International Obesity Task Force Cut-offs Research Articles

Predicting Childhood Overweight in Linked Administrative Data: Are There Lessons for Targeting Early Years Interventions?

IntroductionMany early years interventions, e.g. UK’s Family Nurse Partnership, aim to provide additional support to higher need families to prevent poor health and development. Most prediction studies using cohort surveys have had limited success in identifying which families to target for such interventions. Objectives and ApproachTo examine whether the breadth and volume of information available in linked administrative data can predict childhood overweight (defined using International Obesity TaskForce cut-offs) at age 5 years. Data for all children born in Scotland 2011-2012 (n~120,000) were sourced from: birth registration records, maternity hospital records, health visitor and school health checks, immunisation records, prescription data. Predictors spanned socio-economic (e.g. neighbourhood deprivation, occupational status), demographic (e.g. mother’s age, number of children), birth (e.g. birthweight, APGAR score), service planning (allocation to core/additional services), and health (e.g. smoking in pregnancy, overweight at age 3y). Sensitivity, specificity and positive predictive values (PPV) for each predictor was considered. The collective predictive power of >20 variables (selected a-priori) (complete case sample, n~22000) was examined using conventional area under the curve (AUC) and three machine learning methods: decision tree classification, random forest, gradient boosted trees. ResultsOverweight at 3y was the strongest predictor of overweight at 5y (sensitivity:0.53; specificity:0.89; PPV:0.51). AUC and the machine learning approaches prioritised different sets of predictors, but all included overweight at 3y. All produced ‘Moderate-Good’ predictive power, falling to ‘Poor-Moderate’ when overweight at 3y was excluded. Multiple imputation will be carried out to address item missingness. ConclusionOverweight at 3y was the most informative predictor, yet 49% who were overweight at 3y were not by 5y. Models excluding overweight at 3y had poor predictive power, indicating the challenge of targeting interventions to prevent overweight. Thus, universal interventions addressing the upstream determinants of childhood overweight are likely to have greatest success in supporting child health.

The association of BMI and physical activity on acetabular dysplasia in children

Acetabular dysplasia is an important pre-disposing factor for osteoarthritis of the hip. However, it is not completely known how acetabular dysplasia develops during childhood. To study the prevalence of acetabular dysplasia and its association with body mass index (BMI) and physical activity in 9 year old children. The population for this cross-sectional study was drawn from the ongoing prospective cohort study: Generation R. 9,778 mothers with a delivery date from March 2002 until January 2006 were enrolled. In a random subgroup of these children Dual-energy X-ray absorptiometry (DXA) scanning was performed at age 9. BMI, standardized for the Dutch population and categorized in four groups based on extended international Obesity Task Force cut-offs: underweight, normal, overweight and obesity. Physical activity was based on time spent on playing outdoors, playing sports and walking/cycling to school. The degree of acetabular dysplasia was determined with the centre-edge angle (CEA) and acetabular depth-width ratio (ADR) in DXA images of the hip. 1,188 DXA images of children's hips were available for analysis. The median age of the children was 9.86 years. Prevalence of dysplasia and mild dysplasia was respectively 6.3%; 25.6% with CEA and 4.8%; 25.0% with ADR. BMI was negatively associated with mild dysplasia (OR 0.80 CI 0.71-0.90). Obese children showed less mild dysplasia compared to normal children (OR 0.48 CI 0.24-0.97) in unadjusted analysis. Physical activity represented by walking to school showed a statistically significant negative association with mild dysplasia (OR 0.87 CI 0.76-0.99). After adjustment for age, ethnicity, sex, first born, breech presentation, birthweight, gestational age and Caesarean section, the patterns of association with dysplasia remained for both BMI and physical activity. In this study, being overweight and light physical activity were negatively associated with the development of (mild) acetabular dysplasia at the age of 9 years.

