Obesity in a cohort of black Jamaican children as estimated by BMI and other indices of adiposity

Understanding the need for a whole-of-society approach in school nutrition policy implementation: a qualitative analysis

BACKGROUND

Only three of twenty Caribbean Community (CARCICOM) countries have mandatory school nutrition policies despite one third of the region's children being overweight or obese. In Barbados, there are nutrition guidelines which lack the legal mandate of a formal policy. We aim to assess the comprehensiveness of current national nutrition guidelines and to understand the factors operating in the inner and outer school setting that may influence the implementation of a mandatory school nutrition policy from the perspectives of school administrators.

METHODS

A documentary analysis of existing nutritional guidelines was conducted along with qualitative semi-structured interviews in primary (elementary) and secondary (high) schools in Barbados. We purposively sampled six primary and four secondary school administrators (principals, deputy principals or senior teachers) to explore their knowledge and views on the National School Nutrition Guidelines. The deterministic implementation paradigm, Consolidated Framework for Implementation (CFIR), was used to explore the complexities within the inner and outer settings of schools. Documentary analysis used a theory-based framework informed by the Wellness School Assessment Tool-school policy analysis questionnaire. Interview transcripts were team coded using thematic analysis with constant comparison facilitated by NVIVO software version12.

RESULTS

School administrators were unaware of the existing National School Nutrition Guidelines which documentary analysis found to be restrictive and weak for implementation. Administrators envisioned a government-led (outer setting), whole of society approach as the most effective strategy for the development and implementation of a proposed mandatory school nutrition policy. School administrators identified lack of financial and human resources as barriers to nutrition policy implementation. Formal and informal food vendors are institutionalized in schools and are influential determinants of the school food environment. Schools have individually reached into the outer setting to work with civil society organizations and private individuals to provide financial support and nutrition expertise to their institutions. Mass media campaigns in the outer setting may influence child and parental food choices.

CONCLUSION

School administrators describe that government-led, CSO supported policy development using a whole-of-society approach has implications for improving nutrition policy implementation. Our findings demonstrate the use of a deterministic implementation framework in the pre-implementation phase of school nutrition policy development.

Prevalence of thinness, overweight and obesity among Tibetan adolescents aged 12-17 years

OBJECTIVE

To estimate the prevalence of thinness, overweight and obesity among Tibetan adolescents aged 12-17 years.

DESIGN

Cross-sectional survey.

SETTING

Shigatse City of Tibet municipality, with an average altitude of more than 4000 m.

PARTICIPANTS

Study participants included 2642 adolescents aged 12-17 years selected from six schools using a convenient cluster sampling method.

RESULTS

The prevalence of thinness/overweight/obesity among Tibetan adolescents was 9·4 %/5·4 %/1·4 % (China definition), 14·7 %/4·4 %/0·7 % (International Obesity Task Force (IOTF) definition), and 2·8 %/5·7 %/0·9 % (WHO definition). The prevalence of thinness and overweight was significantly different between both sexes based on each of three BMI classification criteria (P < 0·001). There was no significant difference in the prevalence of obesity between both sexes according to each of three BMI criteria. There was no clear trend in the prevalence of thinness across ages according to the China or IOTF definition (both P > 0·05), whereas an upward trend was observed for thinness in boys according to the IOTF definition (Pfor trend <0·05). In contrast, the prevalence of thinness tended to decrease with increasing age in girls according to the IOTF definition and in total sample according to the WHO definition (Pfor trend <0·05).

CONCLUSIONS

Among Tibetan adolescents, the prevalence of overweight and obesity is relatively low, while the prevalence of thinness is high, especially in boys. These data suggest urgent attention is needed to control adolescent thinness in Tibet.

Comparison of different BMI cut-offs to screen for child and adolescent obesity in urban China

Objectives:

To determine which set of BMI cut-offs is the most appropriate to define child and adolescent obesity in urban China.

Design:

A cross-sectional study was carried out between 1 November and 31 December in 2017.

Setting:

Community Healthcare Center in Minhang District, Shanghai, China.

Participants:

A total of 12 426 children and adolescents aged 7–17 years were selected by cluster random sampling. Bioelectrical impedance analysis was the gold standard to measure body composition.

Results:

Comparisons of three sets of BMI cut-offs by sensitivity and κ value revealed that the Working Group on Obesity in China (WGOC) (sensitivity 39·9–84·0 %; κ 0·51–0·79) and WHO (sensitivity 25·5–74·5 %; κ 0·35–0·78) cut-offs were not superior to the International Obesity Task Force (IOTF) (sensitivity 47·9–92·4 %; κ 0·58–0·85) cut-offs across all subgroups. The WGOC and WHO cut-offs yielded higher misclassification rates, in the worst case, categorising 11·2 % of girls with high adiposity as normal and 44·4 % of them as overweight, while the IOTF cut-offs categorised 2·3 % as normal and 30·7 % as overweight. Individuals who were classified by the IOTF cut-offs as overweight had the lowest ratios of high adiposity (4·2–41·6 %) than by the BMI cut-offs for each subgroup. Among pubertal girls, none of the BMI-based cut-offs indicated excellent agreement with body fat percentage, and κ value of the WHO cut-offs (0·35 (95 % CI 0·29, 0·41)) was lower than the other two sets of BMI cut-offs (all P < 0·001).

Conclusions:

The IOTF cut-offs for Asian should be recommended for child obesity screening in urban China. Pubertal individuals need a more accurate indicator of obesity screening.

Evaluating body composition in infancy and childhood: A comparison between 4C, QMR, DXA, and ADP

BACKGROUND

Accurate and precise methods to measure of body composition in infancy and childhood are needed.

OBJECTIVES

This study evaluated differences and precision of three methods when compared with the four-compartment (4C) model for estimating fat mass (FM).

METHODS

FM of children (age 14 days to 6 years of age, N = 346) was obtained using quantitative nuclear magnetic resonance (QMR, EchoMRI-AH), air-displacement plethysmography (ADP, PeaPod, less than or equal to 8 kg, BodPod age 6 years or older), and dual-energy X-ray absorptiometry (DXA, Hologic QDR). The 4C model was computed. Correlation, concordance, and Bland-Altman analyses were performed.

