Introduction to the Active Living Research Reference List January – July 2008


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R. Kelishadi, G. Ardalan, R. Gheiratmand, R. Majdzadeh, M. Hosseini, M. M. Gouya, E. M. Razaghi, A. Delavari, M. Motaghian, H. Barekati, M. S. Mahmoud-Arabi and K. Lock. (2008). Thinness, overweight and obesity in a national sample of Iranian children and adolescents: CASPIAN Study. Child Care Health Dev. 34, 44-54.

BACKGROUND: This study was conducted to assess the national prevalence of different grades of nutritional status (underweight, normal weight, overweight and obesity) among Iranian school-students and to compare the prevalence of overweight and obesity using three different sets of criteria. METHODS: This cross-sectional national survey was conducted on a representative sample of 21 111 school students including 10 253 boys (48.6%) and 10 858 girls (51.4%) aged 6-18 years, selected by multistage random cluster sampling from urban (84.6%) and rural (15.4%) areas of 23 provinces in Iran The percentage of subjects in the corresponding body mass index (BMI) categories of the Centers of Disease Control and Prevention (CDC), the International Obesity Task Force (IOTF) and the obtained national percentiles were assessed and compared. RESULTS: There was no gender differences in BMI, but was higher in boys living in urban than in rural areas (18.4 +/- 3.88 vs. 17.86 +/- 3.66 kg/m(2) respectively, P < 0.05). The prevalence of underweight was 13.9% (8.1% of boys and 5.7% of girls) according to the CDC percentiles, and 5% (2.6% of boys and 2.4% of girls) according to the obtained percentiles. According to the CDC, IOTF and national cut-offs, the prevalence of overweight was 8.82%, 11.3% and 10.1% respectively; and the prevalence of obesity was 4.5%, 2.9% and 4.79% respectively. The prevalence of overweight was highest (10.98%) in the 12-year-old group and that of obesity (7.81%) in the 6-year-old group. The kappa correlation coefficient was 0.71 between the CDC and IOTF criteria, 0.64 between IOTF and national cut-offs, and 0.77 between CDC and national cut-offs. CONCLUSIONS: The findings of this study warrant the necessity of paying special attention to monitoring of the time trends in child obesity based on uniform definitions, as well as to design programmes to prevent and control associated factors.

T. Kidd, E. Johannes, L. Simonson and D. Medeiros. (2008). KNACK Online: an evidence-based Web site developed to address adolescent obesity. J Nutr Educ Behav. 40, 189-90.

E. G. Klein, L. A. Lytle and V. Chen. (2008). Social ecological predictors of the transition to overweight in youth: results from the Teens Eating for Energy and Nutrition at Schools (TEENS) study. J Am Diet Assoc. 108, 1163-9.

OBJECTIVE: To explore the social ecological predictors of the transition to overweight in youth, as shown in results from the Teens Eating for Energy and Nutrition at Schools study. DESIGN: Longitudinal data from a school-based intervention trial. PARTICIPANTS: Adolescents who were involved in the Teens Eating for Energy and Nutrition at Schools intervention study who reported a healthful weight at baseline in 1998 (n=1,728). MAIN OUTCOME MEASURE: Transition to overweight status (body mass index > or =85th percentile) at follow-up in eighth grade. STATISTICAL ANALYSIS: Generalized linear mixed model regression. RESULTS: Factors in the social, environmental, individual, and behavioral domains had significant unadjusted relationships with a transition to overweight status. In the multivariate analysis, adolescents who perceived themselves to be overweight at baseline were 2.3 times more likely to be overweight at follow-up compared to those with a normal weight self-perception. Compared to nondieters, current dieters were 2.6 times more likely to be overweight at follow-up, and boys were nearly three times more likely to transition to overweight status at follow-up compared with girls. CONCLUSIONS: Individual factors, primarily related to a self-perception of being overweight, were the strongest predictors of transitioning to overweight as adolescents progressed from seventh through eighth grade. A better understanding of the relationship between weight concern and transition to overweight is needed.
L. M. Klesges, D. A. Dzewaltowski and R. E. Glasgow. (2008). Review of external validity reporting in childhood obesity prevention research. Am J Prev Med. 34, 216-23.