The Influence of Adherence to the Mediterranean Diet among Children and Their Parents in Relation to Childhood Overweight/Obesity: A Cross-Sectional Study in Greece

Background: Childhood overweight/obesity constitutes a serious issue, as may cause several health problems. The main characteristics of the Mediterranean Diet have been acknowledged as the most appropriate shield mainly for obesity. Methods: The study was performed on 1728 primary students, during school years 2014-2016, in Greece. Children and their parents completed questionnaires which included dietary and lifestyle habits. The KIDMED score (range -4 to 12) was used to assess the level of childhood adherence to the Mediterranean diet and the MedDietScore (range 0 to 55) was used to assess parental adherence. For the purposes of this analysis, the examined sample was n = 875 of students (522 girls)-parents pairs whose level of adherence to the Mediterranean diet was able to be evaluated. Results: The prevalence of overweight and obesity in the Greek sample was 26.0%, according to International Obesity Task Force (IOTF) cutoff criteria for children. KIDMED Score was significantly lower in children with overweight/obesity compared with children with normal weight (4.65 ± 2.14 vs. 5.16 ± 2.05, p = 0.002). The multiadjusted analysis revealed that children close to the Mediterranean diet were less likely to be overweight/obese (p < 0.001), either parents are away from or close to the Mediterranean diet. Conclusions: This study revealed that children's adherence to the Mediterranean diet was inversely associated with weight status either parents are away from or close to this dietary pattern. Future interventions against childhood obesity have to take into consideration the crucial importance of familial aggregation of healthy food choices and interfamily influences in the home environment on children's weight status.

A Comprehensive Multidisciplinary Management Plan Is Effective in Reducing the Prevalence of Overweight and Obesity in Childhood and Adolescence

Background: Obesity in childhood and adolescence represents a major health problem of our century. In Greece, 30–35% of children and adolescents are overweight or obese. Objective and Hypotheses: To investigate the effectiveness of a comprehensive multidisciplinary personalized management plan at reducing the prevalence of overweight and obesity in childhood and adolescence. Patients and Methods: One thousand (n = 1,000) children and adolescents aged 2–18 years (mean age ± SD: 10.09 ± 2.86 years; 520 females, 480 males) were studied prospectively. Subjects were classified as obese (n = 579, 57.9%), overweight (n = 295, 29.5%) or having a normal body mass index (BMI) (n = 126, 12.6%) according to the International Obesity Task Force cutoff points. All subjects were evaluated by a multidisciplinary team at frequent intervals, received personalized advice on diet and exercise and were studied prospectively for 1 year. Detailed clinical evaluation and laboratory investigations were performed at the beginning and at the end of the study. Results: At initial evaluation, 57.9% of subjects were obese, 29.5% overweight and 12.6% of normal BMI. Indices of cardiometabolic disease were higher in obese than in overweight and normal-BMI subjects. Following 1 year of multidisciplinary management interventions, the prevalence of obesity decreased by 16.8%, the prevalence of normal BMI increased by 8.2%, and all cardiometabolic indices improved significantly. Conclusions: A personalized multidisciplinary management plan is effective at reducing the prevalence of obesity in childhood and adolescence.

Comparison of different BMI cut-offs to screen for child and adolescent obesity in urban China.

To determine which set of BMI cut-offs is the most appropriate to define child and adolescent obesity in urban China. A cross-sectional study was carried out between 1 November and 31 December in 2017. Community Healthcare Center in Minhang District, Shanghai, China. A total of 12 426 children and adolescents aged 7-17 years were selected by cluster random sampling. Bioelectrical impedance analysis was the gold standard to measure body composition. Comparisons of three sets of BMI cut-offs by sensitivity and κ value revealed that the Working Group on Obesity in China (WGOC) (sensitivity 39·9-84·0 %; κ 0·51-0·79) and WHO (sensitivity 25·5-74·5 %; κ 0·35-0·78) cut-offs were not superior to the International Obesity Task Force (IOTF) (sensitivity 47·9-92·4 %; κ 0·58-0·85) cut-offs across all subgroups. The WGOC and WHO cut-offs yielded higher misclassification rates, in the worst case, categorising 11·2 % of girls with high adiposity as normal and 44·4 % of them as overweight, while the IOTF cut-offs categorised 2·3 % as normal and 30·7 % as overweight. Individuals who were classified by the IOTF cut-offs as overweight had the lowest ratios of high adiposity (4·2-41·6 %) than by the BMI cut-offs for each subgroup. Among pubertal girls, none of the BMI-based cut-offs indicated excellent agreement with body fat percentage, and κ value of the WHO cut-offs (0·35 (95 % CI 0·29, 0·41)) was lower than the other two sets of BMI cut-offs (all P < 0·001). The IOTF cut-offs for Asian should be recommended for child obesity screening in urban China. Pubertal individuals need a more accurate indicator of obesity screening.

Maternal antibiotic use and vaginal infections in the third trimester of pregnancy and the risk of obesity in preschool children.

