Prevalence of overweight and obesity among school-aged children in urban, rural and mountain areas of the Veneto Region, Italy

OBJECTIVE: To define the prevalence of overweight and obesity among school-aged children resident in mountain areas, rural areas and urban areas.Design, setting and subjectsThe sample (n = 12 832; 50.7% boys) included 9- and 11-year-old children of the Veneto Region of north-east Italy. Overweight and obesity status were determined using the International Obesity Task Force cut-off points for body mass index. The prevalence of overweight and obese subjects was calculated with a confidence interval of 95%. The Mantel-Haenszel method was used to compare the combined prevalence of overweight and obesity among children resident in mountain areas, rural areas and urban areas. RESULTS: Among boys the prevalence of overweight was 21.06%, while obesity prevalence was 5.92%; among girls overweight prevalence was 21.30%, while obesity prevalence was 5.15%. The prevalence was higher among 11-year-old boys (odds ratio (OR) = 1.19; 95% confidence interval (CI): 1.06-1.33) and 9-year-old girls (OR = 1.13; 95% CI: 1.01-1.26). Children resident in rural areas presented a higher risk of overweight and obesity compared with children resident in mountain areas (Mantel-Haenszel OR = 1.27; 95% CI: 1.13-1.42; chi2 = 17.55; P < 0.0001) and in urban areas (Mantel-Haenszel OR = 1.18; 95% CI: 1.07-1.31; chi2 = 10.39; P < 0.001). CONCLUSIONS: A relevant prevalence of overweight and obesity was found; the excess weight concerns one child in four. There are differences linked to different geographical areas that must be further investigated.     

Association of key foods and beverages with obesity in Australian schoolchildren

OBJECTIVE: To examine the pattern of intake of key foods and beverages of children aged 4-12 years and the association with weight status. DESIGN AND SETTING: A computer-assisted telephone interview was used to determine the intake of fruit, vegetables, packaged snacks, fast foods and sweetened drinks 'yesterday' and 'usually' as reported by parents/guardians of a representative sample of 2184 children from the Barwon South-Western region of Victoria, Australia. RESULTS: Children who consumed >2-3, >3-4 and >4 servings of fruit juice/drinks 'yesterday' were, respectively, 1.7 (95% confidence interval (CI) 1.2-2.2), 1.7 (95% CI 1.2-2.5) and 2.1 (95% CI 1.5-2.9) times more likely to be overweight/obese compared with those who had no servings of fruit juice/drink 'yesterday', adjusted for age, gender and socio-economic status (SES). Further, children who had > or = 3 servings of soft drink 'yesterday' were 2.2 (95% CI 1.3-3.9) times more likely to be overweight/obese compared with those who had no servings of soft drink 'yesterday', adjusted for age, gender and SES. In addition, children who 'usually' drank fruit juice/drinks twice or more per day were 1.7 (95% CI 1.2-2.4) times more likely to be overweight/obese compared with those who drank these beverages once or less per week, adjusted for age, gender and SES. Although fast foods and packaged snacks were regularly eaten, there were no associations between weight status and consumption of these foods. CONCLUSIONS: Intake of sweetened beverages was associated with overweight and obesity in this population of Australian schoolchildren and should be a target for intervention programmes aimed at preventing unhealthy weight gain in children.     

BRAC initiative towards promoting gender and social equity in health: a longitudinal study of child growth in Matlab, Bangladesh

OBJECTIVE: To explore the effect of BRAC (formerly Bangladesh Rural Advancement Committee) initiatives towards promoting gender and social equity in health among children of poor mothers who are BRAC members. DESIGN: A cohort of 576 children from the prospective study of a BRAC- International Centre for Diarrhoeal Disease Research, Bangladesh joint research project was analysed. Data were collected three times during 1995-1996 with approximately 4-month intervals. Stunting, defined as height-for-age below minus two standard deviations from the reference median, was the outcome health measure. The study children were stratified into three groups according to their mother's social and BRAC membership status: poor and BRAC member (BM), poor non-member (TG) and non-poor non-member (NTG). SETTING: Matlab, rural area of Bangladesh. SUBJECTS: Children aged 6-72 months. RESULTS: The overall prevalence of stunting was 76%; the highest prevalence was found among TG (84.6%) children and no significant difference was observed between BM and NTG children (67.3% and 69.4%, respectively). In all groups, a significantly larger proportion of girls was stunted compared with boys in the first round. Group-level analysis showed that stunting decreased among all children except BM boys at the end of third round, with the largest decline among BM girls. In contrast, stunting prevalence increased among BM boys. A similar trend was found in the individual-level analysis, where a larger proportion of BM girls recovered from stunting compared with other groups and no recovery was observed among BM boys. At the end of the third round, the nutritional status of BM girls was almost equal to that of the BM boys, while gender inequity remained large among TG and NTG children. CONCLUSION: The BRAC initiative appeared to contribute to a significant equity gain in health for girls, as well as to decreased differences in ill health between the poor and the non-poor.     

