklinikum Hamburg-Eppendorf, Institut für Gesundheitsökonomie und Versorgungsforschung
| | - Alexander Konnopka
- Universitätsklinikum Hamburg-Eppendorf, Institut für Gesundheitsökonomie und Versorgungsforschung
| | - Hans-Helmut König
- Universitätsklinikum Hamburg-Eppendorf, Institut für Gesundheitsökonomie und Versorgungsforschung
| |
Collapse
|
36
|
Schiel R, Kaps A, Stein G, Steveling A. Identification of Predictors for Weight Reduction in Children and Adolescents with Overweight and Obesity (IDA-Insel Survey). Healthcare (Basel) 2016; 4:E5. [PMID: 27417593 PMCID: PMC4934539 DOI: 10.3390/healthcare4010005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 12/04/2015] [Accepted: 12/28/2015] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Worldwide, overweight and obesity are known as posing serious health risks. Successful methods of prevention and therapy for overweight and obesity have remained elusive. It was the aim of the present trial to identify parameters and determinants to guarantee long-term weight reduction. PATIENTS AND METHODS In total 143/159 children and adolescents (90%) with overweight and obesity completed the prospective, multicenter trial (age 13.9 ± 2.4 years, BMI 31.2 ± 5.4 kg/m², BMI-SDS 2.51 ± 0.57). During a six-week rehabilitation patients participated in a structured treatment and teaching program (STTP). Following the inpatient treatment the children and adolescents were monitored over a period of 24 months (physical examination, measurements of BMI, BMI-SDS, body composition, carotid intima-media thickness, laboratory parameters, blood pressure, and standardized questionnaires to assess socio-demographic, socio-economic parameters, eating behavior, well-being, quality of life, intelligence, intrafamilial conflicts, self-efficacy, resilience, sense of coherence, stress-management, social support, and actual body shape). RESULTS 66% of the children and adolescents showed non-normal laboratory parameters as well as higher blood pressure and/or an increased carotid intima-media thickness. Mean thickness of carotid intima-media was 0.53 ± 0.09 mm (range, 0.40-0.80); 15% of the patients showed a normal range (<0.45 mm), 40% slightly elevated (0.45-0.50 mm) and 45% an elevated (>0.50 mm) thickness. After an inpatient treatment lasting 40.4 ± 4.1 (range, 28-49) days, children and adolescents reached a mean weight reduction of 5.52 ± 3.94 (0.4-13.3) kg (p < 0.01) accompanied by a reduction of body fat mass. Performing multivariate analyses, the most important psychological factors associated with long-term weight reduction were identified (R-square = 0.53): Well-being (β = -0.543), resilience (β = 0.434) and intrafamilial conflicts (β = 0.315). CONCLUSION The different parameters (i.e., resilience, intrafamilial conflicts, structured daily schedule) have demonstrated their utility and strategies should be developed allowing an adaption of these into the STTPs and the integration of intervention into the therapeutic setting.
Collapse
Affiliation(s)
- Ralf Schiel
- MEDIGREIF-Inselklinik Heringsdorf GmbH, Fachklinik für Kinder und Jugendliche, D-17424 Heringsdorf, Germany.
- Mathias-Hochschule, University of Applied Sciences, D-48431 Rheine, Germany.
| | - Alexander Kaps
- MEDIGREIF-Inselklinik Heringsdorf GmbH, Fachklinik für Kinder und Jugendliche, D-17424 Heringsdorf, Germany.
| | - Günter Stein
- Internal Medicine, Friedrich-Schiller-University, D-07745 Jena, Germany.
| | - Antje Steveling
- Internal Medicine A, Ernst-Moritz-Arndt-University, D-17489 Greifswald, Germany.
