Bright Start: Description and Main Outcomes From a Group‐Randomized Obesity Prevention Trial in American Indian Children

The aim of the Bright Start study was to develop and test the effectiveness of a school environment intervention, supplemented with family involvement, to reduce excessive weight gain by increasing physical activity and healthy eating practices among kindergarten and first‐grade American Indian children. Bright Start was a group‐randomized, school‐based trial involving 454 children attending 14 schools on the Pine Ridge Reservation in South Dakota. Children were followed from the beginning of their kindergarten year through the end of first grade. Main outcome variables were mean BMI, mean percent body fat, and prevalence of overweight/obese children. The goals of the intervention were to: increase physical activity at school to at least 60 min/day; modify school meals and snacks; and involve families in making behavioral and environmental changes at home. At baseline, 32% of boys and 25% of girls were overweight/obese. Although the intervention was not associated with statistically significant change in mean levels of BMI, BMI‐Z, skinfolds or percentage body fat, the intervention was associated with a statistically significant net decrease of 10% in the prevalence of overweight. Intervention children experienced a 13.4% incidence of overweight, whereas the control children experienced a corresponding incidence of 24.8%; a difference of ?11.4% (P = 0.033). The intervention significantly reduced parent‐reported mean child intakes of sugar‐sweetened beverages, whole milk, and chocolate milk. Changes in duration of school physical activity were not significant. Because obesity is the most daunting health challenge facing American Indian children today, more intervention research is needed to identify effective approaches.     

Effects of a School‐based Weight Maintenance Program for Mexican‐American Children: Results at 2 Years

The prevalence of childhood overweight has increased significantly, with the highest rates noted among Mexican Americans. Many negative health outcomes are associated with overweight; thus, there is a need for effective weight‐loss interventions tailored to this group. This study evaluated 24‐month outcomes of a randomized, controlled trial involving an intensive lifestyle‐based weight maintenance program targeting overweight Mexican‐American children at a charter school in Houston, Texas. A total of 60 children (33 males, 55%) between the ages of 10 and 14 at or >85th percentile for BMI were recruited. Participants were randomized to an instructor‐led intervention (ILI) or a self‐help (SH) program, both aimed at modifying eating and physical activity behaviors using behavior modification strategies. Changes in participants' standardized BMI (zBMI) were assessed at baseline, 1, and 2 years. Tricep skinfold, total cholesterol, triglycerides, high‐density lipoprotein cholesterol, and calculated low‐density lipoprotein were assessed at baseline and 1 year. ILI participants showed significantly greater decreases in zBMI at 1 and 2 years (F = 26.8, P < 0.001, F = 4.1, P < 0.05, respectively) compared to SH controls. ILI participants showed greater improvements in body composition, as measured by tricep skinfold (F = 9.75, P < 0.01). Children in the ILI condition experienced benefits with respect to total cholesterol (F = 7.19, P < 0.05) and triglycerides (F = 4.35, P < 0.05) compared to children in the SH condition. Overall, the school‐based intervention resulted in improved weight and clinical outcomes in overweight Mexican‐American children, and zBMI was maintained over 2 years.     

Active transportation to school over 2 years in relation to weight status and physical activity

Objective: To prospectively examine potential benefits of active commuting to school on measures of weight status and physical activity in a sample of youth. Research Methods and Procedures: A cohort of students from seven elementary schools was measured four times—in the fall and spring of fourth grade (N = 1083) and fifth grade (N = 924). Participants were classified as active (walking, biking, or skateboarding to school almost every day for baseline analyses or at least 2 d/wk for analyses of consistent active commuting) or non‐active commuters to school. Accelerometers were used to measure physical activity. Height, weight, and skinfolds were objectively assessed. Results: Boys who actively commuted to school had lower BMI (p < 0.01) and skinfolds (p < 0.05) than non‐active commuters to school in the fourth grade. Active commuting to school over 2 years was not associated with BMI change or overweight status. Discussion: Walking and cycling to school may contribute to preventing excessive weight gain, or leaner children may walk or cycle to school.     