SummaryBackground/objectivesSeveral exposures during pregnancy are associated with offspring body mass index (BMI). The objective of this study was to evaluate whether third trimester antibiotic use and vaginal infections are associated with BMI in preschool children.Subjects/methodsThe study population included singletons from the NINFEA birth cohort with available anthropometric measurements at the age of 4 (3151 born with vaginal and 1111 born with caesarean delivery). Self‐reported use of antibiotics and the presence of vaginal infection in the third trimester were analysed in association with the child's BMI, classified into three categories: thinness, normal and overweight/obesity, using both the International Obesity Task Force (IOTF) and the World Health Organization (WHO) recommended cut‐offs.ResultsMaternal vaginal infections in the third trimester of pregnancy were associated with higher relative risk ratios (RRR) for overweight/obesity at age of four in children delivered vaginally: 1.92 (95% confidence interval [CI]: 1.37 to 2.70). This association appeared stronger for children born to women with pre‐pregnancy BMI >25 kg/m2 (RRR: 4.78; 95% CI 2.45 to 9.35), and was robust when different obesity cut‐offs were used. The results regarding third trimester antibiotic use in vaginal deliveries were less conclusive (RRRs for overweight/obesity: 1.43 (0.92 to 2.21) and 1.11 (0.57 to 2.20), for the IOTF and WHO cut‐offs, respectively). Third trimester vaginal infections were not associated with BMI in children delivered by caesarean section.ConclusionsMaternal third trimester vaginal infections are associated with an increased overweight/obesity risk in children born by vaginal delivery, and especially in children of mothers with pre‐pregnancy overweight/obesity.

Correlates of body mass index among primary school children in Ho Chi Minh City, Vietnam

ObjectivesTo document the prevalence of overweight and obesity and examine associated risk factors. Study designA cross-sectional survey was conducted in 16 primary public schools in eight districts of Ho Chi Minh City in 2016. A multistage clustering sampling method was used to collect a sample of 1806 pupils attending the first, second, and third grades (7–9 years). MethodsAge- and sex-adjusted body mass index (BMI) status was defined using International Obesity Taskforce cut-offs. Ordered probit regression models were used to assess the association between child BMI and its socio-economic and demographic risk factors. The model was estimated separately for boys and girls to assess the extent to which the socio-economic gradients in BMI vary by gender. ResultsThe prevalence of obesity among boys was twice the rate for girls (24.7 vs 12.3%). The prevalence of overweight and obesity were also higher among pupils attending schools located in urban districts than in semi-rural districts. Gender, household wealth, the frequency of having breakfast at home, parental body weight, and school location were strong predictors of child BMI status. The protective effect of having breakfast more frequently at home against the risk of overweight/obesity was more pronounced in girls than in boys. Father's body weight and child BMI were more strongly associated with boys from poorer households than boys from wealthier households, while the differences were not significant for girls. ConclusionsThe high prevalence of childhood overweight and obesity indicates an urgent need for more gender-specific, effective intervention, and prevention programs.

Increased prevalence of overweight and obesity in children with X-linked hypophosphatemia.

Background/aimX-linked hypophosphatemia (XLH) is a rare disease characterized by low phosphate levels. Scientific evidence points to a link between hypophosphatemia and obesity in general population. The aim of our longitudinal observational study was to investigate the prevalence of obesity and associated factors in a large cohort of children with XLH.Patients/methodsWe studied 172 XLH-children 5–20 years of age (113 girls/59 boys). Anthropometric parameters (weight, height, and BMI) were collected at birth and during follow-up at mean ages of 5.3, 8.2, 11.3, and 15.9 years (groups 1, 2, 3, and 4, respectively). In each group, subjects were classified based on International Obesity Taskforce (IOTF) cut off values of BMI for age and sex as overweight or obese (IOTF 25–30 or ≥30 kg/m2, respectively).ResultsIn each age-group, almost 1/3 of XLH-patients were classified as overweight or obese (29.4, 28.7, 27.5, and 36.7% in groups 1, 2, 3, and 4, respectively). Children without a XLH-family history had higher BMI-IOTF at every point of follow-up, compared to those with positive XLH-family history. Similarly, higher BMI-IOTF was significantly associated with treatment duration (23.3 ± 4.4 vs 23.8 ± 3.8 vs 25.2 ± 4.5 kg/m2, for subjects with treatment duration of <5, 5–10 and >10 years, respectively, P for trend = 0.025). Multiple regression analysis confirmed an association of treatment duration and lack of XLH-family history with higher BMI-IOTF.ConclusionOne out of three of XLH-children have phenotypically unfavourable metabolic profile expressed as increased prevalence of overweight or obesity in comparison to general population. Both the lack of XLH family history and the duration of treatment increase the risk of higher BMI-IOTF. BMI should be carefully monitored in children, and later in adults, with XLH.

