Comparison of dietary intake among overweight and non-overweight schoolchildren

Describing the longitudinal breakfast quality index trajectories in early childhood: results from Melbourne InFANT program

BACKGROUND

Breakfast quality in early childhood remains understudied. This study describes the changes in breakfast quality index (BQI) (i.e. trajectory) in early childhood and assesses its associations with obesity outcomes.

METHODS

Data from children who participated in the Melbourne InFANT Program were used (n = 328). The Melbourne InFANT Program was a 15-month early obesity prevention intervention conducted from 2008 to 2013. Dietary intakes at ages 1.5, 3.5 and 5.0 years were assessed using three parent-proxy reported 24 h recalls. A revised nine-item BQI tool developed based on Australian dietary recommendations for young children was used to calculate BQI scores. Group-based trajectory modelling identified BQI trajectory groups. Multivariable linear and logistic regression examined the associations between identified BQI trajectory groups and obesity outcomes at age 5 years.

RESULTS

Mean BQI at ages 1.5, 3.5 and 5.0 years was 4.8, 4.8, 2.7 points, respectively. Two BQI trajectory groups were identified, and both showed a decline in BQI. The mean BQI of most children (74%) decreased from 5.0 to 4.0 points from ages 1.5 to 5.0 years (referred as "High BQI" group). The remaining children (26%) had a mean BQI of 4.8 and 1.2 points at age 1.5 and 5.0 years, respectively (referred as "Low BQI" group). The "Low BQI" group appeared to show higher risk of overweight (OR:1.30, 95% CI: 0.60, 2.81, P = 0.66) at age 5 years than the "High BQI" group. No difference in body mass index (BMI) z-score was found between the two groups.

CONCLUSIONS

Two BQI trajectory groups were identified. Both groups showed a decline in breakfast quality from ages 1.5 to 5.0 years. Our study highlights the need for early health promotion interventions and strategies to improve and maintain breakfast quality across early childhood.

Prevention of overweight and obesity in early life

Childhood obesity is a serious challenge for public health. The problem begins early with most excess childhood weight gained before starting school. In 2016, the WHO estimated that 41 million children under 5 were overweight or obese. Once established, obesity is difficult to reverse, likely to persist into adult life and is associated with increased risk of CVD, type 2 diabetes and certain cancers. Preventing obesity is therefore of high importance. However, its development is multi-factorial and prevention is a complex challenge. Modifiable lifestyle behaviours such as diet and physical activity are the most well-known determinants of obesity. More recently, early-life factors have emerged as key influencers of obesity in childhood. Understanding risk factors and how they interact is important to inform interventions that aim to prevent obesity in early childhood. Available evidence supports multi-component interventions as effective in obesity prevention. However, relatively few interventions are available in the UK and only one, TrimTots, has been evaluated in randomised controlled trials and shown to be effective at reducing obesity risk in preschool children (age 1-5 years). BMI was lower in children immediately after completing TrimTots compared with waiting list controls and this effect was sustained at long-term follow-up, 2 years after completion. Developing and evaluating complex interventions for obesity prevention is a challenge for clinicians and researchers. In addition, parents encounter barriers engaging with interventions. This review considers early-life risk factors for obesity, highlights evidence for preventative interventions and discusses barriers and facilitators to their success.

Family Consumer Behaviors, Adolescent Prediabetes and Diabetes in the National Health and Nutrition Examination Survey (2007-2010)

BACKGROUND

Prediabetes or diabetes (characterized by hemoglobin A1c [HbA1c] levels ≥ 5.7 gm%) has been associated with numerous long-term complications. Family consumer behaviors are important risk factors that lead to impaired glucose tolerance or diabetes. However, few studies have studied the association between the family consumer environment and prediabetes and diabetes in adolescents.

OBJECTIVE

The aim of this study was to examine the association between family consumer behaviors (healthy food availability and supermarket spending) and adolescent prediabetes and diabetes (ClinicalTrials.gov identifier #NCT03136289.) Methods: Data from a nationwide survey conducted by the Centers for Disease Control and Prevention (National Health and Nutrition Examination Survey [NHANES] 2007-2010 data) were used for these analyses. Adolescents aged 12-19 years were selected for this study. Bivariate analyses and logistic regression models assessed the relationship between family consumer behaviors and the prevalence of adolescent prediabetes and diabetes. Multivariable models adjusted for age, gender, ethnicity, physical activity, education, income, and household size.

