Social inequality and obesity in Czech school children

Sugar-sweetened beverages and childhood abnormal adiposity in the Czech Republic - narrative literature review

OBJECTIVES

In Czech children, the burden related to the high body-mass index is rising. In the last three decades, Western eating patterns have influenced Czech children's diet, including the high consumption of sugar-sweetened beverages. This narrative review aims to evaluate evidence of the trend of sugar-sweetened beverages consumption in Czech children and its impact on the prevalence of childhood abnormal adiposity.

METHODS

A comprehensive literature review in MEDLINE (PubMed) and a hand search using references in identified articles were performed. The inclusion criteria were population-based studies of randomly selected samples of children from 0 to 18 years old, data involving the Czech population, published from 1990 to 2021. The results were organized into three sections - childhood abnormal adiposity, SSBs consumption, and the association between SSBs consumption and abnormal adiposity.

RESULTS

The studies showed a significant increase in abnormal adiposity in both genders and all age categories. The highest prevalence of abnormal adiposity was observed in boys and younger children. On the contrary, sugar-sweetened beverages showed a significant decline in daily consumption among Czech children of both genders and all age categories. No results were found for consequences of abnormal adiposity concerning sugar-sweetened beverages consumption.

CONCLUSION

Findings from this review could serve public health experts to detect the areas of a gap in research and establish potential interventions in vulnerable groups. Observation of potential obesogenic contributors - including sugar-sweetened beverages - should be an integral part of effective action against the obesity pandemic.

Secular Changes in Body Build and Body Composition in Czech Preschool Children in the Context of Latent Obesity

Changes in lifestyle can be significantly reflected in growth and development. Adaptations to reduced levels of physical activity, together with non-corresponding nutritional intakes, can result in body build and body composition changes at an early age. The present cross-sectional study aimed to evaluate the secular trend of modifications of body composition and body mass index (BMI) in Czech preschoolers over the last two to three decades. Boys and girls (386 boys and 372 girls) aged 4 to 6 years in 2014–2019 were measured. Outcome data were compared with the reference sample of preschoolers from 1990: 911 boys and 896 girls. Body height, BMI, and percentage of body fat, muscle, and bone mass were evaluated. Height and BMI have not changed. Body fat increased in both genders (p < 0.01), and contrarily, a significant reduction of muscle and skeletal mass was revealed (p < 0.001). Significant changes in body composition and unchanged BMI indicate the development of latent obesity during the last few decades. Due to latent obesity in a recent cohort, the differences in the prevalence of overweight and obesity markers according to BMI and fat percentage were tested. The prevalence of overweight and obesity was higher by 7.2% in boys, and by 6.5% in girls, as compared to children evaluated according to only their BMI results. Secular changes in preschoolers’ physical builds over the last 25 years are not reflected in body height and BMI, but in body composition. Insufficient development of active, lean body mass proportionally compensated by increased fat mass was also indicated.

Evaluating the impact of a school-based health intervention using a randomized field experiment

We conduct an econometric evaluation of a health-promoting programme in primary and lower secondary schools in Denmark. The programme includes health-related measurements of the students, communication of knowledge about health, and support of health-promoting projects for students. Half of the schools in the fourth largest municipality in Denmark were randomly selected into a treatment group implementing the programme, while the remainder served as a control group. We estimate both OLS models using only post-intervention observations and difference in differences (DID) models using also pre-intervention observations. We estimate effects of the initiative on BMI, waist/height ratio, overweight and obesity for the entire sample and by gender and grade. We find no consistent effect of the programme. When we use the entire sample, no estimates are statistically significant at conventional levels, although the point estimates for the effect on BMI, indicating an average reduction in the range of 0.10-0.15 kg/m(2), are consistent with the results in a recent Cochrane review evaluating 55 studies of diet and exercise interventions targeting children; and DID estimates which are marginally significant (at the 10% level) indicate that the intervention reduces the risk of obesity by 1% point. Running separate estimations by gender and grade we find a few statistically significant estimates: OLS estimates indicate that the intervention reduces BMI in females in grade 5 by 0.39 kg/m(2) and reduces the risk of obesity in females in grade 9 by 2.6% points; DID estimates indicate an increase in waist for females in preschool class by 1.2 cm and an increase in the risk of obesity in grade 9 males by 4% points. However, if we corrected for multiple hypotheses testing these estimates would be insignificant. There is no statistically significant correlation between participation in the programme and the number of other health-promoting projects at the schools.

