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Abo Hamza E, Tindle R, Pawlak S, Bedewy D, Moustafa AA. The impact of poverty and socioeconomic status on brain, behaviour, and development: a unified framework. Rev Neurosci 2024; 35:597-617. [PMID: 38607658 DOI: 10.1515/revneuro-2023-0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/17/2024] [Indexed: 04/13/2024]
Abstract
In this article, we, for the first time, provide a comprehensive overview and unified framework of the impact of poverty and low socioeconomic status (SES) on the brain and behaviour. While there are many studies on the impact of low SES on the brain (including cortex, hippocampus, amygdala, and even neurotransmitters) and behaviours (including educational attainment, language development, development of psychopathological disorders), prior studies did not integrate behavioural, educational, and neural findings in one framework. Here, we argue that the impact of poverty and low SES on the brain and behaviour are interrelated. Specifically, based on prior studies, due to a lack of resources, poverty and low SES are associated with poor nutrition, high levels of stress in caregivers and their children, and exposure to socio-environmental hazards. These psychological and physical injuries impact the normal development of several brain areas and neurotransmitters. Impaired functioning of the amygdala can lead to the development of psychopathological disorders, while impaired hippocampus and cortex functions are associated with a delay in learning and language development as well as poor academic performance. This in turn perpetuates poverty in children, leading to a vicious cycle of poverty and psychological/physical impairments. In addition to providing economic aid to economically disadvantaged families, interventions should aim to tackle neural abnormalities caused by poverty and low SES in early childhood. Importantly, acknowledging brain abnormalities due to poverty in early childhood can help increase economic equity. In the current study, we provide a comprehensive list of future studies to help understand the impact of poverty on the brain.
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Affiliation(s)
- Eid Abo Hamza
- College of Education, Humanities & Social Sciences, 289293 Al Ain University , 64141, Al Jimi, UAE
- Faculty of Education, Tanta University, Al-Geish St., 122011, Tanta, Egypt
| | - Richard Tindle
- JMS Allied Services, 1109 Coffs Harbour , NSW, 2452, Australia
| | - Simon Pawlak
- Department of Psychological Sciences, Swinburne University of Technology, John Street, Hawthorn, VIC 3122, Australia
| | - Dalia Bedewy
- Department of Psychology, College of Humanities and Sciences, 59104 Ajman University , University Street, Al jerf 1, Ajman, UAE
- Department of Psychology, Faculty of Education, Tanta University, Al-Geish St., 122011, Tanta, Egypt
- 59104 Humanities and Social Sciences Research Center (HSSRC), Ajman University , University Street, Al jerf 1, Ajman, UAE
| | - Ahmed A Moustafa
- Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Cnr Kingsway & University Roads, Auckland Park, Johannesburg, 2092, South Africa
- School of Psychology, Faculty of Society and Design, 448704 Bond University , 14 University Dr, Robina QLD 4226, Gold Coast, QLD, Australia
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Fernández-Lázaro D, Celorrio San Miguel AM, Garrosa E, Fernández-Araque AM, Mielgo-Ayuso J, Roche E, Arribalzaga S. Evaluation of Family-Based Interventions as a Therapeutic Tool in the Modulation of Childhood Obesity: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:930. [PMID: 39201865 PMCID: PMC11352366 DOI: 10.3390/children11080930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 09/03/2024]
Abstract
Childhood obesity is a major public health burden. The prevalence of weight excess for children and the adolescent population (8 to 16 years) is 34.9%. During childhood, lifestyles are acquired, which are developed in adulthood. In this context, the role of parents is crucial, since they are the model to imitate. We aimed to evaluate the current evidence on the effects of family-based interventions as a tool in the treatment of childhood obesity. We reviewed studies indexed in several databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Original articles published from 1 January 2014 to 30 May 2024 with a controlled trial design were considered, in which family-based interventions were carried out compared to a control group or to data before the intervention. Although 148 records were identified in the search, 6 studies met inclusion criteria. Overall, studies reported beneficial effects of family-based interventions on improving anthropometric parameters: BMI z-score, BMI, waist circumference, and body fat percentage. Regarding nutritional and physical activity guidelines, general recommendations must consider increased consumption of fruits and vegetables, reducing sugary drinks, controlled screen time, and 30-60 min of physical activity/day. Thus, family-based interventions could be an effective non-pharmacological strategy for modulating childhood obesity, allowing families to modify their lifestyles.
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Affiliation(s)
- Diego Fernández-Lázaro
- Department of Cellular Biology, Genetic, Histology and Pharmacology, Faculty of Health Sciences, University of Valladolid, Campus de Soria, 42003 Soria, Spain
- Neurobiology Research Group, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain
- “Nutrition for Sport and Exercise” Working Group, Spanish Nutrition Society (SEÑ), 28010 Madrid, Spain; (J.M.-A.); (E.R.)
| | | | - Evelina Garrosa
- Faculty of Psychology, University of Salamanca, 37007 Salamanca, Spain;
| | - Ana M. Fernández-Araque
- Department of Nursing, Faculty of Health Sciences, University of Valladolid, Campus de Soria, 42003 Soria, Spain;
- Pharmacogenetics, Cancer Genetics, Genetic Polymorphisms and Pharmacoepidemiology Research Group, Faculty of Health Sciences, University of Valladolid, Campus de Soria, 42003 Soria, Spain
| | - Juan Mielgo-Ayuso
- “Nutrition for Sport and Exercise” Working Group, Spanish Nutrition Society (SEÑ), 28010 Madrid, Spain; (J.M.-A.); (E.R.)
- Department of Health Sciences, Faculty of Health Sciences, University of Burgos, 09001 Burgos, Spain
| | - Enrique Roche
- “Nutrition for Sport and Exercise” Working Group, Spanish Nutrition Society (SEÑ), 28010 Madrid, Spain; (J.M.-A.); (E.R.)
- Department of Applied Biology-Nutrition, Institute of Bioengineering, University Miguel Hernández, 03202 Elche, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Soledad Arribalzaga
- Faculty of Sport Sciences, European University of Madrid, Villaviciosa de Odón, 28670 Madrid, Spain;
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Lichtwald A, Weiss C, Lange A, Ittermann T, Allenberg H, Grabe HJ, Heckmann M. Association between maternal pre-pregnancy body mass index and offspring's outcomes at 9 to 15 years of age. Arch Gynecol Obstet 2024; 309:105-118. [PMID: 37689592 PMCID: PMC10770235 DOI: 10.1007/s00404-023-07184-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/02/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE Maternal pre-pregnancy underweight, overweight and obesity might increase the risk for worse short- and long-term outcome in the offspring. There is a need for further study into the relationship between maternal pre-pregnancy body mass index (BMI) and the combined outcome of physical development, state of health and social behavior in children. QUESTION Is maternal pre-pregnancy BMI associated with the child outcome in terms of physical development, state of health and social behavior (school and leisure time behavior) at the age of 9 to 15 years? METHODS In the population-based birth cohort study Survey of Neonates in Pomerania (SNIP) children at the age 9-15 years and their families were re-examined by questionnaire-based follow-up. 5725 mother-child pairs were invited to SNiP-follow-up. This analysis is based on the recall fraction of 24.1% (n = 1379). Based on the maternal pre-pregnancy BMI (ppBMI), 4 groups were formed: underweight (ppBMI < 19 kg/m2, n = 117), normal weight (ppBMI 19-24.99 kg/m2, n = 913, reference), overweight (ppBMI 25-30 kg). /m2, n = 237) and obesity (ppBMI > 30 kg/m2, n = 109). RESULTS In the multiple regression model, the BMI-z-score for children of mothers in the underweight group was -0.50 lower, and 0.50/1.07 higher in the overweight/obese group (p < 0.001) compared to reference at median age of 12 years. No differences were found in children of underweight mothers with regard to social behavior (interaction with friends and family), school and sports performance (coded from "very good" to "poor"), other leisure activities (watching television, using mobile phones, gaming), and health (occurrence of illnesses) compared to children of normal weight mothers. In contrast, maternal pre-pregnancy overweight and obesity were associated with lower school and sports performance, and higher screen time (smart phone, gaming, television) compared to children of normal weight mothers. CONCLUSION Maternal pre-pregnancy overweight and obesity but not underweight was negatively associated with school performance and leisure time behavior in the offspring at 9-15 years of age.
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Affiliation(s)
- Alexander Lichtwald
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany.
| | - Cathérine Weiss
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany.
| | - Anja Lange
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute of Community Medicine, Division of Health Care Epidemiology and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Heike Allenberg
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Heckmann
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
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Le Gal C, Lecorguillé M, Poncet L, Cissé AH, Gassama M, Simeon T, Lanoë JL, Melchior M, Bernard JY, Charles MA, Heude B, Lioret S. Social patterning of childhood overweight in the French national ELFE cohort. Sci Rep 2023; 13:21975. [PMID: 38081843 PMCID: PMC10713558 DOI: 10.1038/s41598-023-48431-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
An inverse social gradient in early childhood overweight has been consistently described in high-income countries; however, less is known about the role of migration status. We studied the social patterning of overweight in preschool children according to the mother's socio-economic and migration background. For 9250 children of the French ELFE birth cohort with body mass index collected at age 3.5 years, we used nested logistic regression to investigate the association of overweight status in children with maternal educational level, occupation, household income and migration status. Overall, 8.3% (95%CI [7.7-9.0]) of children were classified as overweight. The odds of overweight was increased for children from immigrant mothers (OR 2.22 [95% CI 1.75-2.78]) and descendants of immigrant mothers (OR 1.35 [1.04-2.78]) versus non-immigrant mothers. The highest odds of overweight was also observed in children whose mothers had low education, were unemployed or students, or were from households in the lowest income quintile. Our findings confirm that socio-economic disadvantage and migration status are risk factors for childhood overweight. However, the social patterning of overweight did not apply uniformly to all variables. These new and comprehensive insights should inform future public health interventions aimed at tackling social inequalities in childhood overweight.
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Affiliation(s)
- Camille Le Gal
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), 75004, Paris, France.
| | - Marion Lecorguillé
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), 75004, Paris, France
| | - Lorraine Poncet
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), 75004, Paris, France
| | - Aminata Hallimat Cissé
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), 75004, Paris, France
| | | | | | | | | | - Jonathan Y Bernard
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), 75004, Paris, France
| | - Marie-Aline Charles
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), 75004, Paris, France
- UMS INED-INSERM-EFS, Paris, France
| | - Barbara Heude
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), 75004, Paris, France.
| | - Sandrine Lioret
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), 75004, Paris, France.
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Spinelli A, Censi L, Mandolini D, Ciardullo S, Salvatore MA, Mazzarella G, Nardone P. Inequalities in Childhood Nutrition, Physical Activity, Sedentary Behaviour and Obesity in Italy. Nutrients 2023; 15:3893. [PMID: 37764677 PMCID: PMC10534384 DOI: 10.3390/nu15183893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Unhealthy diets, physical inactivity and high body mass index (BMI) are preventable risk factors for non-communicable diseases throughout a person's lifespan. The higher prevalence of these risk factors in children from lower socio-economic groups has been generally observed. The aim of this study is to explore the effect of parents' socio-economic conditions on children's consumption of fruit, vegetables and sugar-sweetened drinks, and inactivity, sedentary behaviour, overweight and obesity. This study used data from the sixth cross-sectional survey of the surveillance "OKkio alla Salute" (Italian COSI), involving 2467 schools and 53,275 children in 2019. All the information was collected through four questionnaires addressed to parents, children, teachers and head teachers. The weights and heights of the children were measured with standard techniques and equipment to classify overweight/obesity according to the WOF-IOTF cut-offs. The results showed a high percentage of children who do not adhere to health recommendations and a high prevalence of overweight and obesity. In particular, "less healthy" behaviours and higher BMI were more frequent in children from families with a lower socio-economic status and those residing in Southern Italy. These findings highlight the need for effective interventions that address the differences in these health-related behaviours.
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Affiliation(s)
- Angela Spinelli
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health (Istituto Superiore di Sanità), Viale Regina Elena 299, 00161 Rome, Italy; (D.M.); (S.C.); (M.A.S.); (P.N.)
| | - Laura Censi
- Council for Agricultural Research and Economics-Research Centre for Food and Nutrition, Via Ardeatina 546, 00178 Rome, Italy;
| | - Donatella Mandolini
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health (Istituto Superiore di Sanità), Viale Regina Elena 299, 00161 Rome, Italy; (D.M.); (S.C.); (M.A.S.); (P.N.)
| | - Silvia Ciardullo
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health (Istituto Superiore di Sanità), Viale Regina Elena 299, 00161 Rome, Italy; (D.M.); (S.C.); (M.A.S.); (P.N.)
| | - Michele Antonio Salvatore
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health (Istituto Superiore di Sanità), Viale Regina Elena 299, 00161 Rome, Italy; (D.M.); (S.C.); (M.A.S.); (P.N.)
| | | | - Paola Nardone
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health (Istituto Superiore di Sanità), Viale Regina Elena 299, 00161 Rome, Italy; (D.M.); (S.C.); (M.A.S.); (P.N.)
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Sulistiadi W, Kusuma D, Amir V, Tjandrarini DH, Nurjana MA. Growing Up Unequal: Disparities of Childhood Overweight and Obesity in Indonesia's 514 Districts. Healthcare (Basel) 2023; 11:healthcare11091322. [PMID: 37174864 PMCID: PMC10178417 DOI: 10.3390/healthcare11091322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/18/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Childhood obesity is a major public health concern as it increases the risk of premature death and adult disability. Globally, the latest estimates showed that more than 340 million children and adolescents between the ages of 5 and 19 were overweight or obese in 2016. This study aimed to investigate the disparities in childhood overweight and obesity across 514 districts in Indonesia, based on geographic and socioeconomic factors. METHODS Geospatial and quantitative analyses were performed using the latest Indonesian Basic Health Survey data from 2018. Dependent variables were rates of overweight and obesity among children aged 5-17 years including by gender. RESULTS This study found that the rates of overweight were 17.2%, 17.6%, and 16.8% among all children, boys, and girls, while the rates of obesity were 7.0%, 7.9%, and 6.1%, respectively. Boys were 1.30 times more likely to be obese than girls, while overweight was similar between both sexes. Urban cities had significantly higher prevalence of childhood overweight and obesity compared with rural districts by up to 1.26 and 1.32 times, respectively. In addition, the most developed region had significantly higher prevalence of childhood overweight and obesity than the least developed region by up to 1.37 and 1.38 times, respectively. With regard to socioeconomic factors, our analysis demonstrated a notable disparity in the prevalence of childhood overweight and obesity across income quintiles. Specifically, the wealthiest districts exhibited a 1.18 times higher prevalence of overweight and obesity among all children compared with the poorest districts. This association was particularly pronounced among boys; in the richest quintile, the prevalence of overweight and obesity was 1.24 and 1.26 times higher, respectively, in comparison to the poorest income quintile. In contrast, district-level education appears to exhibit an inverse relationship with the prevalence of childhood overweight and obesity, although the findings were not statistically significant.
