Bidirectionality and gender differences in emotional disturbance associations with obesity among Taiwanese schoolchildren

Household and schooling rather than diet offset the adverse associations of height with school competence and emotional disturbance among Taiwanese girls

OBJECTIVE

Short stature may reflect health in early life and be an enduring disability. How birth weight, gender, household, elementary schooling and diet play a role in associations between stature and overall school competence (OSC) have been assessed.

DESIGN

The 2001-2002 Nutrition and Health Survey in Taiwan (NAHSIT) for elementary schoolchildren (n 2274, 52·1 % boys) was linked to birth records. It provided sociodemographic, dietary quality, body compositional and school performance (as Scale for Assessing Emotional Disturbance, SAED; OSC as an SAED subscale) data. Lower birth weight was ≤15th percentile: 2850 g for boys and 2700 g for girls, and stature as z-scores for Taiwanese. Multivariable linear regression was used for relationships between OSC and stature. Trends in OSC by stature and school grade were assessed.

SETTING

The 2001-2002 NAHSIT for elementary schoolchildren.

PARTICIPANTS

Totally, 2274 schoolchildren aged 6-13 years.

RESULTS

Compared to normal height (-2< height for age z-score (HAZ) <2), shorter girls (HAZ ≤ -2) had a lower OSC (8·87 v. 10·5, P < 0·05) and taller girls (HAZ ≥ 2) had a better OSC (12·3 v. 10·5, P < 0·001). Maternal education and household income each contributed more than 5 % of OSC variance. OSC and HAZ among girls were positively associated and emotional disturbance negatively associated. Shortness-associated lower OSC underwent remediation with advancing school grade. Stature and OSC were not evidently related in boys.

CONCLUSIONS

Shorter stature can compromise OSC among school girls. The major determinants in shorter girls are less household income and limited parental education.

Association of weight change patterns in late adolescence with young adult wage differentials: A multilevel longitudinal study

BACKGROUND

Numerous studies have demonstrated that different weight change patterns from adolescence to adulthood may exert different effects on opportunities from which individuals subsequently benefit.

OBJECTIVES

This study aimed to investigate the association of weight change patterns from late adolescence to young adulthood with monthly wage in young adulthood for both genders in Taiwan.

METHODS

A nationally representative retrospective panel of 3730 young people (1707 men and 2023 women) from the Taiwan Educational Panel Survey (2001-2014) was included. Individuals were divided into four weight-change-pattern categories based on changes in their body mass index at two time points that were 7 years apart, between late adolescence (aged 18-19 years) and young adulthood (aged 25-26 years). These categories were (1) no obesity, (2) obesity reversal, (3) developing obesity, and (4) persistent obesity. Cross-classified, hierarchical linear regression modeling analysis was performed to explore the association of weight change patterns with monthly wage in young adulthood, after adjustment for both individual- and contextual-level variables.

RESULTS

Of the weight-change-pattern categories for both genders, individuals with persistent obesity had the lowest monthly wage. For women, the mean monthly wage decreased progressively for the categories of no obesity, obesity reversal, developing obesity, and persistent obesity (test for difference, P = 0.016; test for trend, P = 0.026). Women with persistent obesity earned 20% less per month than did those who were never obese (P = 0.024), after controlling for individual and contextual factors. For men, no association was found between weight change patterns and monthly wage.

CONCLUSION

Persistent obesity from late adolescence to young adulthood is associated with low monthly wage in young adulthood in women but not in men. These findings highlight the urgency of addressing persistent obesity early in life, especially for women.

Dietary quality linkage to overall competence at school and emotional disturbance in representative Taiwanese young adolescents: dependence on gender, parental characteristics and personal behaviors

BACKGROUND

Child school performance during puberty may be at increased risk through emotional disturbance. It is hypothesized that this may be mitigated by dietary quality.