An Environmental Approach to Obesity Prevention in Children: Medical College of Georgia FitKid Project Year 1 Results

Objective: To test the hypothesis that third grade children (mean age = 8.7, SD = 0.5) who attended an 8‐month after‐school program would exhibit favorable changes in body composition, cardiovascular fitness, blood pressure, total cholesterol, and high‐density lipoprotein‐cholesterol compared with children in control condition. Research Methods and Procedures: Subjects were 61% African‐American, 31% white, and 8% other racial background from 18 public schools. Sixty‐eight percent were eligible for free or reduced price lunch. Percentage body fat and bone mineral density were assessed by DXA, cardiovascular fitness by heart rate response to a step test, resting blood pressure with a Dinamap, and non‐fasting total cholesterol and high‐density lipoprotein‐cholesterol by finger stick. Data pre‐ and post‐intervention were available for 447 children. Children in the nine intervention schools who attended at least 40% of the after‐school sessions were compared with control subjects. Results: Compared with the control subjects and after controlling for race, sex, free/reduced price lunch status, and school‐level covariates, youths in the intervention group showed a relative reduction of percentage body fat [?0.76 (95% confidence interval (CI), ?1.42, ?0.09)], a greater relative gain in bone mineral density [0.008 (95% CI, 0.001, 0.005)], and a greater relative reduction in heart rate response to the step test [?4.4 (95% CI, ?8.2, 0.6)]. The other outcome variables showed non‐significant trends in favor of the intervention subjects. Discussion: These results are promising in light of the potential impact on the emerging childhood obesity epidemic. The Medical College of Georgia FitKid Project has the potential to be institutionalized because it is built on the existing infrastructure in most public schools in the U.S.     

A community intervention reduces BMI z-score in children: Shape Up Somerville first year results

Objective: The objective was to test the hypothesis that a community‐based environmental change intervention could prevent weight gain in young children (7.6 ± 1.0 years). Research Methods and Procedures: A non‐randomized controlled trial was conducted in three culturally diverse urban cities in Massachusetts. Somerville was the intervention community; two socio‐demographically‐matched cities were control communities. Children (n = 1178) in grades 1 to 3 attending public elementary schools participated in an intervention designed to bring the energy equation into balance by increasing physical activity options and availability of healthful foods within the before‐, during‐, after‐school, home, and community environments. Many groups and individuals within the community (including children, parents, teachers, school food service providers, city departments, policy makers, healthcare providers, before‐ and after‐school programs, restaurants, and the media) were engaged in the intervention. The main outcome measure was change in BMI z‐score. Results: At baseline, 44% (n = 385), 36% (n = 561), and 43% (n = 232) of children were above the 85th percentile for BMI z‐score in the intervention and the two control communities, respectively. In the intervention community, BMI z‐score decreased by ?0.1005 (p = 0.001, 95% confidence interval, ?0.1151 to ?0.0859) compared with children in the control communities after controlling for baseline covariates. Discussion: A community‐based environmental change intervention decreased BMI z‐score in children at high risk for obesity. These results are significant given the obesigenic environmental backdrop against which the intervention occurred. This model demonstrates promise for communities throughout the country confronted with escalating childhood obesity rates.     

Four-year follow-up of school-based intervention on overweight children: the KOPS study

Objective: To evaluate the 4‐year outcome of a school‐based health promotion on weight status as part of the Kiel Obesity Prevention Study (KOPS). Research Methods and Procedures: Within a cluster‐sampled quasi‐randomized controlled trial, 1764 children at 6 and 10 years of age were assessed between 1996 and 2005 in 32 primary schools in Kiel, North Germany. Six nutrition units followed by 20‐minute running games were performed within the first year at school. Prevalence, incidence, and remission of overweight were main outcome measures. Results: The 4‐year change in BMI was +11.6%, with increases in prevalence of overweight and obesity from 5.2% to 11.1% and 3.9% to 5.1%, respectively. Cumulative 4‐year incidence of overweight and obesity was 9.2% and 3.1%, respectively. Intervention had no effect on mean BMI. The effect on prevalence was significant in children from families with high socioeconomic status [odds ratio (OR), 0.35; 95% confidence interval (CI), 0.14 to 0.91] and marginally significant in children of normal‐weight mothers (OR, 0.57; 95% CI, 0.33 to 1.00). Cumulative 4‐year incidence of overweight was lower only in intervention children from families with high socioeconomic status (OR, 0.26; 95% CI, 0.07 to 0.87). Remission of overweight was most pronounced in children of normal‐weight mothers (OR, 5.43; 95% CI, 1.28 to 23.01). Prevalence of underweight was unchanged. The intervention had minor but favorable effects on lifestyle. Discussion: A school‐based health promotion has sustainable effects on remission and incidence of overweight; it was most pronounced in children of normal‐weight mothers and children from families with high socioeconomic status. There was no effect on obesity. The data argue in favor of additional measures of prevention.     