RESULTS

A total of 2520 adolescents were eligible for this study. Adolescents with healthier household food availability had negative odds (odds ratio [OR] = 0.74, 95% confidence interval [CI], 0.55-1.00), as did higher log supermarket spending (OR = 0.69; 95% CI, 0.57-0.85). Interaction models demonstrated that adolescent females had more negative odds of prediabetes/diabetes for both healthier food availability (OR = 0.79, 95% CI, 0.39-1.29) and for greater log supermarket spending (OR = 0.69, 95% CI, 0.57-0.85).

CONCLUSION

This study shows that both healthy food availability and an increase in supermarket spending were associated with a decreased adjusted prevalence of prediabetes and diabetes in adolescents, with a greater effect in females. These results suggest the need for policy and dietary interventions targeting the consumer environment.

Protein Intake as a Risk Factor of Overweight/Obesity in 8- to 12-Year-Old Children

Several studies investigating the relationship between body mass index (BMI), waist circumference (WC), and/or body fat (BF) with macronutrient composition of the diet have suggested that dietary composition may play an important role to overweight/obesity in childhood, but its relation remains inconclusive. The aim was to assess the association between energy intake (EI) and macronutrient diet composition with overweight/obesity among children.Nonrandomized cohort study including 396 Italian children and preadolescents (9-13 years old), 200 overweight/obese and 196 normal-weight. The children's weight, height, WC, and food intake were measured.Reported EI was higher in overweight/obese than in nonoverweight children; however, after body weight was considered, the overweight/obese children had less EI than their leaner counterparts. Percentages of EI from proteins, SFA, MUFA and PUFA (in males), and dietary fiber (g/1000 kcal) were higher in the overweight/obese children than in the leaner ones. EI from carbohydrates and fats was lower in overweight/obese males and females, respectively. Positive correlations between BMI and waist-to-height ratio with EI from proteins were found in males (r = 0.296, P < 0.01 and r = 0.326, P < 0.01; respectively) and females (r = 0.374, P < 0.01 and r = 0.405, P < 0.01; respectively), but negative correlations with fats were found in females (r = -0.240, P < 0.01 and r = -0.188, P < 0.05; respectively). Using binary logistic regression, the highest EI from proteins were associated with higher odds ratio for overweight/obesity, while the lowest EI from carbohydrates was associated with higher odds ratio for overweight/obesity in males.Reported EI of overweight/obese children was higher than nonoverweight peers. Overweight/obese children had higher intakes of proteins compared with nonoverweight ones. Overweight/obese males and females showed lower EI from carbohydrates and fats, respectively, than their leaner counterparts.

The effect of physical activity on serum IL-6 and vaspin levels in late elementary school children

[Purpose]

This study investigates the effects of physical activity on serum IL-6 and vaspin in late elementary school children.

[Methods]

Those who (n = 220) completed the 7-day physical activity monitoring underwent a second round of measurements including body fat, serum glucose and insulin, and serum IL-6 and vaspin. One way ANOVAs followed by LSD post hoc tests were used to test for significant differences in dependent variables across incremental physical activity levels at p=0.05. Multivariate stepwise linear regression analyses were used to determine significant predictors for serum IL-6 and vaspin levels at p=0.05.

[Results]

The results showed significant inverse linear trends for body fat parameters across incremental physical activity levels (from low to high); the lower the body fat, the higher the physical activity levels. On the other hand, there were no significant linear trends for insulin resistance markers or dietary intake across incremental physical activity levels. Multiple stepwise linear regression analyses were used to determine significant predictors for individual variations in serum IL-6 and vaspin in the study population. We found that body mass index (p=0.002) and low- and moderate-intensity physical activities (p=0.002 and p=0.0045, respectively) were significant determinants of serum IL-6. In addition, low- and moderate-intensity physical activities (p=0.01 & p=0.022, respectively) were significant determinants of serum vaspin levels in this study population.