BACKGROUND: The translation and dissemination of prevention intervention evidence into practice is needed to address significant public health issues such as childhood obesity. Increased attention to and reporting of external validity information in research publications would allow for better understanding of generalizability issues relevant to successful translation. To demonstrate this potential, recent reports of childhood obesity prevention interventions were evaluated on the extent to which external validity dimensions were reported. METHODS: Childhood obesity prevention studies that were controlled, long-term research trials published between 1980 and 2004 that reported a behavioral target of physical activity and/or healthy eating along with at least one anthropometric outcome were identified in 2005. Studies were summarized between 2005 and 2006 using review criteria developed by Green and Glasgow in 2006. RESULTS: Nineteen publications met selection criteria. In general, all studies lacked full reporting on potential generalizability and dissemination elements. Median reporting over all elements was 34.5%; the mode was 0% with a range of 0% to 100%. Most infrequent were reports of setting level selection criteria and representativeness, characteristics regarding intervention staff, implementation of intervention content, costs, and program sustainability. CONCLUSIONS: The evidence base for future prevention interventions can be improved by enhancing the reporting of contextual and generalizability elements central to translational research. Such efforts face practical hurdles but could provide additional explanation for variability in intervention outcomes, insights into successful adaptations of interventions, and help guide policy decisions.

G. T. Ko, R. Ozaki, G. W. Wong, A. P. Kong, W. Y. So, P. C. Tong, M. H. Chan, C. S. Ho, C. W. Lam and J. C. Chan. (2008). The problem of obesity among adolescents in Hong Kong: a comparison using various diagnostic criteria. BMC Pediatr. 8, 10.

BACKGROUND: Obesity is now a global epidemic. In this study, we aimed to assess the rates of obesity using several major diagnostic criteria in Chinese school adolescents in Hong Kong. METHODS: This is a cross-sectional study. Using a computer-generated coding system, we randomly selected schools from different geographical regions in Hong Kong to obtain a representative sample. Subjects aged 11-18 years of age were randomly selected from different class of the schools. Their rates of obesity according to four different international and local criteria were compared [International Obesity Task Force (IOTF) 2000 criterion; the Group of China Obesity Task Force (COTF) 2004 criterion; Centers for Disease Control and Prevention (CDC) 2000 Growth Charts and the Hong Kong Growth Survey (HKGS) charts in 1993]. RESULTS: Of the 2098 adolescents [982 (46.8%) boys and 1116 (53.2%) girls], the mean age (+/- SD) was 15.1 +/- 1.8 years (range: 11-18 years; median: 15.0 years). The crude rates of obesity were similar based on IOTF, COTF or CDC criteria (boys: 3.9-6.0%, girls: 1.8-3.7%), however, the rate increased to 11-27% if the HKGS charts were used. Obesity rate varied markedly according to age. It decreased from 8-10% among those aged 12-13 years to 2-4% among those aged 17-18 years. CONCLUSION: The prevalence of obesity in Hong Kong adolescents using various diagnostic criteria were similar except for the 1993 HKGS criteria, which gave an exceeding high figure. Using the IOTF, COTF or CDC criteria, the adolescent obesity in Hong Kong varied from 1.8% to 6.0%.

J. A. Kropski, P. H. Keckley and G. L. Jensen. (2008). School-based Obesity Prevention Programs: An Evidence-based Review. Obesity (19307381). 16, 1009.

The article reviews fourteen studies on the effectiveness of school-based programs for reducing childhood overweight or obesity. These studies were published in 1990. Twelve studies indicated significant improvement in at least one measure of dietary intake, physical activity, and/or sedentary behavior.

T. Kubo, M. Furujo, Y. Ueda, K. Imai, K. Tsukahara, H. Morita, K. Ogura, T. Kimura, J. Shimizu, S. Fukuhara, T. Koyama, T. Kanadani and H. Shiraga. (2008). Predicting obesity in early adulthood in Japanese women. J Paediatr Child Health. 44, 33-7.

AIM: We analysed the body measurements of Japanese women to determine which factors may forecast adult obesity and also performed a comparative study of the utility of body mass index (BMI), which is used widely in Western Europe, and percentage of overweight, which is used in Japan. METHODS: Subjects included 244 Japanese women who were born between 1983 and 1986. Using a questionnaire, we investigated anthropometric values from birth to present and parents' present anthropometric data, and analysed factors that correlate with current BMI data. RESULTS: (i) BMI after 10 years of age and BMI increase between ages 7 and 8 years correlated with BMI in adulthood. The carrying over rate of overweight increased with age. Meanwhile, percentage of overweight after 13 years onwards correlated with BMI in adulthood. (ii) Adult BMI positively correlated to both parents' BMI. CONCLUSIONS: (i) For a Japanese woman, BMI in childhood is a good indicator of young adult BMI, and has the possibility of becoming an important parameter to monitor obesity progression. (ii) Therefore, attempts to control obesity in elementary school girls are necessary. (iii) Parents' weights may potentially influence obesity in adulthood; however, further examination of other confounding factors is necessary.