Type of kindergarten and other potential determinants of overweight in pre-school children

OBJECTIVE: The study aimed to assess the relationship of various types of kindergarten differing in length of care and food availability with the development of overweight in pre-school children. DESIGN, SETTING AND SUBJECTS: A cross-sectional study was carried out in 2002 in Stuttgart, Germany, as part of the school entrance examination. Height and weight of 2140 children (participation 70.2%) were measured and information on type of kindergarten and other potential determinants of overweight was collected by a parental questionnaire. Change in relative body mass index (BMI) position between the ages of 4 and 6 years was assessed using medical records. RESULTS: The prevalence of overweight or change in relative BMI position did not differ according to the type of kindergarten. For the prevalence of overweight in German children, adjusted odds ratios (OR) comparing institutions that open only in the morning with those opening in the morning and afternoon or for the full day were 0.86 (95% confidence interval (CI) 0.40, 1.83) and 0.63 (95% CI 0.25, 1.58), respectively. Parental BMI and duration of television watching were positively associated, and maternal educational status and duration of breast-feeding were negatively associated, with overweight and/or change in relative BMI position. The prevalence of overweight was substantially higher among non-German than among German children (adjusted OR 2.17 (95% CI 1.53, 3.07)). CONCLUSIONS: These data show no association between different types of kindergarten and the development of overweight in early childhood. Duration of television watching and breast-feeding, as well as the relatively high prevalence of overweight in ethnic minorities, deserve further attention.     

WHO 2006 child growth standards: implications for the prevalence of stunting and underweight-for-age in a birth cohort of Gabonese children in comparison to the Centers for Disease Control and Prevention 2000 growth charts and the National Center for Health Statistics 1978 growth references

OBJECTIVES: To assess the proportion of children being stunted and underweight-for-age at 3, 9 and 15 months in Lambaréné, Gabon, using the WHO child growth standards released in 2006 as compared with the Centers for Disease Control and Prevention (CDC) 2000 and the National Center for Health Statistics (NCHS) 1978 child growth charts/references. DESIGN AND SETTING: Prospective birth cohort in Lambaréné, Gabon. SUBJECTS: Two hundred and eighty-nine children from birth to 15 months of age. METHODS: Weight and length were recorded at 3, 9 and 15 months. Corresponding Z scores for stunting and underweight-for-age were calculated for the three different standards/references. Children with a height-for-age or weight-for-age below -2 SD of the corresponding reference median (Z score < or = -2) were classified as stunted or underweight-for-age, respectively. RESULTS: With the new WHO 2006 standards a higher proportion (4.0%) of 3-month-old infants were underweight compared with the CDC (1.0%) or the NCHS (0.7%) child growth charts/references. In contrast to the NCHS references or the CDC charts, this proportion did not increase from 3 to 9 months or from 9 to 15 months. The proportion of children being stunted was highest (above 20%) with the WHO 2006 standards at all three ages. Again, in contrast to the old standards, this proportion did not increase from 3 to 9 months or from 9 to 15 months. CONCLUSIONS: The present results show considerably different growth faltering patterns for Gabonese children depending on the growth charts used to assess the prevalence of stunting and underweight. Shifting to the new WHO child growth standards may have important implications for child health programmes.     

Inadequate dietary intake is not the cause of stunting amongst young children living in an informal settlement in Gauteng and rural Limpopo Province in South Africa: the NutriGro study

OBJECTIVE: To measure dietary intakes of young children aged 12-24 months and to determine the impact of poor diets on stunting. DESIGN: A quantitative food-frequency questionnaire was adapted, tested and standardised. Trained enumerators conducted in-depth interviews with the mothers/caregivers of the children. Forty stunted children in urban informal settlements and 30 stunted children in rural areas were selected and pair-matched with controls. The data were captured on the Food Finder Program of the Medical Research Council. RESULTS: In both urban and rural areas, the diet of stunted and non-stunted groups did differ significantly and all diets were of poor nutritional quality. CONCLUSION: Diets in both areas resembled the recommended prudent diet, i.e. low in fat and high in carbohydrates. Poor quality diets were not the primary cause of stunting.     