| |
Collapse
|
37
|
Marquardt L, Krämer A, Fischer F, Prüfer-Krämer L. Health status and disease burden of unaccompanied asylum-seeking adolescents in Bielefeld, Germany: cross-sectional pilot study. Trop Med Int Health 2015; 21:210-8. [PMID: 26610271 DOI: 10.1111/tmi.12649] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This exploratory pilot study aimed to investigate the physical and mental disease burden of unaccompanied asylum-seeking adolescents arriving in Bielefeld, a medium-size city in Germany. METHODS A cross-sectional survey with purposive sampling of 102 unaccompanied asylum-seeking adolescents aged 12-18 years was performed. Information on general health status, selected infectious and non-communicable diseases, iron deficiency anaemia and mental illness was collected during routine check-up medical examinations upon arrival in Bielefeld, Germany. The data were analysed using descriptive statistics. RESULTS The analysis revealed a complex disease burden with a high prevalence of infections (58.8%), mental illness (13.7%) and iron deficiency anaemia (17.6%) and a very low prevalence of non-communicable diseases (<2.0%). One in five of the refugees were infected with parasites. Whilst sub-Saharan Africans showed the highest prevalence of infections (86.7%), including highest prevalences of parasites (46.7%), West Asians had the highest prevalence of mental disorders (20.0%). Overall, the disease burden in females was higher. CONCLUSION A thorough medical and psychological screening after arrival is highly recommended to reduce the individual disease burden and the risk of infection for others. This promotes good physical and mental health, which is needed for successful integration into the receiving society. Barriers to health service access for unaccompanied asylum-seeking adolescents need to be lowered to allow need-specific health care and prevention.
Collapse
Affiliation(s)
- L Marquardt
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany
| | - A Krämer
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany
| | - F Fischer
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany
| | | |
Collapse
|
38
|
Warschburger P. SRT-Joy - computer-assisted self-regulation training for obese children and adolescents: study protocol for a randomized controlled trial. Trials 2015; 16:566. [PMID: 26654798 PMCID: PMC4676168 DOI: 10.1186/s13063-015-1078-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/24/2015] [Indexed: 01/06/2023] Open
Abstract
Background Obesity is not only a highly prevalent disease but also poses a considerable burden on children and their families. Evidence is increasing that a lack of self-regulation skills may play a role in the etiology and maintenance of obesity. Our goal with this currently ongoing trial is to examine whether training that focuses on the enhancement of self-regulation skills may increase the sustainability of a complex lifestyle intervention. Methods/Design In a multicenter, prospective, parallel group, randomized controlled superiority trial, 226 obese children and adolescents aged 8 to 16 years will be allocated either to a newly developed computer-training program to improve their self-regulation abilities or to a placebo control group. Randomization occurs centrally and blockwise at a 1:1 allocation ratio for each center. This study is performed in pediatric inpatient rehabilitation facilities specialized in the treatment of obesity. Observer-blind assessments of outcome variables take place at four times: at the beginning of the rehabilitation (pre), at the end of the training in the rehabilitation (post), and 6 and 12 months post-rehabilitation intervention. The primary outcome is the course of BMI-SDS over 1 year after the end of the inpatient rehabilitation. Secondary endpoints are the self-regulation skills. In addition, health-related quality of life, and snack intake will be analyzed. Discussion The computer-based training programs might be a feasible and attractive tool to increase the sustainability of the weight loss reached during inpatient rehabilitation. Trial registration The present study protocol was registered on 13 July 2015 at German Clinical Trials Register: DRKS00007879.
Collapse
Affiliation(s)
- Petra Warschburger
- Department Psychology, Counselling Psychology, University of Potsdam, Karl Liebknecht-Str. 24-25, 14476, Potsdam, Germany.
| |
Collapse
|
39
|
Fekete C, Weyers S. Soziale Ungleichheit im Ernährungsverhalten. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 59:197-205. [DOI: 10.1007/s00103-015-2279-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
40
|
Brettschneider AK, Brettschneidera AK, Schaffrath Rosario A, Kuhnert R, Schmidt S, Wiegand S, Ellert U, Kurth BM. Updated prevalence rates of overweight and obesity in 11- to 17-year-old adolescents in Germany. Results from the telephone-based KiGGS Wave 1 after correction for bias in self-reports. BMC Public Health 2015; 15:1101. [PMID: 26541820 PMCID: PMC4636076 DOI: 10.1186/s12889-015-2467-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 10/31/2015] [Indexed: 01/11/2023] Open
Abstract
Background The nationwide “German Health Interview and Examination Survey for Children and Adolescents” (KiGGS), conducted in 2003–2006, showed an increase in the prevalence rates of overweight and obesity compared to the early 1990s, indicating the need for regularly monitoring. Recently, a follow-up—KiGGS Wave 1 (2009–2012)—was carried out as a telephone-based survey, providing self-reported height and weight. Since self-reports lead to a bias in prevalence rates of weight status, a correction is needed. The aim of the present study is to obtain updated prevalence rates for overweight and obesity for 11- to 17-year olds living in Germany after correction for bias in self-reports. Methods In KiGGS Wave 1, self-reported height and weight were collected from 4948 adolescents during a telephone interview. Participants were also asked about their body perception. From a subsample of KiGGS Wave 1 participants, measurements for height and weight were collected in a physical examination. In order to correct prevalence rates derived from self-reports, weight status categories based on self-reported and measured height and weight were used to estimate a correction formula according to an established procedure under consideration of body perception. The correction procedure was applied and corrected rates were estimated. Results The corrected prevalence of overweight, including obesity, derived from KiGGS Wave 1, showed that the rate has not further increased compared to the KiGGS baseline survey (18.9 % vs. 18.8 % based on the German reference). Conclusion The rates of overweight still remain at a high level. The results of KiGGS Wave 1 emphasise the significance of this health issue and the need for prevention of overweight and obesity in children and adolescents.
