Prevalence of overweight and obesity in 2- to 6-year-old Italian children

NASCITA Italian birth cohort study: a study protocol

Background

Young children’s healthy development depends on nurturing care, which ensures health, nutrition, responsive caregiving, safety and security, and early learning. Infancy and childhood are characterized by rapid growth and development, and these two factors contribute largely to determining health status and well-being across the lifespan. Identification of modifiable risk factors and prognostic factors during the critical periods of life will contribute to the development of effective prevention and intervention strategies.

The NASCITA (NAscere e creSCere in ITAlia) study was created to evaluate physical, cognitive, and psychological development, health status and health resource utilization during the first six years of life in a cohort of newborns, and to evaluate potential associated factors.

Methods

NASCITA is an ongoing, dynamic, prospective, population-based birth cohort study of an expected number of more than 5000 newborns who will be recruited in 22 national geographic clusters starting in 2019. It was designed to follow children from birth to school entry age for a wide range of determinants, disorders, and diseases. Recruitment of the newborns (and their parents) will take place during the first routine well-child visit, which takes place at the office of the pediatrician assigned to them by the local health unit of residence, and which is scheduled for all newborns born in Italy within the first 45 days of their life.

Data will be web-based and collected by the family pediatricians during each of the 7 standard well-child visits scheduled for all children during their first 6 years of life. Information on every contact with the enrolled children in addition to these prescheduled visits will be also recorded.

Discussion

The NASCITA cohort study provides a framework in which children are followed from birth to six-years of age. NASCITA will broaden our understanding of the contribution of early-life factors to infant and child health and development. NASCITA provides opportunities to initiate new studies, also experimental ones, in parts of the cohort, and will contribute relevant information on determinants and health outcomes to policy and decision makers. Cohort details can be found on https://coortenascita.marionegri.it.

Trial registration

Clinicaltrials.gov: NCT03894566.

Ethics committee approval: 6 February 2019, Verbale N 59.

Prevalence and Trends of Overweight and Obesity in European Children From 1999 to 2016: A Systematic Review and Meta-analysis

IMPORTANCE

Studies of trends in excess weight among European children throughout the last few decades have rendered mixed results. Additionally, some studies were outdated, were based on self-reported weight and height, or included only a few European countries.

OBJECTIVE

To assess prevalence trends in measured overweight and obesity among children across Europe from 1999 to 2016 using a systematic methodology.

DATA SOURCES

MEDLINE, Embase, CINAHL, and Web of Science were searched from their inception until May 2018. Moreover, searches were conducted on health institutions' websites to identify studies not published in scientific journals.

STUDY SELECTION

The inclusion criteria were: (1) studies reporting the population-based prevalence of excess weight (overweight plus obesity) or obesity according to body mass index cutoffs proposed by the International Obesity Task Force; (2) cross-sectional or follow-up studies; and (3) studies including populations aged 2 to 13 years.

DATA EXTRACTION AND SYNTHESIS

Literature review and data extraction followed established guidelines. The Mantel-Haenszel method was used to compute the pooled prevalence estimates and their 95% CI whenever there was no evidence of heterogeneity (I2 < 50%); otherwise, the DerSimonian and Laird random-effects method was used. Subgroup analyses by study year, country, or European region (Atlantic, Iberian, Central, and Mediterranean) were conducted. Prevalence estimates were calculated as an aggregate mean, weighted by the sample size and the number of individuals in each study.

RESULTS

A total of 103 studies (477 620 children aged 2 to 13 years) with data from 28 countries were included. The combined prevalence of overweight and obesity in the Iberian region tended to decrease from 30.3% (95% CI, 28.3%-32.3%) to 25.6% (95% CI, 19.7%-31.4%) but tended to increase in the Mediterranean region from 22.9% (95% CI, 17.9%-27.9%) to 25.0% (95% CI, 14.5%-35.5%). No substantial changes were observed in Atlantic Europe or Central Europe, where the overweight and obesity prevalence changed from 18.3% (95% CI, 14.0%-23.9%) to 19.3% (95% CI, 17.7%-20.9%) and from 15.8% (95% CI, 13.4%-18.5%) to 15.3% (95% CI, 11.6%-20.3%), respectively.

CONCLUSIONS AND RELEVANCE

The prevalence of childhood overweight and obesity is very high, but trends have stabilized in most European countries. There are substantial between-country differences in the current levels and trends of overweight and obesity. The rising prevalence in some Mediterranean countries is worrisome.