S. K. Kumanyika. (2008). Environmental influences on childhood obesity: Ethnic and cultural influences in context. Physiology & Behavior. 94, 61-70.

Ethnicity is associated with differences in food-related beliefs, preferences, and behaviors, and cultural influences may contribute to the higher than average risk of obesity among children and youth in U.S. ethnic minority populations. However, cultural attitudes and beliefs are not the only potential source of ethnic variation in childhood obesity prevalence and should not be studied in isolation. Demographic, socio-structural, and environmental variables must also be considered. Available evidence indicates ethnic differences along several pathways that may increase risks of obesity development during gestation, infancy, childhood and adolescence. These include above-average prevalence of obesity in adult females and of maternal diabetes during pregnancy, parental attitudes and practices that may lead to overfeeding children, above-average levels of consumption of certain high calorie foods and beverages, and inadequate physical activity. Environments with lower than average neighborhood availability of healthful foods and higher than average availability of fast food restaurants, along with exposure to ethnically targeted food marketing may contribute to reliance on high calorie foods and beverages, and these foods may be socially and culturally valued. Attitudes about and environmental contexts for physical activity are also relevant. Increasingly, it is acknowledged that individual behaviors and lifestyles, e.g. food choices or child feeding practices, are responsive to the ecological contexts in which they are practiced. Focusing attention on the fluid interactions of cultural influences with contextual factors, of recognized importance for the study of childhood undernutrition, can also lead to further understanding of how to address ethnic disparities in childhood obesity. (C) 2007 Elsevier Inc. All rights reserved.

B. Landsberg, S. Plachta-Danielzik, D. Much, M. Johannsen, D. Lange and M. J. Muller. (2008). Associations between active commuting to school, fat mass and lifestyle factors in adolescents: the Kiel Obesity Prevention Study (KOPS). European Journal Of Clinical Nutrition. 62, 739-747.

Objective: To examine possible associations between active commuting (walking or cycling) to school, parameters of adiposity and lifestyle factors in 14-year-old adolescents of the Kiel Obesity Prevention Study. Subjects: A total of 626 14-year-old adolescents. Methods: Measured body mass index (BMI), fat mass (FM), distance to school as well as self-reported modes and duration of commuting to school, time spent in structured and unstructured physical activities (PAs), media use, nutrition, alcohol consumption and smoking. Results: Parameters of adiposity did not differ between different commuting modes after stratifying by gender. Active commuters reported higher overall PA, which was caused by commuting activity and time spent in unstructured PA in girls and just by commuting activity in boys. In active commuters, 28.4% of overall PA was explained by commuting activity. Additionally, TV viewing was lower in active commuters. Compared to their inactively commuting counterparts, actively commuting boys were less likely to smoke. After controlling for potential confounders the interaction term 'active commuting by distance to school' and 'time spent in structured PA' were independent predictors of FM, whereas active commuting by itself showed no effect. Conclusion: The present data suggest that active commuting to school per se does not affect FM or BMI until considering distance to school. Increasing walking or cycling distance results in decreasing FM. However, the everyday need to get to and from school may enhance adolescents' overall PA.

K. L. Larson and C. McQuiston. (2008). Walking out of one culture into another: health concerns of early adolescent Latinos. J Sch Nurs. 24, 88-94.

Adolescence is considered a critical life transition that can lead to heightened vulnerability. Acculturation takes on increased importance during this period. The purpose of this study was to explore the relationship between acculturation and perceived health concerns of early adolescent Latinos in rural North Carolina. A qualitative descriptive design using gender-specific focus groups was conducted in the summer of 2001. Twenty-six Latino adolescents, predominantly from Mexico, participated in one of four focus groups. Acculturation was assessed using the Short Acculturation Scale (Marin & Marin, 1991). The most prevalent health concern of the girls was unsolicited physical contact and aggressive male behavior. Boys expressed concerns about stress related to financial worries and drinking alcohol. A better understanding of where Latino adolescents are located in the acculturation process can assist school nurses in developing targeted school-based prevention programs that focus on building specific skills for Latino girls and boys.

K. Laurson, J. C. Eisenmann and S. Moore. (2008). Lack of association between television viewing, soft drinks, physical activity and body mass index in children. Acta Paediatrica. 97, 795-800.