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Affiliation(s)
- Wahyu Sulistiadi
- Department of Health Administration and Policy, Faculty of Public Health, Universitas Indonesia, Depok 16424, Indonesia
| | - Dian Kusuma
- Department of Health Services Research and Management, School of Health & Psychological Sciences, City University of London, London EC1V 0HB, UK
| | - Vilda Amir
- Center for Health Administration and Policy Studies, Faculty of Public Health, Universitas Indonesia, Depok 16424, Indonesia
| | - Dwi Hapsari Tjandrarini
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor 16915, Indonesia
| | - Made Agus Nurjana
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor 16915, Indonesia
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Torbahn G, Brauchmann J, Axon E, Clare K, Metzendorf MI, Wiegand S, Pratt JS, Ells LJ. Surgery for the treatment of obesity in children and adolescents. Cochrane Database Syst Rev 2022; 9:CD011740. [PMID: 36074911 PMCID: PMC9454261 DOI: 10.1002/14651858.cd011740.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Child and adolescent overweight and obesity have increased globally and are associated with significant short- and long-term health consequences. OBJECTIVES To assess the effects of surgery for treating obesity in childhood and adolescence. SEARCH METHODS For this update, we searched Cochrane Central Register of Controlled Trials, MEDLINE, Latin American and Caribbean Health Science Information database (LILACS), World Health Organization International Clinical Trials Registry Platform (ICTRP)and ClinicalTrials.gov on 20 August 2021 (date of the last search for all databases). We did not apply language restrictions. We checked references of identified studies and systematic reviews. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of surgical interventions for treating obesity in children and adolescents (age < 18 years) with a minimum of six months of follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or which included participants with a secondary or syndromic cause of obesity, or who were pregnant. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently extracted data and assessed the risk of bias using the Cochrane Risk of Bias 2.0 tool. Where necessary, we contacted authors for additional information. MAIN RESULTS With this update, we did not find any new RCTs. Therefore, this updated review still includes a single RCT (a total of 50 participants, 25 in both the intervention and comparator groups). The intervention focused on laparoscopic adjustable gastric banding surgery, which was compared to a control group receiving a multi-component lifestyle programme. The participating population consisted of Australian adolescents (a higher proportion of girls than boys) aged 14 to 18 years, with a mean age of 16.5 and 16.6 years in the gastric banding and lifestyle groups, respectively. The trial was conducted in a private hospital, receiving funding from the gastric banding manufacturer. For most of the outcomes, we identified a high risk of bias, mainly due to bias due to missing outcome data. Laparoscopic gastric banding surgery may reduce BMI by a mean difference (MD) of -11.40 kg/m2 (95% CI -13.22 to -9.58) and weight by -31.60 kg (95% CI -36.66 to -26.54) compared to a multi-component lifestyle programme at two years follow-up. The evidence is very uncertain due to serious imprecision and a high risk of bias. Adverse events were reported in 12/25 (48%) participants in the intervention group compared to 11/25 (44%) in the control group. A total of 28% of the adolescents undergoing gastric banding required revisional surgery. The evidence is very uncertain due to serious imprecision and a high risk of bias. At two years of follow-up, laparoscopic gastric banding surgery may increase health-related quality of life in the physical functioning scores by an MD of 16.30 (95% CI 4.90 to 27.70) and change in health scores by an MD of 0.82 (95% CI 0.18 to 1.46) compared to the lifestyle group. The evidence is very uncertain due to serious imprecision and a high risk of bias. No data were reported for all-cause mortality, behaviour change, participants' views of the intervention and socioeconomic effects. Finally, we have identified three ongoing RCTs that are evaluating the efficacy and safety of metabolic and bariatric surgery in children and adolescents. AUTHORS' CONCLUSIONS Laparoscopic gastric banding led to greater body weight loss compared to a multi-component lifestyle program in one small study with 50 participants. These results have very limited application, primarily due to more recent recommendations derived from observation studies to avoid the use of banding in youth due to long-term reoperation rates. This systematic review update still highlights the lack of RCTs in this field. The authors are concerned that there may be ethical barriers to RTCs in this field, despite the lack of other effective therapies for severe obesity in children and adolescents and the significant morbidity and premature mortality caused by childhood obesity. Nevertheless, future studies, whether pre-registered and planned non-randomised or pragmatic randomised trials, should assess the impact of the surgical procedure and post-operative care to minimise adverse events, including the need for post-operative adjustments and revisional surgery. Long-term follow-up is also critical to comprehensively assess the impact of surgery as participants enter adulthood.
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Affiliation(s)
- Gabriel Torbahn
- Department of Pediatrics, Paracelsus Medical University, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität Nürnberg, Nuremberg, Germany
- Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
- Department of Pediatrics, Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria
| | - Jana Brauchmann
- Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Emma Axon
- Cochrane Skin, Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | | | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Susanna Wiegand
- Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Janey Sa Pratt
- Department of Pediatric Surgery, Stanford University, Standford, CA, USA
| | - Louisa J Ells
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
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O'Donnell A, Buffini M, Kehoe L, Nugent A, Kearney J, Walton J, Flynn A, McNulty B. Application of a composite scoring protocol to identify factors that contribute to the risk of overweight and obesity in Irish children. Pediatr Obes 2022; 17:e12922. [PMID: 35604281 PMCID: PMC9541128 DOI: 10.1111/ijpo.12922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 03/08/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Investigations into the main drivers of childhood obesity are vital to implement effective interventions to halt the global rise in levels. The use of a composite score may help to identify children most at risk of overweight/obesity. OBJECTIVES To investigate the cumulative impact of factors associated with overweight/obesity risk in children. METHODS Data were analysed from the Irish National Children's Food Survey II which included 600 children, aged 5-12-years. The risk factors examined included social class, parental, early life, lifestyle, and dietary components. A composite score was calculated which ranged from 0 (no risk factors for overweight/obesity) to 4 (4 risk factors for overweight/obesity). RESULTS In model 1 (%BF) the four factors associated with overweight/obesity risk were having a parent with overweight/obesity (odds ratio 3.1; 95% confidence interval 1.9-4.8), having a high birth weight of ≥4 kg (2.5; 1.6-3.9), being from a low social class (2.3; 1.4-3.8) and low physical activity (1.9; 1.2-2.8). Children who scored 3-4 points on the composite score had a 10-fold (10.0; 4.2-23.9) increased risk of overweight/obesity compared to those with 0 points, a sevenfold (7.2; 3.9-13.5) increased risk compared to those with 1 point and a threefold (2.6; 1.4-4.8) increased risk compared to those with 2 points, with similar results observed in model 2 (BMI). CONCLUSION The use of a composite score is a beneficial means of identifying children at risk of overweight/obesity and may prove useful in the development of effective interventions to tackle childhood obesity.
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Affiliation(s)
- Aisling O'Donnell
- UCD Institute of Food and Health, School of Agriculture and Food ScienceUniversity College DublinDublinIreland
| | - Maria Buffini
- UCD Institute of Food and Health, School of Agriculture and Food ScienceUniversity College DublinDublinIreland
| | - Laura Kehoe
- School of Food and Nutritional SciencesUniversity College CorkCorkIreland
| | - Anne Nugent
- UCD Institute of Food and Health, School of Agriculture and Food ScienceUniversity College DublinDublinIreland,School of Biological Sciences, Institute for Global Food SecurityQueens University BelfastBelfastNorthern Ireland
| | - John Kearney
- School of Biological & Health SciencesTechnological University DublinDublinIreland
| | - Janette Walton
- Department of Biological SciencesMunster Technological UniversityCorkIreland
| | - Albert Flynn
- School of Food and Nutritional SciencesUniversity College CorkCorkIreland
| | - Breige McNulty
- UCD Institute of Food and Health, School of Agriculture and Food ScienceUniversity College DublinDublinIreland
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Herke M, Moor I, Winter K, Hack M, Hoffmann S, Spallek J, Hilger-Kolb J, Herr R, Pischke C, Dragano N, Novelli A, Richter M. Role of contextual and compositional characteristics of schools for health inequalities in childhood and adolescence: a scoping review. BMJ Open 2022; 12:e052925. [PMID: 35105578 PMCID: PMC8808395 DOI: 10.1136/bmjopen-2021-052925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To synthesise the evidence on the role of compositional or contextual characteristics of schools in the association between students' socioeconomic position and their health in primary and secondary education in developed economies. DESIGN Scoping review. We included studies examining the role of at least one school or class characteristic on students' health inequalities and was published since 1 January 2000, in English or German. We searched PubMed/Medline, Web of Science and Education Resources Information Center. We provided a narrative synthesis and an overview of findings. School characteristics were grouped into five broad categories: school composition, school climate, school policies and organisation, food environment and facilities. RESULTS Of 8520 records identified, 26 studies were included. Twelve studies found a moderating and 3 a mediating effect. The strongest evidence came from studies examining the moderating effect of school composition, that is, the negative impact of a low individual socioeconomic position on mental health and well-being was aggravated by a low average socioeconomic position of schools. Evidence concerning the role of school climate, school stratification (eg, performance base tracking) and sponsorship, food environment and sport facilities and equipment was generally weak or very weak and mostly based on singular findings. Overall, favourable meso-level characteristics mitigated the negative impact of low individual socioeconomic position on health outcomes. CONCLUSIONS School characteristics affect health inequalities in children and adolescents to some degree, but future research is necessary to strengthen the existing evidence and address under-represented aspects in school characteristics and health outcomes.
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Affiliation(s)
- Max Herke
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Irene Moor
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Kristina Winter
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Miriam Hack
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Stephanie Hoffmann
- Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | - Jennifer Hilger-Kolb
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim, Germany
| | - Raphael Herr
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim, Germany
| | - Claudia Pischke
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Anna Novelli
- Chair of Health Economics, Technical University of Munich, München, Germany
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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10
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The Infant Health Study - Promoting mental health and healthy weight through sensitive parenting to infants with cognitive, emotional, and regulatory vulnerabilities: protocol for a stepped-wedge cluster-randomized trial and a process evaluation within municipality settings. BMC Public Health 2022; 22:194. [PMID: 35090411 PMCID: PMC8796192 DOI: 10.1186/s12889-022-12551-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background Child mental health problems are a major public health concern associated with poor mental and physical health later in development. The study evaluates a new community-based intervention to promote sensitive parenting and reduce enduring mental health problems and unhealthy weight among vulnerable infants aged 9-24 months. Methods We use a step-wedge cluster randomized controlled trial design conducted within a home visiting program offered by community health nurses to infant families in Denmark. Sixteen municipalities are randomly allocated to implement the intervention starting at three successive time points from May 1, 2022 to January 1, 2023. A total of 900-1000 families will be included. A standardized program, Psykisk Udvikling og Funktion (PUF), is used to identify infants with major problems of eating, sleep, emotional or behavioral regulation or developmental problems. The intervention builds on the Video-Feedback Intervention to Promote Positive Parenting (VIPP) program, adapted to the PUF-context and named the VIPP-PUF. Children will be followed up at ages 18 and 24 months. Primary outcome measure is the Strengths and Difficulties Questionnaire (SDQ) at child age 24 months. The other outcome measures include body mass index z-scores, the Ages and Stages Questionnaire Social-Emotional (ASQ:SE2); the Child Behavior Checklist (CBCL 1½ -5); Eating behavior Questionnaires; the Being a Mother-questionnaire (BaM13); the Parental Stress Scale (PSS); and the WHO-5 well-being index (WHO-5). Data on child and family factors are obtained from National registries and the Child Health Database. Quantitative measures are applied to examine the effectiveness of the VIPP-PUF intervention and the implementation process. Qualitative measures include interviews with CHNs, parents and municipality stakeholders to explore factors that may influence the adherence and effectiveness of the intervention. Discussion The study examines a service-setting based intervention building on the promotion of sensitive parenting to vulnerable infants. We use a mixed methods approach to evaluate the intervention, taking into account the influences of COVID-19 pandemic running since March 2020. Overall, the study has potential to add to the knowledge on the possibilities of prevention within the municipality child health care to reduce the risk of mental health problems and unhealthy weight in early childhood. Trial registration www.ClinicalTrials.gov; IDNCT04601779; Protocol ID 95-110-21307. Registered 25 June 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12551-z.
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11
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Vieira M, Teixeira A, Carvalho GS. Effectiveness of the "Planning Health in School" Programme on Children's Nutritional Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312846. [PMID: 34886571 PMCID: PMC8657562 DOI: 10.3390/ijerph182312846] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022]
Abstract
Effective interventions for guiding children to change behaviours are needed to tackle obesity. We evaluated the effectiveness of the 'Planning Health in School' programme (PHS-pro) on children's nutritional status. A non-randomised control group pretest-posttest trial was conducted at elementary schools of a sub-urban municipality in Porto's metropolitan area (Portugal). A total of 504 children of grade-6, aged 10-14, were assigned in two groups: children of one school as the intervention group (IG), and three schools as the control group (CG). Anthropometric measures included height, weight, waist circumference (WC), BMI and waist-to-height ratio (WHtR), and lifestyle behaviours (self-reported questionnaire) were assessed at baseline and after PHS-pro. IG children grew significantly taller more than CG ones (p < 0.001). WC had reduced significantly in IG (-0.4 cm) whereas in the CG had increased (+0.3 cm; p = 0.015), and WHtR of IG showed a significant reduction (p = 0.002) compared with CG. After PHS-pro, IG children consumed significantly fewer soft drinks (p = 0.043) and ate more fruit and vegetables daily than CG. Physical activity time increased significantly in IG (p = 0.022), while CG maintained the same activity level. The PHS-pro did improve anthropometric outcomes effectively leading to better nutritional status and appears to be promising in reducing overweight and obesity.
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Affiliation(s)
- Margarida Vieira
- Research Centre on Child Studies, University of Minho, 4710-057 Braga, Portugal;
- Correspondence: ; Tel.: +351-253-601-212
| | - Andreia Teixeira
- Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- ADiT-LAB, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial Nun’Álvares, 4900-347 Viana do Castelo, Portugal
| | - Graça S. Carvalho
- Research Centre on Child Studies, University of Minho, 4710-057 Braga, Portugal;
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12
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Buoncristiano M, Williams J, Simmonds P, Nurk E, Ahrens W, Nardone P, Rito AI, Rutter H, Bergh IH, Starc G, Jonsson KR, Spinelli A, Vandevijvere S, Mäki P, Milanović SM, Salanave B, Yardim MS, Hejgaard T, Fijałkowska A, Abdrakhmanova S, Abdurrahmonova Z, Duleva V, Farrugia Sant'Angelo V, García-Solano M, Gualtieri A, Gutiérrez-González E, Huidumac-Petrescu C, Hyska J, Kelleher CC, Kujundžić E, Peterkova V, Petrauskiene A, Pudule I, Sacchini E, Shengelia L, Tanrygulyyeva M, Taxová Braunerová R, Usupova Z, Maruszczak K, Ostojic SM, Spiroski I, Stojisavljević D, Wickramasinghe K, Breda J. Socioeconomic inequalities in overweight and obesity among 6- to 9-year-old children in 24 countries from the World Health Organization European region. Obes Rev 2021; 22 Suppl 6:e13213. [PMID: 34184399 DOI: 10.1111/obr.13213] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 01/17/2023]
Abstract
Childhood overweight and obesity have significant short- and long-term negative impacts on children's health and well-being. These challenges are unequally distributed according to socioeconomic status (SES); however, previous studies have often lacked standardized and objectively measured data across national contexts to assess these differences. This study provides a cross-sectional picture of the association between SES and childhood overweight and obesity, based on data from 123,487 children aged 6-9 years in 24 countries in the World Health Organization (WHO) European region. Overall, associations were found between overweight/obesity and the three SES indicators used (parental education, parental employment status, and family-perceived wealth). Our results showed an inverse relationship between the prevalence of childhood overweight/obesity and parental education in high-income countries, whereas the opposite relationship was observed in most of the middle-income countries. The same applied to family-perceived wealth, although parental employment status appeared to be less associated with overweight and obesity or not associated at all. This paper highlights the need for close attention to context when designing interventions, as the association between SES and childhood overweight and obesity varies by country economic development. Population-based interventions have an important role to play, but policies that target specific SES groups are also needed to address inequalities.