RESULTS

In infants, PeaPod had high individual FM accuracy, whereas DXA had high group FM accuracy compared with 4C. In children, DXA had high group and individual FM accuracies compared with 4C. QMR underestimated group FM in infants and children (300 and 510 g, respectively). The instrument FM precision was best for QMR (10 g) followed by BodPod (34 g), PeaPod (38 g), and DXA (45 g).

CONCLUSIONS

In infants, PeaPod was the best method to estimate individual FM whereas DXA was best to estimate group FM. In children, DXA was best to estimate individual and group FM. QMR had the highest instrument precision.

Diagnostic accuracy of tri-ponderal mass index and body mass index in estimating overweight and obesity in South African children

Background

Prevalence of obesity in youths has drastically increased in both industrialised and non-industrialised countries, and this transition resulted in an increased prevalence of chronic diseases.

Aim

The study aimed to comparatively examine prevalence of overweight and obesity status based on tri-ponderal mass index and body mass index in estimating body fat levels in South African children.

Setting

The study was conducted in Limpopo and Mpumalanga provinces of South Africa.

Methods

A cross-sectional survey of 1361 (boys: n = 678; girls: n = 683) children aged 9–13 years was undertaken. The children’s age and sex-related measurements of body weight, waist-to-height ratio, waist-to-hip ratio, triceps skinfold, subscapular skinfolds and sum of skinfold were taken using the International Society for Advancement of Kinanthropometry protocol. TMI and BMI calculations classified children according to weight and age categories. Descriptive statistics, Spearman’s correlations and multiple linear regression analyses were set at ≤ 0.05.

Results

Obesity classifications on TMI and BMI among children were as follows: Boys: 7.3%, 2.6%; 2.2%, 0.7%; Girls: 4.0%, 1.0%; 1.8%, 0.6%. Body weight, WHtR, WHpR, TSKF, SSKF and ΣSKF significantly correlated with TMI (r = 0.40, p < 0.001; r = 0.73, p < 0.001; r = −0.09, p < 0.001; r = 0.50, p < 0.001; r = 0.51, p < 0.001 and r = 0.52, p < 0.001) and BMI (r = 0.81, p < 0.001; r = 0.59, p < 0.001; r = −0.22, p < 0.001; r = 0.63, p < 0.001; r = 0.67, p < 0.001 and r = 0.66, p < 0.001). Regression analysis revealed that body weight, WHtR, WHpR, TSKF, SSKF and ΣSKF accounted for 65% and 85% of variance in children’s TMI (R² = 0.647, F[6 1354] = 413.977, p < 0.001) and BMI (R² = 0.851, F[6 1354] = 1288.218, p < 0.001).

Conclusion

TMI revealed strikingly higher incidence of overweight and obesity in South African boys and girls than BMI. Future studies are needed to clarify sensitivity of TMI over BMI in quantifying obesity prevalence in children and adolescents.

Prevalence of obesity in Italian adolescents: does the use of different growth charts make the difference?

BACKGROUND

Since populations are becoming increasingly multi-ethnic, the use of local or international charts is a matter of debate. This study aimed to evaluate how the choice of cut-off thresholds affected prevalence of underweight (UW), overweight (OW), obesity (OB) in 1200 11-12-year Italian adolescents, and how their somatic growth depended on parental origin.

METHODS

The height, weight and body mass index were expressed as standard deviation score (SDS) using Italian (ISPED-2006) and UK (UK-1990) charts. The classification of UW/OW/OB was computed with the IOTF international cut-offs, and thresholds were identified as centiles corresponding to BMI values of 18.5/25.0/30.0 kg/m² at 18-year in ISPED-2006 or UK-1990 references.

RESULTS

About 30% participants had non-Italian parents, above all from North-Africa and Romania. Referring to the UK-1990 charts, all groups showed negative mean SDS for height, and positive SDS for weight and BMI. Referring to the ISPED-2006 charts, all mean SDS were negative. Percentage of UW individuals was higher in accordance with ISPED-2006 than with UK-1990 charts, whereas percentages of OW/OB were higher with UK-1990 than ISPED-2006 charts. The results obtained using IOFT cut-offs were similar to UK-1990 cut-offs. These results were due to the different shape of age-dependent cut-off centiles. Independently by the parental origin, the percentages of adolescents classified as OW/OB were closer to the expected values using the ISPED-2006 then the UK-1990 cut-offs. The results suggested the use of the Italian references for adolescents with immigrant parents.

CONCLUSION

The use of local charts seems more appropriate at least in Italian adolescents in the age range studied.

Diagnostic performance of body mass index to identify obesity as defined by body adiposity in children and adolescents: a systematic review and meta-analysis

BACKGROUND

The ideal means of identifying obesity in children and adolescents has not been determined although body mass index (BMI) is the most widely used screening tool.

OBJECTIVE

We performed a systematic review and meta-analysis of studies assessing the diagnostic performance of BMI to detect adiposity in children up to 18 years.

METHODS

Data sources were EMBASE, MEDLINE, Cochrane, Database of Systematic Reviews Cochrane CENTRAL, Web of Science and SCOPUS up to March 2013. Studies providing measures of diagnostic performance of BMI and using body composition technique for body fat percentage measurement were included.

RESULTS

Thirty-seven eligible studies that evaluated 53 521 patients, with mean age ranging from 4 to 18 years were included in the meta-analysis. Commonly used BMI cut-offs for obesity showed pooled sensitivity to detect high adiposity of 0.73 (confidence interval [CI] 0.67-0.79), specificity of 0.93 (CI 0.88-0.96) and diagnostic odds ratio of 36.93 (CI 20.75-65.71). Males had lower sensitivity. Moderate heterogeneity was observed (I(2) = 48%) explained in meta-regression by differences across studies in race, BMI cut-off, BMI reference criteria (Center for Disease Control vs. International Obesity Task Force) and reference standard method assessing adiposity.

CONCLUSION

BMI has high specificity but low sensitivity to detect excess adiposity and fails to identify over a quarter of children with excess body fat percentage.

Systematic review to identify and appraise outcome measures used to evaluate childhood obesity treatment interventions (CoOR): evidence of purpose, application, validity, reliability and sensitivity

BACKGROUND

Lack of uniformity in outcome measures used in evaluations of childhood obesity treatment interventions can impede the ability to assess effectiveness and limits comparisons across trials.