Objective: To examine the cross-sectional and longitudinal associations of physical activity, screen time and dietary habits on the body mass index (BMI) of children. Methods: A cohort of 122 girls and 146 boys (age at entry 10 years) from three rural states in the western USA was studied over an 18-month period. Subjects were measured for height and weight. Habitual physical activity, screen time (television viewing, video games and computer use) and dietary variables were assessed by a questionnaire. Cross-sectional and longitudinal analyses were conducted to examine the associations between physical activity, screen time and diet with BMI at baseline and follow-up and change in BMI. Results: At baseline, approximately 10% of boys and girls were obese and 17.8% of boys and 14.8% of girls were overweight. BMI showed a high degree of stability for boys and girls (r = 0.90), whereas physical activity, screen time and dietary habits showed moderate stability (r = 0.31-0.50) across the 18-month period. Cross-sectional and longitudinal correlations between physical activity, screen time, diet and BMI were low and non-significant (r < 0.15). The regression models explained between 8% and 22% of the variance in the change in BMI; however, none of the predictor variables were statistically significant. Conclusion: Physical activity, screen time and dietary habits were not significantly related to the BMI in cross-sectional or longitudinal analyses. Further research is warranted to better understand the complex, multifactorial phenotype of the BMI in growing and maturing children.

S. A. Lee, W. Q. Wen, W. H. Xu, W. Zheng, H. L. Li, G. Yang, Y. B. Xiang and X. O. Shu. (2008). Prevalence of obesity and correlations with lifestyle and dietary factors in Chinese men. Obesity. 16, 1440-1447.

Objective: To estimate the age-adjusted prevalence of general and centralized obesity among Chinese men living in urban Shanghai. Methods and Procedures: A cross-sectional study was conducted in 61,582 Chinese men aged 40-75. BMI (kg/m(2)) was used to measure overweight (23 <= BMI < 27.4) and obesity (BMI >= 27.5) based on the World Health Organization (WHO) recommended criteria for Asians. Waist-to-hip ratio (WHR) was used to measure moderate (75th <= WHR < 90th percentile) and severe (WHR >= 90th percentile) centralized obesity. Results: The average MI and WHR were 23.7 kg/m(2) and 0.90, respectively. The prevalence of overweight was 48.6% and obesity was 10.5%. The prevalence of general and centralized obesity was higher in men with high income or who were retired, tea drinkers, or nonusers of ginseng than their counterparts. Men with high education had a higher prevalence of overweight and centralized obesity, but had a lower prevalence of obesity and severe centralized obesity compared to those with less education. Current smokers or alcohol drinkers had a lower prevalence of general obesity but higher prevalence of centralized obesity than nonsmokers or nondrinkers of alcohol. Ex-smokers and ex-alcohol drinkers had a higher prevalence of general and centralized obesity compared to nonsmokers and nondrinkers of alcohol. Prevalence of obesity was associated with high energy intake and less daily physical activity. Discussion: The prevalence of obesity among Chinese men in urban Shanghai was lower than that observed in Western countries but higher than that in other Asian countries, and the prevalence of general and centralized obesity differed by demographic, lifestyle, and dietary factors.

N. Leigh-Hunt and M. Rudolf. (2008). A review of local practice regarding investigations in children attending obesity clinics and a comparison of the results with other studies. Child Care Health Dev. 34, 55-8.

BACKGROUND: Obese children are at high risk of developing co-morbidities, with a prevalence of abnormal tests ranging from 30 to 58%. Recent guidance recommends that all children with a body mass index (BMI) above the 95th centile be investigated. This study aimed to determine the prevalence of abnormal results in an urban paediatric population and to compare local practice against these recommendations. METHODS: Patient records of children attending either a community or hospital-based obesity clinic were analysed retrospectively to obtain anthropometric data and laboratory results; from this, the frequency of investigation and the prevalence of abnormal results were calculated. Investigations considered were alanine aminotransferase, thyroid-stimulating hormone (TSH), and fasting glucose, insulin and lipid profiles. RESULTS: One hundred thirty-six children (75 girls, 61 boys) were identified, with mean BMI z-score of 3.27 and mean age of 11.4 years (range 1.4-20.4). Children with BMI z-score >3 were more likely to be investigated, but otherwise, the frequency was similar for both sex and age. The prevalence of abnormal results was liver function tests, 14.3%; TSH, 0.0%; glucose, 0.0%; insulin, 31.6%; triglycerides, 10.0%; cholesterol, 15.6%. The sample size was small, but there did not appear to be a significant difference in the percentage abnormal results found for sex, age, or BMI z-score. CONCLUSION: The prevalence of abnormal results was less than that identified in another UK study carried out in a tertiary centre, suggesting that the true population-based prevalence is lower than believed. This might be especially so because fewer tests were performed in these clinics than currently recommended and children at highest risk were more likely to be investigated. Therefore, further research is indicated to determine the true figure as well as to identify risk factors for co-morbidity, before costly recommendations to test all children with a BMI above the 95th centile are implemented.