Prevalence and secular trend of childhood overweight and obesity in a Mediterranean area of Southeast Spain

ABSTRACT Introduction Childhood obesity epidemic is a worldwide public health problem, but recent studies show a stabilization trend. Objective To study the prevalence of overweight and obesity in school-age children from a Mediterranean area in Southeast Spain from 1992 to 2011. Methods Cross-sectional study at two-time points (1992 and 2011) of representative samples of children aged 6-11 years (n = 737 and 620, respectively). Weight and height were measured by trained personnel. Overweight and obesity were defined according to Body Mass Index (BMI) using the International Obesity Task Force (IOTF) and the World Health Organization (WHO) criteria. Results The prevalence of overnutrition (overweight plus obesity) decreased significantly from 1992 to 2011, with a decrease of 45.4% to 36.0% (according to the WHO cut-offs) or 37.3% to 30.0% (according to the IOTF cut-offs). Obesity decreased significantly according to WHO criteria (19.6% to 13.5%) while overweight remained stable. When grouping by sex, overnutrition in girls remained stable with a prevalence of 39.0% (WHO) or 34.0% (IOTF) in 1992, and 35.7% (WHO) or 31.1% (IOTF) in 2011. However, in boys a significant decrease is observed, with a prevalence of 50.0% (WHO) or 38.8% (IOTF) in 1992, decreasing to 38.8% (WHO) and 29.5% (IOTF) in 2011. Conclusions Even though the prevalence of childhood overweight and obesity remained at high levels, according to our results in the studied period there was a decrease in the Mediterranean area of Southeast Spain. There was variability between sex, with a significant decrease only in males. Prevalence estimates varied depending on the reference values used.

Trend in childhood obesity reflects socioeconomic status in Argentina

Background: Surveillance of childhood obesity is essential to guide preventive policies and interventions.Aim: To analyse trends in overweight and obesity by socioeconomic status (SES) in Argentinian schoolchildren during the last decade.Subjects and methods: Two cross-sectional studies in schoolchildren aged 6–12 years were compared. The first study was conducted in 2005/07 (n = 1418) and the second one in 2015/16 (n = 1366). Overweight and obesity were estimated by the International Obesity Task Force (IOTF) cut-offs. The type of school (public/private) and parental education level were used as measures of SES. Data were analysed by linear and logistic regression with survey year, type of school, parental education level, and sex as independent variables.Results: From 2005 to 2016 overweight and obesity increased by 7.3% and 5.0%, respectively. The change was significantly higher in boys (9.6% and 8.3%) and girls (9.6% and 5.4%) from public schools, and in children whose fathers had low (10% and 8.3%) and middle (9.0% and 5.5%) education levels. No significant changes were found in children attending private school or those whose fathers had a higher education level.Conclusions: Obesity is still increasing in this population. SES disparities are strongly associated with this trend, with stabilisation in children from high SES.

Weight Status and Respiratory Health in Asthmatic Children.

In this study,we explored the effect of adiposity as measured by BMI on lung function in 72 asthmatic school children (5-12years) using baseline data from the Mediterranean diet enriched with fatty fish intervention study. Bronchial function was assessed using spirometry and fractional exhaled nitric oxide (FeNO). BMI categories were classified as normal and overweight/obese based on International Obesity Task Force cut-offs. Weak correlations were observed between BMI and FVC (p = 0.013) and FEV1 (p = 0.026). Median FeNO was lower in the overweight/obese as compared to normal weight group (p = 0.027). Linear regression showed an increment in FEF25-75% in the overweight/obese group as compared to normal weight after controlling for confounders namely age, height, sex, regular physical activity, medication and KIDMED score (p = 0.043; β = 11.65 units, 95% CI 0.36-22.94), although with no effect on FeNO. In conclusion, the findings of this study suggest that excess body weight could impact pulmonary dynamics in childhood asthma.

