International Obesity Task Force Research Articles

Type of delivery, birthweight, breastfeeding and overweight: the 2019 Italian results

Abstract Introduction According to recent studies, childhood obesity can be affected by type of delivery, birthweight and breastfeeding. The data from the surveillance system OKkio alla SALUTE, coordinated by the Italian National Institute of Health, have been used to investigate this association. OKkio alla SALUTE, promoted by the Italian Ministry of Health, is part of the WHO European Childhood Obesity Surveillance Initiative. Methods The study population are children aged 8 or 9 years in the third grade of all primary schools. A stratified cluster sample design, with class as the sampling unit, was used. Children were weighed and measured by trained local health staff and were classified as overweight or obese using the age and sex-specific International Obesity Task Force cut-offs. Parents of children completed a brief questionnaire to assess risk behavior, including information about the birth and the first few months of life of their child. Results In 2019, the sixth round of data collection involved 47,219 children and 50,370 parents with a response rate higher than 94%. 20.4% (95% CI 19.9-20.9) of 8-9 years old children were overweight and 9.4% (95% CI 9.0-9.7) were obese. The prevalence of obesity has decreased steadily since 2008 to 2019. The prevalence of overweight and obesity was higher for children born by caesarean section (33% vs 27% by vaginal childbirth), increased with birthweight (for birthweight >4,000 kg: 39.4% vs for birthweight<2,500 kg: 25.1%) and among children who had been breastfed never or less than 1 month (33.6% vs breastfeeding 6 months and above: 28.9%). Logistic regression analysis confirms the association between characteristics at birth/breastfeeding and overweight/ obesity. Conclusions Type of delivery, birth weight and breastfeeding seem to play a role in the prevalence of childhood overweight and obesity. Although these results may be affected by recall bias, this is unlikely to materially affect the results. Key messages • Type of delivery, birth weight and breastfeeding seem to play a role in the prevalence of childhood overweight and obesity. • Information on breastfeeding and other characteristics at birth that might be associated with overweight and obesity is essential for tracking progress in countries.

Influence of adolescents’ and parental dietary knowledge on adolescents’ body mass index (BMI), overweight/obesity in 2004–2015: a longitudinal study

ObjectiveThe global epidemic of overweight/obesity in children and adolescents poses a significant public health threat. This longitudinal study aims to investigate the relationship between adolescents’ and their parents’ dietary knowledge and overweight/obesity among adolescents in China.MethodsData were collected from the China Health and Nutrition Survey (CHNS) in 2004, 2006, 2009, 2011 and 2015. Overweight/obesity was defined according to the International Obesity Task Force (IOTF) cut-off for body mass index (BMI). A set of questions were used to assess the dietary knowledge scores of both adolescents and their parents during face-to-face interviews. Mixed effect models were used to analyze the data.ResultsA total of 2035 adolescents aged 12–17 years were included in the data analysis. The mean BMI increased from 19.2 in 2004 to 20.5 in 2015, with a significant increase in the prevalence of overweight and obesity from 6.8% and 0.5% in 2004 to 15.1% and 7.8% in 2015, respectively. Adolescents with medium-score dietary knowledge were less likely to be overweight/obese compared to those with low-score dietary knowledge (OR (95% CI): 0.20 (0.05–0.80), P < 0.05). However, there was no association between parental dietary knowledge and adolescents’ BMI or overweight/obesity (P > 0.05). Additionally, a significant interaction between adolescents’ dietary knowledge score and education in relation to adolescents’ BMI (P for interaction < 0.05).ConclusionAdolescents with medium dietary knowledge were less likely to be overweight/obese than those with low knowledge, but no association was found with parental knowledge. Promoting nutritional education and healthy eating habits is vital to prevent overweight/obesity.

Skeletal muscle mass, muscle strength, and physical performance in children and adolescents with obesity.

