Breast-feeding and overweight in Singapore school children

Background:  Studies from developed Western countries have shown inconsistent associations between breast-feeding and overweight/obesity in children and adolescents. Few data are available from Asian populations. The purpose of the present study was therefore to evaluate the association between breast-feeding and overweight/obesity in a study of 10–12-year-old children in Singapore.
Methods:  A total of 797 school children (49% girls, 76% Chinese) who participated in the Singapore Cohort Study of the Risk Factors for Myopia (SCORM) were examined. Overweight/obesity ( n  = 179) was defined as age–sex-specific body mass index (BMI) cut-offs corresponding to BMI of 25 kg/m² for overweight and 30 kg/m² for obesity at age 18 based on the International Obesity Task Force (IOTF) reference.
Results:  The prevalence of overweight/obesity was 22.5%. Overall, breast-feeding was not found to be associated with overweight/obesity. After adjusting for potential confounders, the multivariable odds ratio (95% confidence interval) of overweight/obesity was 1.14 (0.80–1.63) for ever breast-fed compared with never breast-fed, 1.00 (0.57–1.72) for breast-fed for >3 months compared to ≤3 months and 0.79 (0.47–1.34) for exclusive/mostly breast-fed compared to partly breast-fed.
Conclusions:  No significant associations were detected among breast-feeding, its type, and duration with overweight/obesity in this Asian cohort of 10–12-year-old children.     

Prevalence trends of obesity and overweight among 10-year-old children in western Sweden and relationship with parental body mass index

AIM: To determine the regional prevalence, secular and family-related trends of obesity and overweight among 10-y-old children. METHODS: A cross-sectional study of 10-y-old children, born in 1990, was performed during September 2000 to June 2001 at school health centres in three communities in the western part of Sweden. Evaluation was performed in 6311 children, or 81% of the target population. Data from a cohort of children, born in 1974, who form the national growth charts, were available for comparison. RESULTS: The mean body mass index was 17.9 kg/m2 in 10-y-old children born in 1990 and 17.0 kg/m2 for 10-y-olds born in 1974 (p < 0.0001). Of the 10-y-old children in 2000-2001, born in 1990, 18% were overweight and 2.9 % obese, which corresponds to a twofold increase in presence of overweight and a fourfold increase in presence of obesity among 10-y-old children from 1984 to 2000. There was a significant correlation between parental and child body mass index. The prevalence of obesity and being overweight appeared to be higher in children whose parents did not participate in the study. CONCLUSION: During a 16-y period, from 1984 to 2000, a twofold increase in being overweight and a fourfold increase in obesity were seen among 10-y-old children in the western part of Sweden. Parental ponderosity or reluctance to participate in the study was related to a higher prevalence of being overweight or obese in the children. There is a need for the healthcare system to recognize the threats to the health of the population of this new "epidemic" and initiate preventive measures and treatment programmes.     

Prevalence of overweight and obesity in the Netherlands in 2003 compared to 1980 and 1997

Objective

To assess the prevalence of overweight and obesity in children living in the Netherlands and compare the findings with the Third and Fourth National Growth Studies carried out in 1980 and 1997, respectively.

Design and methods

Data were obtained from the child health care system. International cut‐off points for body mass index (BMI) were used to determine overweight and obesity. Cases were weighted for ethnicity and municipality size in such a way that the sample matched the distribution in the general population. The LMS method was used to calculate the age‐related distribution of BMI, and the prevalence was calculated from the fitted distribution.

Patients

Data on 90 071 children aged 4–16 years were routinely collected by 11 community health services during 2002–2004.

Results

On average, 14.5% of the boys and 17.5% of the girls were overweight (including obesity), which is a substantial increase since 1980 (boys 3.9%, girls 6.9%) and 1997 (boys 9.7%, girls 13.0%). Similarly, 2.6% of the boys and 3.3% of the girls aged 4–16 years were obese, which is much higher than in 1980 (boys 0.2%, girls 0.5%) and 1997 (boys 1.2%, girls 2.0%). At the age of 4, 12.3% of the boys and 16.2% of the girls were already overweight.