Predicting overweight and obesity in young adulthood from childhood body-mass index: comparison of cutoffs derived from longitudinal and cross-sectional data

Historically, cutoff points for childhood and adolescent overweight and obesity have been based on population-specific percentiles derived from cross-sectional data. To obtain cutoff points that might better predict overweight and obesity in young adulthood, we examined the association between childhood body-mass index (BMI) and young adulthood BMI status in a longitudinal cohort. In this study, we used data from the International Childhood Cardiovascular Cohort (i3C) Consortium (which included seven childhood cohorts from the USA, Australia, and Finland) to establish childhood overweight and obesity cutoff points that best predict BMI status at the age of 18 years. We included 3779 children who were followed up from 1970 onwards, and had at least one childhood BMI measurement between ages 6 years and 17 years and a BMI measurement specifically at age 18 years. We used logistic regression to assess the association between BMI in childhood and young adulthood obesity. We used the area under the receiver operating characteristic curve (AUROC) to assess the ability of fitted models to discriminate between different BMI status groups in young adulthood. The cutoff points were then compared with those defined by the International Obesity Task Force (IOTF), which used cross-sectional data, and tested for sensitivity and specificity in a separate, independent, longitudinal sample (from the Special Turku Coronary Risk Factor Intervention Project [STRIP] study) with BMI measurements available from both childhood and adulthood. The cutoff points derived from the longitudinal i3C Consortium data were lower than the IOTF cutoff points. Consequently, a larger proportion of participants in the STRIP study was classified as overweight or obese when using the i3C cutoff points than when using the IOTF cutoff points. Especially for obesity, i3C cutoff points were significantly better at identifying those who would become obese later in life. In the independent sample, the AUROC values for overweight ranged from 0·75 (95% CI 0·70-0·80) to 0·88 (0·84-0·93) for the i3C cutoff points, and the corresponding values for the IOTF cutoff points ranged from 0·69 (0·62-0·75) to 0·87 (0·82-0·92). For obesity, the AUROC values ranged from 0·84 (0·75-0·93) to 0·90 (0·82-0·98) for the i3C cutoff points and 0·57 (0·49-0·66) to 0·76 (0·65-0·88) for IOTF cutoff points. The childhood BMI cutoff points obtained from the i3C Consortium longitudinal data can better predict risk of overweight and obesity in young adulthood than can standards that are currently used based on cross-sectional data. Such cutoff points should help to more accurately identify children at risk of adult overweight or obesity. None.

SAT-259 Natural History of Anthropometric Parametres of Obesity in Children Affected by X-Linked Hypophosphatemia: Longitudinal Obserbational Study

Growing body of scientific evidence points to link between fibroblast growth factor-23 (FGF-23) and unfavourable metabolic profile (obesity, insulin resistance, hyperglycemia) and all-cause mortality in general population with normal kidney function. On the other hand, there is little information about metabolic profile in situations characterized by pathophysiologically high FGF-23 such as chronic kidney disease and X-linked hypophosphatemia (XLH). The aim of the present longitudinal observational study was to investigate anthropometric parameters of obesity and metabolic profile on large cohort of children with XLH. Methods: Among 263 XLH-patients registered in our centre we selected 168 children of 5-20 years (108 girls/60 boys). Total period of FU was divided in five sub-periods according age (group 0: birth, N=168; group 1: 5-7 years, N=122; group 2: 7-10 years, N=86; group 3: 10-15 years, N=89; group 4: 15-20 years, N=49). Anthropometric parameters (weight, height, BMI) were collected from birth (group 0) and for every point of FU (group 1-4). In each group, subjects were classified based on International Obesity Taskforce (IOTF) cut off values of BMI for age and sex as overweight or obese (IOTF 25-30 or ≥30 kg/m2, respectively). Metabolic parameters (total cholesterol, triglycerides, HDL, LDL, fasting glycemia and insulinemia, HOMA-IR) were measured at one point of FU in some patients (N=40). Results: In each group of FU (1,2,3,4) almost 1/3 of patients were classified as overweight or obese (29.5% vs 29.4% vs 28.1% vs 36.7%, respectively). Even without reaching statistical significance (p=0.75), there was a tendency of higher number of overweight or obese patients in group 4 (15-20 years) (36.7%) compared to group 1,2,3, which was explained by gender differences (higher number of overweight or obese girls compared to boys (42.4% vs 25%, respectively, p=0.35). There were no differences in BMI z-score (SDS) and BMI-IOTF between groups 1,2,3,4 during FU (BMI-SDS: 0.9±1.1 vs 0.7±1.0 vs 0.6±1.1 vs 0.6±0.9, respectively, p=0.45; BMI-IOTF: 23.5±4.4 vs 23.5±4.1 vs 23.7±4.2 vs 24.3±3.6, respectively, p=0.72). As regard other metabolic parameters, only 1 patient was diagnosed with diabetes mellitus at age 10. No other alterations were found. In each group of FU, no correlation was found between FGF-23 and BMI, total cholesterol, triglycerides, HDL, LDL, fasting glycemia, insulinemia, HOMA-IR. In conclusion, 1/3 of XLH children have phenotypically unfavourable metabolic profile expressed as overweight or obesity which is higher compared to general paediatric population. This phenomenon has increasing tendency after puberty, especially in girls, and requires strict follow-up of BMI in XLH patients. In order to understand the further development of metabolic parameters, the studies on adult XLH population are needed.