OBJECTIVE

To identify and appraise outcome measures to produce a framework of recommended measures for use in evaluations of childhood obesity treatment interventions.

DATA SOURCES

Eleven electronic databases were searched between August and December 2011, including MEDLINE; MEDLINE In-Process and Other Non-Indexed Citations; EMBASE; PsycINFO; Health Management Information Consortium (HMIC); Allied and Complementary Medicine Database (AMED); Global Health, Maternity and Infant Care (all Ovid); Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCOhost); Science Citation Index (SCI) [Web of Science (WoS)]; and The Cochrane Library (Wiley) - from the date of inception, with no language restrictions. This was supported by review of relevant grey literature and trial databases.

REVIEW METHODS

Two searches were conducted to identify (1) outcome measures and corresponding citations used in published childhood obesity treatment evaluations and (2) manuscripts describing the development and/or evaluation of the outcome measures used in the childhood intervention obesity evaluations. Search 1 search strategy (review of trials) was modelled on elements of a review by Luttikhuis et al. (Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O'Malley C, Stolk RP, et al. Interventions for treating obesity in children. Cochrane Database Syst Rev 2009;1:CD001872). Search 2 strategy (methodology papers) was built on Terwee et al.'s search filter (Terwee CB, Jansma EP, Riphagen II, de Vet HCW. Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments. Qual Life Res 2009;18:1115-23). Eligible papers were appraised for quality initially by the internal project team. This was followed by an external appraisal by expert collaborators in order to agree which outcome measures should be recommended for the Childhood obesity Outcomes Review (CoOR) outcome measures framework.

RESULTS

Three hundred and seventy-nine manuscripts describing 180 outcome measures met eligibility criteria. Appraisal of these resulted in the recommendation of 36 measures for the CoOR outcome measures framework. Recommended primary outcome measures were body mass index (BMI) and dual-energy X-ray absorptiometry (DXA). Experts did not advocate any self-reported measures where objective measurement was possible (e.g. physical activity). Physiological outcomes hold potential to be primary outcomes, as they are indicators of cardiovascular health, but without evidence of what constitutes a minimally importance difference they have remained as secondary outcomes (although the corresponding lack of evidence for BMI and DXA is acknowledged). No preference-based quality-of-life measures were identified that would enable economic evaluation via calculation of quality-adjusted life-years. Few measures reported evaluating responsiveness.

LIMITATIONS

Proposed recommended measures are fit for use as outcome measures within studies that evaluate childhood obesity treatment evaluations specifically. These may or may not be suitable for other study designs, and some excluded measures may be more suitable in other study designs.

CONCLUSIONS

The CoOR outcome measures framework provides clear guidance of recommended primary and secondary outcome measures. This will enhance comparability between treatment evaluations and ensure that appropriate measures are being used. Where possible, future work should focus on modification and evaluation of existing measures rather than development of tools de nova. In addition, it is recommended that a similar outcome measures framework is produced to support evaluation of adult obesity programmes.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Nutritional Knowledge and Practices, Lifestyle Characteristics and Anthropometric Status of Turks and Caicos Islands Elementary School Children

OBJECTIVES

To assess nutritional status, knowledge, practices and lifestyle characteristics of Turks and Caicos Islands (TCI) primary school children.

SUBJECTS AND METHODS

Sociodemographic, nutrition knowledge and lifestyle information were collected via an interviewer-assisted questionnaire from grade 5 to 6 participants in a cross-sectional survey; anthropometrics were collected by trained interviewers.

RESULTS

Two hundred and ninety-seven students (mean age = 10.91 ± 1.01 years; female = 162 [54.5%]; overweight/obese = 121 [40.8%]) participated. Most were born (61.8%) or resided in TCI for more than five years (76.1%). Dietary patterns of breakfast (75.8%); ≥ 2 meals/day (81.2%); ≥ 1 snack/day (65%) and consumption of vegetables (14.5%) and fruits (27.3%) ≥ 2/day were reported. Multinomial regression examined lifestyle and sociodemographic characteristics among body mass index (BMI) categories. Breakfast-eaters were 54% less likely (OR = 0.46; p = 0.025) to be obese; consumers of < 3 meals/day were approximately twice more likely to be obese (OR = 2.074; p = 0.02); participants who "ate out" < 2 times/day (including lunch) were less likely to be overweight (OR = 0.365; p = 0.02). More boys reported strenuous activity (p = 0.05) while more girls reported moderate activity (p = 0.004). No vigorous exercise for ≥ 4 days/week was associated with obesity (OR = 2.0; p = 0.03). Most (> 80%) knew the food groups and that non-communicable diseases were related to diet and obesity (> 70%).

CONCLUSION

Findings should inform policy, via the "Health in All" policy initiatives, to develop multisectoral interventions to positively impact children's nutritional status and ultimately eliminate obesogenic environments.

Prevalence of overweight and obesity among primary school children in a developing country: NW-CHILD longitudinal data of 6-9-yr-old children in South Africa

Background

Widespread trends of increasing child obesity are reported in developing countries. This longitudinal NW-CHILD study investigated changes in overweight and obesity over a three year period among 574 children between the ages 6 and 9 (282 boys, 292 girls; 407 black, 143 white) in South Africa (SA), taking into consideration sex, race and school type. Stratified random sampling was used to identify 20 schools, across 5 school SES levels (quintiles), in 4 educational districts of the North West Province of SA. Standard anthropometric techniques and international age adjusted BMI cut-off points for children were used to determine overweight and obesity, 3-years apart. Mixed models were used to analyse the effects of sex, race and socio-economic status (SES) of the school.

Results

Overall obesity increased over 3-years by 4% from 12.5% at baseline to 16.7% during follow-up. Obesity increased significantly in both white (4.2%) and black (2.0%) children, although overall prevalence in the final year was double (27.3%) in white children compared to black children (13.3%). Prevalence in obesity increased more in boys (3.2%) compared to girls (2.4%), although girls showed a higher overall prevalence (18.5%). SES effects were significant where children in schools associated with higher SES, had the highest rate of increase and the highest prevalence of obesity. A significant change towards an unhealthy BMI was found in 9.2% of the group over the 3-year period, although a small percentage (3.0%) also transitioned towards a healthier BMI.