Sarcopenic obesity (SO) is defined as obesity with low skeletal muscle function and mass. This study aimed to evaluate the presence of sarcopenic obesity according to different diagnostic criteria and assess the elements of sarcopenia in children and adolescents with obesity. A total of 95 children and adolescents with obesity (diagnosed with the use of International Obesity Task Force (IOTF) criteria) with a mean age of 12.7( ± 3) years participated in the study. Body composition was assessed with the use of bioelectrical impedance-BIA (Tanita BC480MA) and dual-energy X-ray absorptiometry-DXA (Hologic). Fat mass (FM) and appendicular skeletal muscle mass (SMMa) were expressed as kilograms (kg) and percentage (%). Muscle-to-fat ratio (MFR) was defined as SMMa divided by FM. A dynamometer was used in order to measure grip strength. Six-minute walk test (6MWT) and a timed up-and-go test (TUG) were used to assess physical performance. The presence of SO ranged from 6.32% to 97.89%, depending on the criteria used to define sarcopenia. Children with sarcopenia, defined as a co- occurrence of low skeletal muscle mass % (SMM%) measured by DXA (≤9th centile) according to McCarthy et al. and weak handgrip strength (≤10th centile) according to Dodds et al., had significantly lower SMMa measured by both DXA and BIA, lower maximal handgrip strength, and lower physical performance. Maximal handgrip was positively correlated with SMMa (kg) and SMMa% derived from both DXA and BIA and BIA-MFR. Maximal handgrip was negatively correlated with waist-to-height ratio (WHtR). The distance of 6MWT correlated positively with BIA-measured SMMa% and BIA-MFR. 6MWT distance correlated negatively with BIA-FM% and body mass index (BMI) z-score. TUG was positively correlated with BIA-FM%, BMI z-score, WHtR, and IOTF categories and negatively correlated with BIA-SMMa% and BIA-MFR. The presence of sarcopenia in our study varied depending on the diagnostic criteria used. This is one of the first studies evaluating muscle mass, muscle strength, and physical performance in children and adolescents with obesity. The study highlighted the need for the implementation of a consensus statement regarding SO diagnostic criteria in children and adolescents.

Trends in childhood body mass index between 1936 and 2011 showed that underweight remained more common than obesity among 398 970 Danish school children.

To examine trends in all body mass index (BMI) groups in children from 1936 to 2011. We included 197 694 girls and 201 276 boys from the Copenhagen School Health Records Register, born between 1930 and 1996, with longitudinal weight and height measurements (6-14 years). Using International Obesity Task Force criteria, BMI was classified as underweight, normal-weight, overweight and obesity. Sex- and age-specific prevalences were calculated. From the 1930s, the prevalence of underweight was stable until a small increase occurred from 1950 to 1970s, and thereafter it declined into the early 2000s. Using 7-year-olds as an example, underweight changed from 10% to 7% in girls and from 9% to 6% in boys during the study period. The prevalence of overweight plateaued from 1950 to 1970s and then steeply increased from 1970s onwards and in 1990-2000s 15% girls and 11% boys at 7 years had overweight. The prevalence of obesity particularly increased from 1980s onwards and in 1990-2000s 5% girls and 4% boys at 7 years had obesity. These trends slightly differed by age. Among Danish schoolchildren, the prevalence of underweight was greater than overweight until the 1980s and greater than obesity throughout the period. Thus, monitoring the prevalence of childhood underweight remains an important public health issue.

Protein Intake, Source and Effect on Children's Weight Status: An Epidemiological Study in Greece.

The development of overweight and obesity during late childhood and early adolescence is one of the most critical issues in public health. Additionally, over the past few years, the consumption of protein has tended to increase in both children and adults. The present study aimed to evaluate whether the protein type, either plant- or animal-sourced, as well as the quantity consumed, could potentially have a relationship with excess body weight in children. A total of 47 primary schools were selected, and 1728 students, aged 10-12 years, were enrolled for the purposes of this study, leading to our final sample of 712. Physical measurements, such as weight and height, were measured, and children were separated into two weight status categories according to their Body Mass Index, which was obtained through the International Obesity Task Force criteria. Students' diets were assessed through a questionnaire, and total, plant- and animal-derived protein intakes were calculated. Unadjusted analysis showed a statistically significant association between body weight and plant protein. After adjustment for overall energy intake, sex, age, and exercise, there was a statistically significant negative association between plant protein and excess body weight in children (OR: 0.964, 95% CI: 0.936; 0.992), but a lack of association for animal-sourced protein (OR: 1.002, 95% CI: 0.991; 1.013). Dietary plant-derived protein seems to have a positive effect on weight status in children, independently of total energy intake and physical activity; nevertheless, additional research is required in order to elucidate the underlying mechanisms.

