Dietary patterns among children aged 6-7 y in four Spanish cities with widely differing cardiovascular mortality

OBJECTIVE: Classic cardiovascular risk factors, such as smoking, arterial hypertension and hypercholesterolaemia, cannot explain a substantial part of the geographic differences in cardiovascular mortality. Anthropometric and nutritional factors in early stages of life may contribute to adult cardiovascular disease. Therefore, this work examines certain anthropometric variables and diet among children aged 6-7 y, living in four Spanish cities with widely differing ischaemic heart disease (IHD) mortality. DESIGN AND SETTING: Cross-sectional anthropometric and dietary survey in four cities in Spain. SUBJECTS: A total of 1112 children (50.1% males, 49.9% females) attending public and private schools in Cadiz and Murcia, cities with a relatively high IHD mortality, and Madrid and Orense, cities with a relatively low IHD mortality. A standardized method was used to measure anthropometric variables, and a food-frequency questionnaire completed by subjects' mothers, to measure diet. OUTCOME MEASURES: Body mass index (BMI), overweight (BMI>17.6 kg/m(2)), obesity (BMI>20.1 kg/m(2)) and intake of food and nutrients. RESULTS: Children in the four cities showed a high prevalence of overweight (range across cities, 28.9-34.5%) and obesity (8.5-15.7%). They also had a moderately hypercaloric diet (range, 2078-2218 kcal/day), marked by an excessive intake of lipids (45.0-47.3% kcal), particularly saturated fats (16.6-16.9% kcal), proteins (17.0-17.3% kcal), sugars (20.0-21.9% kcal) and cholesterol (161.6-182.9 mg/1000 kcal/day), and a low intake of complex carbohydrates (17.5-18.1% kcal) and fibre (19.6-19.9 g/day). Compared with children in the two low-IHD-mortality cities, those in the two high-IHD-mortality cities had a greater BMI (mean difference, 0.61 kg/m(2); P=0.0001) and ponderal index (0.58 kg/m(3); P=0.0001) and a higher intake of energy (104 kcal/day; P=0.007), cholesterol (16.00 mg/1000 kcal/day; P=0.0001) and sodium (321 mg/day; P=0.0001). Inter-city differences in anthropometric variables remained after adjustment for birthweight. CONCLUSIONS: Intake of fats, especially saturated fats, and cholesterol should be reduced among Spanish children. It could contribute to a needed reduction of the high prevalence of overweight and obesity in children. If the differences in anthropometric variables and diet between children from the cities with high and low coronary mortality are maintained in future or continue into adulthood, this could contribute to consolidate or even increase the IHD mortality gradient across cities. The finding that differences in anthropometric variables are independent of birthweight suggests that the childhood, rather than intrauterine environment, is involved in the development of such differences. SPONSORSHIP: This study was partly funded by grants from the International Olive Oil Board (Consejo Oleícola Internacional), Comunidad Autónoma de Madrid, Fundación Pedro Barrié de la Maza, and Fundación Eugenio Rodríguez Pascual.     

Continued development of public health in public opinion: results of a representative population survey in Munich,Dresden, Vienna and Bern

OBJECTIVES: The presented study deals with the citizen's view on the development of health care systems. It aims to generate research hypotheses as basis for further studies. METHODS: During February through March 2000 computer-assisted telephone surveys were conducted in Munich, Dresden, Berne and Vienna. Respondents were asked for desired changes in the health care system, among others. 502 interviews were completed. The response rate from target person contacts was 43% to 60%. RESULTS: Improvements were desired most frequently for the domains interaction between therapist and patient, systems organisation and finances. Regional differences in the relative importance of these areas were found, gender specific differences were less prominent. Differences between Dresden and Munich point to persistent disparities within Germany. CONCLUSIONS: The identification of systems-related determinants or deficits bears opportunities for a citizen-centered, humane development of health care systems.     

Prevalence and regional differences in overweight in 2001 and trends in BMI distribution in Swedish children from 1987 to 2001

AIMS: This study was undertaken to assess current prevalence and regional differences of overweight in 2001 and changes in body mass index (BMI) distribution between 1987 and 2001 in Swedish adolescents. METHODS: Comparison was made of two independent samples. For assessment of prevalence and regional differences in 2001, a total of 1732 subjects were used. For trend analyses a total of 1,949 children (516 and 1,470 in 1987 and 2001, respectively), aged 10, 13, and 16 years. RESULTS: The prevalence of overweight in 2001 was between 21.7% and 13.3% for boys and girls aged 10 to 16 years and the prevalence of obesity was between 2.9% and 6.2%. Mean BMI as well as prevalence of overweight and obesity was higher in subjects from schools in smaller towns or from the countryside. Median BMI among adolescents changed from 1987 to 2001, most notably in 13- and 16-year-old children. The prevalence of overweight and obesity combined has changed more than 2.5-fold in children aged 10 to 16 years. In this study, the most pronounced elevation in BMI is found in the upper part of the BMI spectrum. This change is especially apparent in girls. CONCLUSION: The change in mean BMI and prevalence of overweight and obesity in children in this study is mainly due to the pronounced change in BMI at the upper end of the spectrum, indicating that the factors leading to overweight or obesity have changed in only a subgroup of the child population.     