The association of BMI and physical activity with acetabular dysplasia in children

Purpose: Several studies have shown that the morphology of the hip strongly influences the development of osteoarthritis of the hip. Especially the evidence for cam morphology and acetabular dysplasia is strong. Both morphological variants develop during childhood. In order to potentially prevent development of these morphologies and thus to prevent hip OA in later life, it is crucial to understand how these morphologies develop during childhood. Especially little is known on the natural course of primary dysplasia in the developing hip in children. In this study we focused on the association of hip dysplasia with overweight and physical activity in 9 year old children. Methods: The population for this cross-sectional study was drawn from the ongoing prospective pregnancy cohort: Generation R. 9,778 mothers with a delivery date from March 2002 until January 2006 were enrolled. In a random subgroup of children DXA scanning was performed of the left hip and whole body at age 9. Body mass index, standardized for the Dutch population was divided in four categories based on extended international Obesity Task Force cut-offs: underweight, normal BMI, overweight and obesity. Physical activity was based on self-reported data and defined in 3 areas: time spent on playing outdoors, playing sports and walking to school. The amount of acetabular dysplasia was determined with the center-edge angle (CEA) in DXA images of the (left) hip. Mild and severe dysplasia were defined as CEA<20 and CEA<15 respectively. Associations were tested using logistic regression, adjusting for age, ethnicity, sex, first born, breech birth, gestational weight, gestational age and caesarean section. Results: 1,026 DXA images of the children’s hip were available for analysis. The median age of the children was 9.7 years (range: 9.2 - 12.0 years). Mean prevalence of mild and severe dysplasia was 25.6% and 6.3% respectively (table1). Weight was negatively associated with dysplasia. Obese children showed less dysplasia compared to normal children, while underweight children showed more dysplasia. This was significant only for the unadjusted association between being overweight and mild dysplasia, although the pattern was present for both crude and adjusted associations in both mild and severe dysplasia. Physical activity showed a negative association with dysplasia for playing outside and walking/cycling to school, not for sport activity. Meaning the children who play more outside or walk or cycle to school showed a lower prevalence of dysplasia. This association was significant especially for mild dysplasia after adjustment. Stratification for sex revealed no sex-specificity: all associations were similar for boys and girls. Conclusions: The results of this study suggest that being overweight and mild physical activity might be protective against developing (mild) dysplasia of the hip. The cross-sectional nature of this study prevents making conclusions on causality. For instance, the negative association between dysplasia and mild physical activity could point to a reverse causality as well. Obesity is a known risk factor for many types of OA, though not for hip OA. The current result might provide a possible explanation. The direct (positive) effect of obesity on hip OA could be attenuated by the indirect (negative) effect that is mediated by dysplasia, which is one of the strongest risk-factors for hip OA. These results warrant further investigation of developing hip dysplasia using the 14-year time point of this prospective cohort. In conclusion, obesity and mild physical activity were negatively associated with acetabular dysplasia of the hip in 9 year old children.Tabled 1Associations between dysplasia and weight/physical activityMild dysplasia (CEA<20) n=263 out of 1026Severe dysplasia (CEA<15) n=65 out of 1026crude ORadjusted ORcrude ORadjusted ORWeight (normal=ref)Underweight1.14 (0.65 to 0.20)0.99 (0.51 to 1.92)1.51 (0.62 to 3.68)1.75 (0.64 to 4.82)Overweight0.72 (0.48 to 1.08)0.82 (0.52 to 1.28)0.84 (0.40 to 1.74)1.07 (0.50 to 2.31)Obese0.39 (0.17 to 0.94)0.54 (0.22 to 1.33)0.65 (0.15 to 2.76)0.91 (0.21 to 3.96)Physical activity (hours per week)Sport activity1.00 (0.91 to 1.10)1.00 (0.89 to 1.11)1.05 (0.88 to 1.251.02 (0.84 to 1.25)Playing outside0.98 (0.95 to 1.00)0.97 (0.94 to 1.00)0.95 (0.88 to 1.02)0.92 (0.83 to 1.02)Walking/cycling to school0.87 (0.76 to 0.99)0.86 (0.74 to 0.99)0.82 (0.63 to 1.08)0.76 (0.54 to 1.06) Open table in a new tab