TRIAL REGISTRATION

PROSPERO identifier: CRD42017056924.

Prevention of obesity in toddlers (PROBIT): a randomised clinical trial of responsive feeding promotion from birth to 24 months

INTRODUCTION

The aims of the PROBIT trial (clinicaltrials.gov: NCT03131284) were to prevent overweight or obesity occurring at two years of life, and improve feeding patterns during infancy.

METHODS

The trial compared 252 northern Italian newborns whose paediatricians offered their parents an educational programme from the child's birth to the age of two years (intervention arm) with 216 newborns whose parents did not undergo the programme (control arm). This sample size was 80% powerful to detect, with a 0.05 α error, a 40% lower prevalence of overweight/obesity and a 57% lower prevalence of obesity in the intervention arm. At each well visit, the parents of the children in the intervention arm were given oral and written information about protective behaviours, with particular emphasis on responsive feeding. Overweight and obesity at two years of age were, respectively, defined as a body mass index of more than the 85th and the 95th percentile in accordance with the WHO growth charts. The sample size had 80% power to detect a 40% lower prevalence of overweight/obesity and a 57% lower prevalence of obesity in the intervention arm.

RESULTS

At the age of two years, the prevalence of obesity in the intervention arm was 35% lower than among the controls, but the difference was not statistically significant (8.7% vs. 13.4%; p = 0.10) There was no difference in the prevalence of overweight/obesity between the groups (26.8% vs. 28.3%; p = 0.49). At the age of three months, a higher proportion of the infants in the intervention group were fed on demand (93% vs. 80%, p < 0.001).

CONCLUSIONS

The PROBIT trial failed to detect a significantly lower prevalence of obesity in the intervention arm, but did improve early feeding patterns. More powerful trials and meta-analyses are required to establish whether educating newborns' parents can decrease the prevalence of early obesity.

Nutritional status of preschool children attending kindergartens in Kosovo

BACKGROUND

There is very limited data on malnutrition of preschool children in Kosovo. The main objective of the study is to provide a nutritional status profile of preschool children attending kindergartens in Kosovo.

METHODS

Cross-sectional study of children aged 12-59 months (n = 352 children) and children aged 60-83 months (n = 134) enrolled in public and private kindergartens of Kosovo. Anthropometric measurements used for this study are weight and height of the preschoolers (12-83 months). A measuring board was used for measuring the length/height of children younger than 2 years, while digital weight and height scale Seca 763 was used for measuring of preschool children taller than 110 and Seca 213 was used for measuring the height for children who were shorter than 110 cm. Statistical analyses of underweight and overweight trends across sex and age groups as well as between children from public and private kindergartens were carried out. Qualitative variables were tested with a chi-square test. The differences between groups were assessed with a Student t test for normally distributed variables and a Mann-Whitney test for abnormally distributed numerical variables.

RESULTS

The mean z-scores for weight-for-age, height-for-age, weight-for-height, and BMI-for-age largely fell within 0.0 and 1.0. The percentage of stunted children is 3%, whereas child wasting is 1.9%. The overall percentage of obese children is 2.3%; furthermore, 8.9% are overweight and 27.3% have a possible risk of being overweight.

CONCLUSIONS

The incidence of children underweight is slightly decreasing. The prevalence of overweight and obese children in sample chosen is evident.

Exploring the association between body mass index and dental caries in 3–7-year-old children, living in Łódź, Poland

Dental caries and childhood obesity are major problems affecting the health of children and preventing these conditions in children have been recognized as public health priorities (Hong et al. 2008; Odgien et al. 2010). The aim of the present study was to analyze the association between age-specific body mass index (BMI-for age) and dental caries in 3- to 7-year-olds. A cross-sectional study was conducted on 729 children from randomly chosen kindergartens and elementary schools in the urban area of Lodz, Poland. Anthropometric measurements were taken and the BMI-for-age was calculated for each child. Dental examinations were performed according to the WHO criteria. The sum of decayed, missing, filled primary/ permanent teeth and surfaces - dmft/DMFT and dmft/DMFTS, and caries prevalence were computed. The percentage distribution of the BMI categories in the study group was: 72.7% normal weight, 8.92% underweight, 12.89% overweight and 5.49% obese. Caries prevalence in the primary dentition was significantly lower in underweight children than in those who were of normal weight (p=0.004) or were overweight (p=0.039). However, controlling for age and gender, no significant association was noted between BMI and caries prevalence in either dentition group. The Kruskal-Wallis test failed to reveal any significant differences in mean dmft across the four BMI groups in the whole population, nor within particular age groups, nor in DMFT in 5- to 7-year-olds. There was no association between BMI and dental caries either in the primary dentition or permanent teeth in the early period after eruption.

