Complications of obesity in childhood

Association of sleep duration and sleep quality with overweight/obesity among adolescents of Bangladesh: a multilevel analysis

Background

Sleep deprivation is widely recognized as a potential contributor to childhood obesity. However, few studies have addressed this issue in low-income settings. The aim of this study was to determine the association of both sleep duration and sleep quality with overweight/obesity among adolescents of Bangladesh.

Methods

A cross-sectional study was conducted in four randomly selected schools in Gazipur, Bangladesh, from May to August 2019. Using a self-administered semi-structured questionnaire, data on sleep duration and sleep quality were collected from 1,044 adolescents between 13 and 17 years of age. The body mass indices of the study participants were evaluated using their objectively-assessed anthropometric measurements (weight and height). Multilevel logistic regression was used for data analysis.

Results

The prevalence of underweight, overweight and obesity in adolescents in this study were 14.9, 18 and 7.1%, respectively. More than 15% of the students reported sleep disturbance and poor sleep quality. After adjusting for confounders, reduced (<7 h/day) total sleep duration (OR=1.73, 95% CI=1.21-2.47), weekend sleep duration (OR=1.46, 95% CI=1.00-2.12), and night sleep duration (OR=1.55, 95% CI=1.06-2.28) were found to be significantly associated with overweight or obesity in Bangladeshi adolescents. Similarly, significant positive associations were evident between short duration of total sleep (OR=0.33, 95% CI=0.20-0.54), weekday sleep (OR=0.55, 95% CI=0.35-0.84), weekend sleep (OR=0.53, 95% CI=0.31-0.89), and night sleep (OR=0.56, 95% CI=0.36-0.87), and underweight in study participants. Adolescents with short sleep duration were found less likely to be underweight and more likely to be overweight/obese.

Conclusions

Study findings denoted short sleep duration to be associated with overweight/obesity and underweight among adolescents of Bangladesh. Adequate sleep may therefore serve as an effective obesity prevention strategy in the growing stages.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12774-0.

Food and beverage marketing in primary and secondary schools in Canada

BACKGROUND

Unhealthy food marketing is considered a contributor to childhood obesity. In Canada, food marketing in schools is mostly self-regulated by industry though it is sometimes restricted through provincial school policies. The purpose of this study was to document the type of food marketing activities occurring in Canadian schools and examine differences by school characteristics.

METHODS

An online survey was sent to public primary and secondary schools from 27 school boards in Ontario, British Columbia, and Nova Scotia and was completed by 154 Principals in spring 2016. This survey queried the type of food marketing occurring in schools including advertisements, food product displays, fundraising, exclusive marketing agreements, and incentive programs, among others. The occurrence of food marketing was described using frequencies, medians, and ranges. Chi-square and Fisher Exact tests were conducted to assess school-level differences in the frequency of marketing activities by school type (primary versus secondary), province (Ontario versus British Columbia), and the socio-economic status of most students (low versus middle/high income). The significance level was set at α < 0.05 for all tests.

RESULTS

Overall, 84% of schools reported at least one type of food marketing and the median number of distinct types of marketing per school was 1 (range 0-6). The most frequently reported forms of marketing were the sale of branded food, particularly chocolate, pizza, and other fast food, for fundraising (64% of schools); food advertisements on school property (26%), and participation in incentive programs (18%). Primary schools (n = 108) were more likely to report participating in incentive programs (25%) and selling branded food items (72%) compared to secondary schools (n = 46; 2 and 43% respectively; p < 0.01). Conversely, secondary schools were more likely to report food advertising on school property (56%), exclusive marketing arrangements with food companies (43%), and food product displays (19%) than primary schools (13, 5 and 2%, respectively; p < 0.01).

CONCLUSION

The presence of food marketing in most participating schools suggests that the current patchwork of policies that restrict food marketing in Canadian schools is inadequate. Comprehensive restrictions should be mandated by government in both primary and secondary schools to protect children and youth from this marketing.

Association of Anthropometric and Lifestyle Parameters with Fitness Levels in Greek Schoolchildren: Results from the EYZHN Program

Objective

The aim of the study was to evaluate physical fitness (PF) and identify its anthropometric and lifestyle determinants in a sample of Greek schoolchildren.