Child Overweight,Associated Psychopathology,and Social Functioning: A French School‐based Survey in 6‐ to 11‐year‐old Children

The aim of this study was to estimate the prevalence of child overweight in a regional sample of primary school‐aged children, and to examine the relationships among child overweight, psychopathology, and social functioning. A cross‐sectional survey was conducted in 2004 in 100 primary schools of a large French region, with 2,341 children aged 6–11 randomly selected. Child weight and height, lifestyle variables (leisure‐time physical activity (LTPA), watching television (TV), playing video games), and socioeconomic characteristics were collected in parent‐administered questionnaires. Child psychopathology outcomes were assessed using child‐ and parent‐reported instruments (Dominic Interactive (DI) and Strengths and Difficulties Questionnaire (SDQ)). Overweight and obesity were estimated according to the International Obesity Task Force (IOTF) definition. Response rates to the parent questionnaire and DI were 57.4 and 95.1%, respectively. Final sample size was 1,030 children. According to the IOTF, 17.3% of the children were overweight, of whom 3.3% were obese. In univariate analysis, correlates of overweight were low parental education, low monthly income, Disadvantaged School Areas (DSAs), self‐reported generalized anxiety, parent‐reported conduct disorders, emotional problems, and peer difficulties. High monthly income was less frequently associated with overweight. In multivariate analysis, parent‐reported peer difficulties (odds ratio (OR) = 2.06; 95% confidence interval = 1.27–3.35) and DSAs (1.88; 1.03–3.44) were independent factors significantly associated with child overweight. There was a trend of being overweight with elevated TV times (P for trend = 0.02). The psychosocial burden of excess weight appears to be significant even in young children. Findings should be considered for preventing strategies and public health interventions. School‐based overweight prevention programs should be implemented first in disadvantaged areas together with information about weight stigmatization and discrimination.     

Childhood Obesity Prevention: An Intervention Targeting Primary Caregivers of School Children

Community‐based participatory research (CBPR) was used to design and evaluate the effectiveness of a culturally relevant, science‐based intervention for the prevention of childhood obesity in the Commonwealth of the Northern Mariana Islands (CNMI), a US Commonwealth in the western Pacific. This cognitive behavioral lifestyle intervention, Project Familia Giya Marianas (PFGM), was offered during the 2005–2007 school years in all CNMI public elementary schools over eight sessions to primary caregivers of 3rd grade children (N = 407). A crossover design was utilized with half of the schools offering the intervention in the Fall term, while the other half delivered the sessions in the Spring term. The primary outcome measure was change in BMI z‐score. There was an intervention‐dependent effect on BMI z‐score, with program impact being a function of baseline BMI and the number of lessons attended. This effect was most apparent in students whose baseline BMI z‐score was in healthy range (≥5 to <85 percentile). In both Asian and Pacific Island groups, children whose caregivers completed 5–8 lessons experienced a significant change in BMI z‐score as compared to those with 0 lessons (P < 0.05). Research that integrates multidisciplinary and multimethod approaches is effective in identifying and/or devising solutions to address a complex condition such as childhood obesity. PFGM demonstrated that community participation can be successfully utilized in the development and implementation of childhood obesity prevention programs.     