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Affiliation(s)
- Marta Buoncristiano
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Julianne Williams
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Philippa Simmonds
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Eha Nurk
- Department of Nutrition Research, National Institute for Health Development, Tallinn, Estonia
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology, BIPS, Bremen, Germany.,Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Paola Nardone
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | - Ana Isabel Rito
- WHO/Europe Collaborating Center for Nutrition and Childhood Obesity - Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Ingunn Holden Bergh
- Department of Health and Inequality, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Gregor Starc
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Kenisha Russell Jonsson
- Department of Living Conditions and Lifestyle, Public Health Agency of Sweden, Solna, Sweden
| | - Angela Spinelli
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | | | - Päivi Mäki
- Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sanja Musić Milanović
- Croatian Institute of Public Health, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Benoît Salanave
- Departement of Non-Communicable Diseases and Traumatisms, Santé publique France, the French Public Health Agency, Saint Maurice, France.,Nutritional Surveillance and Epidemiology Team (ESEN), University Sorbonne Paris Nord, Bobigny, France
| | | | - Tatjana Hejgaard
- Health Promotion and Inequality, Danish Health Authority, Copenhagen, Denmark
| | - Anna Fijałkowska
- Department of Cardiology, Institute of Mother and Child, Warsaw, Poland
| | - Shynar Abdrakhmanova
- Department of Science and Professional Development, National Center of Public Health of the Ministry of Health of the Republic of Kazakhstan, Almaty, Kazakhstan.,Kazakhstan School of Public Health, Kazakhstan's Medical University, Almaty, Kazakhstan
| | - Zulfiya Abdurrahmonova
- Republican Centre for Nutrition, Ministry of Health and Social Protection of Population, Dushanbe, Tajikistan
| | - Vesselka Duleva
- Department Food and Nutrition, National Centre of Public Health and Analyses, Sofia, Bulgaria
| | | | - Marta García-Solano
- Spanish Agency for Food Safety and Nutrition, Ministry of Consumer Affairs, Madrid, Spain
| | | | | | - Constanta Huidumac-Petrescu
- National Center for Health Assessment and Promotion, National Institute of Public Health, Bucharest, Romania
| | - Jolanda Hyska
- Nutrition and Food Safety Sector, Institute of Public Health, Tirana, Albania
| | - Cecily C Kelleher
- College of Health and Agricultural Sciences, University College Dublin, Dublin, Ireland
| | - Enisa Kujundžić
- Center for Health Ecology, Institute of Public Health, Podgorica, Montenegro
| | - Valentina Peterkova
- Institute of Paediatric Endocrinology, National Medical Research Centre for Endocrinology of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Ausra Petrauskiene
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Iveta Pudule
- Department of Research and Health Statistics, Centre for Disease and Prevention Control, Riga, Latvia
| | - Elena Sacchini
- Health Authority, Ministry of Health, San Marino, San Marino
| | - Lela Shengelia
- Maternal, Child and Reproductive Health, National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Maya Tanrygulyyeva
- Scientific Research Institute of Maternal and Child Health, Ashgabat, Turkmenistan
| | | | - Zhamilya Usupova
- Republican Center for Health Promotion and Mass Communication, Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgyzstan
| | | | - Sergej M Ostojic
- Biomedical Sciences Department, Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Igor Spiroski
- Institute of Public Health, Skopje, North Macedonia.,Faculty of Medicine, SS. Cyril and Methodius University, Skopje, North Macedonia
| | - Dragana Stojisavljević
- Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina.,Public Health Institute of Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Kremlin Wickramasinghe
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - João Breda
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
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13
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Reynolds JP, Ventsel M, Kosīte D, Rigby Dames B, Brocklebank L, Masterton S, Pechey E, Pilling M, Pechey R, Hollands GJ, Marteau TM. Impact of decreasing the proportion of higher energy foods and reducing portion sizes on food purchased in worksite cafeterias: A stepped-wedge randomised controlled trial. PLoS Med 2021; 18:e1003743. [PMID: 34520468 PMCID: PMC8439477 DOI: 10.1371/journal.pmed.1003743] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 07/27/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Overconsumption of energy from food is a major contributor to the high rates of overweight and obesity in many populations. There is growing evidence that interventions that target the food environment may be effective at reducing energy intake. The current study aimed to estimate the effect of decreasing the proportion of higher energy (kcal) foods, with and without reducing portion size, on energy purchased in worksite cafeterias. METHODS AND FINDINGS This stepped-wedge randomised controlled trial (RCT) evaluated 2 interventions: (i) availability: replacing higher energy products with lower energy products; and (ii) size: reducing the portion size of higher energy products. A total of 19 cafeterias were randomised to the order in which they introduced the 2 interventions. Availability was implemented first and maintained. Size was added to the availability intervention. Intervention categories included main meals, sides, cold drinks, snacks, and desserts. The study setting was worksite cafeterias located in distribution centres for a major United Kingdom supermarket and lasted for 25 weeks (May to November 2019). These cafeterias were used by 20,327 employees, mainly (96%) in manual occupations. The primary outcome was total energy (kcal) purchased from intervention categories per day. The secondary outcomes were energy (kcal) purchased from nonintervention categories per day, total energy purchased per day, and revenue. Regression models showed an overall reduction in energy purchased from intervention categories of -4.8% (95% CI -7.0% to -2.7%), p < 0.001 during the availability intervention period and a reduction of -11.5% (95% CI -13.7% to -9.3%), p < 0.001 during the availability plus size intervention period, relative to the baseline. There was a reduction in energy purchased of -6.6% (95% CI -7.9% to -5.4%), p < 0.001 during the availability plus size period, relative to availability alone. Study limitations include using energy purchased as the primary outcome (and not energy consumed) and the availability only of transaction-level sales data per site (and not individual-level data). CONCLUSIONS Decreasing the proportion of higher energy foods in cafeterias reduced the energy purchased. Decreasing portion sizes reduced this further. These interventions, particularly in combination, may be effective as part of broader strategies to reduce overconsumption of energy from food in out-of-home settings. TRIAL REGISTRATION ISRCTN registry ISRCTN87225572.
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Affiliation(s)
- James P. Reynolds
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
- School of Psychology, Aston University, Birmingham, United Kingdom
| | - Minna Ventsel
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Daina Kosīte
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Brier Rigby Dames
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Laura Brocklebank
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Sarah Masterton
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Emily Pechey
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Mark Pilling
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Rachel Pechey
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
- Nuffield Department of Primary Care and Health Science, University of Oxford, Oxford, United Kingdom
| | - Gareth J. Hollands
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
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14
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The economic crisis impact on the body mass index of children living in distinct urban environments. Public Health 2021; 196:29-34. [PMID: 34139606 DOI: 10.1016/j.puhe.2021.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/05/2021] [Accepted: 04/30/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Little is known about the impact of the 2008 global economic recession on childhood obesity in Portugal. Thus, this study's goals were to compare weight status of children during and after the economic crisis according to their neighbourhood environment features and to assess changes in specific dietary habits during the economic crisis. STUDY DESIGN Cross-sectional study. METHODS Data including weight, height, residence address to allow its geocoding and dietary habits changes during the crisis from children living in Lisbon municipality were collected in 2009 (N = 929) and in 2016 (N = 1751). A multidimensional environment index, with data of both built and socioeconomic nature collected at the statistical section level (areas comprised 300 dwellers) in the 2011 census, was used to characterize neighbourhoods. RESULTS Overall, the proportion of children who are overweight or obese living in the socioeconomically vulnerable areas decreased in 2016. Families living in the latter areas stopped buying some food items, started to buy cheaper food items, cooked more meals at home and ate less in restaurants. In 2016, the risk for overweight and obesity increased in children who lived in the least advantageous areas. Living in areas with high socioeconomic status or most advantageous areas no longer represented a decreased risk of being overweight or obese in children in 2016 as it did in 2009. CONCLUSIONS This study suggests that the economic crisis enhanced the social inequalities regarding childhood obesity. These results aid the development of evidence-based strategies to lessen the social inequities in health outcomes created by the crisis.
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15
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Reversal of the Upward Trend of Obesity in Boys, but Not in Girls, in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041842. [PMID: 33672817 PMCID: PMC7918759 DOI: 10.3390/ijerph18041842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/06/2021] [Accepted: 02/11/2021] [Indexed: 01/22/2023]
Abstract
(1) Background: To compare the prevalence of overweight and obesity in boys and girls and to estimate socioeconomic differences associated with obesity in Spain in 1997, 2007, and 2017. (2) Methods: Data were drawn from national health interview surveys. For each year of study, the prevalence of overweight and obesity was measured, and these results were compared by gender (boy/girl) and socioeconomic status (low/high education). (3) Results: The prevalence of overweight and obesity rose from 1997 to 2007 but then fell in 2017 in all subgroups except in girls aged 10 to 15 years. In this group, there was a steady increase in the prevalence of both overweight (1997, 14.6%; 2007, 17.7%; 2017, 19.6%) and obesity (1.1, 3.2, and 3.7%, respectively). The decrease in prevalence of overweight in both sexes and of obesity in boys, along with the increase in prevalence of obesity in girls, was of a higher magnitude in children whose parents had a lower educational level. (4) Conclusions: The apparent turnaround in the obesity epidemic in Spain should be interpreted with caution. Children’s body weight is influenced by both gender and socioeconomic status—considerations that should be kept in mind when designing health promotion interventions.
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16
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Millar SR, Harding M, McCarthy LE, Kelleher V, Harrington JM, James P, Whelton H, Perry IJ. Exploring 12-Year trends in childhood obesity prevalence for the Republic of Ireland - a national study using survey data from 2002 and 2014. HRB Open Res 2021; 4:3. [PMID: 35949452 PMCID: PMC9334843 DOI: 10.12688/hrbopenres.12988.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The prevalence of overweight and obesity among children may have reached a plateau in some developed countries, including Ireland. The aim of this study was to examine 12-year trends in the prevalence of overweight and obesity among primary-school-aged children in the Republic of Ireland between 2002 and 2014. Methods: Two large-scale oral health cross-sectional surveys of primary-school-aged children aged 4-13 years were conducted 12 years apart in 2002 (n=14,055; response rate=68%) and 2014 (n=5,223; response rate=67%). Both surveys included standardised and calibrated height and weight measures. Ownership of a means-tested medical card determined economic status. Standard International Obesity Task Force criteria were applied to determine the prevalence of overweight and obesity. Results: The overall prevalence of overweight/obesity among 4-13-year-olds significantly decreased from 26% (95% CI: 25.1%-26.5%) in 2002 to 24% (95% CI: 22.4%-24.7%) in 2014. Among boys and girls aged 4-13 years, the significant decrease was from 23% (95% CI: 22.1%-24.1%) to 20% (95% CI: 18.9%-22.0 and 28% (95% CI: 27.4%-29.5%) to 27% (95% CI: 25.0%-28.4%), respectively. Among 5-year-old children, the overall prevalence of overweight and obesity significantly decreased from 25% (95% CI: 23.7%-26.2%) to 22% (95% CI: 19.9%-23.4%). In 2002, the estimated prevalence of overweight/obesity was similar in children with and without medical cards, whereas in 2014, overall prevalence was higher in those with medical cards. Conclusions: Results suggest a fall in the prevalence of overweight/obesity between 2002 and 2014, and may suggest a favourable cohort effect. Despite this fall, the overall prevalence remains high and socioeconomic disparities have increased.
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Affiliation(s)
- Seán R. Millar
- School of Public Health, University College Cork, Cork, Co Cork, Ireland
| | - Mairead Harding
- Oral Health Services Research Centre, University College Cork, Cork, Co Cork, Ireland
- Cork University Dental School and Hospital, University College Cork, Cork, Co Cork, Ireland
- Cork Kerry Community Healthcare, Health Service Executive, Cork, Co Cork, Ireland
| | - Laura E. McCarthy
- School of Public Health, University College Cork, Cork, Co Cork, Ireland
| | - Virginia Kelleher
- Oral Health Services Research Centre, University College Cork, Cork, Co Cork, Ireland
| | | | - Patrice James
- Oral Health Services Research Centre, University College Cork, Cork, Co Cork, Ireland
| | - Helen Whelton
- Oral Health Services Research Centre, University College Cork, Cork, Co Cork, Ireland
- College of Medicine and Health, University College Cork, Cork, Co Cork, Ireland
| | - Ivan J. Perry
- School of Public Health, University College Cork, Cork, Co Cork, Ireland
- Oral Health Services Research Centre, University College Cork, Cork, Co Cork, Ireland
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17
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Robinson N, McKay JA, Pearce MS, Albani V, Wright CM, Adamson AJ, Brown H. The Biological and Social Determinants of Childhood Obesity: Comparison of 2 Cohorts 50 Years Apart. J Pediatr 2021; 228:138-146.e5. [PMID: 32949578 DOI: 10.1016/j.jpeds.2020.09.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine whether the same relationships between early-life risk factors and socioeconomic status (SES) with childhood body mass index (BMI) are observed in a modern cohort (2000) compared with a historic cohort (1947). STUDY DESIGN The relationships between early-life factors and SES with childhood BMI were examined in 2 prospective birth cohorts from the same region, born 50 years apart: 711 children in the 1947 Newcastle Thousand Families Study (NTFS) and 475 from the 2000 Gateshead Millennium Study (GMS). The associations between birth weight, breastfeeding, rapid infancy growth (0-12 months), early-life adversity (0-12 months), and parental SES (birth and childhood) with childhood BMI z-scores and whether overweight/obese (BMI >91st percentile using UK 1990 reference) aged 9 years were examined using linear regression, path analyses, and logistic regression. RESULTS In the NTFS, the most advantaged children were taller than the least (+0.91 height z-score, P = .001), whereas in GMS they had lower odds of overweight/obese than the least (0.35 [95% CI 0.14-0.86]). Rapid infancy growth was associated with increased BMI z-scores in both cohorts, and with increased likelihood of overweight/obese in GMS. CONCLUSIONS This study suggests that children exposed to socioeconomic disadvantage or who have rapid infancy growth in modern environments are now at lower risk of growth restriction but greater risk of overweight.
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Affiliation(s)
- Natassia Robinson
- Population Health Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Jill A McKay
- Faculty of Health and Life Sciences, Department of Applied Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Mark S Pearce
- Population Health Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Viviana Albani
- Population Health Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Charlotte M Wright
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Ashley J Adamson
- Population Health Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Heather Brown
- Population Health Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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Herke M, Moor I, Winter K, Hoffmann S, Spallek J, Hilger-Kolb J, Pischke C, Dragano N, Novelli A, Richter M. Role of contextual and compositional characteristics of schools for health inequalities in childhood and adolescence: protocol for a scoping review. BMJ Open 2020; 10:e038999. [PMID: 33361163 PMCID: PMC7759761 DOI: 10.1136/bmjopen-2020-038999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Childhood and adolescence are crucial life stages for health trajectories and the development of health inequalities in later life. The relevance of schools for health and well-being of children and adolescents has long been recognised, and there is some research regarding the association of contextual and compositional characteristics of schools and classes with health, health behaviour and well-being in this population. Little is known about the role of meso-level characteristics in relation to health inequalities. The aim of this scoping review is to retrieve and synthesise evidence about the mediating or moderating role of compositional or contextual characteristics of schools for the association between students' socioeconomic position and health in primary and secondary education. METHODS AND ANALYSIS We will conduct a systematic search of electronic databases in PubMed/Medline, Web of Science and Education Resources Information Center. Studies must meet the following inclusion criteria: (1) The population must be students attending primary or secondary schools in developed economies. (2) The outcomes must include at least one indicator for individual health, health behaviour or well-being. (3) The study must include at least one contextual or compositional characteristic of the school context and one individual determinant of socioeconomic position. (4) The study must also examine the mediating or moderating role of the contextual or compositional characteristic of the school context for the associations between socioeconomic position and health, health behaviour or well-being. (5) The study must be published since 1 January 2000 in English or German language. We will provide a narrative synthesis of findings. ETHICS AND DISSEMINATION We will not collect primary data and only include secondary data derived from previously published studies. Therefore, ethical approval is not required. We intend to publish our findings in an international peer-reviewed journal and to present them at national and international conferences.
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Affiliation(s)
- Max Herke
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Irene Moor
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Kristina Winter
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Stephanie Hoffmann
- Department of Public Health, Faculty for Social Work, Health, and Music, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Jacob Spallek
- Department of Public Health, Faculty for Social Work, Health, and Music, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Jennifer Hilger-Kolb
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Claudia Pischke
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Anna Novelli
- Department of Health Services Management, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Kåks P, Målqvist M. Using an urban child health index to detect intra-urban disparities in Sweden. Scand J Public Health 2020; 49:563-570. [PMID: 33339488 PMCID: PMC8512276 DOI: 10.1177/1403494820980261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: Children’s health is affected by the environment in which they live and grow.