Assessment of the nutritional status of school children in Galle Municipality area: A comparison between different body mass index classification systems

Introduction: Asian populations are at an increased risk of cardiometabolic disorders due to higher fat mass at a relatively lower body mass index (BMI). Several discrepancies have been reported in the BMI classification systems currently in practice to assess the nutritional status among children. Aim of this study was to compare the different international BMI based classification systems to identify the nutritional status in a cohort of Sri Lankan children.Methods: A cross sectional study was conducted on 833 (48.37% boys) school children aged 5-15 years in Galle Municipality area, Sri Lanka. The nutritional status of each child was defined according to five BMI classification systems: World Health Organization (WHO), Centers for Disease Control and Prevention(CDC), and International Obesity Task Force (IOTF), Indian and Sri Lankan systems. The agreement between them was tested using Cohen’s kappa coefficient.Results: Prevalence of under-weight, overweight and obesity of children, as determined by the WHO, CDC, IOTF, Indian and the Sri Lankan classification systems showed significant differences. The WHO classification system had the best agreement (k=0.649) with the Indian classification system. A wide difference between the Sri Lankan classification system (24.37%) and the Indian (9.60%) and WHO (5.04%) classification systems in defining obesity were observed.Conclusion &amp; recommendations: A wide difference between different BMI classification systems when determining the nutritional status in children emphasise the importance of developing a country-specific classification system to identify the nutritional status among Sri Lankan children.

The Outcome of Obese Pregnant Mother Having Gestational Diabetes Mellitus

Background: Gestational diabetes mellitus (GDM) is a public health issue, mainly affecting the Southeast Asian region and Bangladesh( prevalence 9.7 % - 12.9%). It has a significant adverse impact on maternal and fetal outcomes. Obesity is one of the common nutritional problems complicating pregnancy in developed countries. Body mass index &gt; 30 kg/m2 is a globally accepted definition of obesity. The body fat percentage is considered to be higher in the Asian population compared to the European population at the same level of BMI, and therefore, different cut-off levels are recommended for Asians. The provisional recommendations for the Asian Pacific region published in February 2000 by the WHO regional office for the western pacific, the International Association for the Study of Obesity, and the international obesity Task Force are overweight at BMI &gt;23 and obese at BMI &gt; 25 kg/m2. There is a strong association between maternal obesity and gestational diabetes mellitus. So it needs to be addressed energetically to avoid maternal and fetal morbidity and mortality.&#x0D; Materials and methods: This cross-sectional type of comparative study was carried out in the Gynae outdoor and indoor departments of Rajshahi medical college hospital, Rajshahi, and Rajshahi Diabetic Hospital. All patients following inclusion and exclusion criteria on the basis of history and clinical examination were selected. 37 patients are obese having BMI &gt; or = 25 kg/m2 and 55 having BMI &lt; 25 kg/m2. Besides the baseline investigations, some specific investigations like serum urea, creatinine, HbA1C, lipid profile, and ophthalmoscopy were carried out to assess the status of end organs.&#x0D; Results: Vulvovaginitis was more in the obese group than without the obese group, which was 27.03% and 7.24%, respectively. The difference was statistically significant between the two groups (P &lt; 0.05). But PET, UTI, and polyhydramnios were statistically not significant between the two groups (P&gt;0.05). Cesarean section incidence was higher in all GDM patients, and the difference was not statistically significant. Preterm delivery was 13.51% in GDM with obese patients and 3.64% in GDM with non-obese patients, which was statistically significant. Maternal postpartum complications, including PPH, UTI, and wound infection, were 10.81%, 21.62%, and 5.41 %, in GDM, with the obese group and 3.64%, 12.73%, and 1.82%, respectively, in the non-obese group. The rest of the variables had statistically insignificant differences between the two groups (P&gt; 0.05). Fetal distress was not statistically significant. Regarding perinatal outcome, macrosomia was 16.22% and 5.45% in obese and non-obese groups, respectively. The difference was statistically significant between the two groups (P&lt; 0.05). Hypoglycemia in the obese group was 13.51%, and in the non-obese group, 3.64%; the difference is also statistically significant (P&lt; 0.05). However, birth asphyxia, hyperbilirubinemia, and RDS were statistically not significant between the two groups (P&gt; 0.05).&#x0D; Conclusion: The current study finding indicates that obesity in GDM patients is associated with more maternal and perinatal pregnancy complications. Thus pre-pregnancy weight reduction and appropriate weight gain during the antenatal period in all women, especially in women with gestational diabetes, might reduce pregnancy and labor complications and improve maternal and perinatal outcomes.&#x0D; TAJ 2022; 36: No-1: 97-106