Collapse
Affiliation(s)
| | - Anna-Kristin Brettschneidera
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany.
| | - Angelika Schaffrath Rosario
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany.
| | - Ronny Kuhnert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany.
| | - Steffen Schmidt
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany.
| | - Susanna Wiegand
- Department of Pediatric Endocrinology and Diabetology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Ute Ellert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany.
| | - Bärbel-Maria Kurth
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany.
| |
Collapse
|
41
|
von Bremen J, Lorenz N, Ruf S. Impact of body mass index on oral health during orthodontic treatment: an explorative pilot study. Eur J Orthod 2015; 38:386-92. [PMID: 26450695 DOI: 10.1093/ejo/cjv074] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM To answer the question: is there a correlation between body mass index (BMI), oral health, and patient cooperation during multibracket (MB) appliance therapy? MATERIALS AND METHODS All adolescent MB patients started and finished between 2007 and 2012 were analysed. According to their pre-treatment BMI, patients were divided into one of the following groups: normal weight, overweight, or obese. Using the patients' records, the cooperation during treatment was classified as good, bad, or poor and the treatment duration was calculated. Using pre- and post-treatment photographs, white spot lesion (WSL) formation and gingivitis before and after MB therapy were assessed. RESULTS Of the 175 subjects, 138 had a normal BMI (79 per cent), 22 were overweight (12.5 per cent), and 15 obese (8.5 per cent). Whereas 42.8 per cent of the normal weight patients showed a good cooperation, only 22.7 per cent of the overweight and 20.9 per cent of the obese patients cooperated sufficiently. On average, normal weight patients were treated for 22.2 months, overweight patients for 23.0 months, and obese patients for 27.7 months. Normal weight patients developed less WSL (41.3 per cent) during MB treatment than overweight (50 per cent) or obese (66.7 per cent) patients. Furthermore, patients with a normal weight or overweight had less gingival inflammation (79.5 per cent) after treatment than obese individuals (93.3 per cent). CONCLUSION An increased BMI appears to be a risk factor for less cooperation, a longer treatment duration, and more oral health-related problems during MB treatment, indicating that these patients require special attention during orthodontic therapy.