Conclusions

The prevalence of overweight and obesity in the Netherlands is still rising, and at an even faster rate than before. Evidence‐based interventions are needed to counter the obesity epidemic, and there is an urgent need for pre‐school intervention programmes.     

Alarming prevalences of overweight and obesity for children of Turkish, Moroccan and Dutch origin in The Netherlands according to international standards

AIM: Prevalences of overweight in The Netherlands, defined by international cut-off points, are presented in 14 500 children of Dutch origin, 2904 of Turkish and 2855 of Moroccan origin, aged 0-21 y. RESULTS: The mean prevalence for Turkish boys and girls was 23.4% and 30.2%, for Moroccans 15.8% and 24.5%, for Dutch youths in large cities 12.6% and 16.5%, and for other Dutch participants 8.7% and 11.3%, respectively. CONCLUSION: The development of adequate prevention strategies is urgently needed.     

Large summer weight gain in relatively overweight preschool Japanese children

Background: Children's lifestyles have changed recently in Japan. These changes are thought to be associated with their physical growth. The aim of the present paper was to describe and interpret the growth seasonality of children attending day‐nurseries in Osaka Prefecture, Japan. Methods: Results were based on a 6 year follow‐up study of preschool children aged 0 at baseline to 6 years old at the end of the follow up. Longitudinal growth data for 148 boys and 113 girls, born between April 1990 and March 1991, attending day‐nursery were obtained monthly from April 1990 through to March 1996. Children were divided into two groups: those with a normal (<17) or high (≥17) body mass index (BMI) at 5 years of age. Weight and height seasonal gains were estimated for each group. Results: Weight gain was higher during autumn among the group with a normal BMI at 5 years of age. Among high BMI group, weight gain was higher during autumn when they were 0 to 4 years of age, while it was higher during summer when they were 5 years of age. Height gain was higher in spring and summer in both BMI groups. Results were similar in boys and girls. Conclusion: Although the findings are consistent with previous studies for normal BMI children, the present study reports new findings for children with a high BMI at 5 years of age, for whom a large weight gain occurred during summer.     

贵阳市7～17岁少年儿童体质指数分布及超重肥胖状况

目的 了解贵阳市少年儿童体质指数分布及超重、肥胖状况,为儿童营养健康教育提供依据.方法 采用整群随机抽样的方法抽取贵阳市7所中、小学7～17岁的8 616名学生为研究对象,测量身高、体重,计算出体质指数百分位数值.以国际生命科学会中国肥胖问题工作组(WGOC)颁布的"中国学龄儿童青少年超重、肥胖筛查体质量指数值分类标准",对贵阳市少年儿童超重、肥胖状况进行筛查.结果 与WGOC采用的以体质指数P85和P95作为超重和肥胖筛查标准相比,贵阳市男孩P85、P95值均有相对增高趋势,而女孩P85、P95值变化相对不明显;贵阳市少年儿童超重和肥胖总检出率为12.5%和6.8%,其中男孩分别为15.0%和8.4%,女孩分别为9.9%和5.2%,男孩超重、肥胖检出率均高于女孩(P均<0.01).结论 贵阳市超重肥胖儿童日益增多,应重视对儿童超重、肥胖的预防工作.     

Breast-feeding history and overweight in Latino preschoolers.

OBJECTIVE: Describe the relationship between breast-feeding history and risk of overweight in the preschool years in a sample of primarily Mexican-origin Latinos. METHODS: Children's breast-feeding history, health history, and demographics were obtained in interviewer-administered questionnaires of a convenience sample of 364 parents of children ages 2-5 in an outpatient clinic waiting room serving a predominantly Mexican immigrant population in a large Midwestern city. Child weight status was determined by weighing and measuring each child and calculating age- and sex-specific body mass index (BMI) percentile using 2000 Centers for Disease Control reference values, with children > or =95th percentile defined as overweight. RESULTS: Seventy-six of 364 children (21%) were overweight. Eighty-seven percent of children had been breast-fed. Increased duration of breast-feeding was associated with a linearly decreased risk of overweight in bivariate analysis, ranging from an overweight prevalence of 35% for those never breast-fed to 12% for those breast-fed for at least a year. This inverse relationship remained significant in the smaller sample for which maternal BMI data were available (n = 127), as each additional month of breast-feeding was associated with a 10% decreased odds ratio (OR) of overweight (adjusted OR = 0.90; 95% CI = 0.81, 0.99) after controlling for child's sex, current age, prematurity, birth-weight category, maternal education level, and maternal weight status. CONCLUSION: This sample of children of Mexican-origin immigrant families had high rates of overweight at very young ages but also very high rates of breast-feeding. Duration of breast-feeding was strongly and inversely related with prevalence of overweight as a preschooler.     