Within Sweden’s urban areas, several city districts can be classified as
socio-economically disadvantaged. This article describes the creation of a
child health index to visualise disparities within and between Sweden’s
three major cities, and how these relate to indicators of demography and
socio-economic status. Methods: Data were collected for seven child health indicators and seven
socio-economic and demographic indicators from the Swedish Pregnancy
Register, Child Health Services and Statistics Sweden. An index was created
from the health indicators using principal component analysis, generating
weights for each indicator. Correlations between index outcomes and
socio-economic and demographic indicators were analysed using linear
regression. Results: The largest variance in index values could be seen in Stockholm followed by
Malmö, and the poorest mean index outcome was seen in Malmö followed by
Gothenburg. The largest intra-urban percentage range in health indicators
could be seen for tobacco exposure at 0–4 weeks (0.8–33.9%, standard
deviation (SD)=8.8%) and, for the socio-economic and
demographic indicators, foreign background (19.9–88.5%,
SD=19.8%). In the multivariate analysis, index outcomes
correlated most strongly with foreign background
(R2=0.364, p=0.001). Conclusions: Children’s health follows a social gradient and a pattern of ethnic
segregation in Swedish cities, where it can be visualised using an index of
child health. The resulting map highlights the geographical distribution of
these disparities, and displays in which city districts child health
interventions may be most needed.
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Affiliation(s)
- Per Kåks
- Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Department of Women's and Children's Health, Uppsala University, Sweden
| | - Mats Målqvist
- Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Department of Women's and Children's Health, Uppsala University, Sweden
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Abstract
PURPOSE OF REVIEW Despite its rapidly rising global prevalence, obesity is not featured in any of the Sustainable Development Goals (SDGs). This review highlights the multiple points at which obesity is affected by the Goals. RECENT FINDINGS At least 14 out of the 17 thematic SDG targets play a role in driving the obesity epidemic, including health, food, education, water quality, land and ocean quality, urbanisation and employment. Although the SDGs recognise the need to reduce 'malnutrition in all its forms', the Goals underplay the role of urbanisation and unregulated markets on dietary health. Furthermore, adherence to the SDGs may be weak and compromised by conflicted interests. Nonetheless, governments have shown that they can, when pressed, respond to health challenges, and we anticipate how the rise in the numbers of people experiencing excess bodyweight may itself lead to greater demand for collective responsibility to ensure our environments are fully health-creating.
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Affiliation(s)
- Tim Lobstein
- World Obesity Federation, Suite 406, 107-111 Fleet Street, London, EC4A 2AB, UK.
- Boden Institute, University of Sydney, Camperdown, NSW, 2006, Australia.
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21
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Overweight and obesity in Eastern Morocco: Prevalence and associated risk factors among high school students. Rev Epidemiol Sante Publique 2020; 68:295-301. [PMID: 32896444 DOI: 10.1016/j.respe.2020.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/28/2020] [Accepted: 06/19/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Overweight and obesity in children and adolescents have become a major public health problem affecting most countries worldwide. The purpose of the study was to assess the prevalence and risk factors of overweight and obesity among public high school students in Eastern Morocco. METHODS A cross-sectional survey was conducted between February and May 2014 among a sample of 2271 students (1086 girls and 1185 boys). References from the International Obesity Task Force (IOTF) were used to determine the prevalence of overweight and obesity. RESULTS The prevalence of overweight and obesity reached 12.2% (14.2% in girls vs 10.4% in boys, P<0.01) and 3.0% (3.1% in girls vs 2.8% in boys), respectively. Risk factors associated with overweight and obesity were urban residence (OR=1.76; [1.18-2.63]; P<0.01), father's income≥5000MAD (OR=1.32; [1.02-1.70]; P<0.05), father's overweight (including obesity) (OR=1.87; [1.38-2.54]; P<0.001) and female sex (OR=1.31; [1.02-1.68]; P<0.05). CONCLUSION The prevalence of overweight/obesity has reached an alarming rate among high school students in the Eastern region of Morocco. The findings of the present study suggest an urgent need to set up a strategy to prevent and combat this epidemic.
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Kininmonth AR, Smith AD, Llewellyn CH, Fildes A. Socioeconomic status and changes in appetite from toddlerhood to early childhood. Appetite 2020; 146:104517. [DOI: 10.1016/j.appet.2019.104517] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/14/2019] [Accepted: 11/13/2019] [Indexed: 12/12/2022]
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Best KE, Rankin J, Dolk H, Loane M, Haeusler M, Nelen V, Verellen‐Dumoulin C, Garne E, Sayers G, Mullaney C, O'Mahony MT, Gatt M, De Walle H, Klungsoyr K, Carolla OM, Cavero‐Carbonell C, Kurinczuk JJ, Draper ES, Tucker D, Wellesley D, Zymak‐Zakutnia N, Lelong N, Khoshnood B. Multilevel analyses of related public health indicators: The European Surveillance of Congenital Anomalies (EUROCAT) Public Health Indicators. Paediatr Perinat Epidemiol 2020; 34:122-129. [PMID: 32101337 PMCID: PMC7064886 DOI: 10.1111/ppe.12655] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/13/2020] [Accepted: 01/21/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Public health organisations use public health indicators to guide health policy. Joint analysis of multiple public health indicators can provide a more comprehensive understanding of what they are intended to evaluate. OBJECTIVE To analyse variaitons in the prevalence of congenital anomaly-related perinatal mortality attributable to termination of pregnancy for foetal anomaly (TOPFA) and prenatal diagnosis of congenital anomaly prevalence. METHODS We included 55 363 cases of congenital anomalies notified to 18 EUROCAT registers in 10 countries during 2008-12. Incidence rate ratios (IRR) representing the risk of congenital anomaly-related perinatal mortality according to TOPFA and prenatal diagnosis prevalence were estimated using multilevel Poisson regression with country as a random effect. Between-country variation in congenital anomaly-related perinatal mortality was measured using random effects and compared between the null and adjusted models to estimate the percentage of variation in congenital anomaly-related perinatal mortality accounted for by TOPFA and prenatal diagnosis. RESULTS The risk of congenital anomaly-related perinatal mortality decreased as TOPFA and prenatal diagnosis prevalence increased (IRR 0.79, 95% confidence interval [CI] 0.72, 0.86; and IRR 0.88, 95% CI 0.79, 0.97). Modelling TOPFA and prenatal diagnosis together, the association between congenital anomaly-related perinatal mortality and TOPFA prevalence became stronger (RR 0.70, 95% CI 0.61, 0.81). The prevalence of TOPFA and prenatal diagnosis accounted for 75.5% and 37.7% of the between-country variation in perinatal mortality, respectively. CONCLUSION We demonstrated an approach for analysing inter-linked public health indicators. In this example, as TOPFA and prenatal diagnosis of congenital anomaly prevalence decreased, the risk of congenital anomaly-related perinatal mortality increased. Much of the between-country variation in congenital anomaly-related perinatal mortality was accounted for by TOPFA, with a smaller proportion accounted for by prenatal diagnosis.
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Affiliation(s)
- Kate E. Best
- Institute of Health & SocietyNewcastle UniversityNewcastle upon TyneUK
| | - Judith Rankin
- Institute of Health & SocietyNewcastle UniversityNewcastle upon TyneUK
| | - Helen Dolk
- Centre for Maternal, Fetal and Infant ResearchInstitute of Nursing and Health ResearchUlster UniversityUlsterUK
| | - Maria Loane
- Centre for Maternal, Fetal and Infant ResearchInstitute of Nursing and Health ResearchUlster UniversityUlsterUK
| | | | - Vera Nelen
- Provinciaal Instituut voor HygiëneAntwerpBelgium
| | | | - Ester Garne
- Paediatric DepartmentHospital LillebaeltKoldingDenmark
| | | | - Carmel Mullaney
- Public Health DepartmentHSE Southeast areaLackenKilkennyIreland
| | - Mary T. O'Mahony
- Department of Public HealthHealth Service Executive SouthCorkIreland
| | - Miriam Gatt
- Department of Health Information and ResearchGuardamangiaMalta
| | - Hermien De Walle
- Department of GeneticsUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Kari Klungsoyr
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
| | | | - Clara Cavero‐Carbonell
- Rare Diseases Research UnitFoundation for the Promotion of Health and Biomedical Research of the Valencian RegionValenciaSpain
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | | | - David Tucker
- Congenital Anomaly Register and Information Service for WalesPublic Health WalesSwanseaUK
| | - Diana Wellesley
- Faculty of MedicineUniversity of Southampton and Wessex Clinical Genetics ServiceSouthamptonUK
| | | | - Nathalie Lelong
- INSERM U1153 (Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Biostatistics and Epidemiology)Maternité Port RoyalParisFrance
| | - Babak Khoshnood
- INSERM U1153 (Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Biostatistics and Epidemiology)Maternité Port RoyalParisFrance
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Orden AB, Lamarque MS, Apezteguía MC. Trend in childhood obesity reflects socioeconomic status in Argentina. Ann Hum Biol 2019; 46:531-536. [DOI: 10.1080/03014460.2019.1694070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Alicia B. Orden
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)
- Instituto de Desarrollo e Investigaciones Pediátricas (IDIP, MS/CIC, PBA), La Plata, Buenos Aires, Argentina
| | - Muriel S. Lamarque
- Instituto de Desarrollo e Investigaciones Pediátricas (IDIP, MS/CIC, PBA), La Plata, Buenos Aires, Argentina
| | - María C. Apezteguía
- Instituto de Desarrollo e Investigaciones Pediátricas (IDIP, MS/CIC, PBA), La Plata, Buenos Aires, Argentina
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Malden S, Reilly JJ, Gibson AM, Bardid F, Summerbell C, De Craemer M, Cardon G, Androutsos O, Manios Y, Hughes A. A feasibility cluster randomised controlled trial of a preschool obesity prevention intervention: ToyBox-Scotland. Pilot Feasibility Stud 2019; 5:128. [PMID: 31728203 PMCID: PMC6842492 DOI: 10.1186/s40814-019-0521-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/17/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND High levels of childhood obesity have been observed globally over the last three decades. Preschools are promising settings to implement obesity prevention interventions in the early years. The aim of this study was to test the feasibility of a cluster randomised controlled trial of the ToyBox-Scotland preschool obesity prevention intervention. METHODS Six preschools in predominantly deprived areas of Glasgow, UK, were randomised to either the ToyBox intervention (n = 3) or usual curriculum control group (n = 3). The intervention ran for 18 weeks from March-June 2018, and consisted of practitioner-led physical activity and sedentary behaviour sessions in preschools, with an additional interactive home component. Primary outcome measures were intervention fidelity, recruitment rates, attrition rates, and compliance with trial procedures. Secondary outcomes were body mass index (BMI) z-score, bioelectrical impedance analysis (BIA), objectively measured physical activity and sedentary time via activPAL accelerometer, and parent-reported home eating, snacking, and water consumption. RESULTS The preschool component of the intervention was implemented with high fidelity (64%), while the home component was implemented with low fidelity (41%). A cluster-level recruitment rate of 10% was achieved, and the individual-level recruitment rate was 18% (42/233 children, mean age 4.4 years; 17 girls). The attrition rate was 14%, and compliance rates varied considerably by the outcome. Compliance was highest for BMI (86%), while 19% of the sample returned valid accelerometer data for both baseline and follow-up and the parental questionnaire response rate was 23%. Both intervention and control groups showed small increases in BMI z-scores at follow-up of 0.02 and 0.06, respectively. Both groups had small decreases in physical activity and increases in sedentary time at follow-up. CONCLUSIONS Before progression to an effectiveness trial, additional procedures should be considered to improve recruitment rates, compliance with outcome measures, and implementation of the home-based component of the ToyBox-Scotland intervention. TRIAL REGISTRATION ISRCTN12831555.
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Affiliation(s)
- Stephen Malden
- Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1XP UK
| | - John. J. Reilly
- Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1XP UK
| | - Ann-Marie Gibson
- Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1XP UK
| | - Farid Bardid
- School of Education, University of Strathclyde, Glasgow, UK
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Durham City, UK
| | - Marieke De Craemer
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Adrienne Hughes
- Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1XP UK
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Santos PCD, Silva KSD, Silva JAD, Santos CESD, Duca GFD, Lopes ADS, Nahas MV. Change in overweight and obesity over a decade according to sociodemographic factors in Brazilian adolescents. CIENCIA & SAUDE COLETIVA 2019; 24:3335-3344. [PMID: 31508754 DOI: 10.1590/1413-81232018249.29052017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 02/11/2018] [Indexed: 11/22/2022] Open
Abstract
The aims were to examine changes in the prevalence of overweight and obesity among students from 2001 to 2011, and to verify if these changes differ according to age group, area of residence, and family income. We analyzed two cross-sectional surveys conducted in 2001 and 2011 with brazilian adolescents. Sociodemographic and anthropometric characteristics were self-reported using a questionnaire. Multinomial logistic regression was used to analyze changes in overweight and obesity between the two surveys. The nutritional status was the outcome of the present study and the surveys (2001 and 2011) were the exposure. The odds of being overweight and obese were higher among boys and girls in urban areas in the 2011 survey compared to the 2001. Boys and girls with higher income were also more likely to present overweight and obesity in the second survey compared to the first. An increase of overweight and obesity was observed over a decade. We suggest that future interventions consider the area of residence and the family income to strengthen the effectiveness of actions developed to prevent and control these indicators among adolescents.
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Affiliation(s)
- Priscila Cristina Dos Santos
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Santa Catarina. Campus Universitário, Trindade. 88040-900 Florianópolis SC Brasil.
| | - Kelly Samara da Silva
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Santa Catarina. Campus Universitário, Trindade. 88040-900 Florianópolis SC Brasil.
| | - Jaqueline Aragoni da Silva
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Santa Catarina. Campus Universitário, Trindade. 88040-900 Florianópolis SC Brasil.
| | - Carla Elane Silva Dos Santos
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Santa Catarina. Campus Universitário, Trindade. 88040-900 Florianópolis SC Brasil.
| | - Giovani Firpo Del Duca
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Santa Catarina. Campus Universitário, Trindade. 88040-900 Florianópolis SC Brasil.
| | - Adair da Silva Lopes
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Santa Catarina. Campus Universitário, Trindade. 88040-900 Florianópolis SC Brasil.
| | - Markus Vinícius Nahas
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Santa Catarina. Campus Universitário, Trindade. 88040-900 Florianópolis SC Brasil.
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Rotevatn TA, Overgaard C, Melendez-Torres GJ, Mortensen RN, Ullits LR, Høstgaard AMB, Torp-Pedersen C, Bøggild H. Infancy weight gain, parental socioeconomic position, and childhood overweight and obesity: a Danish register-based cohort study. BMC Public Health 2019; 19:1209. [PMID: 31477065 PMCID: PMC6720844 DOI: 10.1186/s12889-019-7537-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/22/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Rapid infant weight gain (RIWG) is a very strong predictor of childhood overweight and obesity (COO). Socioeconomic position (SEP) is also related to the risk of COO and parents of different SEP may differ in their reaction to accelerated infant weight gain. Together this could lead to differences in how weight gain and COO risk relate across SEP. This study aimed to analyse possible interaction of SEP and RIWG on COO risk. METHODS A register-based longitudinal cohort study followed 19,894 healthy, term infants, born in Denmark between December 2011 and May 2015. Logistic regression models were used to estimate odds ratios (OR) of COO risk at 2 years (22-26 months) of age with 95% confidence intervals (95% CI) for categories of infancy weight gain based on changes in weight-for-age z-scores between 0 and 8-10 months of age (slow (<- 0.67), mean (- 0.67-0.67), rapid (> 0.67-1.34) and very rapid (> 1.34)). Possible multiplicative and additive interaction of SEP (based on household income and maternal education) on the relationship between infancy weight gain and COO were analysed. RESULTS In total, 19.1 and 15.1% experienced rapid or very rapid weight gain, respectively, and 1497 (7.5%) children were classified with COO at follow-up. These prevalences were higher in those with lower levels of SEP. Adjusted OR for COO were 3.09 (95% CI [2.66-3.59]) and 7.58 (95% CI [6.51-8.83]) for rapid and very rapid weight gain, respectively, when household income was included in the model. Results were similar in the model including maternal education. No signs of interactions were detected on a multiplicative scale. Weak signs of additive interaction were present, but these values did not reach significance. CONCLUSION Both rapid and very rapid weight gain were associated with substantially higher risks of COO but these associations were not modified by SEP. This indicates that promotion of healthy weight gain should take place in all population groups irrespective of their SEP.