Paternal smoking is associated with increased risk of child malnutrition among poor urban families in Indonesia

OBJECTIVE: Paternal smoking is highly prevalent in Asia, and tobacco may account for a large proportion of household expenditures among poor families. We sought to characterise the relationship between paternal smoking, child malnutrition and food expenditures. DESIGN: Data on smoking, household expenditures and child malnutrition were examined in a stratified multistage cluster sample of households in the Indonesia nutrition surveillance system. Main outcome measures were child wasting (weight-for-height Z-score < - 2), underweight (weight-for-age Z-score < - 2) and stunting (height-for-age Z-score < - 2), and severe wasting, underweight and stunting (defined by respective Z-scores < - 3). SETTING: In total, 175,583 households from urban slum areas in Indonesia. SUBJECTS: Children 0-59 months of age. RESULTS: The prevalence of paternal smoking was 73.8%. After adjusting for child gender and age, maternal age and education, and weekly per capita household expenditures, paternal smoking was associated with child stunting (odds ratio (OR) = 1.11, 95% confidence interval (CI) 1.08-1.14, P < 0.0001), severe wasting (OR = 1.17, 95% CI 1.03-1.33, P = 0.018) and severe stunting (OR = 1.09, 95% CI 1.04-1.15, P < 0.001). In households where the father was a smoker, tobacco accounted for 22% of weekly per capita household expenditures, with less money spent on food compared with households in which the father was a non-smoker. CONCLUSIONS: Among poor families in urban slum areas of Indonesia, paternal smoking diverts household money from food to tobacco and exacerbates child malnutrition.     

Habitual physical activity and body composition of black township adolescents residing in the North West Province, South Africa

OBJECTIVE: It is known that stunting and obesity affect a large proportion of children in the world, and these can be affected by the physical activity levels of the children. In the present study, we evaluated the association between physical activity, physical development and body composition in black adolescent children. DESIGN: Cross-sectional study. SETTING: Black township schools in the North West Province, South Africa. METHODS: Three-hundred and thirteen grade 8 children were included in the Physical Activity in Youth study. Anthropometric measurements, body composition measures and maturity level as assessed by Tanner stages were determined in these children. In addition, Previous Day Physical Activity Recall questionnaires were administered on the children to record the various activities they undertake daily. RESULTS: The demographic characteristics of the children showed a high level of homogeneity. A high prevalence of stunting (16.3%) was observed in the children, which was higher in boys than in girls (21.6 vs. 12.3%). Also prevalent was overweight/obesity (8.6%), but this was higher in girls than in boys (13.4 vs. 1.6%). The children also showed a reduction in levels of physical activity with advancement in maturity; furthermore, boys showed a more central form of fat deposition whilst girls showed more gynoid deposition. CONCLUSIONS: The study revealed that physical activity plays a role in determining body composition, and further indicated that physical activity is associated with favourable body composition measures. Children who were more active were likely to have less fat deposits.     

Prevalence of overweight and obesity among young people in Great Britain

OBJECTIVE: To determine the prevalence of overweight and obesity in British young people (4-18 years) in 1997. DESIGN: Cross-sectional analysis of the National Diet and Nutrition Survey of young people. SETTING: Great Britain. SUBJECTS: Nationally representative sample of 1836 young people (age 4-18 years). RESULTS: The prevalence of obesity based on body mass index (weight/height(2)) and the International Obesity Task Force cut-offs was 4.0%, with a further 15.4% identified as overweight. Asians were almost four times as likely to be obese as white subjects (13.6 vs. 3.5%, P<0.001). Among white subjects there was no significant difference in the prevalence of obesity between girls and boys, or with age. The risk of obesity was significantly higher in subjects from social classes IV and V than from social classes I-III (6.5 vs. 2.7%, P=0.003). Subjects living in Scotland and Wales were significantly more likely to be obese than those in England (7.6 and 6.5 vs. 2.9%, respectively, P<0.01). Multiple logistic regression showed that, among white subjects, those in social classes IV and V living in Wales and Scotland were three times more likely to be obese than the other children in the survey (odds ratio 3.3, 95% confidence interval 1.1-9.8). CONCLUSION: These data provide information on the national prevalence of overweight and obesity in Great Britain and baseline data from which to monitor future trends. This analysis provides important demographic information on those most at risk of obesity, which may be used to inform public health strategies to prevent obesity in young people.     

