Mysore childhood obesity study

Secular trends in prevalence of overweight and obesity over a decade in urban and rural South Indian children integrated with geographic information system

Context

The globalization in the process most of the rural sectors are also upgrading technically with digitalization with more availability of smart phones and gaming along with the refined food influences on the present-day children is causing a trend of overweight among the children.

Aims

To arrive at the prevalence of overweight and obesity considering the Indian Academy of Pediatrics (IAP) cut-offs for growth standards among children aged 12 years from the rural and urban areas of Mysuru District.

Methods and Material

The present program was the third large scale community intervention project carried out including the 7 talukas of Mysuru District which focused on the measurement of the Body mass index (BMI). In this phase between the year 2019 and 2020 anthropometric measurements were undertaken in 1602 urban and rural children aged 12 years from government-funded and privately-funded schools of Mysuru District.

Statistical Analysis Used

The results were analysed statistically using SPSS for Windows (version 23.0) and the t-test, Chi-square test and proportion tests, P value were reported. Results: As per the IAP reference ranges the prevalence of obesity was 5.5% and overweight was 7.1% among children of Mysuru District.

Conclusions

We report that this increase was significantly higher in girls than boys. There was an increasing trend in rural sectors; however, the obese children were more predominantly distributed among the urban sectors. This calls for a precise preventive measure to fulfil the goal of the World Health Organization (WHO) to control prevalence of childhood obesity by the year 2022.

Prevalence of overweight and obesity among school children in Mysuru, Karnataka

Childhood obesity has become a major public health challenge in developing countries including India due to the changes in the lifestyle and food habits of children owing to the influence of urban culture and technological growth. The present study is a cross-sectional, school-based study conducted to assess the prevalence of obesity and to determine the demographic variables influencing the obesity among school children.

Prevalence of abdominal obesity in non-obese adolescents: a North Indian adolescent study

Context Childhood obesity is defined based on body mass index (BMI) criteria. Asian adults have more abdominal adiposity as compared to Western people for an equivalent BMI. Similarly, children who are non-obese/overweight by BMI criteria may have abdominal obesity. It is important to identify and target this population to reduce future cardiovascular risk. Objective To evaluate and inter-relate the prevalence of obesity subtypes (generalized and abdominal) in school going adolescents. Methods A randomized cross-sectional community based study was conducted, which was carried out in 13 schools of Chandigarh, a North Indian city. 10,037 school going adolescents of age 10-18 years were evaluated. Results The prevalence of overweight and generalized obesity in present study was 9.3 and 4.9% respectively. Generalized obesity was observed in 4.2% of males and 5.7% of females (p-Value = 0.001). The abdominal obesity was noted in 5.4% of children and its prevalence increased progressively with age. The prevalence was highest in 16-18 years age-group (7.6%, p<0.001). 39.3% of abdominally obese subjects were not obese by BMI criteria, while prevalence of abdominal obesity in nonobese adolescents was 2.24%. It was more prevalent in females (3.7%) than males (3%, p=0.025). Prevalence of obesity was 7.9 and 1.8% in private and government schools respectively (p<0.001). Conclusions Abdominal obesity is more prevalent than generalized obesity and shows increasing trend with age. Interestingly, over one third of centrally obese adolescents are not obese by BMI criteria. This underlines the importance of waist circumference measurement in addition to BMI while assessing obesity.

Overweight and Obesity in School Children of a Hill State in North India: Is the Dichotomy Urban-Rural or Socio-Economic? Results from a Cross-Sectional Survey

INTRODUCTION

Overweight and obesity are a public health problem in India not only in adults but also in children. The authors sought to estimate the prevalence of overweight and obesity in school-going children of 6-17 years of age and examine its demographic and dietary correlates in context of their urban-rural status and socio-economic status.

METHODS

In this cross-sectional survey height and weight were measured in 1266 school children in government and private schools of urban and rural areas. Dietary assessment was done using single day 24-hour dietary recall method. The data were analyzed using SPSS (IBM SPSS Statistics Version 19) and WHO AnthroPlus Software. Factorial ANOVA was used for testing interaction within and between subgroups for continuous variables and Chi-square test was used for categorical variables.

RESULTS

It was found that the overall prevalence of overweight was 15.6% of which 5.4% were obese, with maximum prevalence in boys attending urban private schools. The mean caloric intake in the study population with 24-hour dietary recall method was 1558.2 kilocalories (SD: 428 kilocalories).