Conclusions

Overall obesity prevalence rose significantly from 6–9-years. Obesity, compared to overweight, increased more during this period. Prevalence and rate of increase differed markedly in different sexes, race and SES, masking the extent of the problem. Shifting towards an unhealthy BMI was more common than obtaining a healthier BMI over the 3-year period. It also demonstrated the difficulty of breaking the cycle of obesity, once it had started. Early prevention strategies are needed based on the trends established in this study, with special attention to white children living in high SES regions, and black children in economic transition.

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.

Sustainability of a Curriculum-based Intervention on Dietary Behaviours and Physical Activity among Primary School Children in Trinidad and Tobago

OBJECTIVES

Childhood obesity and poor lifestyle practices are emerging as major public health challenges in the Caribbean. Given the fact that a significant part of childhood is spent at school, curriculum-based interventions aimed at improving good dietary and physical activity patterns may provide a useful vehicle for mass inculcation of long-term healthy lifestyle practices. In this study, we evaluated the long-term impact of a brief curriculum based intervention on dietary behaviour, physical activity and knowledge level of primary schoolchildren.

METHODS

The study was a randomized, controlled, school-based nutrition education and physical activity intervention. One hundred students each were then randomly assigned to the intervention (IVG) and non-intervention (NIVG) groups and followed-up for 18 months. Participants in the IVG group were exposed to a curriculum consisting of six one-hour modules followed by school-based activities geared at fostering healthy behaviours. Students in the non-intervention group did not receive any modules and were subject to the information available at school on a regular basis.

RESULTS

In multivariate regression equations controlling for age, gender, body mass index (BMI) and baseline values, intervention was associated with lower intake of fried foods and sodas (p < 0.05) and higher knowledge scores (p < 0.01) 18 months later but not significantly associated with improved physical activity or lower BMI.

CONCLUSIONS

In this study, participants in the intervention group reported significantly lower intakes of fried foods and sodas and higher knowledge scores than participants in the control group some 18 months post-intervention independent of age, gender, BMI, ethnicity and the intakes at baseline.

A cross-sectional study of Jamaican adolescents' risk for type 2 diabetes and cardiovascular diseases

OBJECTIVES

To compare obese versus non-obese Jamaican adolescents' risk for type 2 diabetes (T2D) and cardiovascular diseases (CVDs); and to explore a suitable and economical method of screening for these risk factors in the school settings.

DESIGN

A descriptive cross-sectional study of adolescents' risk for T2D and CVD. All the participants were examined at their respective schools.

SETTING

Jamaica, West Indies.

POPULATION

276 Jamaican adolescents aged 14-19 years, randomly selected from grades 9 to 12 from 10 high schools on the island and included both boys and girls. All ethnicities on the island were represented.

MAIN OUTCOME MEASURES

High fasting blood glucose, total cholesterol, glycated haemoglobin (HbA1c), blood pressure, body mass index (BMI), waist circumference, waist-to-hip ratio, family history of obesity, T2D and CVDs, low physical activity, and presence of Acanthosis Nigricans. All blood measures were analysed using the finger prick procedure.

RESULTS

Waist circumference, waist-to-hip ratio, Acanthosis Nigricans, total cholesterol, family history of T2D and blood pressure were the strongest predictors of BMI (p=0.001). Over one-third of the participants were overweight. Jamaican adolescent females had a significantly higher number of risk factors and were less physically active than males (p<0.05). Over 80% of participants reported ≥3 risk factors for T2D and CVD. Participants with BMI ≥25 reported five or more risk factors. One-third of the overweight participants were classified with metabolic syndrome.

CONCLUSIONS

Jamaican adolescents are at risk of T2D and CVD. Family history of disease and anthropometric measures identified more participants at risk than did the blood measures. Jamaican adolescent females reported more risk factors for T2D and CVD as compared to males. Collection of this type of data was feasible within the school settings. All data were collected in 1 day per school. Intervention measures are needed to educate Jamaican adolescents to reduce overweight and subsequently the risk factors.

The abilities of body mass index and skinfold thicknesses to identify children with low or elevated levels of dual-energy X-ray absorptiometry-determined body fatness

OBJECTIVE

To examine the accuracies of body mass index (BMI) and skinfold thicknesses in classifying the body fatness of 7365 8- to 19-year-old subjects in a national sample.

STUDY DESIGN

We used percent body fat determined by dual-energy x-ray absorptiometry (PBFDXA) between 1999 and 2004. Categories of PBFDXA and the skinfold sum (triceps plus subscapular) were constructed so that that numbers of children in each category were similar to the number in each of 5 BMI categories based on the Centers for Disease Control and Prevention growth charts.

RESULTS

Approximately 75% of the children and adolescents who had a BMI-for-age ≥ 95th percentile (considered obese) had elevated body fatness, but PBFDXA levels were more variable at lower BMIs. For example, only 41% of the boys who had a BMI < 25th percentile, had a similarly low PBFDXA. The use of the skinfold sum, rather than BMI, slightly improved the identification of elevated levels of body fatness among boys (P = .03), but not among girls (P > .10). A low sum of the triceps and subscapular skinfold thicknesses was a better indicator of low PBFDXA than was a low BMI, but differences were smaller among children with greater levels of body fatness. Among girls who had a PBFDXA above the median, for example, BMI and the skinfold sum were correlated similarly (r = 0.77-0.79) with body fatness.

CONCLUSIONS

Both BMI and skinfold thicknesses are fairly accurate in identifying children who have excess body fatness. In contrast, if the goal is to identify children who have low body fatness, skinfold thicknesses would be preferred.

High prevalence of hypertension in obese children in the Caribbean

BACKGROUND

The prevalence of obesity is increasing worldwide. Obesity in children and adults leads to diabetes mellitus type 2 and cardiovascular disease.

AIM

To determine the prevalence of high blood pressure in overweight and obese children in the Caribbean.

METHODS

In a cross-sectional study, weight and height were measured in all 5-16-year-old children attending public school in 2008 on Bonaire, an island in the Caribbean. Cut-off values for body mass index (BMI) are defined by the International Obesity Task Force. Blood pressure was measured in all overweight and obese children as well as in a control group with normal weight and compared with reference values from the National High Blood Pressure Working Group on Children.