Nutritional status of the Andean population of Puna and Quebrada of Humahuaca, Jujuy, Argentina

OBJECTIVE: To assess the nutritional status of the Andean population of Puna and Quebrada of Humahuaca, Jujuy, using anthropometric measurements. DESIGN AND SUBJECTS: A cross-sectional nutritional survey was carried out in a representative sample (n = 1236) of individuals from these regions. Children aged 2-9 years, adolescents (10-17 years) and adults (>or=18 years; pregnant and lactating women excluded) were considered. Height-for-age, weight-for-height and body mass index (BMI) were calculated in children and adolescents and compared with World Health Organization/National Center for Health Statistics/Centers for Disease Control and Prevention reference standards using Z-scores or percentiles, in order to assess the prevalence of stunting, wasting/thinness and excess weight. In adults, BMI, waist circumference (WC) and waist-to-hip (WHR) ratio were used to identify obesity and central adiposity. RESULTS: Stunting (height-for-age Z-score <-2 standard deviations) and obesity (BMI >or= 95th percentile) were found to be major nutritional problems in children and adolescents. Stunting was prevalent in 10.7% of children and 12.4% of adolescents; 8.2% of children and 3.5% of adolescents were obese. Adults were short (mean: 155.8 cm) and values of overweight (32.3%), obesity (18.3%) and central adiposity (mean WC: 86.5 cm) were high. Older adults and those with higher economic development showed higher prevalence of obesity and central adiposity. CONCLUSIONS: The present population may be at the early stages of nutritional transition as symptoms of undernutrition and overnutrition coexist at the population level. These results suggest that rates of growth retardation may be decreasing owing to improved nutritional conditions; however, this could be accompanied by a sharp increase in the prevalence of other diet-related chronic diseases.     

Correlates of childhood obesity in Athens, Greece

OBJECTIVE: Childhood obesity is a growing public health problem. We have examined the association between sociodemographic profile and eating and physical activity patterns with overweight among primary-school students in Athens, Greece. DESIGN: Cross-sectional study. SETTING: Eleven primary schools in the greater Athens area, Greece. SUBJECTS: A total of 633 children aged 10-12 years (50 % boys, 50 % girls) were interviewed in person during spring 2003. Multivariate logistic regression was used to investigate the association between eating and physical activity patterns and overweight (> or =85th sex- and age-specific BMI centile). Results are presented as odds ratios and 95 % confidence intervals. RESULTS: Overweight was more common among girls than among boys (OR=1.73; 95% CI 1.11, 2.69) and substantially less common among children born outside Greece (OR=0.46; CI 0.22, 0.95). Reported physical activity (per 1.5 h per day) was unrelated to overweight (OR=0.97; CI 0.85, 1.12) but patent physical inactivity, operationalised as time spent watching television or working/playing with the computer (per 1.5 h per day) was a highly significant predictor of overweight (OR=1.20; CI 1.05, 1.36). Composition of diet was unrelated to overweight but the daily number of eating occasions, controlling for total energy intake, was significantly inversely associated with overweight (OR=0.61; CI 0.48, 0.76). CONCLUSIONS: The principal factor underlying overweight among children in Athens appears to be the extended inactivity imposed by modern childhood lifestyles. An intriguing finding is that spreading a given energy intake over several eating occasions was inversely associated with the likelihood of childhood obesity.     

Prevalence of obesity, food choices and socio-economic status: a cross-sectional study in the north-west of Iran