CONCLUSION

Overweight and obesity is a significant problem in school-going children. Higher socio-economic status continues to remain an important driver of this epidemic in the younger generation and affects demographic and dietary determinants of this problem.

Epidemiology of childhood overweight & obesity in India: A systematic review

BACKGROUND & OBJECTIVES

Childhood obesity is a known precursor to obesity and other non-communicable diseases (NCDs) in adulthood. However, the magnitude of the problem among children and adolescents in India is unclear due to paucity of well-conducted nationwide studies and lack of uniformity in the cut-points used to define childhood overweight and obesity. Hence an attempt was made to review the data on trends in childhood overweight and obesity reported from India during 1981 to 2013.

METHODS

Literature search was done in various scientific public domains from the last three decades using key words such as childhood and adolescent obesity, overweight, prevalence, trends, etc. Additional studies were also identified through cross-references and websites of official agencies.

RESULTS

Prevalence data from 52 studies conducted in 16 of the 28 States in India were included in analysis. The median value for the combined prevalence of childhood and adolescent obesity showed that it was higher in north, compared to south India. The pooled data after 2010 estimated a combined prevalence of 19.3 per cent of childhood overweight and obesity which was a significant increase from the earlier prevalence of 16.3 per cent reported in 2001-2005.

INTERPRETATION & CONCLUSIONS

Our review shows that overweight and obesity rates in children and adolescents are increasing not just among the higher socio-economic groups but also in the lower income groups where underweight still remains a major concern.

Revised Indian Academy of Pediatrics 2015 growth charts for height, weight and body mass index for 5-18-year-old Indian children

Growth chart committee of Indian Academy of Pediatrics (IAP) has revised growth charts for 5-18-year-old Indian children in Jan 2015. The last IAP growth charts (2007) were based on data collected in 1989-92 which is now >2 decades old. India is in an economic and nutrition transition and hence growth pattern of Indian children has changed over last few years. Thus, it was necessary to produce contemporary, updated growth references for Indian children. The new IAP charts were prepared by collating data from nine groups who had published studies in indexed journals on growth from India in the last decade. Growth charts were constructed from a total of 87022 middle and upper socioeconomic class children (m 54086, f 32936) from all five zones of India. Data from middle and upper socioeconomic class children are likely to have higher prevalence of overweight and obesity and hence growth charts produced on such populations are likely to "normalize" obesity. To remove such unhealthy weights form the data, method suggested by World Health Organization was used to produce weight charts. Thus, the new IAP weight charts are much lower than the recently published studies on affluent Indian children. Since Indian's are at a higher risk of obesity-related cardiometabolic complications at lower body mass index (BMI), BMI charts adjusted for 23, and 27 adult equivalent cut-offs as per International obesity task force guidelines were constructed. IAP now recommends use of these new charts to replace the 2007 IAP charts.

Contribution of food sources to the vitamin B12 status of South Indian children from a birth cohort recruited in the city of Mysore

OBJECTIVE

There is evidence that subclinical vitamin B12 (B12) deficiency is common in India. Vegetarianism is prevalent and therefore meat consumption is low. Our objective was to explore the contribution of B12-source foods and maternal B12 status during pregnancy to plasma B12 concentrations.

DESIGN

Maternal plasma B12 concentrations were measured during pregnancy. Children's dietary intakes and plasma B12 concentrations were measured at age 9.5 years; B12 and total energy intakes were calculated using food composition databases. We used linear regression to examine associations between maternal B12 status and children's intakes of B12 and B12-source foods, and children's plasma B12 concentrations.

SETTING

South Indian city of Mysore and surrounding rural areas.

SUBJECTS

Children from the Mysore Parthenon Birth Cohort (n 512, 47.1 % male).

RESULTS

Three per cent of children were B12 deficient (<150 pmol/l). A further 14 % had 'marginal' B12 concentrations (150-221 pmol/l). Children's total daily B12 intake and consumption frequencies of meat and fish, and micronutrient-enriched beverages were positively associated with plasma B12 concentrations (P=0.006, P=0.01 and P=0.04, respectively, adjusted for socio-economic indicators and maternal B12 status). Maternal pregnancy plasma B12 was associated with children's plasma B12 concentrations, independent of current B12 intakes (P<0.001). Milk and curd (yoghurt) intakes were unrelated to B12 status.