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Affiliation(s)
- Torill Alise Rotevatn
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220, Aalborg East, Denmark.
| | - Charlotte Overgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220, Aalborg East, Denmark
| | - G J Melendez-Torres
- DECIPHer, Cardiff School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, Wales, UK
| | - Rikke Nørmark Mortensen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000, Aalborg, Denmark
| | - Line Rosenkilde Ullits
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220, Aalborg East, Denmark
| | - Anna Marie Balling Høstgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220, Aalborg East, Denmark
| | - Christian Torp-Pedersen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220, Aalborg East, Denmark.,Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000, Aalborg, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220, Aalborg East, Denmark.,Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000, Aalborg, Denmark
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Significant Decrease in Childhood Obesity and Waist Circumference over 15 Years in Switzerland: A Repeated Cross-Sectional Study. Nutrients 2019; 11:nu11081922. [PMID: 31443303 PMCID: PMC6722927 DOI: 10.3390/nu11081922] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 11/19/2022] Open
Abstract
Despite a global increase in childhood obesity over the past decades, several countries, including Switzerland, have recently reported stabilizing trends. Using national data from school-aged children in Switzerland over the past 16 years, our study aim was to assess changes in the prevalence of overweight and obesity, central adiposity and predictors of obesity related to lifestyle and parental factors. Nationally representative samples of children aged 6–12 years were studied in 2002 (n = 2493), 2007 (n = 2218), 2012 (n = 2963), and 2017/18 (n = 2279). Height and weight, waist circumference, and multiple skinfold thicknesses were measured. Potential risk factors for overweight and obesity were determined using a self-administered questionnaire in 2017/18, collecting data on diet, physical activity, and parental factors. Prevalence (95% CI) of overweight (incl. obesity) and obesity in 2017/18 was 15.9% (14.4–17.4) and 5.3% (4.5–6.3), respectively. Binary logistic regression revealed a small but significant decrease in the prevalence of overweight (including obesity) since 2002 (OR (95% CI) = 0.988 (0.978–0.997)), while the change in obesity alone was not significant. The most important risk factors for childhood overweight/obesity in 2017/18 were low parental education, non-Swiss origin of the parents, low physical activity of the child, and male sex. In conclusion, we have shown a small but significant declining trend in the childhood overweight/obesity prevalence over the past 15 years in Switzerland. Based on the risk factor analysis, preventive action in schoolchildren might be most effective in boys, migrant populations, and families with lower education, and should emphasize physical activity.
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Rose J, Glazebrook C, Wharrad H, Siriwardena AN, Swift JA, Nathan D, Weng SF, Atkinson P, Ablewhite J, McMaster F, Watson V, Redsell SA. Proactive Assessment of Obesity Risk during Infancy (ProAsk): a qualitative study of parents' and professionals' perspectives on an mHealth intervention. BMC Public Health 2019; 19:294. [PMID: 30866879 PMCID: PMC6417230 DOI: 10.1186/s12889-019-6616-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 03/01/2019] [Indexed: 02/06/2023] Open
Abstract
Background Prevention of childhood obesity is a public health priority. Interventions that establish healthy growth trajectories early in life promise lifelong benefits to health and wellbeing. Proactive Assessment of Obesity Risk during Infancy (ProAsk) is a novel mHealth intervention designed to enable health professionals to assess an infant’s risk of future overweight and motivate parental behaviour change to prevent childhood overweight and obesity. The aim of this study was to explore parents’ and health professionals’ experiences of the overweight risk communication and behaviour change aspects of this mHealth intervention. Methods The study was conducted in four economically deprived localities in the UK. Parents (N = 66) were recruited to the ProAsk feasibility study when their infant was 6–8 weeks old. Twenty two health visitors (HVs) used a hand-held tablet device to deliver ProAsk to parents when their infants were 3 months old. Parents (N = 12) and HVs (N = 15) were interviewed when infants in the study were 6 months old. Interview data were transcribed and analysed thematically using an inductive, interpretative approach. Results Four key themes were identified across both parent and health visitor data: Engaging and empowering with digital technology; Unfamiliar technology presents challenges and opportunity; Trust in the risk score; Resistance to targeting. Most participants found the interactivity and visual presentation of information on ProAsk engaging. Health visitors who were unfamiliar with mobile technology drew support from parents who were more confident using tablet devices. There was evidence of resistance to targeting infants at greatest risk of future overweight and obesity, and both parents and health visitors drew on a number of reasons why a higher than average overweight risk score might not apply to a particular infant. Conclusions An mHealth intervention actively engaged parents, enabling them to take ownership of the process of seeking strategies to reduce infant risk of overweight. However, cognitive and motivational biases that prevent effective overweight risk communication are barriers to targeting an intervention at those infants most at risk. Trial registration NCT02314494. Date registered 11th December 2014. Electronic supplementary material The online version of this article (10.1186/s12889-019-6616-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennie Rose
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, East Road Campus, Cambridge, England.
| | - Cris Glazebrook
- Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, England
| | - Heather Wharrad
- School of Health Sciences, University of Nottingham, Nottingham, England
| | - A Niroshan Siriwardena
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, England
| | - Judy Anne Swift
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Nottingham, England
| | - Dilip Nathan
- Nottingham University Hospitals Trust, Nottingham, England
| | | | | | - Joanne Ablewhite
- Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, England
| | - Fiona McMaster
- Faculty of Medical Sciences, Anglia Ruskin University, Cambridge, England
| | - Vicki Watson
- Nottingham City Care Partnership, Nottingham, England
| | - Sarah Anne Redsell
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, East Road Campus, Cambridge, England
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Brown T, O'Malley C, Blackshaw J, Coulton V, Tedstone A, Summerbell C, Ells LJ. Exploring the evidence base for Tier 3 specialist weight management interventions for children aged 2-18 years in the UK: a rapid systematic review. J Public Health (Oxf) 2018; 40:835-847. [PMID: 29228233 DOI: 10.1093/pubmed/fdx166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Indexed: 11/13/2022] Open
Abstract
Background The impact of specialist weight management services (Tier 3) for children with severe and complex obesity in the UK is unclear. This review aims to examine the impact of child Tier 3 services in the UK, exploring service characteristics and implications for practice. Methods Rapid systematic review of any study examining specialist weight management interventions in any UK setting including children (2-18 years) with a body mass index >99.6th centile or >98th centile with comorbidity. Results Twelve studies (five RCTs and seven uncontrolled) were included in a variety of settings. Study quality was moderate or low and mean baseline body mass index z-score ranged from 2.7 to 3.6 units. Study samples were small and children were predominantly older (10-14 years), female and white. Multidisciplinary team composition and eligibility criteria varied; dropout ranged from 5 to 43%. Improvements in zBMI over 1-24 months ranged from -0.13 to -0.41 units. Conclusions Specialist weight management interventions for children with severe obesity demonstrated a reduction in zBMI, across a variety of UK settings. Studies were heterogeneous in content and thus conclusions on service design cannot be drawn. There is a paucity of evidence for Tier 3 services for children, and further research is required.
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Affiliation(s)
- Tamara Brown
- School of Social Sciences, Durham University, Durham, UK.,FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle Upon Tyne, UK.,School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Claire O'Malley
- School of Social Sciences, Durham University, Durham, UK.,FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle Upon Tyne, UK.,School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Jamie Blackshaw
- Health and Wellbeing, Public Health England, 2nd Floor, Skipton House, 80 London Road, London, UK
| | - Vicki Coulton
- Health and Wellbeing, Public Health England, 2nd Floor, Skipton House, 80 London Road, London, UK
| | - Alison Tedstone
- Health and Wellbeing, Public Health England, 2nd Floor, Skipton House, 80 London Road, London, UK
| | - Carolyn Summerbell
- School of Social Sciences, Durham University, Durham, UK.,FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle Upon Tyne, UK
| | - Louisa J Ells
- FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle Upon Tyne, UK.,School of Health and Social Care, Teesside University, Middlesbrough, UK
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31
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Sánchez-Cruz JJ, de Ruiter I, Jiménez-Moleón JJ, García L, Sánchez MJ. Stabilization and reversal of child obesity in Andalusia using objective anthropometric measures by socioeconomic status. BMC Pediatr 2018; 18:322. [PMID: 30309338 PMCID: PMC6180603 DOI: 10.1186/s12887-018-1295-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 10/01/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Childhood obesity continues to be a significant public health issue worldwide. Recent national studies in Spain show a stable picture. However, prevalence and trends differ by socio-economic status, age, and region. We present the trend in childhood excess weight prevalence, aged 8-15 years, in Andalusia from 2011-2012 to 2015-2016 by socio-economic status. METHODS Using the cross-sectional Andalusian Health Surveys, objective anthropometric measures were taken for a representative sample of 8-15 year olds in Andalusia in 2011-2012 and 2015-2016. Prevalence and changes in prevalence of excess weight (overweight plus obesity) were calculated, using both the WHO and IOTF criteria, overall and for sex, age and three different indicators of SES. RESULTS Overall prevalence of excess weight decreased from 42.0% in 2011-2012 to 35.4% in 2015-2016. Overweight decreased from 28.2 to 24.2% and obesity from 13.8 to 11.2%. In 2011-2012 the prevalence of excess weight in boys was 46.0%and 37.9% in girls; in 2015-2016 the difference became significant with 41% of boys with excess weight compared with 30% in girls. CONCLUSIONS Childhood excess weight prevalence in Andalusia has decreased slightly between 2011-2012 and 2015-2016. Notably, a decrease in obesity prevalence in girls aged 8-15 years was recorded. In 2011-2012 a social gradient for excess weight prevalence across three SES indicators was observed: in 2015-2016 this gradient disappeared. Nonetheless, prevalence remains too high.
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Affiliation(s)
- José-Juan Sánchez-Cruz
- Escuela Andaluza de Salud Pública, Cuesta del Observatorio 4, 18011 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - I de Ruiter
- Escuela Andaluza de Salud Pública, Cuesta del Observatorio 4, 18011 Granada, Spain
| | - J J Jiménez-Moleón
- Escuela Andaluza de Salud Pública, Cuesta del Observatorio 4, 18011 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Ll García
- Escuela Andaluza de Salud Pública, Cuesta del Observatorio 4, 18011 Granada, Spain
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública, Cuesta del Observatorio 4, 18011 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Interventions for treating children and adolescents with overweight and obesity: an overview of Cochrane reviews. Int J Obes (Lond) 2018; 42:1823-1833. [PMID: 30301964 DOI: 10.1038/s41366-018-0230-y] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 05/17/2018] [Accepted: 06/15/2018] [Indexed: 12/13/2022]
Abstract
Children and adolescents with overweight and obesity are a global health concern. This is an integrative overview of six Cochrane systematic reviews, providing an up-to-date synthesis of the evidence examining interventions for the treatment of children and adolescents with overweight or obesity. The data extraction and quality assessments for each review were conducted by one author and checked by a second. The six high quality reviews provide evidence on the effectiveness of behaviour changing interventions conducted in children <6 years (7 trials), 6-11 years (70 trials), adolescents 12-17 years (44 trials) and interventions that target only parents of children aged 5-11 years (20 trials); in addition to interventions examining surgery (1 trial) and drugs (21 trials). Most of the evidence was derived from high-income countries and published in the last two decades. Collectively, the evidence suggests that multi-component behaviour changing interventions may be beneficial in achieving small reductions in body weight status in children of all ages, with low adverse event occurrence were reported. More research is required to understand which specific intervention components are most effective and in whom, and how best to maintain intervention effects. Evidence from surgical and drug interventions was too limited to make inferences about use and safety, and adverse events were a serious consideration.
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Morgen CS, Ängquist L, Baker JL, Andersen AMN, Sørensen TIA, Michaelsen KF. Breastfeeding and complementary feeding in relation to body mass index and overweight at ages 7 and 11 y: a path analysis within the Danish National Birth Cohort. Am J Clin Nutr 2018; 107:313-322. [PMID: 29566190 DOI: 10.1093/ajcn/nqx058] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 12/06/2017] [Indexed: 12/20/2022] Open
Abstract
Background Infant feeding may play an important role in the development of childhood overweight and obesity. Objective The objective of this study was to examine whether duration of breastfeeding (BF), timing of introduction of complementary food, and protein intake at age 18 mo are associated with body mass index [BMI (measured in kg/m2)] and overweight at ages 7 and 11 y, independent of BMI during infancy. Design Children participating in the Danish National Birth Cohort were followed up at ages 7 and 11 y. Information on infant feeding, protein intake at age 18 mo, Ponderal Index at birth, child BMI (at ages 5 mo, 12 mo, 7 y, and 11 y), and several parental factors was available. Path analysis was used to assess the direct and indirect effects of infant feeding on BMI z scores (BMIz) at ages 7 (n = 36,481) and 11 y (n = 22,047). Logistic regression analyses were used to examine associations with overweight. Results Duration of BF was not associated with childhood BMIz at ages 7 and 11 y. Earlier introduction of complementary food (<4 mo old) was not associated with BMIz at age 7 y, but with a 0.069 (95% CI: 0.021, 0.117, P = 0.005) higher BMIz at age 11 y and increased risk of overweight at age 11 y (OR 1.44; 95% CI: 1.04, 2.00; P = 0.03). Protein intake from dairy products (per 5 g/d) was associated with higher BMIz only at age 7 y (OR: 0.012; 95% CI: 0.003, 0.021; P = 0.007). Protein intake from meat and fish (per 2 g/d) was associated with a 0.010 (95% CI: 0.004, 0.017; P = 0.003) higher BMIz at age 7 y, a 0.013 (95% CI: 0.005, 0.020; P = 0.002) higher BMIz at age 11 y and increased odds of overweight at age 7 y (OR: 1.07; 95% CI: 1.03, 1.10; P < 0.001), but not at age 11 y. Conclusions Intake of protein from meat and fish at age 18 mo was associated with higher BMIz and risk of overweight in childhood. However, the effect sizes were small. Early introduction of complementary food may be associated with child BMIz and child overweight. This study was registered at www.clinicaltrials.gov as NCT03334760.
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Affiliation(s)
- Camilla Schmidt Morgen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark.,Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lars Ängquist
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Jennifer L Baker
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thorkild I A Sørensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, Faculty of Sciences, University of Copenhagen, Copenhagen, Denmark
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Llauradó E, Tarro L, Moriña D, Aceves-Martins M, Giralt M, Solà R. Follow-up of a healthy lifestyle education program (the EdAl study): four years after cessation of randomized controlled trial intervention. BMC Public Health 2018; 18:104. [PMID: 29304772 PMCID: PMC5755282 DOI: 10.1186/s12889-017-5006-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 12/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An important challenge of school-based childhood obesity (OB) intervention programs is understanding the maintenance of the effects after cessation of the intervention to overcome the limitations of follow-up studies. The aim of this study is to verify the sustainability of the benefits achieved at a 4-year follow-up of the post-Educació en Alimentació (EDAl) program intervention cessation by assessing the OB-related outcomes and lifestyles of 13- to 15-year-old adolescents. METHODS This paper describes a 4-year follow-up study after the cessation of a school-based randomized controlled intervention in adolescents (n = 349, intervention; n = 154, control) with baseline and 4-year follow-up data from high schools in Reus (intervention group), Salou, Cambrils and Vila-seca (control group). The outcomes are body mass index (BMI), BMI z-score, and OB prevalence according to the World Health Organization and International Obesity Task Force criteria and lifestyle data (obtained from questionnaires). RESULTS Compared with the control girls, the intervention girls showed reduced BMI z-scores (-0.33 units, p < 0.01) from baseline (2007) to the 4-year follow-up post-intervention (2014). Compared with the control boys, the intervention boys showed reduced OB prevalence (-7.7%; p = 0.02). Compared with the control boys, more boys in the intervention group (19% increase; p = 0.059) showed ≥4 h/week after-school physical activity (PA). A decrease in the consumption of dairy products, fruits and fish was observed in both groups. CONCLUSIONS At the 4-year post-intervention follow-up of the EdAl program, compared with the control groups, girls had lower BMI z-scores and boys had lower OB prevalence from the intervention. The encouragement in after-school PA was long-lasting and maintained after the cessation of the intervention, whereas healthy food habits must be further reinforced in adolescents. TRIAL REGISTRATION ISRCTN29247645 .