Socio-Economic and Environmental Factors Associated with Overweight and Obesity in Children Aged 6-8 Years Living in Five Italian Cities (the MAPEC_LIFE Cohort)

The prevalence of obesity among Italian children has reached such alarming levels as to require detailed studies of the causes of the phenomenon. A cross-sectional study was carried out in order to assess the weight status of 1164 Italian children aged 6–8 years (the Monitoring Air Pollution Effects on Children for Supporting Public Health Policy (MAPEC_LIFE) cohort) and to identify any associations between selected socio-economic and environmental factors and overweight/obesity. The data were obtained by means of a questionnaire given to parents, and any associations were examined by binomial logistic regression analyses. Overweight was found to be positively associated with male gender, parents of non-Italian origin, and parents who smoke, and negatively associated with the parents’ level of education and employment. In addition, the frequency of overweight varied in relation to the geographical area of residence, with a greater prevalence of overweight children in the cities of central-southern Italy. This study highlights the need to implement appropriate obesity prevention programs in Italy, which should include educational measures concerning lifestyle for parents from the earliest stages of their child’s life.

Association of eating speed and energy intake of main meals with overweight in Chinese pre-school children

OBJECTIVE

To investigate the association between eating behaviours (eating speed and energy intake of main meals) and overweight in pre-school children.

DESIGN

Cross-sectional study. Data consisted of measurements (height and weight), questionnaire information (eating behaviours of eating speed and overeating) and on-site observation data (meal duration and energy intake of main meals).

SETTING

Seven kindergartens in Beijing, China.

SUBJECTS

Pre-school children (n 1138; age range 3·1-6·7 years old) from seven kindergartens participated in the study.

RESULTS

The multivariate-adjusted odds ratio of overweight in participants with parent-reported 'more than needed food intake' was 3·02 (95 % CI 2·06, 4·44) compared with the 'medium food intake' participants, and higher eating speed was associated with childhood overweight. For the two observed eating behaviours, each 418·7 kJ (100 kcal) increase of lunch energy intake significantly increased the likelihood for overweight by a factor of 1·445, and each 5-min increase in meal duration significantly decreased the likelihood for overweight by a factor of 0·861. Increased portions of rice and cooked dishes were significantly associated with overweight status (OR = 2·274; 95 % CI 1·360, 3·804 and OR = 1·378; 95 % CI 1·010, 1·881, respectively).

CONCLUSIONS

Eating speed and excess energy intake of main meals are associated with overweight in pre-school children.

Nutrient intake in Italian infants and toddlers from North and South Italy: the Nutrintake 636 study

We performed a cross-sectional study to compare the intake of energy, macronutrients, fiber, sodium and iron and the anthropometric status of infants and toddlers living in North (Milano) and South Italy (Catania). Nutrient intake was evaluated using a 7-day weighed food record. Out of 400 planned children aged 6 to 36 months, 390 (98%) were recruited, 189 in Milano and 201 in Catania. The mean (standard deviation) age was 17 (9) months in Milano and 17 (10) months in Catania. Anthropometry, energy intake and macronutrient intake were similar in Milano and Catania. However, iron intake was 27% lower and fiber intake 16% higher in Milano than in Catania. Despite normal anthropometry and energy intake, in the pooled sample there was a high intake of proteins, simple carbohydrates, saturated fats and sodium, and a low intake of iron and fiber compared to Italian reference values. This is the first study to report the macro- and micro-nutrient intake of children aged <12 months using the 7-day weighed food record and one of the very few studies that have employed such reference method in children from the general population.

Correlates of adiposity in a Caribbean pre-school population

OBJECTIVE

To evaluate ethnic and anthropometric correlates of adiposity among a nationally representative, multi-ethnic, Trinidadian pre-school population.

DESIGN

Cross-sectional study conducted between June 2008 and July 2009.

SETTING

Government and privately owned Early Childhood Care and Education Centres in Trinidad.