Lifestyle habits and obesity indices among male adolescents in Riyadh, Saudi Arabia

Obesity among adolescents is a global health apprehension which requires early prevention. The aim of this study was to determine the association between lifestyle habits including physical activity, sedentary behaviors and eating habits with obesity indices of body mass index (BMI) and waist-to-height ratio (WHtR) among male adolescents in Riyadh, Saudi Arabia. We randomly selected 471 secondary school male adolescents aged 14–18 years. A pre-validated self-reported questionnaire was used to record the data on physical activity level, sedentary behaviors, sleep duration and eating habits. The International Obesity Task Force (IOTF) cutoff values for adolescents under 18 years of age were used to define overweight and obesity. Total energy expenditure was calculated using metabolic equivalent-minutes per week. Anthropometry including weight, height, BMI, waist circumference, waist/height ratio (WHtR), were assessed. 53.7% and 48.4% of the adolescents were overweight/obese and had abdominal obesity; respectively. Those with overweight and obesity or above 50% of WHtR were much less active in terms of METs-min/week from vigorous-intensity sports, sum of all METs-min/week from all vigorous-intensity physical activity, total METs-min/week from all physical activity compared with non-obese adolescents and below 50% of WHtR. The present study identified the lifestyle habits that were associated with obesity and may represent valid targets for the prevention and management of obesity among Saudi adolescents. Knowledge of the factors that contribute to obesity could be used in preventive programs for the control of obesity among adolescents.

Maternal vitamin D status and risk of childhood overweight at 5 years of age in two Nordic cohort studies.

Maternal vitamin D status during pregnancy has been suggested to have a role in childhood adiposity development, but results are conflicting. Our aims were to investigate [1] the relationships between maternal 25-hydroxyvitamin D (25OHD) during pregnancy and the child's body mass index (BMI) and risk of overweight at 5 years of age, and [2] maternal pre-pregnancy BMI as effect modifier for these associations. Data sources included a subsample from the Norwegian Mother, Father and Child Cohort Study (MoBa sub-cohort; N = 2,744) and the Swedish GraviD cohort study (N = 891). Maternal 25OHD was analyzed in gestational week 18 in the MoBa sub-cohort and week 10 in the GraviD cohort. In the MoBa sub-cohort, parents reported their child's documented measures of weight and length or height from the health card at routine check-up. In the GraviD cohort, this information was collected directly from medical records. Childhood overweight (including obesity) was identified using the International Obesity Task Force cut-offs. Linear and logistic regression models were used to investigate the association between maternal 25OHD and child's BMI and risk of overweight at 5 years of age in each cohort separately, and in a pooled dataset. In the pooled analysis, maternal 25OHD <30 nmol/L was associated with lower BMI in children at 5 years of age, but not with risk of overweight. Interaction analysis showed that the association was predominant among children of mothers with pre-pregnancy BMI ≥25 kg/m2. Low maternal vitamin D status, particularly in mothers with overweight or obesity, predicted lower BMI in their five-year-old children. However, there was no evidence of an effect on overweight in these children.

Impact of Household Economic and Mothers' Time Affluence on Obesity in Japanese Preschool Children: A Cross-sectional Study.

Although the association between household economic affluence and children's obesity has been reported, the association between mothers' time affluence and obesity remains unclear. We conducted a cross-sectional study using Japanese national survey data (2015). The target population was 2-6-year-old preschool children and their mothers. Subjective household economic affluence and mothers' time affluence were divided into "affluent," "neither," "less affluent," and "non-affluent" groups. Obesity was defined based on the International Obesity Task Force. A logistic regression model was conducted to examine the association between household economic affluence, mothers' time affluence, and children's obesity. A total of 2254 respondents were included in the present analysis. The lower household economic affluence was not significantly associated with higher rates of children's obesity (odds ratio (OR) for the "non-affluent" compared with the "affluent" group was 1.68 (95% CI, 0.93-3.03)). A lower mothers' time affluence was not significantly associated with higher rates of children's obesity (OR for the "non-affluent" compared with the "affluent" group was 1.67 (95% CI, 0.92-3.03)). The prevalence of obesity was not synergistically higher when lower household economic affluence and lower mothers' time affluence were combined.