Methods

The study sample consisted of 335,810 schoolchildren (♂: 51.3%, 6–18 years old). Students’ anthropometric parameters and PF levels—assessed via the Eurofit test battery—were measured by trained physical education teachers and evaluated according to the available norms, while their lifestyle habits were assessed through a questionnaire.

Results

In all applied PF tests, students’ performance was negatively associated with the presence of obesity and central obesity, defined through international criteria for body mass index and waist to height ratio, respectively. According to multiple logistic regression analysis, the presence of overweight/obesity [odds ratio (OR): 4.43, 95% confidence interval (CI): 3.98–4.93], low adherence to the MD (KIDMED ≤ 3) (OR: 1.27, 95% CI: 1.09–1.48), and increased time spent in sedentary activities (>2 h per day) (OR: 1.16, 95% CI: 1.03–1.29) were positively associated with poor PF, after adjusting for age and sex. In contrast, for every 1 day increase in the weekly frequency of engagement in athletic activity, the probability of poor PF decreased by 26% (OR: 0.74, 95% CI: 0.72–0.77). In a similar model, the presence of central obesity emerged as an even stronger possible predictor of poor PF (OR: 5.20, 95% CI: 4.66–5.78), compared to the presence of general obesity.

Conclusion

Higher general or abdominal adiposity, as well as the adoption of a low-quality diet and a sedentary lifestyle, is strongly associated with low PF levels during childhood.

Simple interventions to improve healthy eating behaviors in the school cafeteria

The National School Lunch Program in the United States provides an important opportunity to improve nutrition for the 30 million children who participate every school day. The purpose of this narrative review is to present and evaluate simple, evidence-based strategies to improve healthy eating behaviors at school. Healthy eating behaviors are defined as increased selection/consumption of fruits and/or vegetables, increased selection of nutrient-dense foods, or decreased selection of low-nutrient, energy-dense foods. Data were collected from sales records, 24-hour food recalls, direct observation, and estimation of plate waste. The review is limited to simple, discrete interventions that are easy to implement. Sixteen original, peer-reviewed articles are included. Interventions are divided into 5 categories: modification of choice, behavior modification, marketing strategies, time-efficiency strategies, and fruit slicing. All interventions resulted in improved eating behaviors, but not all interventions are applicable or feasible in all settings. Because these studies were performed prior to the implementation of the new federally mandated school meal standards, it is unknown if these interventions would yield similar results if repeated now.

Measuring parent time scarcity and fatigue as barriers to meal planning and preparation: quantitative scale development

OBJECTIVE

To examine the psychometric properties of 9 quantitative items that assess time scarcity and fatigue as parent barriers to planning and preparing meals for their children.

METHODS

A convenience sample of 342 parents of children aged 2-6 years completed a 20-minute online survey. Exploratory factor analysis was used to examine the factor structure and create summary scales. Internal consistency reliability and measures of construct and concurrent validity were assessed.

RESULTS

Two scales were created based on the factor analysis: time and energy for meals and meal planning. Preliminary evidence suggests that both scales are reliable and valid.

CONCLUSIONS AND IMPLICATIONS

The time and energy for meals and meal planning scales can be completed quickly by busy and tired parents. As many children do not eat nutritious diets, a better understanding of the barriers that parents face is critical and may help inform interventions tailored to the needs of tired, busy parents.

Determinants of (sustained) overweight and complaints in children and adolescents in primary care: the DOERAK cohort study design

BACKGROUND

Almost half of the adult Dutch population is currently overweight and the prevalence of overweight children is rising at alarming rates as well. Obese children consult their general practitioner (GP) more often than normal weight children. The Dutch government has assigned a key role to the GP in the prevention of overweight.The DOERAK cohort study aims to clarify differences between overweight and non-overweight children that consult the GP; are there differences in number of consultations and type and course of complaints? Is overweight associated with lower quality of life or might this be influenced by the type of complaint? What is the activity level of overweight children compared to non-overweight children? And is (sustained) overweight of children associated with parameters related to the energy balance equation?