[Conclusion]

In summary, the findings of the current study suggest that promotion of physical activity along with a healthy diet should be key components of lifestyle interventions to improve serum cytokine profiles associated with insulin resistance syndrome in late elementary school children.

Dietary pattern and leisure time activity of overweight and normal weight children in Germany: sex-specific differences

Background

Several studies indicate that dietary pattern and leisure time activities of adults not only differ between sexes but also between overweight and normal weight individuals. The aim of the present study was to determine if sex-specific differences in dietary pattern and leisure time activity already exist and are associated with weight status in young childhood.

Methods

Nutritional intake, anthropometric parameters, leisure time activities and socio- demographical factors were assessed in 100 overweight and 51 normal weight children (81 girls and 70 boys), aged 5–8 years.

Results

In general, independent of body weight, boys ate more cheese while girls consumed more vegetables and spent more time with sedentary activities. Moreover, regardless of sex, total energy and macronutrient intake did not differ between normal weight and overweight children. Also, time spent with sportive activities did not differ between groups; however, overweight boys spent significantly more leisure time with sedentary activities than normal weight boys. Furthermore, BMI of mothers and time spent with sedentary activities were identified as independent risk factors for the development of overweight when performing multiple regression analyses.

Conclusions

Taken together, results of our study suggest that already at young age sex influences dietary pattern independent of body weight. Furthermore, an increased time spent with sedentary activities and an elevated maternal BMI were found to be associated with an elevated body weight in children. (Trial registration: NCT01306396)

Self-reported energy intake by age in overweight and healthy-weight children in NHANES, 2001-2008

OBJECTIVE

Variation in energy intake by weight status at different ages may explain inconsistencies in previous research on energy intake and obesity. Therefore, our objective was to determine the relationship between reported daily energy intake and categorized weight status across childhood.

METHODS

We examined dietary reports of children ages 1 to 17 years by using the National Health and Nutrition Examination Survey, 2001-2008 (N = 12648). Using measured height and weight, we categorized weight status based on weight-for-length percentile (age <2 years) or BMI percentile (ages 2-17 years) using current recommendations. Dietary intake was reported by using the repeatedly validated automated multiple pass method, a detailed 2-day 24-hour recall. We used ordinary least squares regression to examine the interactions of age and weight category on total energy intake, controlling for gender, race, ethnicity, and income.

RESULTS

Weight status and age both have positive associations with self-reported energy intake. However, the interaction between weight and age demonstrates a negative effect throughout childhood, such that young obese/overweight children reported consuming significantly more calories and obese/overweight adolescents reported consuming fewer calories than their same-age healthy-weight peers.

CONCLUSIONS

In a nationally representative cross-sectional sample, overweight and obese girls older than 7 years and boys older than 10 years reported consuming fewer daily calories than their healthy-weight peers. One explanation for this would be that increased energy intake in early childhood is related to the onset of obesity, but other mechanisms, such as differences in energy expenditure, may contribute more to maintaining obese/overweight status through adolescence.

Energy-Dense Snack Food Intake in Adolescence: Longitudinal Relationship to Weight and Fatness

OBJECTIVE

The longitudinal relationship between the consumption of energy-dense snack (EDS) foods and relative weight change during adolescence is uncertain. Using data from the Massachusetts Institute of Technology Growth and Development Study, the current analysis was undertaken to examine the longitudinal relationship of EDS food intake with relative weight status and percentage body fat and to examine how EDS food consumption is related to television viewing.

RESEARCH METHODS AND PROCEDURES

One hundred ninety-six nonobese premenarcheal girls 8 to 12 years old were enrolled between 1990 and 1993 and followed until 4 years after menarche. At each annual follow-up visit, data were collected on percentage body fat (%BF), BMI z score, and dietary intake. Categories of EDS foods considered were baked goods, ice cream, chips, sugar-sweetened soda, and candy.

RESULTS

At study entry, girls had a mean +/- SD BMI z score of -0.27 +/- 0.89, consumed 2.3 +/- 1.7 servings of EDS foods per day, and consumed 15.7 +/- 8.1% of daily calories from EDS foods. Linear mixed effects modeling indicated no relationship between BMI z score or %BF and total EDS food consumption. Soda was the only EDS food that was significantly related to BMI z score over the 10-year study period, but it was not related to %BF. In addition, a significant, positive relationship was observed between EDS food consumption and television viewing.

