Regionalne i sociodemografske odrednice učestalosti prekomjerne tjelesne mase i debljine u djece u dobi od 7-9 godina u Hrvatskoj

The aim of this study was to determine the prevalence and analyze the determinants of overweight and obesity among Croatian schoolchildren aged 7-9 years in relation to sociodemographic factors. This study used data that were gathered as part of the WHO Europe Childhood Obesity Surveillance Initiative in 2015/2016. The sample for the study was nationally representative. Anthropometric measurements of 5591 children, 2811 boys and 2780 girls, were collected during 8 weeks using standardized equipment. Studied variables included child’s anthropometric measurements and demographics, maternal education and employment status. The results showed a 35.9% prevalence of overweight and obesity in Croatian 7-9-year-old children. Overweight and obesity were more frequent in boys in comparison to girls, especially among boys from the Adriatic region (42.1%). The risk of overweight and obesity was increased in boys living in the Adriatic region (ORadj=1.33; 95% CI 1.03-1.71) and in girls with high-school educated mothers (ORadj=1.36; 95% CI 1.11-1.66). Girls with unemployed mothers had a lower risk of overweight and obesity (ORadj=0.73; 95% CI 0.58-0.92). The observed prevalence of childhood overweight and obesity warrants national and local time-bound targets for reduction of childhood obesity, accompanied by detailed action plans and monitoring mechanisms.Cilj ovoga istraživanja bio je utvrditi učestalost i analizirati odrednice prekomjerne tjelesne mase i debljine kod školske djece u dobi od 7-9 godina u Hrvatskoj u odnosu na sociodemografske čimbenike. U istraživanju su korišteni podaci prikupljeni u sklopu istraživanja SZO Europa ”Europska inicijativa praćenja debljine u djece, Hrvatska 2015./2016.”. Uzorak u ovom istraživanju bio je nacionalno reprezentativan. Antropometrijska mjerenja 5591 djeteta, 2811 dječaka i 2780 djevojčica, provedena su standardiziranom opremom kroz 8 tjedana. Proučavane varijable bili su antropometrijski i demografski podaci djece, obrazovanje i zaposlenost majki. Prema rezultatima, učestalost prekomjerne tjelesne mase i debljine u hrvatske djece u dobi od 7-9 godina iznosi 35,9%. Učestalost prekomjerne tjelesne mase i debljine veća je kod dječaka nego kod djevojčica, a izrazito je velika kod dječaka iz jadranske regije (42,1%). Rizik za prekomjernu tjelesnu masu i debljinu veći je za dječake koji žive u jadranskoj regiji (ORadj=1,33; 95% CI 1,03-1,71) i djevojčice čije majke imaju srednjoškolsko obrazovanje (ORadj=1,36; 95% CI 1,11-1,66). Djevojčice čije su majke nezaposlene imaju manji rizik od prekomjerne tjelesne mase i debljine (ORadj=0,73; 95% CI 0,58-0,92). Uočena učestalost prekomjerne tjelesne mase i debljine zahtijeva vremenski ograničene, nacionalne i lokalne, ciljeve za smanjenje debljine kod djece, praćene detaljnim akcijskim planovima i mehanizmima praćenja

Do Italian pregnant women use periconceptional folate supplementation?

Deficiency of Folic Acid (FA) has been identified as a risk factor for neural tube defects (NTDs) as well as other congenital abnormalities. Thus, periconceptional folate supplementation is recommended for all women planning to get pregnant.We conducted a KAP (knowledge, attitude, practice) survey to investigate the use of FA and its appropriateness. The survey included a sample of 562 women who delivered in Lazio region between 2013 and 2014. Two logistic regression analyses were performed to evaluate the association between the characteristics of participating women and both the information received on FA intake and its use. The prevalence of periconceptional FA assumption was  19.4% although 82.2% of the interviewed women had planned their pregnancies. It shows that more periconceptional counseling is needed to increase women's awareness on the opportunity of FA supplementation