SUBJECTS

A total of 596 pre-school children (aged 31-73 months) from thirty-four schools had their weight, height, mid-upper arm circumference, waist circumference, biceps and triceps skinfold thicknesses measured by a registered dietitian using standard procedures. Percentage body fat was estimated using a foot-to-foot bioelectric impedance analyser (Tanita 531, Tokyo, Japan). Date of birth, religion and ethnicity were extracted from school records and pre-schoolers' ethnicity was categorized as East Indian, African, Mixed (a combination of two or more ethnicities), Chinese or Caucasian.

RESULTS

Anthropometric variables explained significantly more of the variance in adiposity among girls (67·4-88·1 %) than boys (24·4-39·2 %; P < 0·0 0 1). Pre-schoolers of African descent were significantly taller, heavier and had higher abdominal fat and mid-upper arm circumference than their East Indian and Mixed counterparts (all P < 0·001). The overall prevalence of excess adiposity (≥25 % body fat) as determined by bioelectrical impedance was 14·6 %, while 2·9 % of the children were undernourished according to WHO weight-for-age criteria. Differences in anthropometry were non-existent between children attending government and private pre-schools.

CONCLUSIONS

Gender, ethnicity and anthropometry all explained excess adiposity in these pre-schoolers. These findings highlight the need to elucidate the mechanisms that may be involved in explaining these differences, particularly those of ethnic origin.

Trends of body mass index distribution in schoolchildren in Sendai, Japan, 1989-2003

SUMMARY

Accumulating evidence indicates a strong association between obesity and health problems. Childhood obesity increases the risk of adulthood obesity. Although it is reported that the number of obese children in Japan has increased, it is unclear whether the obesity index distribution pattern has changed. To clarify this distribution pattern, we analyzed the changes in the body mass index (BMI) of primary (6th grade, 12 years old) and junior high (3rd year, 15 years old) schoolchildren in the city of Sendai during the period from 1989 to 2003. Our department has accumulated information on the height and body weight of all the schoolchildren in the city of Sendai. BMI was calculated using both the height and body weight data. The change in median BMI for 15 years had a slightly upward trend every year with both gender and school year. Although the BMI distribution showed that there was little or no change over time in the lower (10th and 25th) percentiles, the increases in the 75th and 90th percentiles were more marked than that in the 50th percentile in primary school children. On the other hand, there was only a small increase in BMI in the 3rd year of junior high school. Our results indicated that the changes in BMI distribution were concentrated at the upper end of the distribution in primary school children. The shifts in the value of high percentiles might be due to effect modification of the corresponding exposure by another environmental exposure or genetic predisposition. It is suggested that the factors causing this change influenced only part of this population, and affected individuals might represent a susceptible subpopulation of the exposed children.:

Prevalence of Overweight and Obesity in Chinese Preschoolers in Singapore

Introduction: This study examines the prevalence of overweight and obesity in 6- to 72-month-old Chinese preschoolers in Singapore using 3 references. Materials and Methods: This was a population-based cross-sectional study of 3009 Chinese preschoolers aged 6 to 72 months from southwestern and western parts of Singapore. Overweight and obesity were defi ned by using the Center for Disease Control (CDC) (85th and 95th percentile, respectively), the International Obesity Task Force (IOTF) and the local National Health Group Polyclinics (NHGP), Singapore (90th and 97th percentile, respectively) references. Results: The prevalence of overweight and obesity in 24 to 72 months old Chinese children were 8.1% and 7.1% (the CDC reference), 7.6% and 3.9% (the IOTF reference) and 7.5% and 5.3% (the local reference [NHGP]) respectively. For preschoolers aged 6 to 72 months, the prevalence of overweight and obesity was 7.0% and 5.3%, respectively, using the local reference. An increasing trend in the prevalence of obesity with increasing age was seen in both genders, using the CDC and IOTF references (P ≤0.001 and 0.001, respectively). The boys were more likely to be obese than the girls using the CDC reference (OR = 1.42, 95% CI, 1.02 to 1.97, P = 0.03). Conclusion: Our study showed a lower prevalence of overweight and obesity among Chinese preschoolers in Singapore when compared to other countries like the United States, Italy, Chile using the CDC and/or IOTF references. The CDC reference overestimated whereas the IOTF reference underestimated the prevalence of overweight and obesity for our population when compared to using the local NHGP reference. Key words: CDC, Cross-sectional, IOTF, Population-based

Prevalence of overweight and obesity in preschool children (2-5 year-olds) in Birjand, Iran

BACKGROUND

Childhood overweight and obesity have increased progressively in developing countries and nowadays they are considered as a global epidemic.The aim of the present study was to determine prevalence of overweight and obesity in 2-5 year-old children in kindergartens of Birjand in 2008.