DISCUSSION

In this cohort of initially nonobese girls, overall EDS food consumption does not seem to influence weight status or fatness change over the adolescent period.

The declining prevalence of overweight among Russian children: income, diet, and physical activity behavior changes

The aim of this study is to examine the relationships among income, diet, physical activity behaviors and overweight among Russian children during a period of economic upheaval. Subjects include 2151 schoolchildren aged 7-13 derived from cross-sectional waves of the Russia Longitudinal Monitoring Surveys in 1995 and in 2002. Diet was assessed by 24-h recall and physical activity (h/week) and household income by parental questionnaire. Hours spent in vigorous activities were low (1.0-1.5 h/week), and time spent in sedentary behaviors increased from 31 to 37 h/week between 1995 and 2002. In 1995 there was a direct relationship of income to energy and fat intake, and time spent in vigorous activity, and an inverse relationship of income to h/week spent in moderate activities (such as walking to school). The effect of having low income parents was less in 2002 than in 1995. Overweight prevalence did not differ significantly by income in either year, but there was a significant decline in overweight among high income children. Only hours spent in moderate physical activity was moderately protective against overweight. Income disparities do not explain trends in overweight among Russian children.

Improving the Accuracy of Self-Reports on Diet and Physical Exercise: The Co-Twin Control Method

The objective was to examine the association between several obesity-related nongenetic behaviors and body mass index (BMI) and waist circumference (WC) in young adult twins using reports from both twins on their similarities and differences. A total of 713 monozygotic (MZ) and 698 same-sex dizygotic (DZ) twin pairs aged 22–28 years filled in structured questionnaires to compare their eating, physical activity and dieting behavior with their co-twin's behavior, and to report their own eating and exercise habits. In both MZ and DZ pairs, the co-twins for whom both twin pair members concordantly answered that this twin eats more, snacks more, eats more fatty foods and sweet and fatty delicacies, chooses less healthy foods, eats faster and exercises less, had significantly higher BMIs (0.6–2.9 kg/m2) and WCs (1.5–7.5 cm). Multivariate regression analysis identified co-twin differences in the amount of food consumed as the strongest independent predictor of intrapair differences in BMI (β = 0.63 and 1.21, for MZ and DZ, respectively,p< .001) and WC (β = 1.52 and 3.53, for MZ and DZ, respectively,p< .001). Higher leisure-time physical activity and healthier dietary choices clustered in the same subjects. The measurement of habitual dietary intake and physical activity has previously relied on subjective self-reports that are prone to misreporting. By using comparative measures within twin pairs we found that the amount of food consumed is the major contributor to obesity independent of genetic predisposition.

Higher intakes of energy and grain products at 4 years of age are associated with being overweight at 6 years of age

This study examined dietary factors associated with overweight in a population-based sample of 6-y-old children. Analyses of data from the Québec Longitudinal Study of Child Development (QLSCD) included a representative sample (n = 1014) of children born in 1998 in the province of Québec, Canada. Dietary intake was measured by using a 24-h dietary recall administered at 4 y of age. Weight and height were measured using a standard protocol at 6 y. Using logistic regression, higher daily energy intake at 4 y was significantly related to overweight at 6 y. After adjustment for confounding and overweight at 4 y, the relationship remained significant among girls (P = 0.04) but became marginally significant among boys (P = 0.07). Additionally, boys who consumed ≥5 servings of grain products/d at 4 y were more likely to be overweight at 6 y compared to those who did not [adjusted OR = 3.20 (95% CI): 1.72-5.97]. The association attenuated somewhat after adjustment for overweight at 4 y [OR = 1.82 (95% CI): 0.894-3.71; P = 0.09]. The findings provide support for the revisions made in the Canadian dietary guidelines for young children, which now recommend 4-7 servings of grain products daily for children aged 4-8 y rather than the excessive 5-12 servings of previous recommendations.