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Affiliation(s)
- Elisabet Llauradó
- Facultat de Medicina i Ciències de la Salut, Health Education and Promotion, Functional Nutrition, Oxidation and Cardiovascular Disease Research Group, Medicine and Surgery Department, Universitat Rovira i Virgili, C/Sant Llorenç, 21, 43204 Reus, PC Spain
| | - Lucia Tarro
- Facultat de Medicina i Ciències de la Salut, Health Education and Promotion, Functional Nutrition, Oxidation and Cardiovascular Disease Research Group, Medicine and Surgery Department, Universitat Rovira i Virgili, C/Sant Llorenç, 21, 43204 Reus, PC Spain
| | - David Moriña
- Unit of Infections and Cancer (UNIC – I&I), Cancer Epidemiology Research Program (CERP), Catalan Institute of Oncology, (ICO)-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Magaly Aceves-Martins
- Facultat de Medicina i Ciències de la Salut, Health Education and Promotion, Functional Nutrition, Oxidation and Cardiovascular Disease Research Group, Medicine and Surgery Department, Universitat Rovira i Virgili, C/Sant Llorenç, 21, 43204 Reus, PC Spain
| | - Montse Giralt
- Unit of Farmacobiology, Functional Nutrition, Oxidation and Cardiovascular Disease Research Group, Medicine and Surgery Department, Universitat Rovira i Virgili, C/Sant Llorenç, 21, 43204 Reus, PC Spain
| | - Rosa Solà
- Unit of Lipids and Arteriosclerosis Research, CIBERDEM, Hospital Universitari Sant Joan, IISPV, Universitat Rovira i Virgili, Technological Centre of Nutrition and Health (CTNS), Functional Nutrition, Oxidation and Cardiovascular Disease Research Group, Medicine and Surgery Department, Universitat Rovira i Virgili, C/Sant Llorenç, 21, 43204 Reus, PC Spain
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Lichtveld K, Thomas K, Tulve NS. Chemical and non-chemical stressors affecting childhood obesity: a systematic scoping review. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2018; 28:1-12. [PMID: 28952603 PMCID: PMC6097845 DOI: 10.1038/jes.2017.18] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 07/03/2017] [Indexed: 05/02/2023]
Abstract
Childhood obesity in the United States has doubled over the last three decades and currently affects 17% of children and adolescents. While much research has focused on individual behaviors impacting obesity, little research has emphasized the complex interactions of numerous chemical and non-chemical stressors found in a child's environment and how these interactions affect a child's health and well-being. The objectives of this systematic scoping review were to (1) identify potential chemical stressors in the context of non-chemical stressors that impact childhood obesity; and, (2) summarize our observations for chemical and non-chemical stressors in regards to child-specific environments within a community setting. A review was conducted to identify chemical and non-chemical stressors related to childhood obesity for the childhood life stages ranging from prenatal to adolescence. Stressors were identified and grouped into domains: individual behaviors, family/household behaviors, community stressors, and chemical exposures. Stressors were related to the child and the child's everyday environments and used to characterize child health and well-being. This review suggests that the interactions of chemical and non-chemical stressors are important for understanding a child's overall health and well-being. By considering these relationships, the exposure science research community can better design and implement strategies to reduce childhood obesity.
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Affiliation(s)
- Kim Lichtveld
- ORISE Post-Doctoral Participant, U.S. Environmental Protection Agency, Office of Research and Development, National Exposure Research Laboratory, Research Triangle Park, NC, USA
- Current Affiliation: Assistant Professor, The University of Findlay, Department of Environmental, Safety and Occupational Health, Findlay, OH
| | - Kent Thomas
- U.S. Environmental Protection Agency, Office of Research and Development, National Exposure Research Laboratory, Research Triangle Park, NC, USA
| | - Nicolle S. Tulve
- U.S. Environmental Protection Agency, Office of Research and Development, National Exposure Research Laboratory, Research Triangle Park, NC, USA
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Langeheine M, Pohlabeln H, Lauria F, Veidebaum T, Tornaritis M, Molnar D, Eiben G, de Henauw S, Moreno LA, Williams G, Ahrens W, Rach S. Attrition in the European Child Cohort IDEFICS/I.Family: Exploring Associations Between Attrition and Body Mass Index. Front Pediatr 2018; 6:212. [PMID: 30159304 PMCID: PMC6104127 DOI: 10.3389/fped.2018.00212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/09/2018] [Indexed: 12/14/2022] Open
Abstract
Attrition may lead to bias in epidemiological cohorts, since participants who are healthier and have a higher social position are less likely to drop out. We investigated possible selection effects regarding key exposures and outcomes in the IDEFICS/I.Family study, a large European cohort on the etiology of overweight, obesity and related disorders during childhood and adulthood. We applied multilevel logistic regression to investigate associations of attrition with sociodemographic variables, weight status, and study compliance and assessed attrition across time regarding children's weight status and variations of attrition across participating countries. We investigated selection effects with regard to social position, adherence to key messages concerning a healthy lifestyle, and children's weight status. Attrition was associated with a higher weight status of children, lower children's study compliance, older age, lower parental education, and parent's migration background, consistent across time and participating countries. Although overweight (odds ratio 1.17, 99% confidence interval 1.05-1.29) or obese children (odds ratio 1.18, 99% confidence interval 1.03-1.36) were more prone to drop-out, attrition only seemed to slightly distort the distribution of children's BMI at the upper tail. Restricting the sample to subgroups with different attrition characteristics only marginally affected exposure-outcome associations. Our results suggest that IDEFICS/I.Family provides valid estimates of relations between socio-economic position, health-related behaviors, and weight status.
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Affiliation(s)
- Malte Langeheine
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Hermann Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Fabio Lauria
- Institute of Food Sciences, National Research Council, Avellino, Italy
| | | | | | - Denes Molnar
- Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Gabriele Eiben
- Section for Epidemiology and Social Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Biomedicine and Public Health, School of Health and Education, University of Skövde, Skövde, Sweden
| | | | - Luis A Moreno
- Growth, Exercise, Nutrition and Development, Research Group, Faculty of Health Sciences, University of Zaragoza, Instituto Agroalimentario de Aragón, Instituto de Investigación Sanitaria de Aragón and Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Zaragoza, Spain
| | - Garrath Williams
- Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, United Kingdom
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.,Faculty of Mathematics and Computer Science, Institute of Statistics, University Bremen, Bremen, Germany
| | - Stefan Rach
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
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Albuquerque D, Nóbrega C, Manco L, Padez C. The contribution of genetics and environment to obesity. Br Med Bull 2017; 123:159-173. [PMID: 28910990 DOI: 10.1093/bmb/ldx022] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 06/23/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Obesity is a global health problem mainly attributed to lifestyle changes such as diet, low physical activity or socioeconomics factors. However, several evidences consistently showed that genetics contributes significantly to the weight-gain susceptibility. SOURCES OF DATA A systematic literature search of most relevant original, review and meta-analysis, restricted to English was conducted in PubMed, Web of Science and Google scholar up to May 2017 concerning the contribution of genetics and environmental factors to obesity. AREAS OF AGREEMENT Several evidences suggest that obesogenic environments contribute to the development of an obese phenotype. However, not every individual from the same population, despite sharing the same obesogenic environment, develop obesity. AREAS OF CONTROVERSY After more than 10 years of investigation on the genetics of obesity, the variants found associated with obesity represent only 3% of the estimated BMI-heritability, which is around 47-80%. Moreover, genetic factors per se were unable to explain the rapid spread of obesity prevalence. GROWING POINTS The integration of multi-omics data enables scientists having a better picture and to elucidate unknown pathways contributing to obesity. AREAS TIMELY FOR DEVELOPING RESEARCH New studies based on case-control or gene candidate approach will be important to identify new variants associated with obesity susceptibility and consequently unveiling its genetic architecture. This will lead to an improvement of our understanding about underlying mechanisms involved in development and origin of the actual obesity epidemic. The integration of several omics will also provide insights about the interplay between genes and environments contributing to the obese phenotype.
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Affiliation(s)
- David Albuquerque
- Research Center for Anthropology and Health (CIAS), Department of Life Sciences, University of Coimbra, Coimbra, Portugal.,Fundación Investigación Hospital General Universitario de Valencia, Genomics group, Valencia, Spain
| | - Clévio Nóbrega
- Department of Biomedical Sciences and Medicine (DCBM), University of Algarve, Faro, Portugal.,Centre for Biomedical Research (CBMR), University of Algarve, Faro, Portugal.,Algarve Biomedical Center (ABC), University of Algarve, Faro, Portugal
| | - Licínio Manco
- Research Center for Anthropology and Health (CIAS), Department of Life Sciences, University of Coimbra, Coimbra, Portugal.,Faculty of Sciences and Technology, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - Cristina Padez
- Research Center for Anthropology and Health (CIAS), Department of Life Sciences, University of Coimbra, Coimbra, Portugal.,Faculty of Sciences and Technology, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
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Mead E, Brown T, Rees K, Azevedo LB, Whittaker V, Jones D, Olajide J, Mainardi GM, Corpeleijn E, O'Malley C, Beardsmore E, Al‐Khudairy L, Baur L, Metzendorf M, Demaio A, Ells LJ. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database Syst Rev 2017; 6:CD012651. [PMID: 28639319 PMCID: PMC6481885 DOI: 10.1002/14651858.cd012651] [Citation(s) in RCA: 215] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Child and adolescent overweight and obesity has increased globally, and can be associated with significant short- and long-term health consequences. This is an update of a Cochrane review published first in 2003, and updated previously in 2009. However, the update has now been split into six reviews addressing different childhood obesity treatments at different ages. OBJECTIVES To assess the effects of diet, physical activity and behavioural interventions (behaviour-changing interventions) for the treatment of overweight or obese children aged 6 to 11 years. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of studies and systematic reviews. We did not apply any language restrictions. The date of the last search was July 2016 for all databases. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of diet, physical activity, and behavioural interventions (behaviour-changing interventions) for treating overweight or obese children aged 6 to 11 years, with a minimum of six months' follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity. DATA COLLECTION AND ANALYSIS Two review authors independently screened references, extracted data, assessed risk of bias, and evaluated the quality of the evidence using the GRADE instrument. We contacted study authors for additional information. We carried out meta-analyses according to the statistical guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS We included 70 RCTs with a total of 8461 participants randomised to either the intervention or control groups. The number of participants per trial ranged from 16 to 686. Fifty-five trials compared a behaviour-changing intervention with no treatment/usual care control and 15 evaluated the effectiveness of adding an additional component to a behaviour-changing intervention. Sixty-four trials were parallel RCTs, and four were cluster RCTs. Sixty-four trials were multicomponent, two were diet only and four were physical activity only interventions. Ten trials had more than two arms. The overall quality of the evidence was low or very low and 62 trials had a high risk of bias for at least one criterion. Total duration of trials ranged from six months to three years. The median age of participants was 10 years old and the median BMI z score was 2.2.Primary analyses demonstrated that behaviour-changing interventions compared to no treatment/usual care control at longest follow-up reduced BMI, BMI z score and weight. Mean difference (MD) in BMI was -0.53 kg/m2 (95% confidence interval (CI) -0.82 to -0.24); P < 0.00001; 24 trials; 2785 participants; low-quality evidence. MD in BMI z score was -0.06 units (95% CI -0.10 to -0.02); P = 0.001; 37 trials; 4019 participants; low-quality evidence and MD in weight was -1.45 kg (95% CI -1.88 to -1.02); P < 0.00001; 17 trials; 1774 participants; low-quality evidence.Thirty-one trials reported on serious adverse events, with 29 trials reporting zero occurrences RR 0.57 (95% CI 0.17 to 1.93); P = 0.37; 4/2105 participants in the behaviour-changing intervention groups compared with 7/1991 participants in the comparator groups). Few trials reported health-related quality of life or behaviour change outcomes, and none of the analyses demonstrated a substantial difference in these outcomes between intervention and control. In two trials reporting on minutes per day of TV viewing, a small reduction of 6.6 minutes per day (95% CI -12.88 to -0.31), P = 0.04; 2 trials; 55 participants) was found in favour of the intervention. No trials reported on all-cause mortality, morbidity or socioeconomic effects, and few trials reported on participant views; none of which could be meta-analysed.As the meta-analyses revealed substantial heterogeneity, we conducted subgroup analyses to examine the impact of type of comparator, type of intervention, risk of attrition bias, setting, duration of post-intervention follow-up period, parental involvement and baseline BMI z score. No subgroup effects were shown for any of the subgroups on any of the outcomes. Some data indicated that a reduction in BMI immediately post-intervention was no longer evident at follow-up at less than six months, which has to be investigated in further trials. AUTHORS' CONCLUSIONS Multi-component behaviour-changing interventions that incorporate diet, physical activity and behaviour change may be beneficial in achieving small, short-term reductions in BMI, BMI z score and weight in children aged 6 to 11 years. The evidence suggests a very low occurrence of adverse events. The quality of the evidence was low or very low. The heterogeneity observed across all outcomes was not explained by subgrouping. Further research is required of behaviour-changing interventions in lower income countries and in children from different ethnic groups; also on the impact of behaviour-changing interventions on health-related quality of life and comorbidities. The sustainability of reduction in BMI/BMI z score and weight is a key consideration and there is a need for longer-term follow-up and further research on the most appropriate forms of post-intervention maintenance in order to ensure intervention benefits are sustained over the longer term.
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Affiliation(s)
- Emma Mead
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Tamara Brown
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Liane B Azevedo
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Victoria Whittaker
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Dan Jones
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Joan Olajide
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Giulia M Mainardi
- School of Medicine, University of São PauloDepartment of Preventive MedicineSão PauloBrazilCEP 01246 903
| | - Eva Corpeleijn
- University Medical Centre GroningenDepartment of EpidemiologyHanzeplein 1GroningenNetherlands9713 GZ
| | - Claire O'Malley
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | | | - Lena Al‐Khudairy
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Louise Baur
- The University of SydneyDepartment of Paediatrics and Child HealthLocked Bag 4001WestmeadAustraliaNSW 2145
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | | | - Louisa J Ells
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
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Al‐Khudairy L, Loveman E, Colquitt JL, Mead E, Johnson RE, Fraser H, Olajide J, Murphy M, Velho RM, O'Malley C, Azevedo LB, Ells LJ, Metzendorf M, Rees K. Diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years. Cochrane Database Syst Rev 2017; 6:CD012691. [PMID: 28639320 PMCID: PMC6481371 DOI: 10.1002/14651858.cd012691] [Citation(s) in RCA: 190] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Adolescent overweight and obesity has increased globally, and can be associated with short- and long-term health consequences. Modifying known dietary and behavioural risk factors through behaviour changing interventions (BCI) may help to reduce childhood overweight and obesity. This is an update of a review published in 2009. OBJECTIVES To assess the effects of diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years. SEARCH METHODS We performed a systematic literature search in: CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS, and the trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of identified studies and systematic reviews. There were no language restrictions. The date of the last search was July 2016 for all databases. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of diet, physical activity and behavioural interventions for treating overweight or obesity in adolescents aged 12 to 17 years. DATA COLLECTION AND ANALYSIS Two review authors independently assessed risk of bias, evaluated the overall quality of the evidence using the GRADE instrument and extracted data following the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. We contacted trial authors for additional information. MAIN RESULTS We included 44 completed RCTs (4781 participants) and 50 ongoing studies. The number of participants in each trial varied (10 to 521) as did the length of follow-up (6 to 24 months). Participants ages ranged from 12 to 17.5 years in all trials that reported mean age at baseline. Most of the trials used a multidisciplinary intervention with a combination of diet, physical activity and behavioural components. The content and duration of the intervention, its delivery and the comparators varied across trials. The studies contributing most information to outcomes of weight and body mass index (BMI) were from studies at a low risk of bias, but studies with a high risk of bias provided data on adverse events and quality of life.The mean difference (MD) of the change in BMI at the longest follow-up period in favour of BCI was -1.18 kg/m2 (95% confidence interval (CI) -1.67 to -0.69); 2774 participants; 28 trials; low quality evidence. BCI lowered the change in BMI z score by -0.13 units (95% CI -0.21 to -0.05); 2399 participants; 20 trials; low quality evidence. BCI lowered body weight by -3.67 kg (95% CI -5.21 to -2.13); 1993 participants; 20 trials; moderate quality evidence. The effect on weight measures persisted in trials with 18 to 24 months' follow-up for both BMI (MD -1.49 kg/m2 (95% CI -2.56 to -0.41); 760 participants; 6 trials and BMI z score MD -0.34 (95% CI -0.66 to -0.02); 602 participants; 5 trials).There were subgroup differences showing larger effects for both BMI and BMI z score in studies comparing interventions with no intervention/wait list control or usual care, compared with those testing concomitant interventions delivered to both the intervention and control group. There were no subgroup differences between interventions with and without parental involvement or by intervention type or setting (health care, community, school) or mode of delivery (individual versus group).The rate of adverse events in intervention and control groups was unclear with only five trials reporting harms, and of these, details were provided in only one (low quality evidence). None of the included studies reported on all-cause mortality, morbidity or socioeconomic effects.BCIs at the longest follow-up moderately improved adolescent's health-related quality of life (standardised mean difference 0.44 ((95% CI 0.09 to 0.79); P = 0.01; 972 participants; 7 trials; 8 comparisons; low quality of evidence) but not self-esteem.Trials were inconsistent in how they measured dietary intake, dietary behaviours, physical activity and behaviour. AUTHORS' CONCLUSIONS We found low quality evidence that multidisciplinary interventions involving a combination of diet, physical activity and behavioural components reduce measures of BMI and moderate quality evidence that they reduce weight in overweight or obese adolescents, mainly when compared with no treatment or waiting list controls. Inconsistent results, risk of bias or indirectness of outcome measures used mean that the evidence should be interpreted with caution. We have identified a large number of ongoing trials (50) which we will include in future updates of this review.