Dietary habits among children aged 8-9 years in Italy

Objective To describe dietary habits and related geographic and socio-demographic characteristics among children aged 8-9 years in Italy. Materials and methods Data from the 2012 national nutritional surveillance system collected from children, parents and teachers, have been linked to determine the children's eating habits. Logistic regression analyses were used to investigate the association between incorrect dietary habits and their potential predictors. Results Of the 46307 children, 8.6% skipped breakfast, 48.8% did not eat vegetables and 28.7% did not eat fruit daily, 64.8% ate an abundant mid-morning snack, 41.4% drank sugary beverages and 12.5% drank carbonated beverages at least once a day. Three or more incorrect habits were found in 43.9% of the children. Incorrect dietary habits were more common among children with lower socio-economic conditions, who were resident in the South of the country and who spent more time watching TV. Conclusion In Italy, unhealthy dietary habits are common among children. The deficiencies identified may well be a harbinger of future public health problems

Childhood overweight and obesity in Europe: Changes from 2007 to 2017

The Childhood Obesity Surveillance Initiative (COSI) routinely measures height andweight of primary school children aged 6–9 years and calculates overweight andobesity prevalence within the World Health Organization (WHO) European Regionusing a standard methodology. This study examines the trends in the prevalence ofoverweight and obesity from the first round of COSI carried out in 2007/2008 to thelatest of 2015/2017 in 11 European countries in which data were collected for atleast three rounds. In total 303,155 children were measured. In general, the preva-lence of overweight and obesity among boys and girls decreased in countries withhigh prevalence (Southern Europe) and remained stable or slightly increased in North-ern European and Eastern European countries included in the analysis. Among boys, the highest decrease in overweight (including obesity) was observed in Portugal (from40.5% in 2007/2008 to 28.4 in 2015/2017) and in Greece for obesity (from 30.5% in2009/2010 to 21.7% in 2015/2017). Lithuania recorded the strongest increase in theproportion of boys with overweight (from 24.8% to 28.5%) and obesity (from 9.4% to12.2%). The trends were similar for boys and girls in most countries. Several countriesin Europe have successfully implemented policies and interventions to counteract theincrease of overweight and obesity, but there is still much to be done.The authors gratefully acknowledge support through a grant from the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs. The Ministries of health of Austria, Croatia, Greece, Italy, Malta, Norway, and the Russian Federation provided financial support for the meetings at which the protocol, data collection procedures, and analyses were discussed. Data collection in the countries included in this study was made possible through funding from: Bulgaria: Ministry of Health, National Center of Public Health and Analyses, and WHO Regional Office for Europe; Czechia: WHO grants AZV MZČR 17-31670 A MZČR-RVO EÚ 00023761, World Health Organization Regional Office for Europe, and WHO country office; Greece: International Hellenic University and Hellenic Medical Association for Obesity; Ireland: Health Service Executive; Italy: Ministry of Health and Italian National Institute of Health; Latvia: Ministry of Health and Centre for Disease Prevention and Control; Lithuania: Science Foundation of Lithuanian University of Health Sciences, Lithuanian Science Council, and WHO; Norway: Ministry of Health and Norwegian Institute of Public Health; Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of Health, Regional Health Directorates, and the kind technical support from the Center for Studies and Research on Social Dynamics and Health (CEIDSS); Slovenia: Ministry of Education and Science and Sport of the Republic of Slovenia within the SLOfit surveillance system; and Spain: Spanish Agency for Food Safety and Nutrition (AESAN).info:eu-repo/semantics/publishedVersio

Mobilizing governments and society to combat obesity: Reflections on how data from the WHO European Childhood Obesity Surveillance Initiative are helping to drive policy progress

