A national survey of the prevalence of childhood overweight and obesity in Italy

To estimate the prevalence of childhood overweight and obesity among Italian schoolchildren and to examine geographic differences and present and future implications for health care, we used data from a nationwide representative survey performed in May 2008 among third-grade students in 18 of Italy's 21 regions. Cluster sampling was used to identify classes for participation. The study population included all children aged 8–9 years whose parents agreed to opt-out consent. Parents, children and teachers completed brief questionnaires, and children were weighed and measured by trained staff using standardized equipment. Consent was obtained for 97% of 50 197 third-graders, of whom 44 676 (89%) met study inclusion criteria. Obesity levels (defined using International Obesity Task Force cut-offs) ranged from 7.5% (95% confidence intervals 6.7–8.2) in the north to 16.6% (95% confidence intervals 15.8–17.4) in the south. Behaviours known to be associated with obesity also showed geographic differences. The estimated burden of obesity-related pathologies also increased from north to south. These findings suggest the need for community as well as individual interventions in all areas of the country but with particular attention to the south.     

The impact of school-based prevention of overweight on psychosocial well-being of children

This review aimed to gain insight in the extent to which psychosocial effects of obesity prevention programmes have been studied, to give an overview of the methods used to measure the particular psychosocial aspects and – if possible – to quantify the effects found. Intervention studies ( n  = 267) covering the period 1990–October 2005 were derived from seven reviews about childhood obesity interventions. An additional search identified 2754 studies covering the period January 2005–February 2008. In total, 2901 papers (excluding 120 duplicates) were screened for inclusion. Sixty-nine papers covering 53 interventions were included and screened on measuring psychosocial variables. All original authors were contacted. Seven of the selected interventions measured psychosocial variables, five of which evaluated a net intervention effect as compared with a control condition. Only two interventions reported a statistically significant net intervention effect (a decrease in use of purging or diet pills and a decrease in peer ratings of aggression and observed verbal aggression). We conclude that a minority of childhood obesity interventions investigate the effects of their programmes on psychosocial well-being of children and adolescents. It is recommended that in the future, these programmes will be evaluated in a uniform way on a broad range of psychosocial aspects     

Childhood overweight: a contextual model and recommendations for future research

The prevalence of overweight among children has doubled within the past two decades. Increases in the rate of childhood overweight are of particular concern due to the negative health and psychological effects noted among overweight children. As shown by previous research, the development of childhood overweight involves a complex set of factors from multiple contexts that interact with each other to place a child at risk of overweight. This multifaceted system can be conceptualized using Ecological Systems Theory (EST). EST highlights the importance of considering the context(s), or ecological niche, in which a person is located in order to understand the emergence of a particular characteristic. In the case of a child, the ecological niche includes the family and the school, which are in turn embedded in larger social contexts including the community and society at large. In this review, EST is used as a framework with which to summarize research assessing predictors of childhood overweight. Specifically, child characteristics that place children at risk of the development of overweight (including dietary intake, physical activity, and sedentary behaviour) will be reviewed while taking into consideration the influence of the familial environment, the school environment, and the community and larger social environments. It is concluded that future research needs to adopt a broader contextual approach in order to understand and intervene against the processes leading to the development of overweight among children and that the use of theories or paradigms such as EST will facilitate developing and testing models of causal processes.     

Trends in overweight and obesity in Swedish schoolchildren 1999–2005: has the epidemic reached a plateau?

The aim of this review is to synthesize published evidence on the most recent trends in overweight and obesity among Swedish children. Specifically, trends are reported among fourth graders (10–11 years) from six different municipalities between 1999 and 2005. Weights and heights in representative samples of children within each area were measured by school nurses as part of routine school health examinations. Standardized definitions of overweight, obesity and thinness were calculated by methods described by Cole et al. in 2000 and 2007. In Stockholm, obesity prevalence during academic years starting 1999 and 2003 decreased non‐significantly from 4.4% to 2.8% in girls, and increased non‐significantly from 3.2% to 3.8% among boys. In Gothenburg, comparing academic years starting 2000 and 2004, prevalence of overweight in girls decreased from 19.6% to 15.9% (P < 0.01) while thinness increased from 9.5% to 11.9% (P < 0.05); no significant changes were observed in boys. Finally, the Swedish National Institute of Public Health released figures from Karlstad, Umeå, Västerås and Ystad in 2003–2005 during which time no trends in prevalence could be clearly shown. The stabilized rates are probably a result of regional and local actions that have taken place in many sectors of society, rather than one specific measure or national political action.     