FINDINGS

This cross- sectional and descriptive- analytical study was conducted on 500 children, who were 2-5 years-old, in kindergartens of Birjand selected through census. It was found that prevalence of overweight was 10.6% (11.7% in females and 9.6% in males) and obesity 7.6% (6.3% in females and 9.6% in males). Prevalence of overweight and obesity were statistically significant regarding birth weight, mother's occupation and father's level of education.

CONCLUSION

Prevalence of overweight and obesity in pre-schoolchildren is more than that of 7-18 year-old group in Birjand, but it is less than the result of similar studies in Tehran and most studies in other countries. Further studies are recommended to identify risk factors in obese children. Periodic studies are necessary to compare the changes in prevalence of obesity in children in future.

Metabolic changes after a hypocaloric, low-glycemic-index diet in obese children

BACKGROUND

A low glycemic index (LGI) diet has been proposed as a treatment for obesity in adults; few studies have evaluated LGI diets in obese children.

AIM

The purpose of the study was to compare the effects of two diets, with similar energy intakes, but different glycemic indexes in a pediatric outpatient setting.

SUBJECTS AND METHODS

A parallel- group, randomized controlled trial was conducted, and 22 obese outpatient children with a body mass index (BMI) Z-score >2 (11 females and 11 males, BMI 28.9±2.9 kg/m²) were included in the study. Patients were randomly allocated to a hypocaloric LGI (GI:60), or to a hypocaloric high glycemic index (HGI) diet (GI:90). The LGI and HGI diets were almost equivalent for macronutrient composition. Anthropometric and biochemical parameters were measured at baseline and after 6 months.

RESULTS

In both groups there were significant decreases in BMI, BMI Z-score, blood pressure, and high-sensitivity C-reactive protein. Only LGI diets produced a significant decrease in waist circumference and homeostasis model assessment. Analysis of variance demonstrated that the BMI Z-score decrease from baseline values was significantly greater after the LGI diet than after the HGI diet [-0.20 (95% confidence interval (CI) -0.29 to -0.10) vs -0.34 (95%CI -0.43 to -0.24)], mean difference between groups -0.14 (95%CI -0.27 to -0.01), p<0.05). Changes in triglyceride concentrations were significantly lower in LGI as compared to HGI diet (p<0.05).

CONCLUSIONS

This study demonstrates that a hypocaloric LGI diet has beneficial metabolic effects in comparison to a hypocaloric HGI diet in obese children.

Is the prevalence of overweight reducing at age 5-6 years? Ten years data collection in ASL Milano 2

Background

Prevalence of overweight and obesity has been reported as high even in preschool age children. However, recent international reports suggest that prevalence is now plateauing in pediatric age. Up to now no data are available on prevalence changes in Italy in the new Millennium. Aim of the study was to describe changes of overweight and obesity prevalence during the last decade in 5–6 y children in a large Health Unit in Northern Italy.

Methods

The Health Report n 8, used at 5–6 y and containing body mass index (BMI), was utilized for prevalence estimation from 2002 to 2011 according to BMI cut-offs proposed by Cole et al.

Results

Overweight and obese children progressively decreased during the study period (p 0.0002) with a minimum observed in 2011, showing a cumulative frequency of 23.1% in 2002 and of 16.6% in 2011 (−6.5%). Mean BMI values progressively decreased with time so that BMI values in 2010–2011 were significantly lower than in 2002–2003 (p < 0.0001). Underweight subjects increased with time (p 0.013), from 8.2% in 2002 to 9.9% in 2011, but grade 3 underweight (i.e., severe thinness) did not increase during the study period. In years 2010 plus 2011, not Italians children showed higher percentages of underweight (12.5%) and overweight plus obesity (23.5%) respect to Italian peers (9.0% and 18.1%, respectively, p values <0.01 and 0.0029).

Conclusions

This is the first report suggesting a possible decrease of overweight and obesity at 5–6 y in Italy in the last decade. As the study focused only on 5–6 y children, we don’t know if the true overweight prevalence in pediatric age is really reducing or the starting age of overweight status is simply delayed. The higher risk for malnutrition, both for excess or defect, found in our Area in not Italian children respect to Italian peers, strongly suggests to implement weight control especially for those children. Our finding needs further confirm studies but seems encouraging for true prevention of such condition.