Changes in body mass index in 11-12-year-old children in Hawkes Bay, New Zealand (1989-2000)

OBJECTIVE: To describe and compare the body mass index (BMI; weight/height2) profile of 11-12-year-old children in Hawkes Bay, New Zealand in 1989 and 2000. To subsequently determine the prevalence of overweight and obesity at the two time points using international definitions. METHODOLOGY: As part of asthma prevalence studies in Hawkes Bay data on height, weight and ethnicity were collected from 871 school children in 1989, and 894 children in 2000 who reached 12 years of age during the year of testing. RESULTS: In the total study population the geometric mean BMI increased from 18.1 kg/m2 (95% CI 17.9; 18.3) in 1989 to 19.8 kg/m2 (95% CI 19.6; 20.0) in 2000, a relative increase of 9.2% (95% CI 7.6; 10.9), P < 0.001. Significant relative increases were found for males (9.0%: 95% CI 6.8; 11.3), females (9.3%: 95% CI 6.8; 11.8), Maori (7.6%: 95% CI 4.3; 11.1), European (9.1%: 95% CI 7.3; 11.0) and Pacific Island children (11.0%: 95% CI 2.2; 20.5). In 2000 20.9% of Hawkes Bay children were classified as overweight and 9.1% as obese. The risk of being overweight in 2000 was 2.2 times greater than the risk in 1989, and the risk of being obese was 3.8 times greater, with these problems more pronounced among Maori (overweight 24.7%, obese 15.3%) and Pacific Island (overweight 35.0%, obese 15.0%) than European (overweight: 18.2%, obese 5.7%) children. However, the risk of being overweight (RR = 3.0, 95% CI 2.2-4.0) or obese (RR = 8.3, 95% CI 3.0-23.3) in 2000 compared to 1989 was greater among European children. CONCLUSION: Higher percentages of Maori and Pacific Island children are overweight or obese compared to European, but in all ethnic groups there has been a statistically significant increase in mean BMI over an 11-year period. This increase reflects the trend observed in other developed countries and underlines childhood obesity as a major health problem in New Zealand.     

Body fatness and serum lipids of 11-year-old Chinese children

It has been suggested that distribution of body fat has a stronger bearing on health risk than total body fat. Magnetic resonance imaging (MRI) was used to examine the distribution of fat and correlated with body fat assessed by the usual clinical methods-weight, weight-for-height, body mass index (BMI), triceps and subscapular skinfold thickness in 11-y-old Chinese children. Lipid profiles were used as indicators for coronary risk. Eighty-eight subjects had body fat distribution estimated by MRI, while 49 had serum lipids measured. Anthropometric parameters correlated significantly with total fat at the umbilical level measured by MRI (weight: r = 0.90 in boys, 0.75 in girls; BMI: r = 0.94 in boys, 0.87 in girls; percent median weight-for-height: r = 0.90 in boys, 0.79 in girls, triceps skinfold thickness: r = 0.89 in boys, 0.90 in girls; subscapular skinfold thickness: r = 0.93 in boys, 0.88 in girls). Obese subjects had proportionally less visceral fat than subcutaneous fat at umbilical level. Using stepwise multiple regression, predictive factors for high-density lipoprotein cholesterol were BMI in boys and breast-staging in girls. For triglycerides, it was genital staging in boys and for total cholesterol, it was breast-staging in girls. Visceral fat was not a significant determinant of serum lipids.     