To meet the need for regular and reliable data on the prevalence of overweight andobesity among children in Europe, the World Health Organization (WHO) EuropeanChildhood Obesity Surveillance Initiative (COSI) was established in 2007. Theresulting robust surveillance system has improved understanding of the public healthchallenge of childhood overweight and obesity in the WHO European Region. For the past decade, data from COSI have helped to inform and drive policy action onnutrition and physical activity in the region. This paper describes illustrative examplesof how COSI data have fed into national and international policy, but the real scopeof COSI's impact is likely to be much broader. In some countries, there are signs thatpolicy responses to COSI data have helped halt the rise in childhood obesity. As thecountries of the WHO European Region commit to pursuing United Action for BetterHealth in Europe in WHO's new European Programme of Work, COSI provides anexcellent example of such united action in practice. Further collaborative action willbe key to tackling this major public health challenge which affects children through-out the regionThe authors gratefully acknowledge support through a grant from the Russian government in the context of the WHO European Office for the Prevention and Control of NCDs. The Ministries of Health of Austria, Croatia, Greece, Italy, Malta, Norway, and the Russian Federation provided financial support for the meetings at which the protocol, data collection procedures, and analyses were discussed. Data collection in the countries featured in this paper was made possible through funding from: Bulgaria: Ministry of Health, National Center of Public Health and Analyses, WHO Regional Office for Europe; Croatia: Ministry of Health, Croatian Institute of Public Health, and WHO Regional Office for Europe; Georgia: WHO; Ireland: Health Service Executive; Italy: Ministry of Health and Italian National Institute of Health; Latvia: Centre for Disease Prevention and Control, Ministry of Health, Latvia; Malta: Ministry of Health; North Macedonia: funded by the Government of North Macedonia through National Annual Program of Public Health and implemented by the Institute of Public Health and Centers of Public Health. WHO country office provides support for training and data management; Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of Health, Regional Health Directorates and the kind technical support from the Center for Studies and Research on Social Dynamics and Health (CEIDSS); Turkey: Turkish Ministry of Health and World Bank.info:eu-repo/semantics/publishedVersio

Association between characteristics at birth, breastfeeding and obesity in 22 countries: the WHO European Childhood Obesity Surveillance Initiative – COSI 2015/2017

Objectives: It was the aim of this paper to investigate the association of early-life factors, namely breastfeeding, exclusive breastfeeding and birth weight, with obesity among children. ----- Method: Data from 22 participating countries in the WHO European COSI study (round 4: 2015/2017) were collected using cross-sectional, nationally representative samples of 6- to 9-year-olds (n = 100,583). The children's standardized weight and height measurements followed a common WHO protocol. Information on the children's birth weight and breastfeeding practice and duration was collected through a family record form. A multivariate multilevel logistic regression analysis regarding breastfeeding practice (both general and exclusive) and characteristics at birth was performed. ----- Results: The highest prevalence rates of obesity were observed in Spain (17.7%), Malta (17.2%) and Italy (16.8%). A wide between-country disparity in breastfeeding prevalence was found. Tajikistan had the highest percentage of children that were breastfed for ≥6 months (94.4%) and exclusively breastfed for ≥6 months (73.3%). In France, Ireland and Malta, only around 1 in 4 children was breastfed for ≥6 months. Italy and Malta showed the highest prevalence of obesity among children who have never been breastfed (21.2%), followed by Spain (21.0%). The pooled analysis showed that, compared to children who were breastfed for at least 6 months, the odds of being obese were higher among children never breastfed or breastfed for a shorter period, both in case of general (adjusted odds ratio [adjOR] [95% CI] 1.22 [1.16-1.28] and 1.12 [1.07-1.16], respectively) and exclusive breastfeeding (adjOR [95% CI] 1.25 [1.17-1.36] and 1.05 [0.99-1.12], respectively). Higher birth weight was associated with a higher risk of being overweight, which was reported in 11 out of the 22 countries. Bulgaria, Croatia, France, Italy, Poland and Romania showed that children who were preterm at birth had higher odds of being obese, compared to children who were full-term babies. ----- Conclusion: The present work confirms the beneficial effect of breastfeeding against obesity, which was highly increased if children had never been breastfed or had been breastfed for a shorter period. Nevertheless, adoption of exclusive breastfeeding is below global recommendations and far from the target endorsed by the WHO Member States at the World Health Assembly Global Targets for Nutrition of increasing the prevalence of exclusive breastfeeding in the first 6 months up to at least 50% by 2025

Socioeconomic differences in food habits among 6- to 9-year-old children from 23 countries-WHO European Childhood Obesity Surveillance Initiative (COSI 2015/2017)