The importance of physical education classes in pre-school children

AIM

The purpose of this study was to analyse differences between total physical activity (TPA) and moderate-to-vigorous PA (MVPA) of pre-school children during daily school hours when they attended the physical education class (PED) and school days without PE class (NPED) and to assess the contribution of PE classes to TPA in school hours.

METHODS

The sample was composed of 193 pre-school healthy children (96 girls) aged from three to five years old and was conducted between February and December of 2008. Children wore accelerometers for at least four consecutive days during school hours. Data were analysed with specific software, age-specific counts-per-minute cut-off points and a 5 s epoch were used. Independent and general linear model repeated measures were used to assess differences between gender and differences between different days within each gender, respectively.

RESULTS

Boys engaged more MVPA than girls (P < 0.05). During PED, pre-school children engaged significantly more in TPA and MVPA than during NPED (P < 0.05). PE class contributed, on average, 27.7% for the TPA and 32.8% of daily MVPA during PED in both gender.

CONCLUSION

The results of this study suggest that structured PA such as a PE class increased the daily TPA and MVPA level of pre-school children.

"Mi voglio bene": a pediatrician-based randomized controlled trial for the prevention of obesity in Italian preschool children

Background

The first years of life are crucial to start preventive interventions that can have an impact on lifestyle and later overweight and obesity. Under the Italian National Health System (INHS), children are cared for by family pediatricians who perform health balances at regular intervals. The Italian Society of Preventive and Social Pediatrics (SIPPS) has designed a randomized controlled trial (RCT) to evaluate the effectiveness of family pediatricians for the prevention of childhood obesity in preschool children. We report the rationale and protocol of such trial, named the "Mi voglio bene" ("I love myself") study.

Methods

"Mi voglio bene" is a parallel-arm RCT. Family pediatricians willing to participate to the trial will be randomly assigned to a control group and to an experimental group. The control group will provide the usual standard of care while the experimental group will implement 10 preventive actions (promotion of breastfeeding, avoidance of solid foods, control of protein intake, avoidance of sugar-sweetened beverages, avoidance of bottle, active means of transportation, identification of early adiposity rebound, limitation of television viewing, promotion of movement, and teaching portion size) at 10 time points during a 6-yr follow-up. The main outcome measures is the prevalence of overweight and obesity at 6 years of age. The experimental intervention is expected to reduce the prevalence of overweight and obesity from 25% to 20% and the study requires a total of 3610 children. Each pediatrician will enroll 30 consecutive newborns into the study so that a total of 120 pediatricians will participate to the study.

Discussion

"Mi voglio bene" is expected to provide important information for the INHS and possibly other institutional child care settings about the effectiveness of a pediatrician-based approach to the prevention of childhood obesity. We published this study protocol with the aim of opening a discussion with all people interested in fighting childhood obesity and to receive useful criticisms.

Absence of association between the INSIG2 gene polymorphism (rs7566605) and obesity in the European Youth Heart Study (EYHS)

The first genome-wide association study for BMI identified a polymorphism, rs7566605, 10 kb upstream of the insulin-induced gene 2 (INSIG2) transcription start site, as the most significantly associated variant in children and adults. Subsequent studies, however, showed inconsistent association of this polymorphism with obesity traits. This polymorphism has been hypothesized to alter INSIG2 expression leading to inhibition of fatty acid and cholesterol synthesis. Hence, we investigated the association of the INSIG2 rs7566605 polymorphism with obesity- and lipid-related traits in Danish and Estonian children (930 boys and 1,073 girls) from the European Youth Heart Study (EYHS), a school-based, cross-sectional study of pre- and early pubertal children. The association between the polymorphism and obesity traits was tested using additive and recessive models adjusted for age, age-group, gender, maturity and country. Interactions were tested by including the interaction terms in the model. Despite having sufficient power (98%) to detect the previously reported effect size for association with BMI, we did not find significant effects of rs7566605 on BMI (additive, P = 0.68; recessive, P = 0.24). Accordingly, the polymorphism was not associated with overweight (P = 0.87) or obesity (P = 0.34). We also did not find association with waist circumference (WC), sum of four skinfolds, or with total cholesterol, triglycerides, low-density lipoprotein, or high-density lipoprotein. There were no gender-specific (P = 0.55), age-group-specific (P = 0.63) or country-specific (P = 0.56) effects. There was also no evidence of interaction between genotype and physical activity (P = 0.95). Despite an adequately powered study, our findings suggest that rs7566605 is not associated with obesity-related traits and lipids in the EYHS.