Breastfeeding experiences and support for women who are overweight or obese: A mixed‐methods systematic review

Women who are overweight or obese have increased health risks during and beyond pregnancy, with consequences for their infants' shorter and longer term health. Exclusive breastfeeding to 6 months has many benefits for women and their infants. However, women who are overweight or obese have lower rates of breastfeeding intention, initiation, and duration compared with women with normal weight. This systematic review aimed to examine evidence of (a) breastfeeding barriers and support experienced and perceived by women who are overweight or obese, (b) support shown to be effective in increasing breastfeeding initiation and duration among these women, and (c) perceptions of health care professionals, peer supporters, partners, and family members regarding providing breastfeeding support to these women. Sixteen quantitative and qualitative papers were included and critically appraised. Thematic synthesis was undertaken to obtain findings. Maternal physical barriers such as larger breasts, difficulties of positioning to breastfeed, delayed onset of lactation, perceived insufficient supply of breast milk, and impact of caesarean birth were evident. Maternal psychological barriers including low confidence in ability to breastfeed, negative body image, embarrassment at breastfeeding in public, and experiencing stigma of obesity were also described. Support from health care professionals and family members influenced breastfeeding outcomes. Education for maternity care professionals is needed to enable them to provide tailored, evidence‐based support to women who are overweight or obese who want to breastfeed. Research on health care professionals, partners, and family members' experiences and views on supporting this group of women to breastfeed is needed to support development of appropriate interventions.     

铜陵市6～13 岁小学生血压状况分析

目的了解6～13岁儿童血压的分布特点及体质指数(BMI)的影响。方法对铜陵市3 146名6～13岁小学生的血压和体重、身高及BMI等相关因素进行调查,并进行统计学分析。结果3 146名儿童中患高血压217人,总患病率6.90%,其中男123人,患病率为7.41%,女94人,患病率为6.32%;肥胖儿童72人(2.29%),超重207人(6.58%),肥胖和超重儿童的高血压患病率(26.39%、14.49%)与BMI正常儿童的高血压患病率(5.86%)比较,差异有统计学意义。结论年龄与血压呈正相关,而BMI超过正常者高血压患病率明显升高,提示控制体重可减少儿童高血压的发生。     

Recommended body mass index cutoff values for overweight screening programmes in Australian children and adolescents: Comparisons with North American values

Objectives: Guidelines for screening children and adolescents for overweight have recently been published by a North American Expert Committee. As Australian clinicians might uncritically adopt these recommendations, we explore the consequences of applying North American body mass index (BMI) cutoff values to an Australian population. Methodology The Australian BMI cutoffs were calculated using the methods recommended from height and weight data for 8492 schoolchildren aged 7-15 years old. Results Smoothed Australian BMI cutoffs were similar to those derived from the first United States National Health and Nutrition Examination Survey (NHANES-I) values for whites. However, the NHANES-I cutoffs would result in systematic misclassification. Among 7 year olds, the NHANES-I 85th percentile cutoff would wrongly classify 4.6% of normal males and 9.1% of normal females as ‘at risk of overweight’. At age 14 years, the NHANES-I 95th percentile cutoff would misclassify 3.5% of children as ‘overweight’ instead of ‘at risk of overweight’. Conclusion Australian screening programmes should use BMI cutoffs appropriately derived from local measurements, and these are given for Australian children.     

Problems with body mass index as an index to evaluate physical status of children in puberty

Background: The aim of the present study was to examine the problems associated with using body mass index (BMI) for evaluating the physical status of children during puberty and the problems associated with establishing international standard values as cut‐off points for obesity and thinness in children. Methods: A cohort study was undertaken on BMI as an indicator of physical status in puberty based on the data in the 2000 Annual Report of School Health Statistics. The subjects were 695,600 children from 5 to 17 years of age. Results: In puberty, even in those with the optimal weight for their sex and age, BMI increases as height increases; therefore, a considerable variation in the range of BMI is observed in normal individuals of the same degree of fatness. For this reason, there is considerable overlap in the “healthy weight”, “overweight” and “obese” groups defined by the CDC using BMI percentile with regard to fatness in puberty. When the pubertal growth patterns are different among children from different countries, it is difficult to determine internationally average BMI by sex and age. Conclusions: Distinguishing the respective healthy weight, overweight, and obese groups based on cut‐off points using BMI percentile during puberty is difficult. If differences exist in the socioeconomic status of the subject cohorts and in the passage through puberty among children from different countries, we must consider that average values of BMI for the same age of children in puberty will have different meanings. With regard to evaluation of physical status in pubertal children, only BMI average values for the same stage of pubertal development are meaningful, rather than individual values.     