Frequency of under- and overweight among children and adolescents during the economic transition in Poland

The aim of this study is to examine the prevalence of underweight, overweight and obesity, using International Obesity Task Force (IOTF) criteria, in four cohorts of children and adolescents living in Poland in different economic eras: communist economy (1977/1978), crisis of the 1980s (1987/1988), political and economic transformation (1992/1994) and the free market economy (2002/2004). Analysis was conducted on a database including 10,934 records for children of the age 7-18 years. In Poland, in the last 26 years of economic and political transformations, the epidemic of obesity was not noticed but the growing incidence of children and adolescents with body mass deficit was observed (p<0.0001) (20.2% of girls in 2002/2004 vs. 11.0% in 1977/1978 and 12.1% of boys in 2002/2004 vs. 7.2% in 1977/1978). Lower parental education and a higher number of children in a family resulted in a higher prevalence of underweight (odds ratio [OR] fluctuated from 1.26 to 1.63). The social effects of the political transformation in Poland significantly affected families with low socio-economic status (SES), and especially more eco-sensitive boys. This result is opposite to the trends observed in Western countries and makes an important contribution to the current knowledge of the course of further changes in weight-to-height ratio at a global scale.

Socio-economic position and adiposity among children and their parents in the Republic of Belarus

BACKGROUND

Socio-economic differences in the prevalence of overweight/obesity may be one factor through which health inequalities arise and may vary by the population studied.

METHODS

Analysing a cohort of 13 889 children born in Belarus between June 1996 and December 1997, the authors investigated associations of parental educational attainment and highest household occupation with: (i) measured body mass index (BMI), waist circumference and skinfold thicknesses at age 6.5 years and (ii) the parents' reported BMI.

RESULTS

Overall, 10% of children, 37% of mothers and 53% of fathers were either overweight or obese. Children from non-manual households were 27% [95% confidence interval (CI): 10%, 47%] more likely to be overweight/obese (based on BMI) than those from manual households. They also had larger waist circumferences and higher percentage body fat (calculated from subscapular and triceps skinfolds). Similar associations for being overweight/obese were seen for fathers [odds ratio (OR), 1.10; 95% CI: 1.02, 1.18], but mothers from non-manual households were less likely to be overweight/obese: (OR, 0.84; 95% CI: 0.79, 0. 90). Associations of childhood and parental overweight/obesity with higher educational status of either parent were similar to those observed for non-manual households.

CONCLUSION

We observed socio-economic differentials in overweight/obesity prevalence among children and their parents in Belarus. More affluent children and their fathers were more likely to be overweight/obese but the reverse was found for mothers.

Fatores ambientais associados ao sobrepeso infantil

OBJETIVO: Avaliar os fatores ambientais intra-uterinos, perinatais e familiares associados ao sobrepeso infantil, ainda controversos na literatura. MÉTODOS: Estudo transversal realizado com 627 crianças, de 6 a 10 anos, matriculadas em escolas urbanas públicas e privadas do município de Viçosa (MG). O estado nutricional das crianças foi classificado pelo índice de massa corporal, segundo a preconização do Centers for Disease Control and Prevention. Foram aferidas as medidas de peso, estatura, pregas cutâneas tricipital e subescapular, circunferências da cintura e do quadril e pressão arterial das crianças, sendo os fatores ambientais obtidos por meio de questionário, segundo informações maternas. Classificou-se o estado nutricional das mães segundo a recomendação do World Health Organization. RESULTADOS: Do total de crianças, 87,9% eram eutróficas e 12,1% apresentavam sobrepeso. De acordo com a análise de regressão logística múltipla, os fatores associados ao sobrepeso infantil foram apresentar mãe obesa (OR: 6,92; p<0,001), ser filho unigênito (OR: 1,87; p=0,03), permacer tempo superior a 3 horas diárias em frente à televisão (OR: 1,91; p=0,04), não realizar educação física na escola (OR: 4,80; p=0,02) e ser do sexo masculino (OR: 2,60; p=0,001). CONCLUSÃO: Este estudo permite elucidar a identificação de fatores ambientais, potencialmente modificáveis, associados ao sobrepeso infantil no município de Viçosa. A determinação dos fatores ambientais é importante, uma vez que o aumento na prevalência do sobrepeso na infância não pode ser totalmente explicado pelos fatores genéticos.

Socio-economic differentiation of the growth and the dietary intake of Polish boys aged 7-16 years

BACKGROUND

The period of the constitutional transformation, apart from many advantages, has generated a number of serious problems that may affect the biological state of children and adolescents in Poland.