METHODS/DESIGN

A total of 2000 overweight (n = 500) and non-overweight children (n = 1500) aged 2 to 18 years who consult their GP, for any type of complaint in the South-West of the Netherlands are included.At baseline, height, weight and waist circumference are measured during consultation. The number of GP consultations over the last twelve months and accompanying diagnoses are acquired from the medical file. Complaints, quality of life and parameters related to the energy balance equation are assessed with an online questionnaire children or parents fill out at home. Additionally, children or parents keep a physical activity diary during the baseline week, which is validated in a subsample (n = 100) with an activity monitor. Parents fill out a questionnaire about demographics, their own activity behaviour and perceptions on dietary habits and activity behaviour, health and weight status of their child. The physical and lifestyle behaviour questions are repeated at 6, 12 and 24 months follow-up. The present study is a prospective observational cohort in a primary care setting.

DISCUSSION

The DOERAK cohort study is the first prospective study that investigates a large cohort of overweight and non-overweight children in primary care. The total study population is expected to be recruited by 2013, results will be available in 2015.

Relation between sleep duration and BMI varies by age and sex in youth age 8-19

OBJECTIVES

The objectives of this study were to (i) compare the strength of associations between sleep duration and body mass index (BMI) in middle childhood, and early and late adolescence; (ii) determine whether sleep duration in middle childhood predicts BMI in early or late adolescence; and (iii) examine the consistency of these associations by sex.

METHODS

Subjects included 313 children/adolescents aged 8-19 participating in a longitudinal cohort study on sleep and health. Participants were assessed at three time points approximately 4 years apart: ages 8-11, 12-15 and 16-19. BMI z-score (BMIz) was calculated using age and sex normative data from the Centers for Disease Control. Sleep duration was reported by the parent (ages 8-15) or the adolescent (ages 16-19).

RESULTS

[corrected] Half of the participants were male and 79% were Caucasian. Sleep duration had a negative linear association with BMIz for boys but not girls, and the magnitude of this association decreased with age. Sleep duration at age 8-11 predicted BMIz in early and late adolescence for boys but not girls, and associations were largely attenuated after adjusting for BMIz at age 8-11. The strongest predictor of adolescent BMIz was BMIz at age 8-11 for both boys and girls.

CONCLUSION

We conclude that the association between sleep duration and BMIz varies by sex and age, with stronger associations in boys and in middle childhood compared with adolescence.

Nutritional status of students in Kocaeli, Turkey: a population-based study

BACKGROUND

  The aim of this study was to determine the nutritional status of students in Kocaeli, Turkey.

METHODS

  This cross-sectional study was carried out among the students of secondary schools in Kocaeli. Of the students, 2491 subjects were selected using multi-stage stratified sampling.

RESULTS

  Of the students, 51.1% were male and 48.9% were female. Mean age was 14.35±1.87 (range 10.1-19.8) in overall subjects, 14.38±1.87 in boys and 14.31±1.85 in girls. The prevalence of obesity and of overweight was estimated as 7.3% and 11.8%, respectively. Also, 3.1% of the subjects were underweight and 2.9% were thin. The rate of obesity was 1.5 times higher in girls and that of overweight was 1.2 times higher in girls. Similarly, students aged 15 years old and younger were 1.2 times more obese and 1.7 times more overweight than older students. Students living in urban areas had a higher prevalence of obesity and of overweight.

CONCLUSION

  Nutritional problems in students should be dealt with by some regulations in schools; for example, providing healthy food in schools or food aid, particularly in poor regions.

Obesity in pediatric orthopaedics

Obesity is a rapidly expanding health problem in children and adolescents and is the most prevalent nutritional problem for children in the United States. Some believe that obesity has become a major epidemic in American children, with the prevalence having more than doubled since 1980. This epidemic has led to a near-doubling in hospitalizations with a diagnosis of obesity between 1999 and 2005 and an increase in costs from $125.9 million to $237.6 million between 2001 and 2005. This article describes some of the orthopaedic conditions commonly encountered in overweight/obese children and adolescents, classically infantile and adolescent tibia vara and slipped capital femoral epiphysis. Also discussed are genu valgum, which has been associated with obesity, and other difficulties encountered in providing orthopaedic care to obese children.

The association of sleep duration with adolescents' fat and carbohydrate consumption

STUDY OBJECTIVES

To investigate the relation between sleep duration and energy consumption in an adolescent cohort.

DESIGN

Cross-sectional.

SETTING

Free-living environment.

PARTICIPANTS

Two hundred forty adolescents (mean age 17.7 +/- 0.4 years).