AIM: To document the epidemiological features and influencing factors of obesity in the north-west of Iran, to provide baseline information for setting up a regional population-based centre to control and prevent obesity-related disorders in the area. METHODS: In this cross-sectional study, a total of 300 subjects were selected/studied in Tabriz, one of the major cities in Iran. Data on basic characteristics, anthropometric measurements, dietary assessment and physical activity were collected. Obesity was defined as body mass index > or =30 kg m(-2) for both women and men. RESULTS: Total prevalence of obesity in the area was 22.4% (95% confidence interval (CI): 18.0-27.6). The prevalence of obesity was 24% (95% CI: 18.5-31.4) for women and 18% (95% CI: 12.5-25.6) for men. For both women and men obesity prevalence showed a positive association with age (P<0.001), while there was a negative correlation of obesity with education and income (P<0.001). Fruit consumption decreased the risk of obesity in both women and men (odds ratio (OR)=0.60, 95% CI: 0.49-0.71 vs. OR=0.62, 95% CI: 0.51-0.74, respectively). The same significant pattern was observed for the consumption of green vegetables (OR=0.71, 95% CI: 0.57-0.63 vs. OR=0.86, 95% CI: 0.77-0.98 for women and men, respectively), legumes (OR=0.70, 95% CI: 0.59-0.84 vs. OR=0.78, 95% CI: 0.66-0.91 for women and men, respectively) and dairy products (OR=0.73, 95% CI: 0.61-0.91 vs. OR=0.77, 95% CI: 0.63-0.93 for women and men, respectively). CONCLUSIONS: Our study showed that educational attainment, higher income and consumption of certain food groups (i.e. vegetables, fruits, legumes and dairy products) may decrease the risk of obesity. Our findings also indicate the crucial necessity of establishing a population-based centre for obesity in the area. The essential information is now achieved to propose to local health authorities to act accordingly. However, more population-based investigations on dietary choices are needed to develop effective preventive strategies to control overweight and obesity disorders in different regions.     

Effect of economic inequality on chronic childhood undernutrition in Ghana

OBJECTIVE: Food insecurity and undernutrition remain particularly severe in developing countries where improvements in economic conditions have tended to benefit the advantaged groups and resulted in widespread inequalities in health. This study examined how economic inequality is associated with chronic childhood undernutrition. DESIGN: A child was defined as chronically undernourished (stunted) if his or her height-for-age index was more than two standard deviations below the reference median. Household economic status was measured by an index based on household ownership of durable assets. Bivariate and multivariate analyses were used to estimate the effects of household economic status on stunting. SETTING: A nationally representative sample of 6251 household interviews in Ghana.Subjects A total of 3077 children aged 0-59 months included in the 2003 Ghana Demographic and Health Survey. RESULTS: Children in the poorest 20% of households are more than twice as likely to suffer from stunting as children in the richest 20% of households independent of the child's age, sex, birth order, breast-feeding duration, birth weight; mother's age at childbirth, body mass index, education; and household access to safe drinking water, hygienic toilet facilities, residence and geographic region (odds ratio = 2.3; 95% confidence interval 1.4-3.7). Also children in the next poorest and in the middle quintiles are significant more likely to be chronically undernourished than children in the richest 20% of households. CONCLUSION: This study concludes that economic inequality is strongly associated with chronic childhood undernutrition; and reducing economic inequalities and making services more accessible to the poor will be key to improving the health and nutritional status of children in Ghana.     

Detection of cardio-metabolic risk by BMI and waist circumference among a population of Guatemalan adults

BACKGROUND: BMI and waist circumference (WC) are used to screen for cardio-metabolic risk; however it is unclear how well these indices perform in populations subject to childhood stunting. OBJECTIVES: To evaluate BMI and WC as indicators of cardio-metabolic risk and to determine optimal cut-off points among 1325 Guatemalan adults (44 % stunted: 162 cm men). METHODS: Cardio-metabolic risk factors were systolic/diastolic blood pressure 85 mmHg, glucose 5 mmol/l, TAG 7 mmol/l, ratio of total cholesterol to HDL-cholesterol 0, and the presence of two or more and three or more of the preceding risk factors. Receiver operating characteristic (ROC) curve analysis was used. RESULTS: Areas under the ROC curve were in the range of 005978 for WC among men and 006472 among women, respectively. Optimal cut-off points for BMI were 242651 kg/m2 stunted; 242656 kg/m2 among women (262769 kg/m2 non-stunted). Optimal cut-off points for WC were 879134 cm stunted; 889333 cm among women (909486 cm non-stunted).ConclusionOptimal cut-off points for BMI were slightly higher among women than men with no meaningful differences by stature. Optimal cut-off points for WC were several centimetres lower for stunted compared with non-stunted men, and both were substantially lower than the current recommendations among Western populations. Cut-off points derived from Western populations may not be appropriate for developing countries with a high prevalence of stunting.     