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Affiliation(s)
- Lena Al‐Khudairy
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Emma Loveman
- Effective Evidence LLP26 The CurveWaterloovilleHampshireUKPO8 9SE
| | - Jill L Colquitt
- Effective Evidence LLP26 The CurveWaterloovilleHampshireUKPO8 9SE
| | - Emma Mead
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Rebecca E Johnson
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Hannah Fraser
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Joan Olajide
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Marie Murphy
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Rochelle Marian Velho
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Claire O'Malley
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | - Liane B Azevedo
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Louisa J Ells
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
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Morgen CS, Andersen PK, Mortensen LH, Howe LD, Rasmussen M, Due P, Sørensen TIA, Andersen AMN. Socioeconomic disparities in birth weight and body mass index during infancy through age 7 years: a study within the Danish National Birth Cohort. BMJ Open 2017; 7:e011781. [PMID: 28110282 PMCID: PMC5253532 DOI: 10.1136/bmjopen-2016-011781] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 11/07/2016] [Accepted: 12/15/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities in birth weight and in body mass index (BMI) later in childhood are in opposite directions, which raises questions about when during childhood the change in direction happens. We examined how maternal and paternal education and household income were associated with birthweight z-scores and with BMI z-scores at age 5 and 12 months and 7 years, and we examined the socioeconomic differences in the tracking of these z-scores across infancy and childhood. METHODS The associations were studied in a cohort of children in the Danish National Birth Cohort, single born between 1997 and 2003, for whom information on body size from at least 1 of 4 time points (n=85 062) was recorded. We examined the associations using linear mixed-effects modelling. RESULTS Children from families with a low maternal and paternal educational level changed their body size z-scores upwards between birth and age 7 years. At age 5 and 12 months, there were no educational gradient. A low maternal educational level was associated with lower birth weight for gestational age z-scores at birth for boys (-0.199; 95% CI -0.230 to -0.169) and girls (-0.198; 95% CI -0.229 to -0.167) and higher BMI z-scores at age 7 for boys (0.198; 95% CI 0.154 to 0.242) and girls (0.218; 95% CI 0.173 to 0.264). There was not a similarly clear pattern in the tracking between different household income groups. However, a low household income level was associated with higher z-scores of both birth weight and BMI at age 7 years, but with a much weaker gradient at 5 and 12 months. CONCLUSIONS The educational gradient shifts from positive with birth weight, to none during infancy to inverse with BMI at age 7 years. In contrast, the income gradient was positive at birth and at 7 years and much weaker during infancy.
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Affiliation(s)
- Camilla Schmidt Morgen
- Department of Clinical Epidemiology (formerly Institute of Preventive Medicine), Copenhagen, Denmark
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Per Kragh Andersen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Laust Hvas Mortensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Laura D Howe
- MRC Integrative Epidemiology Unit, The University of Bristol, and School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Pernille Due
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Thorkild I A Sørensen
- Department of Clinical Epidemiology (formerly Institute of Preventive Medicine), Copenhagen, Denmark
- MRC Integrative Epidemiology Unit, The University of Bristol, and School of Social and Community Medicine, University of Bristol, Bristol, UK
- Faculty of Health and Medical Sciences, Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Hardy LL, Mihrshahi S, Gale J, Drayton BA, Bauman A, Mitchell J. 30-year trends in overweight, obesity and waist-to-height ratio by socioeconomic status in Australian children, 1985 to 2015. Int J Obes (Lond) 2017; 41:76-82. [PMID: 27847388 PMCID: PMC5220161 DOI: 10.1038/ijo.2016.204] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/15/2016] [Accepted: 10/23/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND/OBJECTIVE To report 30-year (1985-2015) prevalence trends in overweight, obesity and abdominal obesity among children by school level and socioeconomic status (SES). SUBJECTS/METHODS Five cross-sectional, population child surveys (age 4-18 years; n=27 808) conducted in 1985-1997-2004-2010-2015 in New South Wales, Australia. Outcomes were prevalence of measured overweight, obesity and waist-to-height ratio (WHtR⩾0.5) by sex, school level (children (primary) and adolescents (high)) and SES tertile. RESULTS In 2015, the prevalences of overweight, obesity and WHtR⩾0.5 in children were 16.4%, 7.0% and 14.6%, respectively, and in adolescents 21.9%, 17.2% and 4.6%, respectively. Obesity prevalence has not significantly changed in children or adolescents since 1997, nor since 2010 (children, P=0.681; adolescents, P=0.21). Overweight has not significantly changed in children since 1997, but has in adolescents since 1985, with a relative increase of 16 percentage points (P<0.001) between 2010 and 2015. WHtR⩾0.5 prevalence has significantly changed since 1985, except in adolescent girls between 2010 and 2015. Between 2010 and 2015 the relative increase in WHtR⩾0.5 was 17 and 40 percentage points in children and adolescent boys, respectively. Significant disparities in prevalence rates between children and adolescents from low and high SES backgrounds began in 2010 for overweight, since 1997 for obesity and since 2004 for WHtR⩾0.5. Differences between SES groups have become larger over the past 18 years. CONCLUSIONS Since 1997, obesity has remained stable, and overweight has stabilized in children, not in adolescents. WHtR⩾0.5 significantly increased between 1985 and 2015, with prevalence rates at each survey around twice the obesity prevalence. Compared with high SES children and adolescents, the risk of overweight, obesity and WHtR⩾0.5 was significantly higher for low SES children and adolescents. The findings are highly relevant to policy makers involved in child obesity prevention interventions and highlight the need for better targeted interventions among children and adolescents from low SES backgrounds, and adolescents in particular.
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Affiliation(s)
- L L Hardy
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - S Mihrshahi
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - J Gale
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - B A Drayton
- NSW Ministry of Health, North Sydney, NSW, Australia
| | - A Bauman
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - J Mitchell
- NSW Ministry of Health, North Sydney, NSW, Australia
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Axon E, Atkinson G, Richter B, Metzendorf M, Baur L, Finer N, Corpeleijn E, O'Malley C, Ells LJ. Drug interventions for the treatment of obesity in children and adolescents. Cochrane Database Syst Rev 2016; 11:CD012436. [PMID: 27899001 PMCID: PMC6472619 DOI: 10.1002/14651858.cd012436] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Child and adolescent obesity has increased globally, and can be associated with significant short- and long-term health consequences. OBJECTIVES To assess the efficacy of drug interventions for the treatment of obesity in children and adolescents. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PubMed (subsets not available on Ovid), LILACS as well as the trial registers ICTRP (WHO) and ClinicalTrials.gov. Searches were undertaken from inception to March 2016. We checked references and applied no language restrictions. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of pharmacological interventions for treating obesity (licensed and unlicensed for this indication) in children and adolescents (mean age under 18 years) with or without support of family members, with a minimum of three months' pharmacological intervention and six months' follow-up from baseline. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity. In addition, we excluded trials which included growth hormone therapies and pregnant participants. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data following standard Cochrane methodology. Where necessary we contacted authors for additional information. MAIN RESULTS We included 21 trials and identified eight ongoing trials. The included trials evaluated metformin (11 trials), sibutramine (six trials), orlistat (four trials), and one trial arm investigated the combination of metformin and fluoxetine. The ongoing trials evaluated metformin (four trials), topiramate (two trials) and exenatide (two trials). A total of 2484 people participated in the included trials, 1478 participants were randomised to drug intervention and 904 to comparator groups (91 participants took part in two cross-over trials; 11 participants not specified). Eighteen trials used a placebo in the comparator group. Two trials had a cross-over design while the remaining 19 trials were parallel RCTs. The length of the intervention period ranged from 12 weeks to 48 weeks, and the length of follow-up from baseline ranged from six months to 100 weeks.Trials generally had a low risk of bias for random sequence generation, allocation concealment and blinding (participants, personnel and assessors) for subjective and objective outcomes. We judged approximately half of the trials as having a high risk of bias in one or more domain such as selective reporting.The primary outcomes of this review were change in body mass index (BMI), change in weight and adverse events. All 21 trials measured these outcomes. The secondary outcomes were health-related quality of life (only one trial reported results showing no marked differences; very low certainty evidence), body fat distribution (measured in 18 trials), behaviour change (measured in six trials), participants' views of the intervention (not reported), morbidity associated with the intervention (measured in one orlistat trial only reporting more new gallstones following the intervention; very low certainty evidence), all-cause mortality (one suicide in the orlistat intervention group; low certainty evidence) and socioeconomic effects (not reported).Intervention versus comparator for mean difference (MD) in BMI change was -1.3 kg/m2 (95% confidence interval (CI) -1.9 to -0.8; P < 0.00001; 16 trials; 1884 participants; low certainty evidence). When split by drug type, sibutramine, metformin and orlistat all showed reductions in BMI in favour of the intervention.Intervention versus comparator for change in weight showed a MD of -3.9 kg (95% CI -5.9 to -1.9; P < 0.00001; 11 trials; 1180 participants; low certainty evidence). As with BMI, when the trials were split by drug type, sibutramine, metformin and orlistat all showed reductions in weight in favour of the intervention.Five trials reported serious adverse events: 24/878 (2.7%) participants in the intervention groups versus 8/469 (1.7%) participants in the comparator groups (risk ratio (RR) 1.43, 95% CI 0.63 to 3.25; 1347 participants; low certainty evidence). A total 52/1043 (5.0%) participants in the intervention groups versus 17/621 (2.7%) in the comparator groups discontinued the trial because of adverse events (RR 1.45, 95% CI 0.83 to 2.52; 10 trials; 1664 participants; low certainty evidence). The most common adverse events in orlistat and metformin trials were gastrointestinal (such as diarrhoea, mild abdominal pain or discomfort, fatty stools). The most frequent adverse events in sibutramine trials included tachycardia, constipation and hypertension. The single fluoxetine trial reported dry mouth and loose stools. No trial investigated drug treatment for overweight children. AUTHORS' CONCLUSIONS This systematic review is part of a series of associated Cochrane reviews on interventions for obese children and adolescents and has shown that pharmacological interventions (metformin, sibutramine, orlistat and fluoxetine) may have small effects in reduction in BMI and bodyweight in obese children and adolescents. However, many of these drugs are not licensed for the treatment of obesity in children and adolescents, or have been withdrawn. Trials were generally of low quality with many having a short or no post-intervention follow-up period and high dropout rates (overall dropout of 25%). Future research should focus on conducting trials with sufficient power and long-term follow-up, to ensure the long-term effects of any pharmacological intervention are comprehensively assessed. Adverse events should be reported in a more standardised manner specifying amongst other things the number of participants experiencing at least one adverse event. The requirement of regulatory authorities (US Food and Drug Administration and European Medicines Agency) for trials of all new medications to be used in children and adolescents should drive an increase in the number of high quality trials.
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Affiliation(s)
- Emma Axon
- University of NottinghamCochrane Skin GroupNottinghamUKNG7 2NR
| | - Greg Atkinson
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Bernd Richter
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Louise Baur
- The University of SydneyDepartment of Paediatrics and Child HealthLocked Bag 4001WestmeadAustraliaNSW 2145
| | - Nicholas Finer
- UCL Institute of Cardiovascular ScienceNational Centre for Cardiovascular Prevention and Outcomes170 Tottenham Court RoadLondonUKW1T 7HA
- Novo Nordisk A/SGlobal Medical Affairs ManagementCopenhagenDenmark
| | - Eva Corpeleijn
- University Medical Centre GroningenDepartment of EpidemiologyHanzeplein 1GroningenNetherlands9713 GZ
| | - Claire O'Malley
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUKDH1 3HN
| | - Louisa J Ells
- Teesside UniversitySchool of Health and Social CareParkside West OfficesMiddlesbroughUKTS1 3BA
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Family Affluence and the Eating Habits of 11- to 15-Year-Old Czech Adolescents: HBSC 2002 and 2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13101034. [PMID: 27783063 PMCID: PMC5086773 DOI: 10.3390/ijerph13101034] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 10/02/2016] [Accepted: 10/18/2016] [Indexed: 12/22/2022]
Abstract
Socioeconomic inequalities in eating habits have a profound impact on the health of adolescents. The aim of the present study was to evaluate socioeconomic disparities in the eating habits of Czech adolescents and to compare their change between 2002 and 2014. The data from the Czech Health Behavior in School-aged Children (HBSC) study conducted in 2002 and 2014 was utilized. The Family Affluence Scale (FAS) was used to assess socioeconomic disparities. Higher odds of daily consumption of fruit (2002: OR = 1.67; 2014: OR = 1.70, p < 0.001) and vegetables (2002: OR = 1.54; 2014: OR = 1.48, p < 0.001) were associated with high FAS in both genders. Adolescents with higher FAS were less likely to consume sweets (2002: OR = 0.72, p < 0.05) and more likely to eat breakfast on weekdays (2014: OR = 1.19, p < 0.05). In 2002 and 2014, the data showed lower odds of daily consumption of soft drinks (Low: OR = 0.47; Medium: OR = 0.43; High: OR = 0.41, p < 0.001), fruit (Low: OR = 0.73; Medium: OR = 0.74, p < 0.001; High: OR = 0.75, p < 0.05), sweets (Low: OR = 0.71; Medium: OR = 0.79, p < 0.001) and breakfast on weekends (High: OR = 0.70, p < 0.05), and a higher likelihood of eating breakfast on weekdays (Low: OR = 1.26, p < 0.01; Medium: OR = 1.13, p < 0.05). These findings play an important role in future public measures to improve dietary habits and decrease social inequalities in youth.