Prevalence of overweight in kindergarten children in the centre of Israel - association with lifestyle habits

OBJECTIVES

(1) To determine the prevalence of overweight and at risk for overweight in a sample of 4- to 6-year-old Israeli children; and (2) to delineate factors which may be associated with excess of overweight such as food intake, food habits physical and sedentary activity, family and socio-economic factors.

METHODS

In a cross-sectional survey in six kindergartens in the centre of Israel, 204 children (104 boys), mean age 5.5 years were studied.

RESULTS

In total, 40% of the children were either at risk for overweight (25%) or overweight (15%). Parents of one-third of all children reported their children ate unbalanced meals; however, caloric intake was not different between the weight groups. Overweight children were reported to eat according to mood status and preferred eating candies. Knowledge of dietary requirements was fairly good and similar in all three weight groups. Screen viewing time was more than twofold greater than the recommended in all weight groups. The rate of parental obesity was not different in the weight groups.

CONCLUSIONS

A high rate of overweight was documented among pre-schoolers in the centre of Israel. Poor lifestyle habits were noted in about one-third of all children; however, no association was found between the poor lifestyle habits and overweight but more overweight children eat according to mood status and preferred eating candies as a snack.

Body Mass Index and Serum Lipid Changes During Treatment with Valproic Acid in Children with Epilepsy

BACKGROUND

Valproic acid is the drug of choice for a wide variety of epileptic seizures and syndromes because of its broad spectrum of activity and because, in most patients, it is well tolerated. Although weight gain is a well-known adverse effect of valproic acid therapy, only a few studies have addressed weight gain associated with it in children aged 2–8 years.

OBJECTIVE

To evaluate valproic acid–associated changes in the body mass index (BMI) z-scores and to assess changes in serum triglyceride, cholesterol, and fasting glucose levels in young children receiving valproic acid treatment.

METHODS

Eighty-seven patients (39 females, 48 males) receiving valproic acid therapy for at least 3 months were included in the retrospective longitudinal study. Mean ± SD age at initiation of therapy was 4.8 ± 0.8 years. Changes in BMI z-scores as well as serum triglyceride, total cholesterol, and fasting glucose levels were evaluated as continuous variables and analyzed by longitudinal methods for all patients.

RESULTS

The average change from baseline in BMI z-scores was 0.80 (p = 0.001) at 3.1 years of follow-up. No significant change in triglyceride, cholesterol, and serum fasting glucose levels was observed over the same period. The percentage of overweight children at baseline was 6.9% and rose to 16% by the final visit (p = 0.081).

CONCLUSIONS

Valproic acid–associated weight gain may occur in young children. However, only 16% of patients were categorized as overweight at the end of the study; this percentage overlaps the percentage of overweight healthy young Italian children. The BMI z-scores significantly increased during the first 16 months of therapy, then appeared to level off. These observations may influence clinical practice and decision-making regarding suspending the drug due to weight gain in children in whom seizure control has been achieved. A For Our Patients summary of this article is available at www.ForOurPatients.info

Obesity in Mediterranean region (1997-2007): a systematic review

The objective of this review is to determine the distribution of obesity by geographical location, income, age and sex in the Mediterranean region during the last decade. A meta-analysis was conducted for 102 articles cited during the period (1997-2007) in Medline database (for 17 Mediterranean countries) searched during the summer of 2007 using the word 'obesity' and its related keywords. The study showed that adults were more obese than children in all Mediterranean continents and in different levels of income. The prevalence of obesity among European children was higher than among Asians. Also, European adults were more obese than European children. The total female adults were found to be more obese (median: 25.3%) than male adults (median: 20.0%). The regression model analysis indicated that male adults were more likely to be obese in the Euro-Med region. Taking different factors into consideration, it was noticed that Mediterranean adults, especially those in the European region, are at higher risk of obesity. Awareness programmes addressing the importance of adopting healthy dietary habits combined with physical activity should target the whole community in general and adults in particular. The findings could guide health planners for better management of obesity.