Collapse
Affiliation(s)
| | | | - Sabine Ruf
- Department of Orthodontics, University of Giessen, Germany
| |
Collapse
|
42
|
|
43
|
Finger JD, Varnaccia G, Tylleskär T, Lampert T, Mensink GBM. Dietary behaviour and parental socioeconomic position among adolescents: the German Health Interview and Examination Survey for Children and Adolescents 2003-2006 (KiGGS). BMC Public Health 2015; 15:498. [PMID: 25985772 PMCID: PMC4492169 DOI: 10.1186/s12889-015-1830-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 05/12/2015] [Indexed: 11/24/2022] Open
Abstract
Background The positive association between parental socioeconomic position (PSEP) and health among adolescents may be partly explained by dietary behaviour. We investigated the associations between fruit intake, vegetable intake, energy-dense food intake, the Healthy Nutrition Score for Kids and Youth (HuSKY) and parental education in a nationwide, cluster-randomized sample of adolescents in Germany. Methods The German Health Interview and Examination Survey for Children and Adolescents 2003–2006 (KiGGS) included 17,641 individuals aged 0–17 years and their parents. Complete information on relevant variables was available for 6359 individuals in the 11–17 age group. The associations between nutrition indicators and parental education were analysed separately for boys and girls, using multivariate logistic regression analysis. Odds ratios (ORs) adjusted for age, region, income, occupation, physical activity and weight status related variables, were calculated for the associations between parental education and nutrition indicators. Results After full adjustment, higher parental education level was associated with lower energy-dense food intake – with an OR of 1.3 (95 % CI 1.0–1.7) for boys with secondary educated parents and 1.8 (1.4–2.3) for boys with tertiary educated parents compared to boys with primary educated parents; the corresponding ORs for girls were 1.2 (0.9–1.5) and 1.6 (1.2–2.2). Higher parental education was associated with higher fruit intake – with an OR of 1.3 (1.0–1.7) for boys with secondary educated parents and 2.0 (1.5–2.7) for boys with tertiary educated parents compared to boys with primary educated parents; the corresponding ORs for girls were 1.0 (0.8–1.4) and 1.5 (1.0–2.1). Among boys and girls with tertiary educated parents compared to those with primary educated parents an OR of 1.3 (CI boys: 1.0–1.7, CI girls: 1.0–1.6) was observed for high vegetable intake. Among boys with tertiary educated parents compared to boys with primary educated parents an OR of 1.6 (1.2–2.2) was observed for a high HuSKY; the corresponding OR for girls was 1.5 (1.1–1.9). Conclusions A high PSEP is associated with consumption of less energy-dense food, more fruits and vegetables and more favourable overall dietary behaviour. Preferably school-based interventions are needed to promote healthy dietary behaviour among German adolescents and a special effort is needed to reach adolescents from low-PSEP families. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1830-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jonas D Finger
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
| | - Gianni Varnaccia
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
| | - Thorkild Tylleskär
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Thomas Lampert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
| | - Gert B M Mensink
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
| |
Collapse
|
44
|
Wirt T, Schreiber A, Kesztyüs D, Steinacker JM. Early life cognitive abilities and body weight: cross-sectional study of the association of inhibitory control, cognitive flexibility, and sustained attention with BMI percentiles in primary school children. J Obes 2015; 2015:534651. [PMID: 25874122 PMCID: PMC4383153 DOI: 10.1155/2015/534651] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/08/2014] [Accepted: 10/09/2014] [Indexed: 01/08/2023] Open
Abstract
The objective of this study was to investigate the association of different cognitive abilities with children's body weight adjusted for further weight influencing sociodemographic, family, and lifestyle factors. Cross-sectional data of 498 primary school children (7.0 ± 0.6 years; 49.8% boys) participating in a health promotion programme in southwest Germany were used. Children performed a computer-based test battery (KiTAP) including an inhibitory control task (Go-Nogo paradigm), a cognitive flexibility task, and a sustained attention task. Height and weight were measured in a standardized manner and converted to BMI percentiles based on national standards. Sociodemographic features (migration background and parental education), family characteristics (parental body weight), and children's lifestyle (TV consumption, physical activity, consumption of sugar-sweetened beverages and breakfast habits) were assessed via parental questionnaire. A hierarchical regression analysis revealed inhibitory control and cognitive flexibility to be significant cognitive predictors for children's body weight. There was no association concerning sustained attention. The findings suggest that especially cognitive abilities known as executive functions (inhibitory control and cognitive flexibility) are associated with children's body weight. Future longitudinal and intervention studies are necessary to investigate the directionality of the association and the potential of integrating cognitive training in obesity prevention strategies. This trial is registered with ClinicalTrials.gov DRKS00000494.