Trends in snacking among U.S. children

Nationally representative surveys of food intake in U.S. children show large increases in snacking between the 1989-91 to 1994-98 and 1994-98 to 2003-06 periods. Childhood snacking trends are moving toward three snacks per day, and more than 27 percent of children's daily calories are coming from snacks. The largest increases have been in salty snacks and candy. Desserts and sweetened beverages remain the major sources of calories from snacks.

Associations of body mass index and waist circumference with: energy intake and percentage energy from macronutrients, in a cohort of Australian children

Background

It is evident from previous research that the role of dietary composition in relation to the development of childhood obesity remains inconclusive. Several studies investigating the relationship between body mass index (BMI), waist circumference (WC) and/or skin fold measurements with energy intake have suggested that the macronutrient composition of the diet (protein, carbohydrate, fat) may play an important contributing role to obesity in childhood as it does in adults. This study investigated the possible relationship between BMI and WC with energy intake and percentage energy intake from macronutrients in Australian children and adolescents.

Methods

Height, weight and WC measurements, along with 24 h food and drink records (FDR) intake data were collected from 2460 boys and girls aged 5-17 years living in the state of Queensland, Australia.

Results

Statistically significant, yet weak correlations between BMI z-score and WC with total energy intake were observed in grades 1, 5 and 10, with only 55% of subjects having a physiologically plausible 24 hr FDR. Using Pearson correlations to examine the relationship between BMI and WC with energy intake and percentage macronutrient intake, no significant correlations were observed between BMI z-score or WC and percentage energy intake from protein, carbohydrate or fat. One way ANOVAs showed that although those with a higher BMI z-score or WC consumed significantly more energy than their lean counterparts.

Conclusion

No evidence of an association between percentage macronutrient intake and BMI or WC was found. Evidently, more robust longitudinal studies are needed to elucidate the relationship linking obesity and dietary intake.

Assessing the nutritional status of Palestinian adolescents from East Jerusalem: a school-based study 2002-03

In Palestine, there is a little information about nutrition of adolescents compared to other age groups. This study was designed to assess the nutritional status of Palestinian school-aged children (11-16 years) in East Jerusalem during 2002-03. A school-based cross-sectional study targeted randomly 313 adolescents from public and private schools. A previously validated and reliable questionnaire was administered through interviews that included anthropometric and hemoglobin measurements, 24-h dietary intake recall and physical activity questionnaire. It was found that being overweight (24.3%) or obese (9.9%) coexisted with being underweight (4.8%) and/or anemic (23.3%). Only 22.4% of the study subject had physical activity for ≥5 days a week with boys being more physically active than girls (p < 0.01). Inadequate energy intake had 55.66% of boys and 64.81% of girls; inadequate protein intake was reported by 15.07% of boys and 43.08% of girls. The majority of them met <80% of the recommended daily allowances for most micronutrients. The whole sample and especially boys consumed more total, saturated fat, less monounsaturated fat and carbohydrates than what is advised. Obese and overweight adolescents had lower energy intake (p < 0.05) and a lower trend in being physically active than normal weight counterparts. School health education programs targeted at adolescents and parents need to be developed as part of overweight-obesity, malnutrition and anemia prevention.

Consumption of vegetables, cooked meals, and eating dinner is negatively associated with overweight status in children

OBJECTIVE

To evaluate potential associations between diet- and physical activity-related lifestyle patterns and obesity indices in a cohort of children.

STUDY DESIGN

Dietary and physical activity information and anthropometric indices were collected from 1138 children (53% girls; age, 11.2 ± 0.7 years). Dietary intake was evaluated with two 24-hour recalls, which were analyzed for nutrient and food intake, eating frequency, and meal quality. Principal component analysis was used to extract salient lifestyle patterns.

RESULTS

Five lifestyle behavioral patterns were identified. The "dinner, cooked meals and vegetables pattern," a multidimensional lifestyle pattern including the consumption of vegetables, cooked meals, and eating dinner, was negatively associated with all obesity indices, even after adjustment for potential confounders and exclusion of low energy reporters. A "high fiber pattern," representing high consumption of whole-grain cereals, legumes, and low intake of sugar-sweetened beverages was negatively correlated with obesity indices; when the analysis included only acceptable energy reporters, these associations became non-significant, except for triceps skinfolds.