RESULTS

94% (2023/2152) of all children participated in the study. 17% (335/2023) of the children were overweight (excluding obesity) and a further 12% (246/2023) were obese. Hypertension was found in 13% (67/526) of children of normal weight, in 23% (71/307) of overweight children and in 53% (127/242) of obese children. Compared with normal-weight children, the odds for hypertension were 2.1 (95% CI 1.4-3.0) for overweight children and 7.2 (95% CI 5.0-10.3) for obese children.

CONCLUSION

There is a high prevalence of hypertension in overweight and obese children on Bonaire. As hypertension is a harbinger of cardiovascular disease, early detection and treatment of overweight and obese children is of paramount importance and their blood pressure needs to be measured regularly.

Tracking of fatness during childhood, adolescence and young adulthood: a 7-year follow-up study in Madeira Island, Portugal

AIMS

Investigating tracking of fatness from childhood to adolescence, early adolescence to young adulthood and late adolescence to young adulthood.

SUBJECTS AND METHODS

Participants from the Madeira Growth Study were followed during an average period of 7.2 years. Height, body mass, skin-folds and circumferences were measured, nine health- and performance-related tests were administered and the Baecke questionnaire was used to assess physical activity. Skeletal maturity was estimated using the TW3 method.

RESULTS

The prevalence of overweight plus obesity ranged from 8.2-20.0% at baseline and from 20.4-40.0% at follow-up, in boys. Corresponding percentages for girls were 10.6-12.0% and 13.2-18.0%. Inter-age correlations for fatness indicators ranged from 0.43-0.77. BMI, waist circumference and sum of skin-folds at 8, 12 and 16-years old were the main predictors of these variables at 15, 19 and 23-years old, respectively. Strength, muscular endurance and aerobic fitness were negatively related to body fatness. Physical activity and maturation were independently associated with adolescent (15 years) and young adult (19 years) fatness.

CONCLUSIONS

Over 7.2 years, tracking was moderate-to-high for fatness. Variance was explained by fatness indicators and to a small extent by physical fitness, physical activity and maturation.

Factors associated with tracking of BMI: a meta-regression analysis on BMI tracking

Stable tracking of body composition is a prerequisite for the long-term effect of preventive measures against obesity and its harmful effects. As BMI tracking estimates reported by individual studies vary considerably, we performed a meta-regression analysis to provide a summary estimate and to assess determinants of BMI tracking. Using the Medline and EMBASE databases, a systematic review was conducted to identify publications reporting correlation coefficients as tracking estimates between BMI at baseline and follow-up measurements and the time interval between these measurements. Additional information recorded included age at baseline measurement, gender, and origin of the studied population. Based on the extracted data, a meta-regression analysis was performed using mixed effects models to account for multiple measurements of the same cohorts. Data on 55,072 individuals (797,094 person-years) extracted from 48 publications with follow-up times between 0.5 and 44 years entered the analysis. The overall estimates for the 1-year tracking correlation coefficient were strong (r = 0.78-0.86 depending on age at baseline measurement) and gradually decreasing over time (0.67-0.78 after 10 years, and 0.27-0.47 after 30 years). Study origin classified by continent was another significant predictor of BMI tracking whereas gender was not. In conclusion, this meta-regression analysis showed a high degree of BMI tracking across all age groups investigated and independent of BMI. Successful prevention in weight control is likely to have long term effects at any age, thereby being beneficial with respect to the associated risks of over- and underweight.

Accuracy of simple clinical and epidemiological definitions of childhood obesity: systematic review and evidence appraisal

The optimum means of defining obesity in children is unclear, creating variation in practice, and hindering obesity surveillance, prevention and treatment. This study aimed to review evidence on the use of body mass index (BMI) and waist circumference for diagnosis of high body fat content and adverse cardiometabolic risk factors in children and adolescents. A systematic literature review was carried out and evidence appraised using the Quality Assessment of Studies of Diagnostic Accuracy in Systematic Reviews method. Literature searching began following the last systematic review of this topic (end 2001) and collected evidence in MEDLINE and EMBASE in 0- to 18-year-olds that compared the accuracy of BMI vs. waist circumference and compared BMI interpreted relative to national reference data vs. BMI interpreted relative to Cole/International Obesity Task Force international reference data. Ten studies compared diagnostic accuracy of BMI vs. waist circumference: they reported no improved identification of adverse cardiometabolic risk profiles from waist circumference over that provided by high BMI. Eight studies compared BMI with national reference data vs. the international approach: 5/8 found significantly poorer accuracy (lower sensitivity) using BMI with the international approach; 3/8 found similar sensitivity; in 7/7 studies that compared specificity this was similar. In conclusion, the present review provides no compelling evidence for use of either high waist circumference or BMI interpreted using the International Obesity Task Force approach in preference to the use of national BMI percentiles for the identification of children and adolescents with excess fatness and adverse cardiometabolic risk profile.

Growth, body composition, and the onset of puberty: longitudinal observations in Afro-Caribbean children

CONTEXT

Childhood growth and body composition may influence the onset of puberty.

OBJECTIVE

We examined the effects of birth size, growth rates throughout childhood, and body composition on the onset of puberty in Afro-Caribbean children.

DESIGN AND SETTING

This was a longitudinal birth cohort study (the Vulnerable Windows Cohort Study) in Jamaica.

SUBJECTS AND MEASUREMENTS

The anthropometry (weight, height, skinfold measurements, and waist circumference) of 259 children was measured at birth, at 6 wk, every 3 months to 2 yr, and then every 6 months. Tanner staging for puberty and orchidometry were performed every 6 months starting at approximately age 8 yr. Bioelectrical impedance was done at age 11 yr.

RESULTS

In the girls, thelarche, pubarche, and menarche occurred at median ages of 8.8, 9.9, and 12.0 yr, respectively. Pubarche in boys occurred at a median age of 11.3 yr when the median testicular volume was 2.8 ml. Faster weight gain during infancy (age 0-6 months) and childhood, but not birth size, was associated with more advanced puberty (P values <0.05). Fat mass at age 8 yr was associated with more advanced puberty (P values <0.001) in both sexes. At age 11 yr, lean mass, but not fat mass, was associated with more advanced puberty (P values <0.001).