A family-based approach to preventing excessive weight gain

Objective: Preventing weight gain in adults and excessive weight gain in children is a high priority. We evaluated the ability of a family‐based program aimed at increasing steps and cereal consumption (for breakfast and snacks) to reduce weight gain in children and adults. Research Methods and Procedures: Families (n = 105) with at least one 8‐ to 12‐year‐old child who was at‐risk‐for‐overweight or overweight (designated as the target child) were recruited for the study. Eighty‐two families were randomly assigned to receive the family‐based intervention and 23 families to the control condition. The 13‐week intervention consisted of specific increases in daily steps (an additional 2000 steps/d) and consumption of 2 servings/d of ready‐to‐eat cereal. Results: The intervention was successful in increasing walking (steps) and cereal consumption. The intervention had positive, significant effects on percentage BMI‐for‐age and percentage body fat for target children and weight, BMI, and percentage body fat for parents. On further analysis, the positive effects of the intervention were seen largely in target girls and moms, rather than in target boys and dads. Discussion: This family‐based weight gain prevention program based on small changes holds promise for reducing excessive weight gain in families and especially in growing overweight children.     

Eleven‐year Prevalence Trends of Obesity in Greek Children: First Evidence that Prevalence of Obesity Is Leveling Off

We examined 11‐year (1997–2007) trends in underweight, overweight, and obesity in Greek children. Population data derived from a yearly, school‐based health survey carried out between 1997 and 2007 in >80% of all Greek schools. Height and weight measurements from 651,582 children, aged 8–9 years (boys: 51.2%) were analyzed. The gender‐ and age‐specific BMI cutoff points by the International Obesity Task Force (IOTF) were used in order to define underweight, normal weight, overweight, and obesity. Trend analysis showed an increase in the prevalence of obesity from 7.2 ± 0.2% in 1997 to 11.3 ± 0.2% in 2004 for girls (P < 0.001) and from 8.1 ± 0.2% in 1997 to 12.3 ± 0.2% in 2004 for boys (P < 0.001). An apparent leveling off in obesity rates was observed during 2004–2007 for both boys and girls. The prevalence of overweight rose between 1997 and 2007 from 20.2 ± 0.2% to 26.7 ± 0.2% for girls (P < 0.001) and from 19.6 ± 0.2% to 26.5 ± 0.2% for boys (P < 0.001). The overall prevalence of thinness in the same period remained constant in both sexes. The presented population‐based data revealed that the prevalence of overweight and obesity among 8‐ to 9‐year‐old Greek children is alarmingly elevated, with the overweight rates rising continuously. However, an apparent leveling off in obesity rates for the past 4 consecutive years was documented for the first time in both genders.     

Children at High Risk for Overweight: A Classification and Regression Trees Analysis Approach

Objective: Early identification of children at high risk for childhood overweight is a major challenge in fighting the obesity epidemic. We tried to identify the most powerful set of combined predictors for childhood overweight at school entry. Research Methods and Procedures: A classification and regression trees analysis on risk factors for childhood overweight in 4289 children 5 to 6 years of age participating in the obligatory school entry health examination 2001/2002 in Bavaria, Germany, was performed. Parental questionnaires asked for children's weight at birth and 2 years, breastfeeding history, maternal smoking in pregnancy, parental education, parental overweight/obesity, nationality, and number of older siblings. Overweight was defined according to sex‐ and age‐specific BMI cut‐points proposed by the International Obesity Task Force. Results: Prevalence of overweight was 11% among the entire study population. Although high early weight gain >10, 000 grams was found in about one‐half of the overweight children, its positive predictive value reached only 25%, indicating that one of four children with a high early weight gain is overweight at school entry. The best reliable set of predictors included high early weight gain and obese parents and accounted for a likelihood ratio of 3.6, with a corresponding positive predictive value of 40%, and was found in 4% of all children. Discussion: A combination of predictors available at 2 years of age could improve predictability of overweight at school entry. However, corresponding low positive predictive values indicate a precision of the prediction that might be insufficient for targeting intervention programs for identified high‐risk children.     

Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial

Objective To determine if a school based educational programme aimed at reducing consumption of carbonated drinks can prevent excessive weight gain in children.Design Cluster randomised controlled trial.Setting Six primary schools in southwest England.Participants 644 children aged 7-11 years.Intervention Focused educational programme on nutrition over one school year.Main outcome measures Drink consumption and number of overweight and obese children.Results Consumption of carbonated drinks over three days decreased by 0.6 glasses (average glass size 250 ml) in the intervention group but increased by 0.2 glasses in the control group (mean difference 0.7, 95% confidence interval 0.1 to 1.3). At 12 months the percentage of overweight and obese children increased in the control group by 7.5%, compared with a decrease in the intervention group of 0.2% (mean difference 7.7%, 2.2% to 13.1%).Conclusion A targeted, school based education programme produced a modest reduction in the number of carbonated drinks consumed, which was associated with a reduction in the number of overweight and obese children.     