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Lakes T, Burkart K. Childhood overweight in Berlin: intra-urban differences and underlying influencing factors. Int J Health Geogr 2016; 15:12. [PMID: 27001085 PMCID: PMC4802651 DOI: 10.1186/s12942-016-0041-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/09/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In recent years, childhood overweight and obesity have become an increasing and challenging phenomenon in Western cities. A lot of studies have focused on the analysis of factors such as individual dispositions and nutrition balances, among others. However, little is known about the intra-urban spatial patterns of childhood overweight and its associations with influencing factors that stretch from an individual to a neighbourhood level. The aim of this paper is to analyse the spatial patterns of childhood obesity in Berlin, and also to explore and test for associations with a complex set of risk factors at the individual, household and neighbourhood levels. METHODS We use data from a survey of 5-6 year-olds that includes health status, height, and weight, as well as several socioeconomic and other risk variables. In addition, we use a set of neighbourhood variables, such as distance, and density measures of parks or fast food restaurants. Our outcome variable is the percentage of children of 5-6 years who were reported overweight or obese in 2012. The aggregated data is available for 60 areas in Berlin. We first analyse the outcome and risk factor data descriptively, and subsequently apply a set of regression analyses to test for associations between reported overweight and obesity, and also individual, household and neighbourhood characteristics. RESULTS Our analysis returned a distinct spatial distribution of childhood overweight in Berlin with highest shares in the city centre. Moreover, we were able to identify significant effects regarding the social index, and the percentage of non-German children being obese or overweight; additionally, we identified fast food restaurant density as a possible influencing factor. For the other variables, including the neighbourhood variables, we could not identify a significant association on this aggregated level of analysis. CONCLUSIONS Our findings confirm the results of earlier studies, in which the social status and percentage of non-German children is very important in terms of the association with childhood overweight and obesity. Unlike many studies conducted in North America, this study did not reveal an influence of neighbourhood variables. We argue that European urban structures differ from North American structures and highlight the need for a more detailed analysis of the association between the neighbourhood environment and the physical activity of children in urban setting.
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Affiliation(s)
- Tobia Lakes
- />Geography Department, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany
| | - Katrin Burkart
- />Geography Department, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany
- />Department of Environmental Health Science, Mailman School of Public Health, Columbia University in the City of New York, New York, NY USA
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Colquitt JL, Loveman E, O'Malley C, Azevedo LB, Mead E, Al‐Khudairy L, Ells LJ, Metzendorf M, Rees K. Diet, physical activity, and behavioural interventions for the treatment of overweight or obesity in preschool children up to the age of 6 years. Cochrane Database Syst Rev 2016; 3:CD012105. [PMID: 26961576 PMCID: PMC6669248 DOI: 10.1002/14651858.cd012105] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Child overweight and obesity has increased globally, and can be associated with short- and long-term health consequences. OBJECTIVES To assess the effects of diet, physical activity, and behavioural interventions for the treatment of overweight or obesity in preschool children up to the age of 6 years. SEARCH METHODS We performed a systematic literature search in the databases Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, and LILACS, as well as in the trial registers ClinicalTrials.gov and ICTRP Search Portal. We also checked references of identified trials and systematic reviews. We applied no language restrictions. The date of the last search was March 2015 for all databases. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of diet, physical activity, and behavioural interventions for treating overweight or obesity in preschool children aged 0 to 6 years. DATA COLLECTION AND ANALYSIS Two review authors independently assessed risk of bias, evaluated the overall quality of the evidence using the GRADE instrument, and extracted data following the Cochrane Handbook for Systematic Reviews of Interventions. We contacted trial authors for additional information. MAIN RESULTS We included 7 RCTs with a total of 923 participants: 529 randomised to an intervention and 394 to a comparator. The number of participants per trial ranged from 18 to 475. Six trials were parallel RCTs, and one was a cluster RCT. Two trials were three-arm trials, each comparing two interventions with a control group. The interventions and comparators in the trials varied. We categorised the comparisons into two groups: multicomponent interventions and dietary interventions. The overall quality of the evidence was low or very low, and six trials had a high risk of bias on individual 'Risk of bias' criteria. The children in the included trials were followed up for between six months and three years.In trials comparing a multicomponent intervention with usual care, enhanced usual care, or information control, we found a greater reduction in body mass index (BMI) z score in the intervention groups at the end of the intervention (6 to 12 months): mean difference (MD) -0.3 units (95% confidence interval (CI) -0.4 to -0.2); P < 0.00001; 210 participants; 4 trials; low-quality evidence, at 12 to 18 months' follow-up: MD -0.4 units (95% CI -0.6 to -0.2); P = 0.0001; 202 participants; 4 trials; low-quality evidence, and at 2 years' follow-up: MD -0.3 units (95% CI -0.4 to -0.1); 96 participants; 1 trial; low-quality evidence.One trial stated that no adverse events were reported; the other trials did not report on adverse events. Three trials reported health-related quality of life and found improvements in some, but not all, aspects. Other outcomes, such as behaviour change and parent-child relationship, were inconsistently measured.One three-arm trial of very low-quality evidence comparing two types of diet with control found that both the dairy-rich diet (BMI z score change MD -0.1 units (95% CI -0.11 to -0.09); P < 0.0001; 59 participants) and energy-restricted diet (BMI z score change MD -0.1 units (95% CI -0.11 to -0.09); P < 0.0001; 57 participants) resulted in greater reduction in BMI than the comparator at the end of the intervention period, but only the dairy-rich diet maintained this at 36 months' follow-up (BMI z score change in MD -0.7 units (95% CI -0.71 to -0.69); P < 0.0001; 52 participants). The energy-restricted diet had a worse BMI outcome than control at this follow-up (BMI z score change MD 0.1 units (95% CI 0.09 to 0.11); P < 0.0001; 47 participants). There was no substantial difference in mean daily energy expenditure between groups. Health-related quality of life, adverse effects, participant views, and parenting were not measured.No trial reported on all-cause mortality, morbidity, or socioeconomic effects.All results should be interpreted cautiously due to their low quality and heterogeneous interventions and comparators. AUTHORS' CONCLUSIONS Muticomponent interventions appear to be an effective treatment option for overweight or obese preschool children up to the age of 6 years. However, the current evidence is limited, and most trials had a high risk of bias. Most trials did not measure adverse events. We have identified four ongoing trials that we will include in future updates of this review.The role of dietary interventions is more equivocal, with one trial suggesting that dairy interventions may be effective in the longer term, but not energy-restricted diets. This trial also had a high risk of bias.
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Affiliation(s)
- Jill L Colquitt
- Effective Evidence LLP7 Bournemouth RoadChandlers FordEastleighHampshireUKSO53 3DA
| | - Emma Loveman
- Effective Evidence LLP7 Bournemouth RoadChandlers FordEastleighHampshireUKSO53 3DA
| | - Claire O'Malley
- Queen's University, Durham UniversitySchool of Medicine and Health, Wolfson Research InstituteUniversity BoulevardThornabyStockton‐on‐TeesUKTS17 6BH
| | - Liane B Azevedo
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Emma Mead
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Lena Al‐Khudairy
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Louisa J Ells
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
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Subica AM, Grills CT, Douglas JA, Villanueva S. Communities of Color Creating Healthy Environments to Combat Childhood Obesity. Am J Public Health 2016; 106:79-86. [PMID: 26562108 PMCID: PMC4695934 DOI: 10.2105/ajph.2015.302887] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2015] [Indexed: 11/04/2022]
Abstract
Ethnic and racial health disparities present an enduring challenge to community-based health promotion, which rarely targets their underlying population-level determinants (e.g., poverty, food insecurity, health care inequity). We present a novel 3-lens prescription for using community organizing to treat these determinants in communities of color based on the Robert Wood Johnson Foundation's Communities Creating Healthy Environments initiative, the first national project to combat childhood obesity in communities of color using community organizing strategies. The lenses--Social Justice, Culture-Place, and Organizational Capacity-Organizing Approach--assist health professional-community partnerships in planning and evaluating community organizing-based health promotion programs. These programs activate community stakeholders to alter their community's disease-causing, population-level determinants through grassroots policy advocacy, potentially reducing health disparities affecting communities of color.
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Affiliation(s)
- Andrew M Subica
- Andrew M. Subica is with the Center for Healthy Communities, School of Medicine, University of California, Riverside. Cheryl T. Grills, Jason A. Douglas, and Sandra Villanueva are with the Psychology Applied Research Center, Loyola Marymount University, Los Angeles, CA
| | - Cheryl T Grills
- Andrew M. Subica is with the Center for Healthy Communities, School of Medicine, University of California, Riverside. Cheryl T. Grills, Jason A. Douglas, and Sandra Villanueva are with the Psychology Applied Research Center, Loyola Marymount University, Los Angeles, CA
| | - Jason A Douglas
- Andrew M. Subica is with the Center for Healthy Communities, School of Medicine, University of California, Riverside. Cheryl T. Grills, Jason A. Douglas, and Sandra Villanueva are with the Psychology Applied Research Center, Loyola Marymount University, Los Angeles, CA
| | - Sandra Villanueva
- Andrew M. Subica is with the Center for Healthy Communities, School of Medicine, University of California, Riverside. Cheryl T. Grills, Jason A. Douglas, and Sandra Villanueva are with the Psychology Applied Research Center, Loyola Marymount University, Los Angeles, CA
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Loveman E, Al‐Khudairy L, Johnson RE, Robertson W, Colquitt JL, Mead EL, Ells LJ, Metzendorf M, Rees K. Parent-only interventions for childhood overweight or obesity in children aged 5 to 11 years. Cochrane Database Syst Rev 2015; 2015:CD012008. [PMID: 26690844 PMCID: PMC8761478 DOI: 10.1002/14651858.cd012008] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Child and adolescent overweight and obesity have increased globally, and are associated with short- and long-term health consequences. OBJECTIVES To assess the efficacy of diet, physical activity and behavioural interventions delivered to parents only for the treatment of overweight and obesity in children aged 5 to 11 years. SEARCH METHODS We performed a systematic literature search of databases including the Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS as well trial registers. We checked references of identified trials and systematic reviews. We applied no language restrictions. The date of the last search was March 2015 for all databases. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of diet, physical activity and behavioural interventions delivered to parents only for treating overweight or obesity in children aged 5 to 11 years. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for risk of bias and evaluated overall study quality using the GRADE instrument. Where necessary, we contacted authors for additional information. MAIN RESULTS We included 20 RCTs, including 3057 participants. The number of participants ranged per trial between 15 and 645. Follow-up ranged between 24 weeks and two years. Eighteen trials were parallel RCTs and two were cluster RCTs. Twelve RCTs had two comparisons and eight RCTs had three comparisons. The interventions varied widely; the duration, content, delivery and follow-up of the interventions were heterogeneous. The comparators also differed. This review categorised the comparisons into four groups: parent-only versus parent-child, parent-only versus waiting list controls, parent-only versus minimal contact interventions and parent-only versus other parent-only interventions.Trial quality was generally low with a large proportion of trials rated as high risk of bias on individual risk of bias criteria.In trials comparing a parent-only intervention with a parent-child intervention, the body mass index (BMI) z score change showed a mean difference (MD) at the longest follow-up period (10 to 24 months) of -0.04 (95% confidence interval (CI) -0.15 to 0.08); P = 0.56; 267 participants; 3 trials; low quality evidence. In trials comparing a parent-only intervention with a waiting list control, the BMI z score change in favour of the parent-only intervention at the longest follow-up period (10-12 months) had an MD of -0.10 (95% CI -0.19 to -0.01); P = 0.04; 136 participants; 2 trials; low quality evidence. BMI z score change of parent-only interventions when compared with minimal contact control interventions at the longest follow-up period (9 to 12 months) showed an MD of 0.01 (95% CI -0.07 to 0.09); P = 0.81; 165 participants; 1 trial; low quality evidence. There were few similarities between interventions and comparators across the included trials in the parent-only intervention versus other parent-only interventions and we did not pool these data. Generally, these trials did not show substantial differences between their respective parent-only groups on BMI outcomes.Other outcomes such as behavioural measures, parent-child relationships and health-related quality of life were reported inconsistently. Adverse effects of the interventions were generally not reported, two trials stated that there were no serious adverse effects. No trials reported on all-cause mortality, morbidity or socioeconomic effects.All results need to be interpreted cautiously because of their low quality, the heterogeneous interventions and comparators, and the high rates of non-completion. AUTHORS' CONCLUSIONS Parent-only interventions may be an effective treatment option for overweight or obese children aged 5 to 11 years when compared with waiting list controls. Parent-only interventions had similar effects compared with parent-child interventions and compared with those with minimal contact controls. However, the evidence is at present limited; some of the trials had a high risk of bias with loss to follow-up being a particular issue and there was a lack of evidence for several important outcomes. The systematic review has identified 10 ongoing trials that have a parent-only arm, which will contribute to future updates. These trials will improve the robustness of the analyses by type of comparator, and may permit subgroup analysis by intervention component and the setting. Trial reports should provide adequate details about the interventions to be replicated by others. There is a need to conduct and report cost-effectiveness analyses in future trials in order to establish whether parent-only interventions are more cost-effective than parent-child interventions.
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Affiliation(s)
- Emma Loveman
- Effective Evidence LLP7 Bournemouth RoadEastleighHampshireUKSO53 3DA
| | - Lena Al‐Khudairy
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Rebecca E Johnson
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Wendy Robertson
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Jill L Colquitt
- Effective Evidence LLP7 Bournemouth RoadEastleighHampshireUKSO53 3DA
| | - Emma L Mead
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Louisa J Ells
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
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Carrillo-Larco RM, Miranda JJ, Bernabé-Ortiz A. Wealth index and risk of childhood overweight and obesity: evidence from four prospective cohorts in Peru and Vietnam. Int J Public Health 2015; 61:475-85. [DOI: 10.1007/s00038-015-0767-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 11/03/2015] [Accepted: 11/12/2015] [Indexed: 11/24/2022] Open
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Wynne C, Comiskey C, McGilloway S. The role of body mass index, weight change desires and depressive symptoms in the health-related quality of life of children living in urban disadvantage: Testing mediation models. Psychol Health 2015; 31:147-65. [DOI: 10.1080/08870446.2015.1082560] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Cameron AJ, Spence AC, Laws R, Hesketh KD, Lioret S, Campbell KJ. A Review of the Relationship Between Socioeconomic Position and the Early-Life Predictors of Obesity. Curr Obes Rep 2015; 4:350-62. [PMID: 26627493 DOI: 10.1007/s13679-015-0168-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A range of important early-life predictors of later obesity have been identified. Children of lower socioeconomic position (SEP) have a steeper weight gain trajectory from birth with a strong socioeconomic gradient in child and adult obesity prevalence. An assessment of the association between SEP and the early-life predictors of obesity has been lacking. The review involved a two-stage process: Part 1, using previously published systematic reviews, we developed a list of the potentially modifiable determinants of obesity observable in the pre-natal, peri-natal or post-natal (pre-school) periods; and part 2, conducting a literature review of evidence for socioeconomic patterning in the determinants identified in part 1. Strong evidence was found for an inverse relationship between SEP and (1) pre-natal risk factors (pre-pregnancy maternal body mass index (BMI), diabetes and pre-pregnancy diet), (2) antenatal/peri natal risk factors (smoking during pregnancy and low birth weight) and (3) early-life nutrition (including breastfeeding initiation and duration, early introduction of solids, maternal and infant diet quality, and some aspects of the home food environment), and television viewing in young children. Less strong evidence (because of a lack of studies for some factors) was found for paternal BMI, maternal weight gain during pregnancy, child sleep duration, high birth weight and lack of physical activity in young children. A strong socioeconomic gradient exists for the majority of the early-life predictors of obesity suggesting that the die is cast very early in life (even pre-conception). Lifestyle interventions targeting disadvantaged women at or before child-bearing age may therefore be particularly important in reducing inequality. Given the likely challenges of reaching this target population, it may be that during pregnancy and their child's early years are more feasible windows for engagement.
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Affiliation(s)
- Adrian J Cameron
- World Health Organization Collaborating Centre for Obesity Prevention, Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia.
| | - Alison C Spence
- School of Exercise and Nutrition Science, Deakin University, 221 Burwood Hwy, Burwood, 3125, Australia
| | - Rachel Laws
- School of Exercise and Nutrition Science, Deakin University, 221 Burwood Hwy, Burwood, 3125, Australia
- Centre for Obesity Prevention and Management Research Excellence in Primary Health Care, Sydney, Australia
| | - Kylie D Hesketh
- School of Exercise and Nutrition Science, Deakin University, 221 Burwood Hwy, Burwood, 3125, Australia
| | - Sandrine Lioret
- INSERM, UMR1153 Epidemiology and Statistics Sorbonne Paris Cité Research Center (CRESS), Early Origins of Child Health and Development Team (ORCHAD), Villejuif, F-94807, France
- Paris-Descartes University, Paris, France
| | - Karen J Campbell
- School of Exercise and Nutrition Science, Deakin University, 221 Burwood Hwy, Burwood, 3125, Australia
- Centre for Obesity Prevention and Management Research Excellence in Primary Health Care, Sydney, Australia
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