CONCLUSION

These data support the hypothesis that faster growth throughout childhood, especially with fat mass accretion, is associated with more advanced puberty apart from menarche. With the onset of puberty, lean mass accretion significantly increases.

Ethnic differences in subcutaneous adiposity and waist girth in children and adolescents

The purpose of this study was to examine ethnic differences in adiposity as measured by sum of skinfolds (SKF) and waist circumference (WC) in children and adolescents, after statistical adjustment for the BMI and age. A cross sectional sample of 3,218 (55% white, 49% male) children and adolescents aged 5-18 years who participated in the Bogalusa Heart Study (1992-1994) were included in these analyses. Sex-specific ANOVAs, adjusted for BMI and age, for each 2-year age group compared measures of adiposity (SKF and WC) between ethnic groups. No significant differences in the proportions of children and adolescents who were overweight and obese by ethnicity or sex were found. Mean SKF in normal weight (P < 0.0001) and overweight (P < 0.0001) categories was higher for white than black children of both sexes. Across most age categories, white boys and girls had significantly higher SKF than black boys and girls, respectively (P Collapse

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MESH Headings

• Adiposity/ethnology
• Adolescent
• Black or African American
• Aging
• Body Mass Index
• Child
• Child, Preschool
• Cross-Sectional Studies
• Female
• Humans
• Louisiana
• Male
• Obesity/ethnology
• Overweight/ethnology
• Risk
• Sex Factors
• Skinfold Thickness
• Subcutaneous Fat/anatomy & histology
• Waist Circumference/ethnology
• White People

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Grants

• P30 DK072476 NIDDK NIH HHS
• R03 HD043820 NICHD NIH HHS
• HL38844 NHLBI NIH HHS
• HD043820 NICHD NIH HHS

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Affiliation(s)

Susan B. Sisson Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
Peter T. Katzmarzyk Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
Sathanur R. Srinivasan Department of Epidemiology, Tulane Center for Cardiovascular Health, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
Wei Chen Department of Epidemiology, Tulane Center for Cardiovascular Health, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
David S. Freedman Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Claude Bouchard Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
Gerald S. Berenson Department of Epidemiology, Tulane Center for Cardiovascular Health, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA

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Collaborators Collapse

The validity of BMI as an indicator of body fatness and risk among children

PURPOSE OF REVIEW

Although the prevalence of childhood obesity, as assessed by BMI (kg/m(2)), has tripled over the last 3 decades, this index is a measure of excess weight rather than excess body fatness. In this review we focus on the relation of BMI to body fatness and health risks, particularly on the ability of BMI for age >or=95th Centers for Disease Control and Prevention [CDC] percentile to identify children who have excess body fatness. We also examine whether these associations differ according to race/ethnicity and whether skinfold and circumference measurements provide additional information on body fatness or health risks.

RESULTS

The accuracy of BMI varies according to the degree of body fatness. Among relatively fat children, BMI is a good indicator of excess adiposity, but differences in the BMIs of relatively thin children can be largely due to fat-free mass. Although the accuracy of BMI in identifying children with excess body fatness depends on the chosen cut points, we have found that a high BMI-for-age has a moderately high (70%-80%) sensitivity and positive predictive value, along with a high specificity (95%). Children with a high BMI are much more likely to have adverse risk factor levels and to become obese adults than are thinner children. Skinfold thicknesses and the waist circumference may be useful in identifying children with moderately elevated levels of BMI (85th to 94 th percentiles) who truly have excess body fatness or adverse risk factor levels.

CONCLUSION

A BMI for age at >or=95th percentile of the CDC reference population is a moderately sensitive and a specific indicator of excess adiposity among children.

Receiver operating characteristic (ROC) curve analysis in 5–10-year-old Bengalee girls from Calcutta, India

OBJECTIVE

The purpose of the present cross-sectional study was to evaluate the sensitivity (SN) and specificity (SP) of body mass index (BMI) and skinfolds thickness: BMI (subcutaneous to overall fat) in detecting excess adiposity in pre-menarcheal Bengalee girls.

METHODS

Four hundred and fifty Bengalee girls aged 7.4 +/- 1.16 years (mean +/- SD; range: 5-10 years) from Calcutta were studied. Anthropometric measures--namely height, weight, circumference of mid upper arm, waist and hip, and skinfold thickness at biceps, triceps, subscapular and suprailiac - were taken from all participants using standard protocols. BMI and the log-transformed sum of four (biceps, triceps, subscapular, suprailiac) skinfolds (log10 SF4) were computed subsequently. Values of log10 SF4 were then converted into seven percentiles category (5th, 10th, 25th, 50th, 75th, 85th and 95th). Excess adiposity was defined as a level of log10 SF4 greater than the internally derived 85th percentile (log10 SF4>85th percentile). SN and SP of each internally derived percentile of BMI and log10 SF4:BMI in detecting excess adiposity were then computed.

RESULTS

SN and SP were 0.49 and 0.94 for the 95th percentile of BMI, and 0.76 and 0.82 for the 95th percentile of log10 SF4:BMI. Moreover, there was a considerable decrease in overall misclassification with the use of log10 SF4:BMI instead of BMI at the 95th percentile (11.2% vs 32%).

CONCLUSION

Percentiles of BMI in the study had higher SP but low SN in detecting excess adiposity. The use of log10 SF4:BMI, on the other hand, had the merit of increasing SN in a screening programme to evaluate excess adiposity in Bengalee children aged 5-10 years.

Ethnic differences in overweight and obesity in early adolescence in the MRC DASH study: the role of adolescent and parental lifestyle

BACKGROUND

Ethnicity is a consistent correlate of excess weight in youth. We examine the influence of lifestyles on ethnic differences in excess weight in early adolescence in the UK.

METHOD

Data were collected from 6599 pupils, aged 11-13 years in 51 schools, on dietary practices and physical activity, parental smoking and overweight, and on overweight and obesity (using International Obesity Task Force criteria).