AIM

The study documented socio-economic differentiation of growth and dietary intake of boys.

SUBJECTS AND METHODS

The research involved 523 boys aged 7-16; 54.4% of subjects came from Kielce (a city with a population of over 200 000) and 45.6% came from rural areas - from a region underprivileged in terms of economic development, with a majority of its inhabitants living off the land. Height and weight measurements of the subjects were taken, which allowed for computation of BMI. Dietary intake was assessed using the interview method for 24 h dietary recall. A multifactor variance analysis for unequal numbers in subclasses was applied to estimate the influence of socio-economic factors such as place of residence, mother's education and number of children in the family on somatic traits and on nutrient intake.

RESULTS

Urban boys whose mothers had experienced higher education were characterized by the greatest height (p<0.000). The percentage of the investigated subjects with an excessive body mass was over twice as high among boys in families with one or two children (15.0%) than among boys in families with three or more children (6.1%), and twice as high among urban boys (14.1%) in comparison with rural boys (7.0%). No significant differences in the energy value of daily food intake in each social group were found. The diet of rural boys included a lower percentage of energy intake derived from protein (10.7%) than that of urban boys (12.4%). This percentage decreased together with the lowering level of mother's education. The greatest amount of minerals and vitamins was found in the diets of boys whose mothers had higher education and lived in a city.

CONCLUSIONS

Diets of boys with the greatest body height were also characterized by a greater content of mineral components and vitamins, and a greater percentage of energy derived from protein. The relative body mass of the investigated subjects was probably more influenced by factors other than nutrition, i.e. mostly physical activity.

Breakfast skipping is associated with differences in meal patterns, macronutrient intakes and overweight among pre-school children

Objectives

To examine the association between skipping breakfast, daily energy, macronutrients and food intakes, and BMI in pre-school children.

Design

A cross-sectional study using information on children’s food consumption and measured height and weight. Energy and macronutrient intakes of the children were derived from parent/day-care attendant’s responses to 24 h recall interviews and eating behaviour questionnaires.

Setting

Data obtained from a representative sample (n2103) of children born in Quebec (Canada) in 1998.

Subjects

One thousand five hundred and forty-nine children, with a mean age of 49 (sd3·12) months.

Results

Ten per cent of children ate breakfast on fewer than 7 days per week. This behaviour was associated with a lower diet quality and concentrated energy intakes through higher protein intakes at lunch and the consumption of snacks higher in energy and carbohydrate in the afternoon and evening; yet total daily energy intakes were not significantly different from those of pre-school children who ate breakfast every day. Breakfast skippers’ mean BMI increased as intake of energy, carbohydrates or servings of grain products increased; however, this was not the case for breakfast eaters. When Cole’s cut-off for overweight/obesity was used, overweight/obesity in breakfast skippers was related to the dinner-time consumption of approximately 3000 kJ (700 kcal) or more for energy intake, approximately 100 g or more of carbohydrates, or approximately 3 servings or more of grain products.

Conclusions

Eating breakfast every day is associated with having a healthy body weight, likely due to a more even distribution of energy intake across meals throughout the day.

Effect of body weight in the pathogenesis of ligature-induced periodontal disease in Wistar rats

OBJECTIVE

The aim of this study was to compare ligature-induced alveolar bone loss between obese and non-obese rats.

MATERIAL AND METHODS

Thirty female Wistar rats were randomly divided into two groups: a test group comprising 14 rats fed with a "cafeteria diet" for 120 days in order to gain weight and a control group comprising 16 regularly fed rats. Ligatures were placed around the 2nd upper molars, and the contralateral teeth served as intra-group controls. After 30 days, the animals were killed and the maxillae were removed. Sodium hypochlorite was used to prepare the specimens, and the cementum-enamel junction was stained with methylene blue 1%. Morphometric analysis of alveolar bone loss was by standardized digital photographs and the distance between the cementum-enamel junction and the alveolar bone crest was measured using the software Image Tool 3.0.

RESULTS

Body weight differed statistically between test and controls (268.6 and 242.4 g, respectively). Test animals demonstrated a mean (SD) alveolar bone loss of 0.51 (0.11) mm and in the controls 0.52 (0.14) mm in teeth with ligatures. No statistically significant differences were observed (ANOVA+Tukey), except for teeth with and without ligatures in both groups.

CONCLUSIONS

The establishment and progression of alveolar bone loss in rats was not influenced by body weight in the present study.