Associations of polymorphisms of some genes with cardiometabolic risk factors in adolescents from Novosibirsk

Aim of the study was to investigate the association of polymorphisms of some genes with overweight and certain anthropometric and biochemical parameters in a population sample of adolescents in Novosibirsk. Material and methods. In 2019, a population-based screening of a representative sample of adolescents (609 people) was carried out in Novosibirsk. All children and their parents signed an informed consent for the examination. The study was approved by the local Ethics Committee of the Research Institute of Internal and Preventive Medicine – Branch of the Institute of Cytology and Genetics of SB RAS. During the examination, a questionnaire was filled out, anthropometric measurements were carried out, blood sampling was carried out, followed by a biochemical study. 157 people (75 boys (47.8 %), 82 girls (52.2 %)) were selected for molecular genetic analysis using tables of random numbers. The weight status of adolescents was assessed using the IOTF (International Obesity Task Force) criteria. The subsequent analysis compared 2 groups: 1st group included teenagers with weight deficiency and normal body weight), the 2nd – with overweight, obesity and extreme obesity). Results. In the general group, differences in carriers of different genotypes of the rs9939609 FTO gene were found in the level of low-density lipoprotein cholesterol (LDL-C) (p = 0,024). The girls with the AA rs9939609 genotype had the greatest average thickness of the skin fold in the middle third of the right shoulder. Differences were found in carriers of different genotypes rs7903146 of TCF7L2 gene in the average fasting plasma glucose (FPG) level (p = 0,021). The average thickness of the skin fold in the middle third of the right shoulder was greater in girls carrying the CC genotype compared with carriers of the CT and TT genotypes (p = 0,041). In separate subgroups, in carriers of different genotypes of rs10811661 CDKN2AB gene were found differences in high-density lipoprotein cholesterol, FPN, and waist circumference, in nucleotide sequence variant (NSV) rs2237892 KCNQ1 gene carriers – in triglyceride, FPG, LDL-C and total cholesterol concentration, in rs1111875 HHEX gene carriers – in total cholesterol, LDL-C level, waist and hip circumference, thickness of the skin fold under the scapula, diastolic blood pressure. Conclusions. Associations of the studied NSV (rs9939609, rs7903146, rs10811661, rs2237892, rs1111875) were found in the group as a whole and in separate subgroups (with division by body mass index, gender), with anthropometric and biochemical parameters, such as total cholesterol, triglyceride, LDL-C, FPN content, diastolic blood pressure, waist and hip circumferences, thickness of the skin fold under the scapula and in the middle third of the right shoulder. There were no statistically significant differences in the frequencies of studied NVS genotypes and alleles between the 1st and 2nd groups.

Associations among metabolic health, weight status, and various physical fitness components in Japanese adolescents: a cross-sectional study (NICE EVIDENCE study- Agano 3)

ABSTRACT Aim was to examine associations among metabolic health, weight status, and various physical fitness (PF) components in 1744 Japanese adolescents aged 13–14. Anthropometric measurements and PF tests (20 m shuttle run test [20mSRT], handgrip strength/body mass [HG], standing long jump [SLJ], and sit ups [SU]) were administered. The bottom sex-specific quintile of PF indicated “low fit”. Participants were classified as non-overweight (non-OW) or overweight/obese (OW) according to the International Obesity Task Force. Clustered metabolic risk was defined as the sum of Z scores for mean arterial pressure, non-high-density lipoprotein cholesterol, and HbA1c, divided by three, and ≥ 1 SD. Combination of weight status and scores for HG or SU were additively associated with clustered metabolic risk. Compared with the non-OW-moderate-high fit group, the OW-low HG group was 3.05 (95%CI: 1.88–4.97) times more likely to have clustered metabolic risk although risk was not significantly elevated in the OW-moderate-high HG group (1.52 [95%CI: 0.88–2.62]). A similar association was observed between OW and low SU scores but not between OW and low 20mSRT or SLJ scores. Adolescents with OW and moderate-high HG or SU scores had a lower prevalence of an unfavourable metabolic state than those with OW and low HG or SU results.