CONCLUSIONS

Our findings are supportive of the synergistic or conditional effects of distinct lifestyle-related behaviors on obesity. Although these results are hypothesis-generating and need replication, they suggest potential preventive approaches, interventional approaches, or both to combat childhood obesity.

Association of dietary patterns with BMI and waist circumference in a low-income neighbourhood in Brazil

Traditional analysis of food intake usually fails to show an association between energy and nutrient intake and indicators of obesity. The analysis of food patterns can contribute to the understanding of the association between eating habits and anthropometric indicators. A population-based cross-sectional study was carried out on a low-income neighbourhood in the Rio de Janeiro metropolitan area, and 1009 subjects between 20 and 65 years of age completed an FFQ. Dietary patterns were identified by means of factor analysis, and their associations with BMI and waist circumference (WC) were ascertained by applying a linear regression analysis. Three main dietary patterns were identified: a mixed pattern, which included cereals, fish and shrimp, vegetables, roots, fruits, eggs, meat and caffeinated beverages; a Western pattern, which consisted of ‘fast foods’, soft drinks, juices, cakes, cookies, milk and dairy, sweets and snacks; a traditional pattern, which included rice, beans, bread, sugar, fats and salad dressings. After adjusting for age and energy intake, we found that the traditional dietary pattern was inversely associated with BMI (β = − 1·14, P < 0·001) and WC (β = − 14·9, P = 0·002) among females. Additionally, a positive association between the Western pattern and WC (β = 12·8, P = 0·02) was observed for females. A diet based on rice and beans may have a protective role against weight gain in women.

Plausible reports of energy intake may predict body mass index in pre-adolescent girls

Inaccurate reporting of energy intake makes it difficult to study the associations between diet and weight status. This study examined reported energy intake at age 9 years as a predictor of girls' body mass index (BMI) at age 11 years, before and after adjusting for parents' BMI and girls' pubertal status. This prospective, observational cohort study included 177 non-Hispanic white girls and their parents. When the subjects were 9 years of age, three 24-hour recalls were used to categorize girls as plausible or implausible over-reporters and under-reporters based on previously published methods. Height and weight was measured to calculate BMI. Linear and hierarchical regression analyses were used to predict girls' BMI. Results revealed that girls who under-reported had significantly higher BMIs than plausible and overreporters. Among the total sample and among implausible reporters, reported energy intake was not a significant predictor of BMI; however, among plausible reporters, reported energy intake explained 14% of the variance in BMI and remained a significant predictor after adjusting for parental BMI and girls' pubertal status. Systematic bias related to underreporting in dietary data can obscure relationships with weight status, even among young girls. A relatively simple analytical procedure can be used to identify the magnitude and nature of reporting bias in dietary data.

Gender differences in growth and nutrition in a sample of rural ontario schoolchildren

This paper reports findings of a cross-sectional study of the growth and nutrition of children living in rural Ontario, Canada. The objectives of the research were threefold: (1) to obtain data on obesity prevalence and nutrient intake in a sample of rural Canadian schoolchildren, (2) to compare findings with rural and national-level data on obesity prevalence and nutrient intake, and (3) to provide data to school board and public health agencies planning and implementing nutrition policy and programs to this population. Measures of height and weight were obtained for 504 children ages 7-13 years. Height for age and body mass index scores were calculated and compared with 2000 data from the Centers for Disease Control (Kuczmarski et al. [2002]: Vital Health Stat 246:1-190). Weekday 24-h dietary recall was conducted on a subsample of 352 children and the results compared with Canada's Food Guide (Health Canada,1997) and dietary reference data from the US Institute of Medicine (2000). Prevalence of overweight and obesity were high in this sample, with 17.7% of children classified as overweight and 10.9% of children classified as obese. Fifteen percent of boys were classified as obese, compared to 6.8% of girls. Boys consumed significantly more servings from the grain and meat food groups than girls. While mean daily intake of fiber and micronutrients was significantly low for both boys and girls, there were significant gender differences in nutrient intake, with boys consuming greater energy, protein, carbohydrate, calcium, iron, phosphorus, and sodium than girls. A number of limitations are discussed, in particular issues arising from the use of Dietary Reference Intakes.