MEASUREMENTS AND RESULTS

Daily 24-hour food-recall questionnaires and wrist-actigraphy measurements of sleep duration were employed to test the hypothesis that shorter weekday sleep duration (< 8 h) is associated with altered nutrient intake. Nutrition parameters included total calories, calories from meals and snacks, and proportions of caloric intake from fat and carbohydrates. Compared with adolescents sleeping 8 or more hours on average on weekdays, those sleeping less than 8 hours consumed a higher proportion of calories from fats (35.9% +/- 6.7% vs 33.2% +/- 6.9%; mean +/- SD; P = 0.004) and a lower proportion of calories from carbohydrates (49.6% +/- 8.2% vs 53.3% +/- 8.3%; P = 0.001). After adjusting for potential confounders, shorter sleep duration was significantly associated with an average daily increase of calories consumed from fat of 2.2 percentage points and an average daily decrease in percentage of calories from carbohydrates of 3.0 percentage points. In unadjusted analyses, shorter sleep duration was also associated with a 2.1-fold increased odds (95% confidence interval: 1.03, 4.44) of daily consuming 475 or more kcal from snacks.

CONCLUSION

Quantitative measures of macronutrient intake in adolescents were associated with objectively measured sleep duration. Short sleep duration may increase obesity risk by causing small changes in eating patterns that cumulatively alter energy balance.

Body mass index changes and chronic neuroleptic drug treatment for Tourette syndrome

A known risk of neuroleptic medications is weight gain, but few studies have estimated long-term effects in childhood. This study evaluated effects of neuroleptics on body mass index for age and sex (body mass index Z scores) in a matched cohort of neuroleptic-treated (n = 16) and nonneuroleptic-treated (n = 29) children and adolescents with Tourette syndrome. Growth parameters were assessed in 45 children, aged 5-15 years, treated for an average of 3 years (range, 1-6) with low doses of pimozide or risperidone. Effects of neuroleptic treatment, age, duration, and treatment x duration interactions on changes in Z score were assessed with regression, and time course of changes was modeled using repeated measures analysis of variance. Although the mean first-year weight gain differed significantly (13.5 kg neuroleptic vs 3.2 kg nonneuroleptic), the longterm Z score changes did not (0.3 vs 0.1; F(4,44) = 0.87, P = 0.49). Repeated measures analysis of Z scores differed significantly by treatment (F(3,77.6) = 6.34, P = 0.0007), related to first-year changes only. In children and adolescents with Tourette syndrome treated for longer than 1 year with neuroleptics, weight gain is not necessarily excessive.

Musculoskeletal problems in overweight and obese children

PURPOSE

The obesity epidemic in children is spreading at alarming rates. Because musculoskeletal problems can influence physical activity, we compared the frequency of musculoskeletal problems in overweight and obese children with that in normal-weight children.

METHODS

We performed a cross-sectional database and face-to-face interview study that included 2,459 children aged 2 to 17 years from Dutch family practices. We collected data on self-reported height and weight (body mass index), self-reported musculoskeletal problems in the 2 weeks before the interview, number of family physician consultations for musculoskeletal problems in 1 year, and age (2 age-groups were analyzed: 2 to 11 years and 12 to 17 years, because of the proxy interview in the youngest age-group). We calculated the odds ratio (OR) and 95% confidence interval (CI) for musculoskeletal problems in overweight and obese children, compared with normal-weight children.

RESULTS

Overweight and obese children in both age-groups (2 to 11 years and 12 to 17 years) reported significantly more musculoskeletal problems (OR = 1.86; 95% CI, 1.18-2.93; and OR = 1.69; 95% CI, 1.08-2.65, respectively) than normal-weight children. The total group of children who were overweight or obese reported more lower extremity problems than did the normal-weight children (OR = 1.62; 95% CI, 1.09-2.41); furthermore, they reported more ankle and foot problems than children who were of normal weight (OR = 1.92; 95% CI, 1.15-3.20). Overweight and obese children aged 12 to 17 years consulted their family physicians more often with lower extremity problems than did the normal-weight children (OR = 1.92; 95% CI, 1.05-3.51).

CONCLUSION

This study shows that overweight and obese children more frequently experience musculoskeletal problems than do normal-weight children.