Secular and seasonal trends in obesity in Chilean preschool children, 1996-2004

OBJECTIVES

Chile is a unique example of the nutrition transition, with improvements in undernutrition and subsequent rapid increases in obesity occurring at a rate much faster than in other countries. This study aims to describe the cross-sectional obesity trends in Chilean preschool children from 1996 to 2004.

MATERIALS AND METHODS

Anthropometric measurements from preschool children (ages 2-5) registered in the Junta Nacional de Jardines Infantiles program from 1996 to 2004 were analysed. The weight-for-height z score using the World Health Organization 1977/1985 reference curves for age, sex, height, and weight were defined to estimate overweight and obesity. The overall trends in obesity were described for each study year and generalized estimating equation models were used to describe trends in obesity after adjusting for the correlated nature of repeated measurements in individual children in consecutive years.

RESULTS

The prevalence of obese and overweight children has remained constant in both boys and girls during the past 9 years; however, after adjustment for repeated measurements in individual children, the odds of obesity increased by 30% each year (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.27-1.31, P < 0.001). Furthermore, the odds of obesity were significantly greater in both August and November compared with March.

CONCLUSIONS

The prevalence of obesity in Chilean preschool children continues to be a major public health concern, and cross-sectional trends may underestimate the magnitude of the problem.

Prevalence of metabolic syndrome (MS) in children and adolescents with varying degrees of obesity

OBJECTIVE

Childhood obesity is increasingly common and is associated with health problems; in particular, obesity plays a central role in the metabolic syndrome (MS). We estimated the prevalence of MS in Caucasian children and adolescents with varying degrees of obesity.

PATIENTS AND METHODS

We studied 191 obese [body mass index (BMI) > 97th percentile] children and adolescents. Obesity was stratified on the basis of a threshold BMI z-score and subjects were classified as moderately (z-score 2-2.5) or severely obese (z-score > 2.5). Seventy-six, nonobese subjects were recruited into a comparison group. Thirty-one of them were of normal weight (BMI < 75th percentile) and 45 overweight (BMI 75th-97th percentile). Patients were classified as having MS if they met three or more of the following criteria for age and sex: BMI > 97th percentile, triglyceride levels > 95th percentile, high density lipoprotein (HDL) cholesterol level < 5th percentile, systolic or diastolic blood pressure > 95th percentile and impaired glucose tolerance (blood glucose level: 7.8-11.1 mmol/l at 2 h). Insulin resistance was calculated using the homeostasis model assessment for insulin resistance (HOMA-IR) and impaired insulin sensitivity was defined as a HOMA-IR > or = 2.5 in prepubertal patients and HOMA-IR > 4 in pubertal subjects.

RESULTS

The overall prevalence of MS was 13.9% and was present in 12.0% of moderately obese and 31.1% of severely obese subjects; no overweight or normal weight subjects met the criteria for MS. The rate of the MS increased progressively with increasing BMI categories (P < 0.001). Severely obese patients had a threefold increased risk with respect to moderately obese patients.

CONCLUSIONS

The prevalence of the MS is higher in obese as opposed to nonobese subjects and increases with severity of obesity.

Gendered dimensions of obesity in childhood and adolescence

Background

The literature on childhood and adolescent obesity is vast. In addition to producing a general overview, this paper aims to highlight gender differences or similarities, an area which has tended not to be the principal focus of this literature.

Methods

Databases were searched using the terms 'obesity' and 'child', 'adolescent', 'teenager', 'youth', 'young people', 'sex', 'gender', 'masculine', 'feminine', 'male', 'female', 'boy' and 'girl' (or variations on these terms). In order to limit the potential literature, the main focus is on other reviews, both general and relating to specific aspects of obesity.

Results

The findings of genetic studies are similar for males and females, and differences in obesity rates as defined by body mass index are generally small and inconsistent. However, differences between males and females due to biology are evident in the patterning of body fat, the fat levels at which health risks become apparent, levels of resting energy expenditure and energy requirements, ability to engage in certain physical activities and the consequences of obesity for the female reproductive system. Differences due to society or culture include food choices and dietary concerns, overall physical activity levels, body satisfaction and the long-term psychosocial consequences of childhood and adolescent obesity.

Conclusion

This review suggests differences between males and females in exposure and vulnerability to obesogenic environments, the consequences of child and adolescent obesity, and responses to interventions for the condition. A clearer focus on gender differences is required among both researchers and policy makers within this field.