Undernutrition is still highly frequent in hospitalized children with cystic fibrosis

The aim of our study was to assess the nutritional status of hospitalized children with cystic fibrosis. We extracted data from the ePINUT surveys. Undernutrition was defined as a body mass index (BMI) of <18.5 according to the International Obesity Task Force cut-off, and the nutritional status goal was defined as a BMI z-score ≥0 SD for children older than 2 years and a weight-for-height z-score ≥0 SD for those younger than 2 years. Undernutrition frequency in the 114 patients with cystic fibrosis was 46% and was higher than in children with other chronic diseases (n = 5863; 30.5%; p = 0.001); 81% of children were below the nutritional status goal. Undernutrition frequency in cystic fibrosis is higher than in other chronic diseases.

Association of Body Mass Index With Disease Progression in Children With Charcot-Marie-Tooth Disease.

The aim of this study was to evaluate the impact of body mass index (BMI) on disease progression over 2 years in children with Charcot-Marie-Tooth disease (CMT). BMI was classified in 242 participants aged 3-20 years with CMT enrolled in the Inherited Neuropathy Consortium, using the International Obesity Task Force (based on adult BMI values, kg/m2) criteria. Groups were categorized as severely underweight (BMI <17 kg/m2), underweight (BMI ≥17 to <18.5 kg/m2), healthy weight (BMI ≥18.5 to <25 kg/m2), overweight (BMI ≥25 to <30 kg/m2), and obese (BMI ≥30 kg/m2). Disease severity was assessed using the CMT Pediatric Scale (CMTPedS), a clinical outcome assessment of disability (0-44 points, mild to severe). At baseline, compared with individuals being of a healthy weight (mean CMTPedS 15.48, SD 9.22), children who were severely underweight (mean CMTPedS difference 9.03, 95% CI 0.94-17.12; p = 0.02), underweight (mean CMTPedS difference 5.97, 95% CI 0.62-11.31; p = 0.02), or obese (mean CMTPedS difference 7.96, 95% CI 1.03-14.88; p = 0.015) exhibited greater disability. At 2 years, compared with individuals being of a healthy weight (mean CMTPedS 17.53, SD 9.41), children who were severely underweight exhibited greater disability (mean CMTPedS difference 9.27, 95% CI 0.90-17.64; p = 0.02). Over the 2-year periods, the mean CMTPedS for the whole sample deteriorated by 1.72 points (95% CI 1.09-2.38; p < 0.001), with severely underweight children progressing at the fastest rate (mean CMTPedS change of 2.3, 95% CI 1.53-6.13; p = 0.21). In children who did not have a change in BMI categories over 2 years (69% of sample), CMTPedS scores deteriorated faster in those who were severely underweight (mean CMTPedS change 6.40 points, 95% CI 2.42-10.38; p = 0.01) than those of healthy weight (mean CMTPedS change 1.79 points, 95% CI 0.93-2.69; p < 0.001). For children who changed BMI categories (31% of sample), CMTPedS scores deteriorated faster in children who became overweight/obese (mean CMTPedS change 2.76 points, 95% CI 0.11-5.41; p = 0.031). Children with CMT who were severely underweight, underweight, or obese exhibited greater disability at baseline. Over the 2-year period in those whose BMI remained stable, severely underweight children deteriorated at the fastest rate. For children who changed BMI categories over the 2 years, CMTPedS scores deteriorated faster in children who became overweight/obese. Interventions that maintain or improve BMI toward healthy weight may reduce disability in children with CMT.

MULT: A new BMI reference to assess nutritional status of multi-ethnic children and adolescents.

To develop a new Body Mass Index (BMI) reference (MULT) based on longitudinal data of multi-ethnic populations and to compare it to international BMI references. The MULT BMI reference was constructed through the LMS method and the Generalized Additive Models for Location Scale and Shape (GAMLSS), with 81 310 observations of 17 505 subjects aged 0-22 years old, from the United Kingdom, Ethiopia, Peru, India, Vietnam, Brazil, and Portugal. Outlier values were removed based on weight z-scores (population level) and based on BMI z-scores using the linear mixed effects model (individual level). The MULT M, S and L curves were compared to the ones of the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), International Obesity Task Force (IOTF), and Dutch Growth Study (DUTCH). The MULT BMI percentile cutoffs for overweight and obesity were calculated using the adult BMI values of 25 and 30 kg/m2 at 17, 18, 19, and 20 years old. MULT presented the lowest mean BMI values for the ages 102-240 months for boys and 114-220 months for girls. MULT S values were similar to the WHO and IOTF for children under 60 months of age and the highest during puberty, while the L curve showed to be more symmetric than the other BMI references. The MULT BMI reference was constructed based on recent data of populations from 10 countries, being a good option to assess the nutritional status of multi-ethnic populations.