Aerobic exercise and snoring in overweight children: a randomized controlled trial

Objective: To determine whether regular aerobic exercise improves symptoms of sleep‐disordered breathing in overweight children, as has been shown in adults. Research Methods and Procedures: Healthy but overweight (BMI ≥85th percentile) 7‐ to 11‐year‐old children were recruited from public schools for a randomized controlled trial of exercise effects on diabetes risk. One hundred children (53% black, 41% male) were randomly assigned to a control group (n = 27), a low‐dose exercise group (n = 36), or a high‐dose exercise group (n = 37). Exercise groups underwent a 13 ± 1.5 week after‐school program that provided 20 or 40 minutes per day of aerobic exercise (average heart rate = 164 beats per minute). Group changes were compared on BMI z‐score and four Pediatric Sleep Questionnaire scales: Snoring, Sleepiness, Behavior, and a summary scale, Sleep‐Related Breathing Disorders. Analyses were adjusted for age. Results: Both the high‐dose and low‐dose exercise groups improved more than the control group on the Snoring scale. The high‐dose exercise group improved more than the low‐dose exercise and control groups on the summary scale. No group differences were found for changes on Sleepiness, Behavior, or BMI z‐score. At baseline, 25% screened positive for sleep‐disordered breathing; half improved to a negative screen after intervention. Discussion: Regular vigorous exercise can improve snoring, a symptom of sleep‐disordered breathing, in overweight children. Aerobic exercise programs may be valuable for prevention and treatment of sleep‐disordered breathing in overweight children.     

Impact of Information About Obesity Genomics on the Stigmatization of Overweight Individuals: An Experimental Study

Advances in genomic technologies are rapidly leading to new understandings of the roles that genetic variations play in obesity. Increasing public dissemination of information regarding the role of genetics in obesity could have beneficial, harmful, or neutral effects on the stigmatization of obese individuals. This study used an online survey and experimental design to examine the impact of genetic versus non‐genetic information on obesity stigma among self‐perceived non‐overweight individuals. Participants (n = 396) were randomly assigned to read either genetic, non‐genetic (environment), or gene—environment interaction obesity causal information. A total of 48% of participants were female; mean age was 42.7 years (range = 18–86 years); 75% were white; 45.2% had an annual household income of less than $40,000; mean BMI was 23.4 kg/m². Obesity stigma was measured using the Fat Phobia Scale — short form (FPS‐S). After reading the experimental information, participants in the genetic and gene—environment conditions were more likely to believe that genetics increase obesity risk than participants in the non‐genetic condition (both P < 0.05), but did not differ on obesity stigma. Obesity stigma was higher among whites and Asians than Hispanics and African Americans (P = 0.029), and associated with low self‐esteem (P = 0.036). Obesity stigma was also negatively associated with holding 'germ or virus' (P = 0.033) and 'overwork' (P = 0.016) causal beliefs about obesity, and positively associated with 'diet or eating habits' (P = 0.001) and 'lack of exercise' (P = 0.004) causal beliefs. Dissemination of brief information about the role of genetics in obesity may have neither a beneficial nor a harmful impact on obesity stigmatization compared with non‐genetic information among self‐perceived non‐overweight individuals.     

The Microbiota of the Gut in Preschool Children With Normal and Excessive Body Weight

The aim of this study was to investigate the gut microbiota in preschool children with and without overweight and obesity. Twenty overweight or obese children and twenty children with BMI within the normal range (age: 4–5 years) were recruited from the south of Sweden. The gut microbiota was accessed by quantitative PCR (qPCR) and terminal restriction fragment length polymorphism and calprotectin was measured in feces. Liver enzymes were quantified in obese/overweight children. The concentration of the gram‐negative family Enterobacteriaceae was significantly higher in the obese/overweight children (P = 0.036), whereas levels of Desulfovibrio and Akkermansia muciniphila‐like bacteria were significantly lower in the obese/overweight children (P = 0.027 and P = 0.030, respectively). No significant differences were found in content of Lactobacillus, Bifidobacterium or the Bacteroides fragilis group. The diversity of the dominating bacterial community tended to be less diverse in the obese/overweight group, but the difference was not statistically significant. Concentration of Bifidobacterium was inversely correlated to alanine aminotransferase (ALT) in obese/overweight children. The fecal levels of calprotectin did not differ between the study groups. These findings indicate that the gut microbiota differed among preschool children with obesity/overweight compared with children with BMI within the normal range.     