RESULTS

Skipping breakfast [girls odds ratio (OR) 1.74, 95% confidence interval (CI) 1.30-2.34; boys OR 2.06; CI 1.57-2.70], maternal smoking (girls OR 2.04, CI 1.49-2.79; boys OR 1.63, CI 1.21-2.21) and maternal overweight (girls OR 2.01, CI 1.29-3.13; boys OR 2.47, CI 1.63-3.73) were associated with obesity. Skipping breakfast, more common among girls, was associated with other poor dietary practices. Compared with White UK peers, Black Caribbeans (girls OR 1.62, CI 1.24-2.12; boys OR 1.49, CI 1.15-1.95) and Black Africans (girls OR 1.96, CI 1.52-2.53; boys OR 2.50, CI 1.92-3.27) were more likely to skip breakfast and engage in other poor dietary practices, and Indians were least likely. White Other boys reported more maternal smoking (OR 1.37, CI 1.03-1.82). All these reports were more common among those born in the UK than those born elsewhere. Black Caribbean girls were more likely to be overweight (OR 1.38, CI 1.02-1.87) and obese (OR 1.65, CI 1.05-2.58), Black African girls to be overweight (OR 1.35, CI 1.02-1.79) and White Other boys to be overweight (OR 1.37, CI 1.00-1.88) and obese (OR 1.86, CI 1.15-3.00). Adverse dietary habits and being born in the UK contributed to these patterns.

CONCLUSION

These findings signal a potential exacerbating effect on ethnic differences in obesity if adverse dietary habits persist. Combined adolescent and parent-focused interventions should be considered.

Misperceptions, inactivity and maternal factors may drive obesity among Barbadian adolescents

Objectives

To describe (1) the prevalence of overweight and obesity and their association with physical activity; (2) the effect of different cut-off points for body mass index (BMI) on weight status categorisation; and (3) associations of weight status with perceptions of body size, health and diet quality.

Design

A cross-sectional study.

Setting

Secondary schools in Barbados.

Subjects

A cohort of 400 schoolchildren, 11–16 years old, selected to study physical education practices.

Results

Prevalence of overweight (15% boys; 17% girls) and obesity (7% boys; 12% girls) was high. Maternal obesity, as defined by the International Obesity Task Force (IOTF) BMI cut-off points, predicted weight status such that reporting an obese mother increased the odds of being overweight by 5.25 (95% confidence interval: 2.44, 11.31). Physical activity was inversely associated with weight status; however levels were low. Recreational physical activity was not associated with weight status in either category. Overweight subjects tended to misclassify themselves as normal weight and those who misclassified perceived themselves to be of similar health status to normal-weight subjects. The National Center for Health Statistics and IOTF BMI cut-off points produced different estimates of overweight and obesity.

Conclusions

Our findings suggest that inadequate physical activity and ignorance related to food and appropriate body size are promoting high levels of adiposity with a strong contribution from maternal obesity, which may be explained by perinatal and other intergenerational effects acting on both sexes. Prevalence studies and local proxy tools for adiposity assessment are needed.

Anthropometric reference values in an Afro-Caribbean adolescent population

Childhood and adolescent obesity is increasingly becoming a major public health issue in the Caribbean. In this study, we analyze patterns of growth in a population of Afro-Caribbean adolescents 12-18 years old and to compare these with those established for US adolescents. A cross-section of adolescent schoolchildren had weight and height measured using standardized procedures. In addition, percentage body fat (% BF) was measured using a foot-to-foot bioelectric impedance body fat analyzer (Tanita model 531). Selected age- and gender- specific percentiles of BMI, %BF, weight and height were derived and smoothed by cubic splines. These were compared with similar percentiles from US adolescent growth data. A total of 3,707 adolescents (1,585 males; 2,122 females) participated in the study. The age-specific correlation between BMI and %BF ranged from 0.75 to 0.87 in males and 0.79 to 0.87 in females. Females had significantly higher %BF than males in each age category. Overall, Tobagonian females were heavier and had higher BMI than their US counterparts especially levels above the median percentiles. Tobagonian males had similar height, weight, and BMI to their US counterparts over the range of percentiles. Overall, the pattern of growth in this group of adolescents suggests that they are growing at rates that are comparable to those seen in a more well-nourished population.

Diagnosis of overweight and obesity in adolescents from the 1993 Pelotas Birth Cohort Study, Rio Grande do Sul State, Brazil: comparison of two diagnostic criteria

Various cut-off points for body mass index have been proposed to assess nutritional status in adolescents. The aim of this study was to compare two methods for evaluating overweight and obesity. In 2004-5, 4,452 adolescents from the 1993 Pelotas (Brazil) birth cohort study were evaluated, representing 87.5% of the original cohort. Overweight and obesity were evaluated using the methods proposed by the World Health Organization (WHO) and International Obesity Task Force (IOTF). Prevalence of overweight was similar when comparing the two methods (WHO: 23.2%; IOTF: 21.6%). Prevalence of obesity was higher according to the WHO criterion (total sample: 11.6%; boys: 15.1%; girls: 8.2%) as compared to IOTF (total sample: 5.0%; boys: 5.6%; girls: 4.4%). The kappa statistic was around 0.9 for determining overweight and 0.4 for obesity. The IOTF classification showed high specificity in comparison to the WHO criterion for determining overweight and obesity. However, sensitivity was high for overweight but low for obesity. Our data show that the IOTF classification underestimates the prevalence of obesity in early adolescence.

BMI-based obesity cutoffs and excess adiposity in a Caribbean adolescent population of African origin

OBJECTIVE

To evaluate the diagnostic utility of recommended body mass index (BMI)-based classification systems in detecting excess body fat (BF) in an Afro-Caribbean adolescent population.

SUBJECTS

All adolescents aged 12-18 years were invited to participate in the study. A total of 3749 persons participated fully in the study.

RESULT

Males (12.2%) (95% confidence interval (CI): 10.7, 13.9) and females (43.6%) (95% CI: 41.5, 45.7) had excess adiposity. Specificities were high for all cutoff values (range 90.1-99.7%). Sensitivities ranged from 25.7 to 86.4% and from 15.6 to 54.4% for Centre for Disease Control (CDC) and International Obesity Task Force (IOTF) cutoff values, respectively. The mean areas under the receiver-operating characteristic curves ranged from 62.7 to 88.2% in males and 57.7 to 75.1% in females, while positive likelihood ratios ranged from 8.7 to 90.9 for the recommended BMI cutoff values.