Eating competence: definition and evidence for the Satter Eating Competence model

The evidence- and practice-based Satter Eating Competence Model (ecSatter) outlines an inclusive definition of the interrelated spectrum of eating attitudes and behaviors. The model is predicated on the utility and effectiveness of biopsychosocial processes: hunger and the drive to survive, appetite and the need for subjective reward and the biological propensity to maintain preferred and stable body weight. According to ecSatter, competent eaters have 1) positive attitudes about eating and about food, 2) food acceptance skills that support eating an ever-increasing variety of the available food, 3) internal regulation skills that allow intuitively consuming enough food to give energy and stamina and to support stable body weight, and 4) skills and resources for managing the food context and orchestrating family meals. Identifying these four constructs allows nutrition professionals to target interventions as well as trust and support the individual's own capabilities and tendency to learn and grow.

Dietary intake among under-, normal- and overweight 9- and 15-year-old Estonian and Swedish schoolchildren

OBJECTIVES

To determine the differences in macronutrient and food group contribution to total food and energy intakes between Estonian and Swedish under-, normal- and overweight schoolchildren, and to estimate the association between diet and body mass index (BMI).

DESIGN

Cross-sectional comparison between Estonian and Swedish children and adolescents of different BMI groups.

SETTING

Twenty-five schools from one region in Estonia and 42 in two regions of central Sweden.

SUBJECTS

In total 2308 participants (1176 from Estonia and 1132 from Sweden), including 1141 children with a mean age of 9.6 +/- 0.5 years and 1167 adolescents with a mean age of 15.5 +/- 0.6 years.

RESULTS

Overweight was more prevalent among younger girls in Sweden (17.0 vs. 8.9%) and underweight among girls of both age groups in Estonia (7.9 vs. 3.5% in younger and 10.5 vs. 5.1% in older age group of girls). Compared with that of normal- and underweight peers, the diet of overweight Estonian children contained more energy as fat (36.8 vs. 31.7%) but less as carbohydrates, and they consumed more milk and meat products. Absolute BMI of Estonian participants was associated positively with energy consumption from eggs and negatively with energy consumption from sweets and sugar. Swedish overweight adolescents tended to consume more energy from protein and milk products. Risk of being overweight was positively associated with total energy intake and energy from fish or meat products. In both countries the association of overweight and biological factors (pubertal maturation, parental BMI) was stronger than with diet.

CONCLUSION

The finding that differences in dietary intake between under-, normal- and overweight schoolchildren are country-specific suggests that local dietary habits should be considered in intervention projects addressing overweight.

Fitness levels of Greek primary schoolchildren in relationship to overweight and obesity

OBJECTIVES

The aim of the present cross-sectional study was to provide estimates for overweight and obesity in a sample of Greek schoolchildren and to determine their possible relation with selected motor and health-related fitness parameters.

MATERIALS AND METHODS

The study sample consisted of 709 healthy children (328 girls, 381 boys, mean age = 8.9+/-1.6 years), living in the towns of Agios Stefanos (approximately 12,000 citizens) and Alexandroupolis (approximately 60,000 citizens), Greece. All pupils underwent anthropometric, motor and cardiovascular fitness assessments (Eurofit test battery). The body mass index (BMI) cut-off points adopted by the International Obesity Task Force were utilized for the assessment of overweight and obesity.

RESULTS

59.4% of the participants had a normal BMI, 25.8% were overweight and 14.8% were obese, without significant differences between genders.

DISCUSSIONS

In general, the higher BMI categories were strongly associated with inferior performances in all fitness tests, except flexibility. This graded relationship was consistent for both boys and girls, although the statistical relationship between BMI categories and fitness performance varied by gender.

CONCLUSIONS

In conclusion, the findings of the current study offer some support to the reported high prevalence of childhood obesity in Greece and suggest that overweight and obesity are limiting factors for fitness performance in primary schoolchildren. The present data suggest that interventions promoting children's health should, ideally, begin early in life and involve measures that simultaneously improve fitness and lower fatness.

Short-term predictors of overweight in early adolescence

OBJECTIVE

To identify short-term predictors of risk for overweight in early adolescence in a sample of Caucasian origin subjects, in Cyprus.