Height-specific body mass index reference curves for Japanese children and adolescents 5−17 years of age

BACKGROUND: Body mass index (BMI) reference values in consideration of height variation have not previously been reported. This study established height-specific BMI reference curves for Japanese children and adolescents aged from 5 to 17 years. METHODS: The 2001 nationwide survey data were utilized for the study. First, the range of variation in BMI corresponding to height (mean +/- 2SD) at each age was compared with the range of variation in BMI corresponding to age (from minimum to maximum) at every cm height. Second, various age groups were combined, and percentile values of BMI (3rd, 5th, 15th, 50th, 85th, 95th, and 97th) were calculated for every cm height, regardless of age, and height-specific BMI reference values (males 100-179 cm, females 100-169 cm) were prepared. RESULTS: Variation in BMI due to variation in height at each age was significantly (P <0.05) greater than variation in BMI due to age at every cm height [males, 12.7 +/- 0.4 vs 9.2 +/- 0.4; females, 11.7 +/- 0.8 vs 8.8 +/- 0.3 (mean +/- SE)]. CONCLUSION: Although the use of standard values established in consideration of age and height is desirable for BMI-based guidelines for determining childhood overweight and obesity, to simplify the procedure for practical use, it is necessary to establish standard values by height, not by age. Height-specific BMI reference curves are useful for BMI-based evaluation of childhood overweight and obesity in the school health service and follow-up of obese children until adulthood.     

Prevalence of acanthosis nigricans in relation to anthropometric measures: Community‐based cross‐sectional study in Korean pre‐adolescent school children

Background: This cross‐sectional study was performed to assess the prevalence of acanthosis nigricans (AN) across various anthropometric measures and to identify the cut‐offs for anthropometric indices of adiposity for development of AN in Asian preadolescent school children. Methods: Body mass index (BMI), percentage weight for height (PWH), percentage body fat (PBF), and AN of the neck were evaluated in children in the fifth grade of all elementary schools in one metropolitan, Korean city (2117 boys and 1916 girls, mean age 10.9 ± 0.6 years, mean BMI 18.6 ± 3.3 kg/m²). Results: The prevalence of AN was 8.4% in boys and 5.1% in girls, and was proportional to the BMI, PWH, and PBF. The prevalence of AN rose steeply in the 80th and 90th percentiles of the BMI, PWH, and PBF in boys and girls, respectively. According to receiver operating characteristic analysis, AN was observed in boys with BMI >22.2 kg/m², and in girls with BMI >21.2 kg/m², which are below the current criteria for childhood obesity (local BMI 95th percentile and International Obesity Task Force BMI 30 kg/m²). Conclusions: AN has a good correlation with level of adiposity, and was already present in overweight children that were not considered obese by definition.     