R. S. Levine, R. G. Feltbower, A. M. Connor, M. Robinson and M. C. J. Rudolf. (2008). Monitoring trends in childhood obesity: A simple school-based model. Public Health. 122, 255-260.

Background: The UK Government has set a target of halting the rise in childhood obesity by 2010. However, at the time the target was set, no monitoring process existed. The English Department of Health has now issued guidelines to primary care trusts for the annual weighing and measuring of all children on entry to primary school and in year 6. Aim: Development of an inexpensive school-based monitoring scheme for trends in childhood obesity suitable for national implementation. Method: The methodology was developed in 10 pilot schools in 2004 and implemented in 25 primary schools and three secondary schools in 2005. Specialty trained healthcare support workers (HCSWs) recorded height and weight measurements of primary school children in reception and year 4, and secondary school children in year 8 (aged 5, 8 and 13 years, respectively, on average). The ethnic and socio-economic profile of the sample was compared with census data, and the levels of obesity were calculated using standard age cut-offs. Results: While monitoring in primary schools was achieved with no evidence of disruption to the schools or distress to the subjects, monitoring in secondary schools was deemed to be impractical. Cost analysis indicated an estimated cost of less than (sic)1.50 per primary school child measured. Conclusions: The model provides a viable means of monitoring childhood obesity trends. Monitoring should be confined to primary schools and should be conducted by specially trained HCSWs rather than school nurses. (C) 2007 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.

Y. Li, X. Yang, F. Zhai, J. Piao, W. Zhao, J. Zhang and G. Ma. (2008). Childhood obesity and its health consequence in China. Obes Rev. 9 Suppl 1, 82-6.

Analyses of data from the representative 2002 National Nutrition and Health Survey were used to assess the likelihood of metabolic complications of overweight and obesity in Chinese children aged 7-17 years. Chinese criteria for body mass index classification were used for overweight and obesity with the 75th percentile US adolescent values for waist circumferences and all the metabolic criteria for blood pressure, lipids, fasting glucose established for US adolescents. Diabetes in 7-12-year-olds was 0.2% and 0.4% in children aged 12-18 years. Prevalences of dyslipidaemia (61.9%), hypertriglyceridaemia (18.2%) and low high-density lipoprotein cholesterol (56.1%) were high and 16.0% of 15-18 years had hypertension. The overall prevalence of the metabolic syndrome was 3.3% with more than half the children having at least one metabolic abnormality and 19.8% having at least two. All the metabolic parameters were significantly elevated in the overweight and obese children except high-density lipoprotein cholesterol. These data emphasize the marked sensitivity of Chinese children to the metabolic complications of overweight and obesity and amplify the need for early preventive measures.

C. A. Loucaides and R. Jago. (2008). Differences in physical activity by gender, weight status and travel mode to school in Cypriot children. Preventive Medicine. 47, 107-111.

Objective. More information about children's physical activity during different periods of the day is needed. The purpose of this study was to describe children's physical activity during the segmented school day and examine potential differences during different periods of the day across gender, travel mode to school and weight status. Methods. School children (N=247) wore pedometers for four consecutive school days and recorded their steps during the before school period, the 20-min school break, the whole school period, the after school period and for the whole day. Children also reported how they traveled to school. Data were collected in Cyprus, in January/February of 2007. Results. T-tests indicated that boys took significantly higher steps than girls throughout all the segments of the day (p<0.001) and children who walked to school exhibited higher step counts during the before school period (p<0.001), the after school period (p<0.01), and the whole day (p<0.01) in comparison to children who used motorized transport. A three-way ANOVA revealed significant two-way interactions between weight status and travel mode to school. Conclusion. Results suggest that there is a need to promote physical activity among children, especially among girls. Promoting active transport to school may further enhance the effectiveness of intervention programs. (C) 2008 Elsevier Inc. All rights reserved.

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