Collapse
Affiliation(s)
- Tamara Wirt
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, 89075 Ulm, Germany
| | - Anja Schreiber
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, 89075 Ulm, Germany
| | - Dorothea Kesztyüs
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, 89075 Ulm, Germany
| | - Jürgen M. Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, 89075 Ulm, Germany
| |
Collapse
|
45
|
Effertz T, Garlichs D, Gerlach S, Müller MJ, Pötschke-Langer M, Prümel-Philippsen U, Schaller K. Wirkungsvolle Prävention chronischer Krankheiten. PRAVENTION UND GESUNDHEITSFORDERUNG 2015. [DOI: 10.1007/s11553-014-0483-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
46
|
Kesztyüs D, Lauer R, Schreiber AC, Kesztyüs T, Kilian R, Steinacker JM. Parents' willingness to pay for the prevention of childhood overweight and obesity. HEALTH ECONOMICS REVIEW 2014; 4:20. [PMID: 26208923 PMCID: PMC4883987 DOI: 10.1186/s13561-014-0020-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 08/12/2014] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To determine parental willingness-to-pay (WTP) for childhood obesity prevention. METHODS Cross-sectional data from the follow-up measurements (2011) of a health promotion programme in German primary schools. Data collection included anthropometric measurements of children and self-administered questionnaires for parents, including WTP assessment. Mann-Whitney U-Test was used for differences between groups, and regression analysis to identify factors associated with general WTP and amount of WTP. RESULTS From 1 534 parents, 97.8% considered overweight/obesity to be serious public health problems. A general WTP to reduce the incidence of childhood overweight/obesity by half, was declared by 48.8%. Parents of overweight/obese children showed with 61.4%, significantly more frequently, their general WTP than the others with 47.2% (p = 0.001). Mean WTP was <euro>23.04 (99% confidence interval (CI) [22.45; 23.75]) per month. Parents of centrally obese children showed significantly higher WTP than parents of the other children (p = 0.001). General WTP and the amount of WTP were associated with the central obesity of the child, migration status and household income. Additionally, general WTP was associated with maternal obesity. CONCLUSIONS Nearly half of the parents were willing to invest in prevention of obesity. The general WTP significantly occurs more often and with higher amount in affected parents.
Collapse
Affiliation(s)
- Dorothea Kesztyüs
- />Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, Ulm, D-89075 Germany
| | - Romy Lauer
- />Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, Ulm, D-89075 Germany
| | - Anja C Schreiber
- />Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, Ulm, D-89075 Germany
| | - Tibor Kesztyüs
- />Department of Computer Science, University of Applied Sciences, Ulm, Germany
| | - Reinhold Kilian
- />Section Health Economics and Health Services Research, Department of Psychiatry II, Ulm University, Günzburg, Germany
| | - Jürgen M Steinacker
- />Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, Ulm, D-89075 Germany
| |
Collapse
|
47
|
Disse S, Zimmer KP. Obesity in children- a chronic disease? DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:816-817. [PMID: 25512007 PMCID: PMC4269074 DOI: 10.3238/arztebl.2014.0816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
48
|
Kobel S, Wirt T, Schreiber A, Kesztyüs D, Kettner S, Erkelenz N, Wartha O, Steinacker JM. Intervention effects of a school-based health promotion programme on obesity related behavioural outcomes. J Obes 2014; 2014:476230. [PMID: 25328688 PMCID: PMC4190828 DOI: 10.1155/2014/476230] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 08/20/2014] [Accepted: 08/21/2014] [Indexed: 12/04/2022] Open
Abstract
Studies have shown preventive effects of an active lifestyle during childhood on later life; therefore, health promotion has to start early. The programme "Join the Healthy Boat" promotes a healthy lifestyle in primary school children. In order to evaluate it, children's behaviours in respect of increased physical activity (PA), a decrease in screen media use (SMU), more regular breakfast, and a reduction of the consumption of soft drinks (SDC) were investigated. 1943 children (7.1 ± 0.6 years) participated in the cluster-randomised study and were assessed at baseline and 1736 of them at follow-up. Teachers delivered lessons, which included behavioural contracting and budgeting of SMU and SDC. Daily SMU, PA behaviours, SDC, and breakfast patterns were assessed via parental questionnaire. After one-year intervention, significant effects were found in the intervention group for SMU of girls, children without migration background, and children with parents having a low education level. In the control group, second grade children skipped breakfast significantly more often. Tendencies but no significant differences were found for PA and SDC. This intervention seems to affect groups, which are usually hard to reach, such as children of parents with low education levels, which shows that active parental involvement is vital for successful interventions.