不同参考标准下重庆城区儿童超重／肥胖检出率比较

目的比较3种筛查标准下重庆城区儿童超重/肥胖现况,寻求适宜的儿童肥胖筛查标准。方法按照整群抽样原则抽取本市3个城区的12534名2～18岁儿童作为调查对象,测量其身高及体质量。并分别采用WHO的身高标准体质量法标准(标准1)、国际肥胖工作组(IOTF)的超重/肥胖体质量指数(BMI)标准(标准2)和国立卫生统计中心/疾病预防控制中心(NCHS/CDC)的BMI标准(标准3)评价儿童的超重/肥胖。结果按照标准1、2和3的规定,重庆城区儿童的超重检出率分别为13.0%、9.8%、9.8%;肥胖检出率分别为9.8%、2.9%、6.0%,均有显著性差异(Pa<0.001),且男童超重/肥胖检出率均高于女童。3种标准间,健康儿童、超重儿童或肥胖儿童的BMI均值均有显著性差异(Pa<0.001)。采用标准1和2得到的超重检出率,或采用标准1和3得到的超重检出率均在6岁前和14岁后2个年龄段存在统计学差异(Pa<0.01)。在2～6岁各年龄组,采用标准1和3得到的儿童肥胖检出率比较无显著性差异;在6～18岁各年龄组,采用标准1得到的肥胖检出率均显著高于采用标准2和3得到的肥胖检出率(Pa<0.01);在3～6岁、8～10岁、13岁组采用标准2和3得到的儿童肥胖检出率比较有显著性差异。结论儿童肥胖已经成为重庆城区重要的健康问题之一。采用3种标准筛查的儿童超重/肥胖检出率在2～18岁各年龄组均有所不同,应谨慎使用。     

The association of overweight and ankle injuries in children.

OBJECTIVES: Overweight children are at increased risk for many medical problems. Trauma is the leading etiology of childhood morbidity and mortality. No previous study has evaluated the association between overweight and acute ankle injuries in children. We hypothesized that being overweight is associated with an increased risk of ankle injury in children. METHODS: We conducted a case-control study in an urban pediatric emergency department. Subjects aged 5 to 19 years were recruited from June 2005 through July 2006. Children with acute ankle trauma were enrolled as cases. A convenience sample of children with a chief complaint of fever, headache, or sore throat was enrolled as controls. Demographic information and anthropometric measurements were obtained. Age- and gender-specific body mass index percentiles (BMI-Ps) were calculated using pediatric norms. Multivariate unconditional logistic regression was used to assess the relationship between overweight and ankle injury, adjusting for demographic variables. Through medical records, we obtained demographic information and weight, but not height, of all cases that were not enrolled. This allowed us to conduct a sensitivity analysis in which we combined the enrolled and nonenrolled cases into a single case group and made increasingly more unlikely assumptions about the height percentiles of the nonenrolled cases. RESULTS: One hundred eighty cases and 180 controls were enrolled in the study. We observed a significant association between overweight and ankle injury (multivariate-adjusted odds ratio 3.26, 95% confidence interval, 1.86-5.72; P value for trend <.0001). Although this result may be an overestimate of the magnitude of the association due to a possible bias in the selection of cases, sensitivity analysis demonstrated the robustness of the statistical significance of the finding. CONCLUSIONS: Overweight children may be at increased risk of ankle injury.     

Obesity and under-nutrition in a tertiary paediatric hospital

OBJECTIVE: (i) To determine the prevalence of over- and under-nutrition in both inpatients and outpatients in a tertiary paediatric hospital; (ii) to compare the prevalence of over-nutrition with that in the Australian community and (iii) to determine whether nutritional status has an impact on length of stay in hospital. METHODS: Patients aged over 12 months were proportionately sampled from medical and surgical wards and outpatient clinics. Data were collected for 245 inpatients (54% male) and 272 outpatients (55% male). Children's height, weight and body mass index (kg/m2) were measured. Overweight, obesity and under-nutrition were defined according to international criteria. Prevalence of overweight and obesity was compared with that in the 1995 Australian National Nutrition Survey (NNS). RESULTS: Similar proportions of inpatients and outpatients were underweight (6%) and wasted (4%). The prevalence of overweight and obesity in inpatients (22%) was similar to the NNS but was significantly higher in outpatients (32%, P < 0.0001). In a regression model to predict inpatient length of stay, nutritional status (P = 0.004) and the interaction between age and nutritional status (P = 0.009) were significant predictors. For over-nourished inpatients, length of stay increased significantly with age. For normally nourished and under-nourished inpatients, length of stay was relatively constant, regardless of age. CONCLUSIONS: There is a high prevalence of over-nutrition in paediatric patients, and increased length of stay for older over-nourished inpatients. These issues need to be addressed in terms of opportunities for intervention and impact on hospital resources.