Obesity and undernutrition in sub-Saharan African immigrant and refugee children in Victoria, Australia

The study assessed the anthropometric status of 337 sub-Saharan African children aged between 3-12 years who migrated to Australia. These children were selected using a snowball sampling method stratified by age, gender and region of origin. The prevalence rates for overweight and obesity were 18.4% (95%CI: 14 - 23%) and 8.6% (95%CI: 6% -12%) respectively. The prevalence rates for the indicators of undernutrition were: wasting 4.3% (95%CI: 1.6%-9.1%), underweight 1.2% (95%CI: 0.3%-3.0%), and stunting 0.3 (95%CI: 0.0%-1.6%). Higher prevalence of overweight/obesity was associated with lower household income level, fewer siblings, lower birth weight, western African background, and single parent households (after controlling for demographic and socio-economic factors). Higher prevalence rates for underweight and wasting were associated with lower household income and shorter lengths of stay in Australia respectively. No effect was found for child's age, gender, parental education and occupation for both obesity and undernutrition indices. In conclusion, obesity and overweight are very prevalent in SSA migrant children and undernutrition, especially wasting, was also not uncommon in this target group.     

Comparison of anthropometry and parent-reported height and weight among nine year olds

BACKGROUND: There is mounting evidence that the prevalence of overweight and obesity in children is reaching epidemic proportions in North America. We compared parent-report vs. measured BMI overweight and obesity prevalence estimates among 9 year olds using the 1996 NLSCY reports published by Willms et al. (2003) and anthropometric measurements from a regional population of public school children. METHODS: Body mass index (BMI) was calculated for 1,497 9-year-old children (males N = 734; females N = 763) from 75 public schools in the Niagara Region of Ontario, Canada. BMI from the 1996 NLSCY was based on parental reports of height and weight of 879 nine year olds. To define overweight and obese children, we used internationally accepted age- and gender-specific cut-offs as defined by Cole et al. (2000). RESULTS: The NLSCY overweight prevalence estimates of boys and girls may overestimate overweight boys and girls by 17% and 10%, respectively. Measured obesity prevalence estimates were similar to parent-reports. CONCLUSIONS: Our results suggest that parental reports of height and weight may inflate prevalence estimates of overweight children, but appear reasonably accurate for estimating obesity. Since prevalence of overweight and obesity are often combined to form a global estimate, reliance on parent-reported height and weight may overstate the magnitude of the problem.     

三代直系亲属超重、肥胖的比较及与学龄前儿童肥胖关系的研究

目的 比较学龄前儿童及其父母、祖父母及外祖父母三代直系亲属之间超重、肥胖发生率的差异,探究直系亲属超重、肥胖与儿童肥胖的关系,为预防和减少学龄前儿童肥胖的发生提供科学依据。方法 2019年5-6月,对南京市雨花台区辖区内幼儿园采用整群分层随机抽样调查方法,共有2 217名3~5岁学龄前儿童作为研究对象,通过问卷调查收集所有研究对象年龄、性别、出生体重及其父母、祖父母及外祖父母年龄、体重、身高等信息,并采用统一标准方法测量儿童的体重、身高,分析直系亲属超重、肥胖与儿童超重、肥胖之间的关系。结果 学龄前儿童超重发生率7.80%、肥胖发生率2.75%。儿童中男性肥胖发生率明显高于女性(3.4% vs. 2.0%, P<0.05);在中年父母辈中,男性的超重及肥胖发生率分别为36.1%、11.1%,均显著高于女性(13.6%、3.3%)(P<0.001),而在祖父母辈,女性的肥胖发生率却显著高于男性(祖父母:10.1% vs. 5.9%,P<0.001;外祖父母:7.5% vs. 6.2%,P<0.05)。经有序Logistic回归模型分析,母亲超重(OR＝1.614,95%CI:1.132~2.301,P<0.01)及父亲肥胖(OR＝2.584,95%CI:1.773~3.765,P<0.001)是导致儿童超重肥胖的独立危险因素;而二代亲属祖父母和外祖父母肥胖与儿童肥胖无显著关系。结论 直系三代亲属中,中年男性的超重、肥胖发生率最高,父母超重、肥胖可导致学龄前儿童肥胖发生风险显著增加。     

Die Verbreitung von Übergewicht und Adipositas bei Kindern und Jugendlichen in Deutschland

Overweight and obesity are an increasing problem: worldwide, for Germany and for children and adolescents. Until now there have been no representative and age-specific assessments of the prevalence of obesity among children and adolescents in Germany. Thus, the standardised height and weight measurements gathered in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) have, for the first time, provided national, representative data about overweight and obesity in young people. The terms 'overweight' and 'obese' are defined based on percentiles of the body mass index (BMI) of the Kromeyer-Hauschild reference system. Of children and adolescents between the ages of 3 and 17, 15% exceed the 90th BMI percentile of the reference data and are thus overweight, 6.3% exceed the 97th BMI percentile and thus suffer from obesity by this definition. The proportion of overweight rises from 9% of 3-6-year-olds to 15% of 7-10-year-olds and 17% of 14-17-year-olds. The prevalence of obesity is 2.9%, 6.4% and 8.5% for the same age groups respectively. No clear differences between boys and girls or between East and West Germany are detected. Children are at a higher risk of being overweight or obese if they have a lower socioeconomic status, have a migration background, or have mothers who are also overweight.     