Short sleep and low milk intake are associated with obesity in a community of school aged children from Argentina

Understanding the factors related to obesity during childhood allows for improved preventive actions specifically adapted to particular communities. The purpose of this study was to identify individual and familiar factors related to obesity in children. A cross-sectional study was conducted in an urban community in Argentina during the years 2015-2016. Weight and height were measured on a probabilistic sample of 1366 schoolchildren aged 6 to 12 years. BMI categories were established according to International Obesity Task Force (IOTF) cut-offs. Data were analyzed using multivariate and logistic regression models. Independent variables corresponded to four domains: anthropometric, socioeconomic and demographic, nutritional, and energy balance. Twenty percent of children were categorized as overweight (OW) and 12.2% were obese (OB). Parental IOTF grade was positively associated with childhood OW/OB (father B = 0.421 P = 0.000, OR = 1.52, 95% CI 1.24-1.88; mother B = 0.498 P = 0.000, OR = 1.65, 95% CI 1.37-1.97). The remaining variables were negatively associated with OW/OB: hours of sleep (B = -0.566 P = 0.001, OR = 0.57, 95% CI 0.41-0.79), physical activity (B = -0.362 P = 0.017, OR = 0.70, 95% CI 0-52-0.94), and daily milk intake (B = -0.178 P = 0.045, OR = 0.84, 95% CI 0.70-0.99). Parental IOTF predicted both OW and OB, while sleep hours predicted OW and physical activity predicted OB. Family should be considered the initial target for effective strategies to reduce obesity. Like physical activity, the promotion of milk and dairy intake, as well as sleep, may have a major role in obesity reduction because of their protective effects in this community.

Subjective Household Economic Status and Obesity in Toddlers: A Cross-Sectional Study of Daycare Centers in Japan.

BackgroundAlthough lower household economic status is known to be a risk factor for obesity among school-age children, such an association among toddlers remains unclear. The present study investigated the association between household economic status and obesity in toddlers.DesignWe conducted a cross-sectional study of children aged 4 years attending daycare centers in Japan. Information on subjective household economic status [“affluent”, “neither”, “less affluent”, or “non-affluent”] was collected via questionnaire from the children’s guardians in 2015. Based on measured values of height and weight, obesity was defined using the International Obesity Task Force cut-offs of overweight (BMI ≥17.47 for boys and ≥17.19 for girls). We used the logistic regression model to investigate the association between household economic status and obesity.ResultsAmong 1,848 respondents, the prevalence of obesity was 6.8%. Non-affluent household economic status was associated with a significantly higher probability of obesity in toddlers; the multivariate adjusted odds ratio for “non-affluent” households was 2.31 (95% confidence interval, 1.23–4.33) compared with “affluent” households.ConclusionPerception of non-affluent economic status by the guardian was associated with a higher probability of toddler obesity. This result suggests that non-affluent household economic status is associated with obesity in toddlers.

The Relationship of Eating Rate and Degree of Chewing to Body Weight Status among Preschool Children in Japan: A Nationwide Cross-Sectional Study.

There is growing recognition that eating slowly is associated with a lower risk of obesity, and chewing well might be an effective way to reduce the eating rate. However, little is known about these relationships among children. We therefore investigated the associations of eating rate and chewing degree with weight status among 4451 Japanese children aged 5–6 years. Information on eating rate (slow, medium, or fast), degree of chewing (not well, medium, or well), and nutrient intake of children were collected from guardians using a diet history questionnaire. Weight status was defined using the International Obesity Task Force cut-offs based on BMI calculated from guardian-reported height and weight. The prevalence of overweight and thinness was 10.4% and 14.3%, respectively. A higher eating rate and a lower degree of chewing were associated with being overweight (both p < 0.001). Eating slowly was associated with being thin (p < 0.001), but no association was observed between chewing degree and thinness. These associations were still evident after controlling for potential confounders including parental educational attainment, weight status, and the child’s nutrient intake. In conclusion, this cross-sectional study suggested that chewing well, rather than eating slowly, might be a more effective way for healthy weight management among Japanese preschool children.