Nutrition transition and dietary energy availability in Eastern Europe after the collapse of communism

After the economic transition of the late 1980s and early 1990s there was a rapid increase in overweight and obesity in many countries of Eastern Europe. This article describes changing availability of dietary energy from major dietary components since the transition to free-market economic systems among Eastern European nations, using food balance data obtained at national level for the years 1990-92 and 2005 from the FAOSTAT-Nutrition database. Dietary energy available to the East European nations satellite to the former Soviet Union (henceforth, Eastern Europe) was greater than in the nations of the former Soviet Union. Among the latter, the Western nations of the former Soviet Union had greater dietary energy availability than the Eastern and Southern nations of the former Soviet Union. The higher energy availability in Eastern Europe relative to the nations of the former Soviet Union consists mostly of high-protein foods. There has been no significant change in overall dietary energy availability to any category of East European nation between 1990-1992 and 2005, indicating that, at the macro-level, increasing rates of obesity in Eastern European countries cannot be attributed to increased dietary energy availability. The most plausible macro-level explanations for the obesity patterns observed in East European nations are declines in physical activity, increased real income, and increased consumption of goods that contribute to physical activity decline: cars, televisions and computers.

Socio-economic factors and prevalence of underweight and overweight among female students in Poland

The aim of the work was to assess the prevalence of underweight among young women and to analyse factors contributing to this phenomenon. The study group consisted of 718 female students aged 18-24 years. Underweight, overweight and obesity was classified according to BMI and WHO criteria. To assess the socio-economic status (SES), place of residence before entering the university and education of parents were used. Variables characterising lifestyle such as sports activity, cigarette smoking and alcohol drinking were also taken into account. In the studied group, the prevalence of underweight was much higher than the prevalence of overweight and obesity (15.3% and 3.5%, respectively). Low BMI was more frequent among persons with higher SES. Moreover, it was noted that 70% of women having normal weight (BMI=18.50-24.99 kg/m2) wanted to have slimmer figure. No correlation was found between prevalence of very low body mass and lifestyle variables.

Breakfast eating and overweight in a pre-school population: is there a link?

Objectives

To analyse the socio-economic factors related to breakfast eating, the association between breakfast eating and overweight, and to gain a more thorough understanding of the relationship between these two elements in a population-based cohort of 4.5-year-old children. We hypothesised that a relationship could be observed between breakfast skipping and overweight independently of socio-economic factors such as ethnicity, maternal education, single parenting and family income.

Design

A population-based study whereby standardised nutritional interviews were conducted with each child's parent. The children's height and weight were taken by a trained nutritionist and parents were asked about their child's breakfast eating.

Setting

The analyses were performed using data from the Québec Longitudinal Study of Child Development (1998–2002), conducted by Santé Québec (Canada).

Subjects

Subjects were 1549 children between the ages of 44 and 56 months, with a mean age of 49 months.

Results

Almost a tenth (9.8%) of the children did not eat breakfast every day. A greater proportion of children with immigrant mothers (19.4% vs. 8.3% from non-immigrant mothers), with mothers with no high school diploma (17.5% vs. <10% for higher educated mothers) and from low-income families (15% for income of $39 999 or less vs. 5–10% for better income) did not eat breakfast every day. Not eating breakfast every day nearly doubled the odds (odds ratio = 1.9, 95% confidence interval 1.2–3.2) of being overweight at 4.5 years when mother's immigrant status, household income and number of overweight/obese parents were part of the analysis.

Conclusion

Although our results require replication before public policy changes can be advocated, encouraging breakfast consumption among pre-school children is probably warranted and targeting families of low socio-economic status could potentially help in the prevention of childhood obesity.

Health and nutrition in Eastern Europe and the former Soviet Union during the decade of transition: a review of the literature

The collapse of the Soviet Union was the most important historical event at the close of the 20th century. The jarring nature of this transition has resulted in large fluctuations in household resources and increased uncertainty in all facets of life for the individuals concerned. Much academic research and popular writing has explored the socioeconomic and political ramifications of bringing these countries into mainstream capitalism. This paper provides a review of the literature examining health outcomes in Eastern Europe and the former Soviet Union during the transition period. The research, which has studied the human face of transition, spans multiple disciplines and it is thus currently difficult for interested researchers to obtain an overview of the basic facts, as well as, the more detailed nuances, concerning developments. This paper highlights what we currently know about health outcomes in transition countries and what we do not know, and suggests future areas of research which may help fill important gaps in our knowledge.