METHODS

In a nationally representative sample (Nutrition and Health Survey in Taiwan, NAHSIT), 1371 Taiwanese aged 11-16 years, overall competence at school, (OCS) and emotional status have been assessed by teachers with the SAED (Scale for Assessing Emotional Disturbance). Parents provided family socio-demographics and students completed a behavioral and dietary questionnaire (Youth Healthy Eating Index - Taiwan, YHEI-TW). Associations between emotional disturbance (ED), OCS and dietary quality (YHEI-TW) were assessed in multiple linear regression models with adjustments for covariates including parental characteristics, personal behaviors, body fatness and puberty.

RESULTS

Boys or girls with ED had a less favorable OCS (p < 0.001), minimally dependent on YHEI-TW. On multivariable analysis there was a more positive association between OCS and YHEI-TW among boys (β = 0.05, p < 0.01) and girls (β = 0.07, p < 0.001). Poor dietary quality was associated with ED, especially in girls (β =  - 0.06, p < 0.001). Additionally, parental characteristics, body fatness, and personal behaviors are associated with OCS. Puberty is associated with ED and may be indirectly linked to OCS.

CONCLUSIONS

Unsatisfactory food intake is associated with the link between emotional disturbance and impaired school performance, as assessed by OCS, especially among girls. For both genders, socio-economic and behavioral factors including parenteral income, reading, screen viewing and smoking are modulators of this association. Puberty was a modifying factor in girls. Dietary quality is a relevant factor for health (ED) as well as education (OCS) during early adolescence.

Fitness and food environments around junior high schools in Taiwan and their association with body composition: Gender differences for recreational, reading, food and beverage exposures

School environments may contribute to adolescent behavior, reproductive physiology and body composition (BC). The Nutritional and Health Survey in Taiwan (2010) for 1458 junior high school students was geo-mapped for 30 school environs. Facilities for physical activity (fitness centers, gymnasia and sports stadiums, activity centers and parks), sedentary activities (reading material rental shops (RMRS), internet cafes) and food and beverage outlets (FBOs) were calculated as weighted numbers within 1000m of schools. Multiple linear regressions were used to predict BC variable z-scores. For boys, higher fitness center densities and, for girls, gymnasia and sports stadiums were associated with less abdominal fatness. For girls, body mass index, waist circumference (WC) and triceps skinfold thickness (TSF) were greater when RMRS density was higher as was TSF with internet café density. Where there were no FBOs, boys’ WC and TSF were less with more parks, but girls were shorter and WC more adverse. With greater RMRS density and no FBOs, girls still had increased WC/Hip ratio, and less mid-arm muscle circumference. Boys’ findings were more evident after considering puberty. Physical activity facilities (differently by gender), food and beverage outlets absence for boys and low reading material rental shop density for girls increase the likelihood of healthier body composition.

Chinese Version of the Healthy Lifestyle Beliefs Scale for Taiwanese Adolescents: A Psychometric Study

BACKGROUND

Taiwanese adolescents' unhealthy lifestyles (e.g., unhealthy eating and sedentary behavior) are associated with excess weight and obesity, which affect their physical and mental health (e.g., depression). Because adolescents' beliefs about healthy lifestyles predict their actual lifestyles, a valid and reliable tool to measure their beliefs about healthy lifestyles is needed.

METHODS

The Healthy Lifestyle Behavior Scale (HLBS) was translated into Chinese based on recommended guidelines. A convenience sample of 186 Taiwanese adolescents completed the Chinese version Healthy Lifestyle Behavior Scale (CHLBS) anonymously. We used Cronbach's α to determine the internal consistency of the CHLBS and exploratory and confirmatory factor analyses to examine the factor structure.

RESULTS

The Cronbach's α for the CHLBS was .94. Exploratory analysis suggested that there were two factors and explained 57% of the total variance. The confirmatory factor analysis indicated an acceptable fit.

CONCLUSION

The CHLBS is a reliable and valid scale. It can be used to gather information about Taiwanese adolescents' beliefs about healthy lifestyles, which will assist in developing culturally and developmentally relevant interventions.