Background: Socioeconomic differences in children's food habits are a key public health concern. In order to inform policy makers, cross-country surveillance studies of dietary patterns across socioeconomic groups are required. The purpose of this study was to examine associations between socioeconomic status (SES) and children's food habits. Methods: The study was based on nationally representative data from children aged 6-9 years (n = 129,164) in 23 countries in the World Health Organization (WHO) European Region. Multivariate multilevel analyses were used to explore associations between children's food habits (consumption of fruit, vegetables, and sugar-containing soft drinks) and parental education, perceived family wealth and parental employment status. Results: Overall, the present study suggests that unhealthy food habits are associated with lower SES, particularly as assessed by parental education and family perceived wealth, but not parental employment status. We found cross-national and regional variation in associations between SES and food habits and differences in the extent to which the respective indicators of SES were related to children's diet. Conclusion: Socioeconomic differences in children's food habits exist in the majority of European and Asian countries examined in this study. The results are of relevance when addressing strategies, policy actions, and interventions targeting social inequalities in children's diets.The authors gratefully acknowledge support from a grant from the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs. Data collection in the countries was made possible through funding from Albania: WHO through the Joint Programme on Children, Food Security and Nutrition “Reducing Malnutrition in Children,” funded by the Millennium Development Goals Achievement Fund, and the Institute of Public Health; Bulgaria: Ministry of Health, National Center of Public Health and Analyses, WHO Regional Office for Europe; Croatia: Ministry of Health, Croatian Institute of Public Health and WHO Regional Office for Europe; Czechia: Ministry of Health of the Czech Republic, grant nr. AZV MZČR 17-31670 A and MZČ–VO EÚ 00023761; Denmark: Danish Ministry of Health; Georgia: WHO; Ireland: Health Service Executive; Italy: Ministry of Health and Italian National Institute of Health; Kazakhstan: Ministry of Health of the Republic of Kazakhstan and WHO Country Office; Kyrgyzstan: World Health Organization; Latvia: Ministry of Health, Centre for Disease Prevention and Control; Lithuania: Science Foundation of Lithuanian University of Health Sciences and Lithuanian Science Council and WHO; Malta: Ministry of Health; Montenegro: WHO and Institute of Public Health of Montenegro; Norway: Ministry of Health and Norwegian Institute of Public Health; Poland: National Health Programme, Ministry of Health; Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of Health, Regional Health Directorates and the kind technical support from the Center for Studies and Research on Social Dynamics and Health (CEIDSS); Romania: Ministry of Health; Russian Federation: WHO; San Marino: Health Ministry, Educational Ministry; Serbia: This study was supported by the World Health Organization (Ref. File 2015-540940); Spain: Spanish Agency for Food Safety and Nutrition (AESAN); Tajikistan: WHO Country Office in Tajikistan and Ministry of Health and Social Protection; Turkmenistan: WHO Country Office in Turkmenistan and Ministry of Health; Turkey: Turkish Ministry of Health and World Bank. The CO-CREATE project has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No. 774210.info:eu-repo/semantics/publishedVersio

Socioeconomic inequalities in overweight and obesity among 6‐ to 9‐year‐old children in 24 countries from the World Health Organization European region