Do childhood growth indicators in developing countries cluster? Implications for intervention strategies

OBJECTIVE: The effectiveness of geographic targeting in nutrition programmes depends largely on the degree to which malnutrition clusters within particular areas. This study investigates the extent to which the childhood nutrition indicators, stunting (height-for-age Z-score <-2) and wasting (weight-for-height Z-score <-2), are spatially clustered; this information is used to determine the implications of spatial clustering for the effectiveness of geographic targeting. DESIGN: Analysis of data from Demographic and Health Survey (DHS) results. Clustering is assessed by calculating intra-cluster correlation coefficients (ICCs). Estimating the proportion of malnourished children covered by a programme successfully targeting 10% of clusters with the highest malnutrition prevalences allows an assessment of the effectiveness of geographic targeting. SETTING: Fifty-eight DHS III (1992-1997) and DHS IV (1998-2001) reports from 46 developing countries. SUBJECTS: Pre-school children of mothers interviewed by DHS. MAIN RESULTS: The extent of clustering of nutritional status was surprisingly low (median ICC for national samples: stunting=0.054, wasting=0.032) and most countries were characterised by having an ICC <0.1--i.e. low clustering--for childhood undernutrition (91% of countries for wasting and 78% for stunting). Our assessment of the effectiveness of geographic targeting showed that coverage was better for wasting than for stunting; for wasting, 23% of countries would achieve less than 20% coverage, compared with 76% of countries achieving less than 20% coverage for stunting. Coverage is dependent on the overall prevalence of malnutrition and the ICC. CONCLUSIONS: Childhood nutritional status is determined at the household, or even individual, level; nutrition programmes that are geographically targeted may result in high levels of under-coverage and leakage, thereby compromising their cost-effectiveness; the lack of clustering questions the appropriateness of current nutrition interventions.     

The National Food Consumption Survey (NFCS): South Africa, 1999

OBJECTIVE: The aim of the National Food Consumption Survey (NFCS) in South Africa was to determine the nutrient intakes and anthropometric status of children (1-9 years old), as well as factors that influence their dietary intake. DESIGN: This was a cross-sectional survey of a nationally representative sample of all children aged 1-9 years in South Africa. A nationally representative sample with provincial representation was selected using 1996 Census information. SUBJECTS: Of the 3120 children who were originally sampled data were obtained from 2894, a response rate of 93%. METHODS: The sociodemographic status of each household was assessed by a questionnaire. Dietary intake was assessed by means of a 24-hour recall and a food-frequency questionnaire from the caregivers of the children. Food purchasing practices were determined by means of a food procurement questionnaire. Hunger was assessed by a modified hunger scale questionnaire. Nutritional status was determined by means of anthropometric measurements: height, weight, head circumference and arm circumference. RESULTS: At the national level, stunting (height-for-age below minus two standard deviations (< -2SD) from the reference median) was by far the most common nutritional disorder, affecting nearly one in five children. The children least affected (17%) were those living in urban areas. Even with regard to the latter, however, children living in informal urban areas were more severely affected (20%) compared with those living in formal urban areas (16%). A similar pattern emerged for the prevalence of underweight (weight-for-age < -2SD), with one in 10 children being affected at the national level. Furthermore, one in 10 (13%) and one in four (26%) children aged 1-3 years had an energy intake less than half and less than two-thirds of their daily energy needs, respectively. For South African children as a whole, the intakes of energy, calcium, iron, zinc, selenium, vitamins A, D, C and E, riboflavin, niacin, vitamin B6 and folic acid were below two-thirds of the Recommended Dietary Allowances. At the national level, data from the 24-hour recalls indicated that the most commonly consumed food items were maize, sugar, tea, whole milk and brown bread. For South African children overall, one in two households (52%) experienced hunger, one in four (23%) were at risk of hunger and only one in four households (25%) appeared food-secure. CONCLUSION: The NFCS indicated that a large majority of households were food-insecure and that energy deficit and micronutrient deficiencies were common, resulting in a high prevalence of stunting. These results were used as motivation for the introduction of mandatory fortification in South Africa.     