Secular Trends in Obesity and Serum Lipid Values among Children in Oita City,Japan, during a 27-Year Period

Aims: We assessed 27-year trends in obesity and blood lipid levels of 10-year-old children to estimate the risk of metabolic syndrome in adulthood. Methods: Based on a screening program for lifestyle-related diseases in school children in Oita City, Japan, we evaluated secular trends in height, weight, percentage of overweight (POW), total cholesterol (TC), triglyceride (TG), HDL cholesterol (HDL-C), and non-HDL cholesterol (non-HDL-C) of fifth graders (median age: 10.8 years) in Oita City from 1991 to 2017. We focused on the secular trend in the percentage of children with inappropriate serum levels of each lipid. We also evaluated the long-term trends in the 95^th, 50^th, and 5^th percentiles for each parameter, as dependent variables, with the calendar year as an independent variable. Percentages of children with mild obesity (POW-20), moderate obesity (POW-30), and severe obesity (POW-50) were set as dependent variables. Results: A total of 58,699 boys and 56,864 girls were evaluated during the study period. The percentage of children with severe obesity (POW-50) consistently increased during these years, and the 95^th percentile of degree of obesity significantly increased in both boys and girls. The plot of percentages of children with inappropriate levels of TC, TG, and non-HDL-C showed a mild inverted U shape during the study period. The HDL-C level typically decreased in the study period, and the TC, TG, and non-HDL-C levels were markedly higher while the HDL level was lower in obese children than in non-obese children. Conclusion: The number of children with severe obesity increased, and obese children had higher percentages of inappropriate lipid levels than non-obese children. The rate of dyslipidemia with low HDL levels gradually increased in all children in Oita City, Japan, over the past 27 years.     

Energy recommendations for normal weight,overweight and obese children and adolescents: are different equations necessary?

In 2002/2005, separate energy requirement equations were generated by the Institute of Medicine's (IOM) Dietary Reference Intake process for normal weight and overweight/obese children and adolescents. The current paper questions the theoretical rationale of having two sets of equations (based solely on body-weight classification): when body weight is considered, overweight and obese children and adolescents do not seem to differ from their normal weight counterparts in energy expended for basal metabolism or physical activity tasks. However, energy needs for weight maintenance among overweight/obese girls were consistently higher when predicted using the equations for overweight/obese individuals compared with those developed for normal weight individuals. In contrast, among overweight/obese boys, they were consistently lower . Although the differences are within the variability of the estimates, even theoretical support for a higher energy intake (as occurs in girls) seems unwise because of the potential contribution to a higher body mass in children who are already at risk. It is the opinion of the authors that the IOM revisit the use of two separate equations and generate one set that is appropriate for all children and adolescents.     

The Association of Metabolic Syndrome, Insulin Resistance and Non-alcoholic Fatty Liver Disease in Overweight/Obese Children

Background/Aim:

To study the prevalence of metabolic syndrome (MS), insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD) in overweight/obese children with clinical hepatomegaly and/or raised alanine aminotransferase (ALT).

Patients and Methods:

Thirty-three overweight and obese children, aged 2-13 years, presenting with hepatomegaly and/or raised ALT, were studied for the prevalence of MS, IR and NAFLD. Laboratory analysis included fasting blood glucose, serum insulin, serum triglycerides (TG), total cholesterol, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c) and liver biochemical profile, in addition to liver ultrasound and liver biopsy.

Results:

Twenty patients (60.6%) were labeled with MS. IR was present in 16 (48.4%). Fifteen (44%) patients had biopsy-proven NAFLD. Patients with MS were more likely to have NAFLD by biopsy (P=0.001). Children with NAFLD had significantly higher body mass index, waist circumference, ALT, total cholesterol, LDL-c, TG, fasting insulin, and lower HDL-c compared to patients with normal liver histology (P< 0.05) and fitted more with the criteria of MS (80% vs. 44%). IR was significantly more common among NAFLD patients (73% vs. 28%).

Conclusion:

There is a close association between obesity, MS, IR and NAFLD. Obese children with clinical or biochemical hepatic abnormalities are prone to suffer from MS, IR and NAFLD.