1718-P: Association between Sleep Habits and Overweight among Adolescents in Japan

Insufficient sleep and late bedtime are associated with deteriorating glucose tolerance status, diabetes and overweight. Although lifestyle in adulthood is influenced by childhood and adolescent experiences, little is known about the association between sleep habits and glucose status in children. Thus, we investigated the association between sleep habits and overweight in 1050 Japanese adolescents (497 boys) considering the effects of diet, physical activity and screen time. Overweight was defined by the International Obesity Task Force. Sleep duration and wake/sleep time were based on questionnaires, and their association with overweight was analyzed by logistic regression. On weekends, girls with overweight had short sleep duration. In a univariate analysis of participants divided into 4 groups, the relationship between sleep habits and overweight did not present a U- or J-shaped curve. We conducted a multivariate logistic regression analysis based on the median bedtime of 23:00 and sleep duration of 9 h. In boys, there was no association between sleep habits and overweight. The odds ratios for overweight in girls with long sleep duration were high regardless of bedtime (early bedtime: odds ratio 3.42 [95% CI 1.15-10.17]; late bedtime 3.08 [1.14-8.33]). Gender differences exist in the association between sleep habits and overweight. In Japanese adolescent girls, sufficient sleep duration on weekends may be necessary. Disclosure H.Shiozaki: None. E.D.Ferreira: None. H.Ishiguro: None. Y.Ogawa: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. K.Fujihara: None. Y.Takeda: None. I.Ikeda: None. S.Y.Morikawa: None. K.Tsuruoka: None. R.Kodera: None. L.Khin: None. S.Wu: None.

Eating Disorder Attitudes and Body Self-Image of Urban Mediterranean Adolescents.

Early detection tools for eating disorders play an essential role in their prevention. The aim of this study was to analyze different variables associated with the risk of eating disorders and their relation to anthropometric parameters, nutritional status and body self-image. The Eating Disorder Invetory-3 Referral Form (EDI-3 RF) and the Body Shape Questionnaire (BSQ) were administered to 809 adolescents (413 boys and 396 girls), aged 11 to 17 years, from three randomly chosen schools in a big Mediterranean city. Anthropometric measurements were taken following standardized methods. Overweight and obesity were determined according to the International Obesity Task Force (IOTF). Overweight (23%) prevailed over obesity (9.37%). Girls registered a higher score in the Obsession for Thinness EDI-3 RF subscale and in the body dissatisfaction section of the BSQ. The only statistically significant differences in the Obsession for Thinness and Body Dissatisfaction levels among the different ages were seen in boys. In this series, body dissatisfaction assessed by the EDI-3 RF was not correlated with BSQ body dissatisfaction. Sex and age in adolescence determine the relationship between eating disorder attitudes and body shape dissatisfaction. It is necessary to look for other parameters to investigate to determine body dissatisfaction.

Population-based references for waist and hip circumferences, waist-to-hip and waist-to-height ratios for children and adolescents, and evaluation of their predictive ability