Predictors of weight status in school-aged children: a prospective cohort study.

To prospectively investigate the predictors of overweight/obesity and of body mass index (BMI) change in schoolchildren. A cohort of 2755 Irish children (53.7% girls), aged 6-10 years at baseline, participating in the Childhood Obesity Surveillance Initiative were included. Height and weight were objectively measured and BMI was calculated. Overweight/obesity were defined according to the International Obesity Task Force cut-offs. Prevalence of overweight/obesity at baseline and follow-up, incidence of overweight/obesity and changes in BMI over time were computed. Lifestyle indicators were parentally reported with a questionnaire. Predictors of overweight/obesity were investigated by multivariate mixed logistic regression models. Baseline BMI (OR = 6.46, 95% CI = 4.56-9.17) and school socioeconomic level (OR = 2.12, 95% CI = 1.16-3.86) were associated with higher risk of becoming overweight/obese. Children with no savoury snacks consumption (OR = 0.22, 95% CI = 0.07-0.69), or with frequent sports/dancing clubs attendance (OR = 0.41, 95% CI = 0.19-0.88) had lower odds of overweight/obesity at follow-up. Poor fruit intake was associated with higher risk of overweight/obesity (OR = 2.16, 95% CI = 1.23-3.78). Initial BMI was the main predictor of subsequent overweight/obesity in schoolchildren, followed, to a lesser extent, by school socioeconomic status. Although lifestyle behaviours appeared to have lower effect as compared with prior BMI, children with healthier lifestyle behaviours were at reduced risk of overweight/obesity at follow-up. Programmes that aim at preventing the onset of overweight and obesity need to be a priority given the existing difficulties to reverse this condition later in life.

Impact of Parents' Comprehensive Health Literacy on BMI in Children: A Multicenter Cross-Sectional Study in Japan.

Low-functional health literacy (HL) of parents influences poor child health outcomes. This study aimed to assess the relationship between comprehensive HL of parents and body mass index (BMI) of their children. We enrolled 3- to 6-year-old preschool-aged children and their parents in this multicenter cross-sectional cohort study. We evaluated parents' comprehensive HL with the 14-item HL scale. Children's BMI categories were defined using International Obesity Task Force cutoffs according to age and sex. We analyzed differences in data between the high-HL group and the low-HL group and investigated the association between HL of parents and their children's BMI by multivariate logistic regression analysis. The high-HL group comprised 208 (75.1%) children and the low-HL group comprised 69 (24.9%) children of whom 23 (8.3%) were overweight and 35 (12.6%) were thin. The low-HL group had more children with poor BMI than the high-HL group. Multivariate analysis showed an association between the low HL of parents and the poor BMI of their children after adjustment for all other confounding factors. Comprehensive HL of parents appears to affect the BMI of their children independently, suggesting that interventions to improve HL in parents are necessary.

Secular trend of childhood nutritional status in Calabria (Italy) and the United States: the spread of obesity

The number of children who are overweight has been increasing worldwide, including in Mediterranean countries. Based on this, we hypothesized that the weights of Italian children from Calabria have also increased across the years, approaching even the levels of their North American counterparts. This cross-sectional study, which was conducted at 3 time points (1992, 2004, and 2013/2014) with Calabrian children between the ages of 9 and 10 years, aimed to (1) examine a 20-year trend of growth and weight in Calabrian children and (2) compare these trends to those of children from the United States within a similar period. Data from the National Health and Nutrition Examination Survey were used for comparing Calabrian and American children at similar time points. Height and weight were measured, and body mass index was calculated. Nutritional status was defined by International Obesity Task Force cutoffs. Across 20 years, a positive trend was observed in the height and weight of Calabrian children. Trends of preobesity and obesity increased significantly in Calabria from 10.7% (95% confidence interval [CI] 7.1-15.3) to 30.5% (95% CI 26.4-34.8) and from 2.1% (95% CI 0.7-4.8) to 13.8% (95% CI 10.9-17.2), respectively. Although a cessation was observed between 2004 and 2013/2014, from 2003 to 2004, childhood overweight rates in Calabria were as high as those seen in the United States. There was no significant difference between boys from Calabria and the United States in 2013/2014. Over time, odds to become overweight were significant for most of the children from both populations but higher for those from Calabria. Therefore, inducting a reform in the political, environmental, and societal systems may protect children from becoming overweight by increasing quality of diet and physical activity.