Associations of television viewing time with excess body weight among urban and rural high-school students in regional mainland China

OBJECTIVE: To examine the relationship between television (TV) viewing and body mass index (BMI) among adolescents in a region of mainland China. DESIGN: Population-based cross-sectional study, conducted between September and November of 2004, on a sample of enrolled high-school students aged 12-18 years. SETTING: One hundred and sixty-eight classes randomly selected from both urban and rural areas and belonging to 15 senior and 41 junior high schools in Nanjing, China, with a regional population of 6.0 million. SUBJECTS: In total 6848 students participated; 47.7 % from urban and 52.3 % from rural areas; 49.0 % male and 51.0 % female. The response rate among eligible participants was 89.3 %. RESULTS: The proportion of overweight was 6.6 % according to the criteria of overweight recommended for Chinese adolescents. Boys than girls (8.9 % vs. 4.4 %) had higher odds of being overweight (odds ratio (OR) 2.12, 95 % confidence interval (CI) 1.74, 2.60), while the proportion of overweight was significantly lower among rural students than urban students (4.5 % vs. 8.9 %; OR 0.49, 95 % CI 0.40, 0.60). Those students who watched TV for more than 7 h/week had a 1.5 times greater odds of being overweight relative to their counterparts who watched TV for 7 h/week or less (adjusted OR 1.51, 95 % CI 1.24, 1.82). Furthermore, there was a positive linear relationship between TV viewing time and BMI, even after adjusting for age, gender, residence area, time spent in study, in sleeping and in physical activity, and monthly pocket money. CONCLUSIONS: Viewing TV might increase the likelihood of being overweight for Chinese adolescents in China.     

Assessment of obesity and fear of fatness among inner-city Dublin schoolchildren in a one-year follow-up study

BACKGROUND: Positive secular trends in adolescent obesity and an increased prevalence of fear of fatness, particularly among girls, have been documented world-wide. There is a lack of consensus about assessment criteria for childhood obesity and no standard exists for assessing Irish children. In 1990, the Irish National Nutrition Survey used body mass index (BMI) > or =26 kg m(-2) to describe the prevalence of overweight among Irish adolescents. OBJECTIVES: (1) To examine the range in classification of Dublin schoolchildren as overweight according to four standard assessment methods; (2) to assess changes in weight status, prevalence of fear of fatness and accompanying slimming practices in a one-year follow-up; and (3) to compare the prevalence of overweight with that documented in 1990 among adolescents of similar age. DESIGN: A one-year follow-up study of 199 healthy schoolchildren (90 boys and 109 girls; mean age of 11 years at baseline) attending seven fee-paying (six single- and one mixed-sex) and eight non-fee-paying (four single- and four mixed-sex) primary schools in Dublin city centre. MEASUREMENTS: Weight, height, waist circumference and triceps skinfold were measured and used in five definitions of overweight, including published cut-off points of BMI-for-age (Centers for Disease Control and Prevention BMI-for-age charts for boys and girls; BMI reference curves for the UK 1990; International Obesity Task Force age- and sex-specific BMI cut-offs), actual relative weight and BM > or =26 kg m(-2). Assessment of body image perceptions and satisfaction (using figure line drawings) was reported in a questionnaire specifically designed for this study. RESULTS: The prevalence of overweight within the total group differed between the four standard definitions of weight status, by 9% at baseline and 8% at follow-up. Accordingly, increasing trends over the year ranged from zero to 3%. Using the criterion BMI > or =26 kg m(-2), 6% of Dublin schoolchildren were overweight, compared with 1.9% of schoolchildren in 1990. Significantly more girls than boys were affected by fear of fatness and were trying to lose weight. CONCLUSION: A standard method for assessment of weight status is urgently needed for the evaluation of obesity prevention initiatives among Irish schoolchildren. Such initiatives need to be sensitive to the pervasiveness of fear of fatness among adolescent girls.     

Prevalence and predictors of food insecurity among low-income households in Los Angeles County

OBJECTIVES: To assess the prevalence and identify the predictors of food insecurity among households in Los Angeles County with incomes below 300% of the federal poverty level. METHODS: The Six-Item Short Form of the US Department of Agriculture's Household Food Security Scale was used as part of a 1999 county-wide, population-based, telephone survey. RESULTS: The prevalence of food insecurity was 24.4% and was inversely associated with household income. Other independent predictors of food insecurity included the presence of children in the household (odds ratio (OR) 1.7, 95% confidence interval (CI) 1.2-2.3) and a history of homelessness in the past five years (OR 5.6, 95% CI 3.4-9.4). CONCLUSION: Food insecurity is a significant public health problem among low-income households in Los Angeles County. Food assistance programmes should focus efforts on households living in and near poverty, those with children, and those with a history of homelessness.