CONCLUSIONS

Meat and fish are important B12 sources in this population. Micronutrient-enriched beverages appear to be important sources in our cohort, but their high sugar content necessitates care in their recommendation. Improving maternal B12 status in pregnancy may improve Indian children's status.

Childhood obesity and the metabolic syndrome in developing countries

Rapidly changing dietary practices accompanied by an increasingly sedentary lifestyle predispose to nutrition-related non-communicable diseases, including childhood obesity. Over the last 5 y, reports from several developing countries indicate prevalence rates of obesity (inclusive of overweight) >15 % in children and adolescents aged 5-19 y; Mexico 41.8 %, Brazil 22.1 %, India 22.0 % and Argentina 19.3 %. Moreover, secular trends also indicate an alarming increase in obesity in developing countries; in Brazil from 4.1 % to 13.9 % between 1974 and 1997; in China from 6.4 % to 7.7 % between 1991 and 1997; and in India from 4.9 % to 6.6 % between 2003-04 to 2005-06. Other contributory factors to childhood obesity include: high socio-economic status, residence in metropolitan cities and female gender. Childhood obesity tracks into adulthood, thus increasing the risk for conditions like the metabolic syndrome, type 2 diabetes mellitus (T2DM), polycystic ovarian syndrome, hypertension, dyslipidemia and coronary artery disease later in life. Interestingly, prevalence of the metabolic syndrome was 35.2 % among overweight Chinese adolescents. Presence of central obesity (high waist-to-hip circumference ratio) along with hypertriglyceridemia and family history of T2DM increase the odds of T2DM by 112.1 in young Asian Indians (< 40 y). Therapeutic lifestyle changes and maintenance of regular physical activity are most important strategies for preventing childhood obesity. Effective health awareness educational programs for children should be immediately initiated in developing countries, following the successful model program in India (project 'MARG').

Childhood obesity in developing countries: epidemiology, determinants, and prevention

Rapidly changing dietary practices and a sedentary lifestyle have led to increasing prevalence of childhood obesity (5-19 yr) in developing countries recently: 41.8% in Mexico, 22.1% in Brazil, 22.0% in India, and 19.3% in Argentina. Moreover, secular trends indicate increasing prevalence rates in these countries: 4.1 to 13.9% in Brazil during 1974-1997, 12.2 to 15.6% in Thailand during 1991-1993, and 9.8 to 11.7% in India during 2006-2009. Important determinants of childhood obesity include high socioeconomic status, residence in metropolitan cities, female gender, unawareness and false beliefs about nutrition, marketing by transnational food companies, increasing academic stress, and poor facilities for physical activity. Childhood obesity has been associated with type 2 diabetes mellitus, the early-onset metabolic syndrome, subclinical inflammation, dyslipidemia, coronary artery diseases, and adulthood obesity. Therapeutic lifestyle changes and maintenance of regular physical activity through parental initiative and social support interventions are the most important strategies in managing childhood obesity. Also, high-risk screening and effective health educational programs are urgently needed in developing countries.

Secular trends in prevalence of overweight and obesity from 2006 to 2009 in urban asian Indian adolescents aged 14-17 years

The present study examines the secular trends in prevalence of overweight and obesity among urban Asian Indian adolescents in New Delhi (North India). The data were derived from cross-sectional sampling of children, 3493 in year 2006 and 4908 in year 2009, aged 14-17 years studying in privately-funded and government-funded schools. Age, gender and Asian Indian-specific cut offs of body mass index (BMI) were used to define overweight and obesity. The prevalence of obesity increased significantly from 9.8% in 2006 to 11.7% in 2009 (p<0.01), whereas underweight decreased from 11.3% to 3.9% (p<0.001). There was a significantly higher risk of being overweight (OR 1.28; 95% CI, 1.15-1.42) and obese (OR 1.44; 95% CI, 1.24-1.66) in year 2009 than 2006, after adjusting for age, gender and type of school. Males and privately-funded school children had significantly higher increase in prevalence and risk of being overweight and obese over the three years. In conclusion, this study showed an increasing trend in prevalence of overweight and obesity in urban Asian Indian adolescents. More specifically, the study showed the association of this increasing trend of overweight and obesity prevalence with male gender and high socio-economic status, calling for an urgent need for immediate and targeted preventive measures.