Weight Loss Attempts and Attitudes toward Body Size,Eating, and Physical Activity in American Indian Children: Relationship to Weight Status and Gender

Objective: This study examined dieting, weight perceptions, and self‐efficacy to eat healthy foods and engage in physical activity and their relationships to weight status and gender among American Indian elementary schoolchildren. Research Methods and Procedures: Data for this study were collected as part of the baseline examination for the Pathways study. Participants were 1441 second‐ through third‐grade American Indian children in 41 schools representing seven tribes in Arizona, New Mexico, and South Dakota who filled out a questionnaire and had heights and weights taken. Results: Forty‐two percent of the children were overweight or obese. No differences were found between overweight/obese and normal weight children for healthy food intentions or self‐efficacy. Heavier children (especially those with body mass index > 95th percentile) were more likely to have tried to lose weight or were currently trying to lose weight. No gender differences were found. Normal weight children chose a slightly heavier body size as most healthy compared with overweight/obese children. Discussion: The results indicate that children are concerned about their weight and that weight modification efforts are common among overweight American Indian children. School, community, and family‐based programs are needed to help young people adopt lifelong healthful eating and physical activity practices.     

Assessment of obesity stigmatization in children and adolescents: modernizing a standard measure

Objective: Stigmatization of overweight children is highly prevalent. However, the measurement of stigma has varied widely across studies. An up‐to‐date version of a commonly used measure of weight‐related stigma is needed. Research Methods and Procedures: Poser 5 (DAZ software) was used to develop 12 modernized figures, using three‐dimensional models rendered as high‐resolution images. They depicted one overweight, one non‐overweight, and four disabled children of each sex. Children recruited from public and private schools (N = 261; mean age, 11.3 years; median BMI z‐score = 0.33; 77.0% white, 11.5% Asian, and 7.7% Maori) ranked these figures in order of liking. Participants also ranked traditionally used line drawings depicting comparable images. Participants rated each new figure on measures of liking and stereotypical attributes on 100‐mm visual analog scales (VASs). Results: Rankings of liking of the new figures were highly correlated with rankings of corresponding old figures, especially for overweight figures [boys: ρ (77) = 0.72, p < 0.001; girls: ρ (153) = 0.68, p < 0.001]. Rankings of overweight and other figures were also highly correlated with VAS assessment of liking and with a composite, internally consistent VAS measure of liking and stereotypical attributes. Only negative stereotypes about the intelligence of overweight boys and girls contributed significantly to the variance in liking. Discussion: An updated and modernized tool for assessing children's weight stigma was developed and its construct validity supported. The present findings suggest that stereotypes about low intelligence may contribute to weight stigma among children. More research is needed on the causes and components of weight stigma so that it can be effectively reduced.     

Sleep patterns and sleep problems among Egyptian school children living in urban,suburban, and rural areas

The present study was conducted to determine the prevalence of sleep patterns and sleep problems among Egyptian school-aged children and to compare sleep patterns and sleep problems among school children from urban, suburban, and rural areas. In this cross-sectional survey, parents of 629 school-aged children, aged 6 to 10 years, from 15 elementary schools in five rural, urban, and suburban areas in the Giza governorate, Egypt, completed the Arabic version of the Children’s Sleep Habits Questionnaire (CSHQ) and questions about parents’ level of education and significant medical problems and/or medication for the child. The mean (SD) of total sleep duration for all children was 8.96 h (SD, 1.20). The most prevalent CSHQ subscales were: bedtime resistance, daytime sleepiness, and night wakings. There were significant differences regarding bedtime (P= 0.006) and night-time sleep duration (P < 0.001) among school children from different areas, but there were no significant differences regarding wake-up time, total sleep duration, duration of nap, and the eight CSHQ subscale scores. The percentage of children who took a daytime nap was 52.9% (n= 184) and the mean (SD) duration of a nap was 1.5 h (SD, 0.92). Paternal illiteracy was associated with higher CSHQ total score and many subscales. In conclusion, sleep duration was shorter than that reported in previous studies. Sleep problems are fairly common among elementary school children in the Giza governorate, whether in urban, suburban, or rural areas. Paternal level of education has an impact on the prevalence of sleep problems.