Childhood obesity is a public health problem globally as well as in Poland. This paper aimed to provide age- and sex-specific waist circumference, hip circumference, waist-to-height ratio and waist-to-hip ratio normative values for Polish children and adolescents aged 3 − 18 years for more precise monitoring of abdominal fat accumulation. The waist circumference, hip circumference, waist-to-height ratio and waist-to-hip ratio references were constructed with the lambda-mu-sigma (LMS) method using data from two nationally representative health surveys: the OLA study and the OLAF study, the largest available paediatric surveys in Poland which provided measured height, weight, waist, hip and blood pressure for 22,370 children and adolescents aged 3 − 18 years. The predictive ability of newly established references for overweight/obesity as defined by the International Obesity Task Force criteria and elevated blood pressure was tested with receiver operating characteristic. Abdominal obesity cut-offs linked to adult cardiometabolic cut-offs were established. Reference values for waist circumference, hip circumference, waist-to-height ratio and waist-to-hip ratio are presented, as well as waist circumference, waist-to-height ratio and waist-to-hip ratio cut-off values linked to adult’s cut-offs of cardiometabolic risk. The predictive value for overweight and obesity of population-based waist, hip and waist-to-height ratio references was outstanding–area under the receiver operating characteristic curve > 0.95 in both sexes, whereas with regard to the elevated blood pressure predictive ability was low—area under the receiver operating characteristic curve < 0.65. Conclusion: This paper presents the first waist, hip, waist-to-height ratio and waist-to-hip ratio references for Polish children and adolescents aged 3–18 years. The 90th and 95th percentile and cut-offs linked to adult thresholds for cardiometabolic risk are proposed as cut-offs for abdominal obesity.What is Known:• Waist circumference, waist-to-height ratio and waist-to-hip ratio are used to assess abdominal obesity in children and adults.• In Poland, there is no abdominal obesity and hip circumference references for children and adolescents from 3 to 18 years of age.What is New:• Population-based references of central obesity indices and hip references for children and youth aged 3–18 years and cardiometabolic risk thresholds for children and adolescents linked to adult’s cut-offs were established.

The Influence of Obesity in the Autonomic Nervous System Activity in School-Aged Children in Northern Portugal: A Cross-Sectional Study.

Obesity is one of the most prevalent chronic diseases in childhood, being an important public health issue. Excessive weight has been associated with autonomic dysfunction but the evidence in children is scarce. Therefore, the aim of this study was to assess the effect of overweight and obesity on the autonomic nervous system activity, in children. Data from a cross-sectional study of 1602 children, aged 7 to 12 years, was used and 858 children were included in the analysis. Body mass index was calculated and classified according to criteria of the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC) and the International Obesity Task Force (IOTF). Body composition was characterized by bioelectrical impedance. Linear regression models were used to determine the association between body mass index, body composition and the autonomic nervous system activity, assessed by pupillometry. Average dilation velocity was higher among children with obesity, according to the CDC and percentage of body fat criteria (β = 0.053, 95% CI = 0.005 to 0.101 and β = 0.063, 95% CI = 0.016 to 0.109, respectively). The same trend was observed for WHO and IOTF criteria (β = 0.045, 95% CI = -0.001 to 0.091, and β = 0.055, 95% CI = -0.001 to 0.111, respectively). CDC and WHO body mass index z-scores were also positively associated with the values of average dilation velocity (rs = 0.030, p = 0.048; and rs = 0.027, p = 0.042, respectively). Our findings suggest an association between body mass and changes in the autonomic activity, Moreover, this study provides proof of concept for interventions targeting the prevention/treatment of obesity in children that may offer some benefit in re-establishing the balance of the autonomic nervous system, and subsequently preventing the consequences associated with the autonomic nervous system dysfunction.

Mediterranean Diet Adherence and Physical Activity Level in Adolescents During the Lockdown in the COVID-19 Pandemic: A Cross-sectional Study in Greek Island of Rhodes

Background: Nutrition is involved in various ways in the 17 distinct SDGs of United Nations Agenda 2030. The COVID-19 pandemic is testing the world threatening health, nutrition, education, and social protection. Objective: The objective of this study was to assess the adolescents’ adherence to the Mediterranean diet that attended senior high school in the Greek city of Rhodes during the lockdown period. Methods: In this cross-sectional, observational study the sample of the research was 227 students aged 11-15 years old, that self-reported their weight and height and completed validated questionnaires for their nutritional attitudes. Results: The percentages of students who were overweight/obese were 22.5% of the total sample (17.2% overweight and 5.3% obese) according to the IOTF (International Obesity Taskforce) cutoffs and 30.4% (21.6% overweight and 8.8% obese) according to the WHO (World Health Organization) cutoffs. The average KIDMED score of the sample was medium (6.00) and the adherence to the Mediterranean diet of the sample needs improvement. Conclusion: Results support a shift from traditional Mediterranean diet to more unhealthy eating patterns. Adolescents' limited physical activity mainly on weekdays was reported, and further research could examine the role of distant education for this behavior. Policies and strategies targeting the students’ population are essential for adolescents’ nutrition education and the improvement of their dietary habits toward the sustainable Mediterranean diet, during the specific circumstances of covid pandemic.