Secondary Analysis of Anthropometric Data from a South African National Food Consumption Survey, Using Different Growth Reference Standards

The National Center for Health Statistics (NCHS) references were used to analyse anthropometric data from the 1999 National Food Consumption Survey (NFCS) of South Africa. Since then, however, The Centers for Disease Control and Prevention (CDC) 2000 reference and the World Health Organization (WHO) 2006 standards were released. It was anticipated that these reference and standards may lead to differences in the previous estimates of stunting, wasting, underweight and obesity in the study population. The aim was to compare the anthropometric status of children using the 1977 NCHS, the 2000 CDC growth references and the 2006 WHO standards. All children 12–60 months of age with a complete set of anthropometric data were included in the analyses. Data for 1,512 children were analysed with SAS 9.1 for Windows. A Z-score was calculated for each child for weight-for-age (W/A), weight-for-length/height (W/H), length/height-for-age (H/A) and body mass index (BMI)-for-age, using each of the three reference or standards for comparison. The prevalence of stunting, obesity and overweight were significantly higher and the prevalence of underweight and wasting were lower when using the WHO standards compared to the NCHS and the CDC references. The higher than previously established prevalence of stunting at 20.1% and combined overweight/obesity at 30% poses a challenge to South African policy makers to implement nutrition programmes to decrease the prevalence of both stunting and overweight. The 2006 WHO growth standard should be the standard used for assessment of growth of infants and children younger than 5 years in developing countries.     

Prevalence of overweight and obesity and its associated factors: findings from National Nutrition and Health Survey in Taiwan, 1993-1996

BACKGROUND: To report the overall and regional prevalence of obesity/overweight in Taiwan and to study its associated risk factors. METHODS: A total of 3046 adults > or = 20 years of age collected in National Nutrition and Health Survey in Taiwan, 1993-1996. RESULTS: Prevalence rates of overweight and obesity were 21.1 and 4.0% under the current WHO definition. The prevalence rates of overweight and obesity, using the Taiwanese definition (BMI = 24-26.99 kg/m(2) and > or = 27 kg/m(2), respectively), were 22.9 and 10.5% for males and 20.3 and 13.2% for females, respectively. The highest prevalence rates of obesity were found in the mountainous areas. In addition to age and residing location, education level in women and metabolic equivalent (MET) score and alcohol consumption in men were correlates of obesity. Effects of nutrition/health-related behaviors might be in part explained by education level and residing location of the subjects. CONCLUSION: The prevalence of obesity defined by WHO criteria among people in Taiwan was moderate, with considerable regional variation. The regional differences in obesity prevalence could not be completely accounted for by the sociodemographic and lifestyle factors studied.     

Viva la Familia Study: genetic and environmental contributions to childhood obesity and its comorbidities in the Hispanic population

BACKGROUND: Genetic and environmental contributions to childhood obesity are poorly delineated. OBJECTIVE: The Viva la Familia Study was designed to genetically map childhood obesity and its comorbidities in the Hispanic population. The objectives of this report were to describe the study design and to summarize genetic and environmental contributions to the phenotypic variation in obesity and risk factors for metabolic diseases in Hispanic children. DESIGN: The Viva la Familia cohort consisted of 1030 children from 319 families selected based on an overweight proband between the ages of 4 and 19 y. In-depth phenotyping to characterize the overweight children and their siblings included anthropometric and body-composition traits by dual-energy X-ray absorptiometry and assessments of diet by 24-h recalls, physical activity by accelerometry, and risk factors for metabolic diseases by standard biochemical methods. Univariate quantitative genetic analysis was used to partition phenotypic variance into additive genetic and environmental components by using the computer program SOLAR. RESULTS: Sex, age, and environmental covariates explained 1-91% of the phenotypic variance. Heritabilities of anthropometric indexes ranged from 0.24 to 0.75. Heritability coefficients for the body-composition traits ranged from 0.18 to 0.35. Diet and physical activity presented heritabilities of 0.32 to 0.69. Risk factors for metabolic diseases were heritable with coefficients ranging from 0.25 to 0.73. Significant genetic correlations between obesity traits and risk factors for metabolic diseases substantiated pleiotropy between traits. CONCLUSION: The Viva la Familia Study provides evidence of a strong genetic contribution to the high prevalence of obesity and its comorbidities in Hispanic children.