     

Energy intake, diet composition, energy expenditure, and body fatness of adolescents in northern Greece

Objective: The purpose of this study was to examine energy intake, energy expenditure, diet composition, and obesity of adolescents in Northern Greece. Research Methods and Procedures: Anthropometric measurements were taken for all participants. Height, weight, and skinfold thickness at two sites were measured. BMI and percentage body fat were calculated. Energy intake and macronutrient and micronutrient intakes were determined by a 3‐day weighed dietary diary. Energy expenditure was calculated based on calculated resting metabolic rate (RMR) 1 multiplied by an activity factor based on reported physical activity. Results: Thirty‐one percent of boys and 21% of girls had BMI corresponding to ≥25 kg/m² at 18 years and were classified as overweight. Both overweight boys and girls reported a lower energy intake compared with their non‐overweight counterparts when expressed as kilocalories per kilogram body weight. Overweight children had a higher negative energy balance. Both overweight and non‐overweight adolescents had higher than recommended fat intakes. Mean daily carbohydrate, protein, and fat intake, expressed as grams per kilogram body weight, of overweight adolescents were significantly lower compared with the non‐overweight adolescents. Total daily carbohydrate intake, when expressed in grams, was found to be higher for non‐overweight adolescents. Both overweight boys and girls had lower iron intakes than their non‐overweight counterparts. Overweight boys had statistically lower fiber and niacin intakes than non‐overweight boys. Both overweight and non‐overweight adolescents had lower than recommended iron intakes. Furthermore, overweight adolescents consumed more snacks (potato chips, chocolate bars, pizza, cheese pie, and cream pie), more sugar, jam, and honey, and fewer legumes, vegetables, and fruits than their non‐overweight counterparts. Discussion: Reported energy intake of overweight adolescents was lower than their non‐overweight counterparts. Regarding diet composition overweight subjects had significantly lower intakes of carbohydrates compared with non‐overweight subjects. The food consumption pattern of overweight children showed less adherence to the traditional Mediterranean diet.     

Soda consumption and overweight status of 2-year-old mexican-american children in california

Objective: The prevalence of overweight in United States children, 2 to 5 years old, has increased 2‐fold since 1975, with the highest prevalence in Mexican Americans. The objective of this study was to determine the association between current soda consumption and overweight in 2‐year‐old Mexican‐American children. Research Methods and Procedures: The Center for the Health Assessment of Mothers and Children of Salinas study is a longitudinal study of the health of low‐income Latino pregnant women and their children living in the Salinas Valley, CA. Six hundred pregnant women were enrolled (October 1999 to October 2000), and their children were followed until 2 years of age. This cross‐sectional analysis includes the 354 children who completed the 2‐year follow‐up interview. Standing height (centimeters) and weight (grams) were measured at 2 years. Overweight was defined as ≥95th percentile of the sex‐specific BMI for each child's age. Results: Fifty‐five (15.5%) children were overweight. Over half (56%) reported consuming any soda in the last week. After covariate adjustment, compared with no soda consumption, <1 soda/d was not related to overweight (adjusted odds ratio, 0.97; 95% confidence interval, 0.47, 1.99), but ≥1 soda/d was significantly associated with overweight (adjusted odds ratio, 3.39; 95% confidence interval, 1.43, 8.07), and the test for trend was significant (p = 0.02). Discussion: At 2 years of age, the prevalence of overweight among the Center for the Health Assessment of Mothers and Children of Salinas cohort is higher than the national prevalence estimate for Mexican‐American 2‐ to 5‐year‐old children and is significantly associated with current soda consumption. Interventions to reduce consumption of soda in young Mexican‐American children should be considered.