Collapse
Affiliation(s)
- Susanne Kobel
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, 89075 Ulm, Germany
| | - Tamara Wirt
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, 89075 Ulm, Germany
| | - Anja Schreiber
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, 89075 Ulm, Germany
| | - Dorothea Kesztyüs
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, 89075 Ulm, Germany
| | - Sarah Kettner
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, 89075 Ulm, Germany
| | - Nanette Erkelenz
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, 89075 Ulm, Germany
| | - Olivia Wartha
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, 89075 Ulm, Germany
| | - Jürgen M. Steinacker
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, 89075 Ulm, Germany
| |
Collapse
|
49
|
Hoffmann SW, Tug S, Simon P. Child-caregivers' body weight and habitual physical activity status is associated with overweight in kindergartners. BMC Public Health 2014; 14:822. [PMID: 25106439 PMCID: PMC4132909 DOI: 10.1186/1471-2458-14-822] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/29/2014] [Indexed: 01/29/2023] Open
Abstract
Background The aim of this study was to examine whether child-caregivers’, both parents and kindergarten teachers, health parameters (age, weight status, habitual physical activity score) are significantly associated with the risk of overweight in young children. Methods We assessed the individual body mass index standard deviation score in a regional cross-sectional health study and matched a representative sample of 434 kindergartners aged 3 to 6-years with their caregivers’ weight and habitual physical activity status. Furthermore, we identified factors associated with the general ability of child-caregivers to identify overweight in children, and the awareness to classify a child within the correct weight category. Results Our study confirmed most of the known associations between parental anthropometrics and psychosocial factors with childhood overweight and obesity. A significantly higher proportion of boys tended to be overweight or obese (p = 0.027) and parents were more likely to misclassified boys overweight as normal weight (OR: 1.86; 95% CI 1.21-2.86). Adjusted for confounders, logistic regression analysis revealed that kindergarten teachers’ weight status (OR: 1.97; 95%-CI: 1.01-3.83) and habitual physical activity scores (OR: 2.32; 95%-CI: 1.10-4.92) were associated with children’s weight status. Conclusions Kindergarten teachers’ weight and habitual physical activity score seem to be new independent risk factors for overweight in kindergartners 3 to 6-years of age. Our results suggest that the psychosocial, non-genetic association of non-parental child-caregivers on children’s weight is relatively high and that the association of non-parental child-caregivers warrants further investigation.
Collapse
Affiliation(s)
| | | | - Perikles Simon
- Department of Sports Medicine, Disease Prevention and Rehabilitation, Faculty of Social Science, Johannes Gutenberg-University Mainz, Media and Sport, Albert-Schweitzer-Str, 22, 55128 Mainz, Germany.
| |
Collapse
|
50
|
Ellert U, Brettschneider AK, Wiegand S, Kurth BM. Applying a correction procedure to the prevalence estimates of overweight and obesity in the German part of the HBSC study. BMC Res Notes 2014; 7:181. [PMID: 24670124 PMCID: PMC3986913 DOI: 10.1186/1756-0500-7-181] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 03/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background Prevalence rates for overweight and obesity based on self-reported height and weight are underestimated, whereas the prevalence rate for underweight is slightly overestimated. Therefore a correction is needed. Aim of this study is to apply correction procedures to the prevalence rates developed on basis of (self-reported and measured) data from the representative German National Health Interview and Examination Survey for Children and Adolescents (KiGGS) to (self-reported) data from the German Health Behaviour in School Aged Children (HBSC) study to determine whether correction leads to higher prevalence estimates of overweight and obesity as well as lower prevalence rates for underweight. Methods BMI classifications based on self-reported and measured height and weight from a subsample of the KiGGS study (2,565 adolescents aged 11–15) were used to estimate two different correction formulas. The first and the second correction function are described. Furthermore, the both formulas were applied to the prevalence rates from the HBSC study (7,274 adolescents aged 11–15) which are based on self-reports collected via self-administered questionnaires. Results After applying the first correction function to self-reported data of the HBSC study, the prevalence rates of overweight and obesity increased from 5.5% to 7.8% (compared to 10.4% in the KiGGS study) and 2.7% to 3.8% (compared to 7.8% in the KiGGS study), respectively, whereas the corrected prevalence rates of underweight and severe underweight decreased from 8.0% to 6.7% (compared to 5.7% in the KiGGS study) and from 5.5% to 3.3% (compared to 2.4% in the KiGGS study), respectively. Application of the second correction function, which additionally considers body image, led to further slight corrections with an increase of the prevalence rates for overweight to 7.9% and for obese to 3.9%. Conclusion Subjective BMI can be used to determine the prevalence of overweight and obesity among children and adolescents. Where there is evidence of bias, the prevalence estimates should be corrected using conditional probabilities that link measured and subjectively assessed BMI from a representative validation study. These corrections may be improved further by considering body image as an additional influential factor.
Collapse
Affiliation(s)
- Ute Ellert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str, 62-66, 12101 Berlin, Germany.
| | | | | | | |
Collapse
|