SUBJECTS

A total of 357 subjects (178 males) with baseline age 11.5+/-0.4 y were re-evaluated after a mean of 1.6+/-0.5 y.

MEASUREMENTS

Body weight and height, calculated body mass index (BMI), and blood pressure at baseline and follow-up. Serum lipids were determined at baseline. Obesity and overweight were defined at baseline and follow-up, according to the International Obesity Task Force data set. Socioeconomic class was determined. Self-reported parental weight and height were used to calculate the parental BMI. BMI tracking and changes in BMI categories were calculated (with 95% confidence interval (CI)). The future risk of overweight in baseline normal weight subjects was predicted using logistic regression analyses, where only normal weight subjects at baseline were included.

RESULTS

More males remained in the overweight or obese category than females: 86.7% (95% CI: 73.2, 94.9) vs 71.8% (95% CI: 55.1, 85.0), respectively, P=0.03. The identified predictors for future overweight were paternal obesity, odds ratio (OR): 7.1 (95% CI: 1.3, 38.0), systolic blood pressure >95th percentile, OR: 8.9 (95% CI: 1.9, 41.7), high triglyceride levels, OR: 4.2 (95% CI: 1.0, 16.9) and low HDL-cholesterol levels, OR: 7.6 (95% CI: 1.7, 34.3).

CONCLUSIONS

Triglycerides and HDL-cholesterol levels have been proved predictors for overweight in early adolescence for the first time. The different sex pattern in BMI tracking observed, and also the different environmental influences on future overweight risk compared to other studies, indicate that local circumstances should be considered when implementing national intervention strategies for the prevention of obesity.

Position of the American Dietetic Association: the role of dietetics professionals in health promotion and disease prevention

In the United States, the leading determinants of morbidity and mortality are rooted in behavioral choices related to eating habits, exercise, tobacco, alcohol consumption, and stress reduction. Scientific data consistently provide evidence that diet plays an important role in health promotion and disease prevention. Healthy eating habits--coupled with other healthful lifestyle behaviors--have the potential to reduce the risk of chronic disease. Health care typically assumes a curative or treatment role in the United States. However, dietetics professionals are shaping an alternate view of health, which includes developing healthy public policies, creating safe and supportive environments, building communities and coalitions, and reorienting health services to include health promotion as a primary approach to delivering health care. Individual-level approaches, such as counseling and group education, have been employed most often in modifying health behaviors. However, population-level approaches that affect availability of or access to healthy foods, opportunities for physical activity, and other healthy lifestyle determinants also are important. Dietetics professionals have pivotal roles in both individual- and population-level approaches.

Obesity in children and adolescents in Cyprus. Prevalence and predisposing factors

OBJECTIVE

To estimate the prevalence of childhood and adolescent obesity in Cyprus and define possible associated risk factors.

STUDY DESIGN

Cross-sectional study of a representative sample of children 6-17 y of age performed during October 1999 to June 2000.

METHODS

Anthropometric data were taken using standard methods, from 2467 children. Certain diet and physical activities as well as other socioeconomic family parameters were assessed with the aid of a questionnaire. Obesity and overweight were defined using both the National Health and Nutrition Examination Survey (NHANES) I definition and the newer International Obesity Task Force (IOTF) definition. Logistic regression analyses were performed to estimate the influence of various parameters.

RESULTS

The prevalence of obesity in males was 10.3% and in females 9.1% using the NHANES I definition and 6.9 and 5.7%, respectively, using the IOTF definition. The percentages presented a decreasing trend with age. There were an additional 16.9% of males and 13.1% of females defined as overweight with the NHANES I definition and 18.8 and 17.0%, respectively, using the IOTF definition. The most significant associated factor for obesity was parental obesity status. The odds ratio for offspring obesity when both parents were obese ranged from 11.34 (95% CI 1.83-75.50) in females 6 to 11-y-old to 18.09 (95% CI 2.06-158.81) for males 12 to 17-y-old.

CONCLUSIONS

The prevalence of childhood and adolescent obesity was estimated for the first time in a representative sample from Cyprus, and this rate is comparable to that observed in North America. These results indicate the need for individual and population measures for the treatment and prevention of pediatric obesity. The rate of obesity differs significantly depending on the method of estimation.