CONCLUSIONS

Overall, the CDC cutoffs had a higher sensitivity than the IOTF cutoffs in screening for excess fat. Specificities were high for cutoff values in both systems and would produce fewer false negatives.

Tracking of overweight status from childhood to young adulthood: the Bogalusa Heart Study

OBJECTIVE

To understand tracking of overweight status from childhood to young adulthood in a biracial sample.

DESIGN

A longitudinal sample was created from cross-sectional surveys at two time points, childhood (baseline) and young adulthood (follow-up).

SETTING

Bogalusa Heart Study, Louisiana, United States of America.

SUBJECTS

A total of 841 young adults, 19-35 years (68% Euro-Americans (EA), 32% African-Americans (AA)) were studied. The same subjects had also participated in one of the five cross-sectional surveys at childhood (9-11 years).

METHODS

Body mass index (BMI) was used to determine overweight status as per the Centers for Disease Control and Prevention standards. Change in the BMI status from childhood to young adulthood was used to group the participants into the following categories: normal weight to normal weight (NW-NW); normal weight to overweight (NW-OW); overweight to normal weight (OW-NW); and overweight to overweight (OW-OW). Tracking of overweight was defined by (1) correlations between baseline and follow-up BMI, (2) Cohen's kappa concordance test to determine the strength of tracking in BMI quartiles and (3) the percentage of individuals who remained in the same overweight status group from baseline to follow-up.

RESULTS

From baseline to follow-up, the percentage of participants who were overweight increased from 24.7 to 57.7%. A total of 35.2% of the children shifted from normal weight in childhood to overweight in young adulthood (P < 0.0005). Baseline BMI was positively correlated with follow-up BMI (r = 0.66, P < 0.0005). A total of 61.9% of the participants in the highest BMI quartile in childhood remained in the highest BMI quartile in young adulthood. The strength of tracking in BMI quartiles was 27% for EA men (P < 0.0005), 23% for EA women (P < 0.0005), 27% for AA men (P<0.0005) and 35% for AA women (P < 0.0005). A total of 53.7% of the EA women remained in the NW-NW category and 31.2% of the AA women remained in the OW-OW category. The percentage tracking (NW-NW and OW-OW) was 72.8% in EA women, 59.6% in AA men, 59.5% in AA women and 48.8% in EA men (P < 0.0001).

CONCLUSION

Childhood overweight tracked into young adulthood in this sample and the tracking of NW-NW and OW-OW was the most prominent among the EA women.

Childhood growth and chronic disease: evidence from countries undergoing the nutrition transition

Evidence is accumulating that the pattern of growth in childhood is associated with development of cardiovascular disease in adulthood, but such evidence comes mostly from developed countries. We conducted a review of studies from countries undergoing the nutrition transition. Five birth cohorts with measures of child growth and outcomes through adolescence were identified, from China, India, Guatemala, Brazil and the Philippines. Across studies there are major differences in data availability and in statistical approaches to modelling child growth and its effects. Nevertheless, generally consistent associations of growth failure in early childhood and development of overweight in later childhood with the risk of elevated blood pressure, glucose, and serum lipids in adulthood were observed. As these cohorts mature they will provide a wealth of critical information on the relation between early life factors and later disease risk, and efforts should be made to ensure ongoing follow-up using standardized approaches and more comprehensive assessments.

Prevalência de sobrepeso e obesidade em escolares de uma escola pública de Florianópolis, Santa Catarina

OBJETIVOS: determinar a prevalência de sobrepeso e obesidade em escolares de sete a nove anos de uma escola pública de Florianópolis. MÉTODOS: foram investigadas 419 crianças entre sete e nove anos de idade, sendo 215 (51,3%) do sexo masculino e 204 (48,7%) do feminino. Como critério diagnóstico de sobrepeso e obesidade foram utilizados os pontos de corte de Índice de Massa Corporal (IMC). Para a verificação das diferenças entre prevalências utilizou-se o teste qui-quadrado. RESULTADOS: encontrou-se prevalência de 17,9% de sobrepeso, sendo maior no sexo masculino (19,1%) do que no feminino (16,7%) e 6,7% de obesidade, com maiores valores no sexo masculino (7,9%) do que no feminino (5,4%), embora a diferença não tenha sido estatisticamente significante. Observou-se maior prevalência de sobrepeso entre as crianças de oito anos (20,4%) e a maior prevalência de obesidade entre aquelas de nove anos (6,8%). Considerando-se faixa etária e sexo a maior prevalência de sobrepeso foi no sexo feminino aos oito anos e de obesidade no sexo masculino aos sete anos de idade. CONCLUSÕES: verificou-se uma elevada prevalência de sobrepeso e obesidade, quando comparada a outros estudos nacionais e internacionais. Esses achados apontam para a adoção de medidas de intervenção nutricional visando à melhoria dos hábitos alimentares e do estado nutricional dos escolares investigados.

A relação cintura quadril e o perímetro da cintura associados ao índice de massa corporal em estudo com escolares

O objetivo deste estudo foi determinar os valores percentis de índice de massa corporal (IMC), relação cintura quadril (RCQ) e perímetro da cintura (PC) e verificar as possíveis correlações existentes entre esses índices em escolares matriculados no Instituto Estadual de Educação, Florianópolis, Santa Catarina, Brasil. Foram investigadas 419 crianças entre sete e nove anos de idade, sendo 215 (51,3%) do sexo masculino e 204 (48,7%) do sexo feminino. O sexo masculino apresentou maiores valores de IMC, RCQ e PC em relação ao sexo feminino; entretanto, com diferença estatística somente para RCQ e PC. Encontrou-se prevalência de 17,9% de sobrepeso e 6,7% de obesidade. Os índices antropométricos que apresentam maior correlação foram o IMC e o PC (r = 0,87 e p < 0,01). Em condições de sobrepeso, o IMC e o PC apresentaram os melhores valores de correlação (r = 0,74). Por outro lado, em condições de obesidade, a RCQ e o PC apresentaram os melhores valores de correlação (r = 0,54).