Childhood overweight and obesity have significant short- and long-term negative impacts on children's health and well-being. These challenges are unequally distributed according to socioeconomic status (SES); however, previous studies have often lacked standardized and objectively measured data across national contexts to assess these differences. This study provides a cross-sectional picture of the association between SES and childhood overweight and obesity, based on data from 123,487 children aged 6–9 years in 24 countries in the World Health Organization (WHO) European region. Overall, associations were found between overweight/obesity and the three SES indicators used (parental education, parental employment status, and family-perceived wealth). Our results showed an inverse relationship between the prevalence of childhood overweight/obesity and parental education in high-income countries, whereas the opposite relationship was observed in most of the middle-income countries. The same applied to family-perceived wealth, although parental employment status appeared to be less associated with overweight and obesity or not associated at all. This paper highlights the need for close attention to context when designing interventions, as the association between SES and childhood overweight and obesity varies by country economic development. Population-based interventions have an important role to play, but policies that target specific SES groups are also needed to address inequalities.The authors gratefully acknowledge support through a grant from the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs. The Ministries of health of Austria, Croatia, Greece, Italy, Malta, Norway, and the Russian Federation provided financial support for the meetings at which the protocol, data collection procedures, and analyses were discussed. Data collection in the countries was made possible through funding from: Albania: World Health Organization (WHO) Country Office Albania and the WHO Regional Office for Europe. Bulgaria: WHO Regional Office for Europe. Croatia: Ministry of Health, Croatian Institute of Public Health and WHO Regional Office for Europe. Czechia: Ministry of Health of the Czech Republic, grant nr. 17-31670A and MZCR—RVO EU 00023761. Denmark: The Danish Ministry of Health. France: Santé publique France, the French Agency for Public Health. Georgia: WHO. Ireland: Health Service Executive. Italy: Italian Ministry of Health; Italian National Institute of Health (Istituto Superiore di Sanità). Kazakhstan: the Ministry of Health of the Republic of Kazakhstan within the scientific and technical program. Kyrgyzstan: World Health Organization. Latvia: Centre for Disease Prevention and Control, Ministry of Health, Latvia. Lithuania: Science Foundation of Lithuanian University of Health Sciences and Lithuanian Science Council and WHO. Malta: Ministry of Health; Montenegro: WHO and Institute of Public Health of Montenegro. Poland, National Health Program, Ministry of Health. Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of Health, Regional Health Directorates and the kind technical support from the Center for Studies and Research on Social Dynamics and Health (CEIDSS). Romania: Ministry of Health; Russian Federation: WHO. San Marino: Health Ministry, Educational Ministry, Social Security Institute and Health Authority. Spain: the Spanish Agency for Food Safety & Nutrition. Tajikistan: WHO Country Office in Tajikistan and Ministry of Health and Social Protection. Turkmenistan: WHO Country Office in Turkmenistan and Ministry of Health. Turkey: Turkish Ministry of Health and World Bank.info:eu-repo/semantics/publishedVersio

Socioeconomic disparities in physical activity, sedentary behavior and sleep patterns among 6- to 9-year-old children from 24 countries in the WHO European region

Physical activity, sedentary behavior, and sleep are important predictors of children's health. This paper aimed to investigate socioeconomic disparities in physical activity, sedentary behavior, and sleep across the WHO European region. This cross-sectional study used data on 124,700 children aged 6 to 9 years from 24 countries participating in the WHO European Childhood Obesity Surveillance Initiative between 2015 and 2017. Socioeconomic status (SES) was measured through parental education, parental employment status, and family perceived wealth. Overall, results showed different patterns in socioeconomic disparities in children's movement behaviors across countries. In general, high SES children were more likely to use motorized transportation. Low SES children were less likely to participate in sports clubs and more likely to have more than 2 h/day of screen time. Children with low parental education had a 2.24 [95% CI 1.94-2.58] times higher risk of practising sports for less than 2 h/week. In the pooled analysis, SES was not significantly related to active play. The relationship between SES and sleep varied by the SES indicator used. Importantly, results showed that low SES is not always associated with a higher prevalence of "less healthy" behaviors. There is a great diversity in SES patterns across countries which supports the need for country-specific, targeted public health interventions.The authors gratefully acknowledge support from a grant from the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs. Data collection in the countries was made possible through funding from: Croatia: Ministry of Health, Croatian Institute of Public Health and WHO Regional Office for Europe. Albania: World Health Organization (WHO) Country Office Albania and the WHO Regional Office for Europe. Bulgaria: WHO Regional Office for Europe. Czech Republic: Ministry of Health of the Czech Republic, grant nr. AZV MZČR 17-31670 A and MZČR–RVO EÚ 00023761. Denmark: The Danish Ministry of Health. France: Santé publique France, the French Agency for Public Health. Georgia: WHO. Ireland: Health Service Executive. Italy: Italian Ministry of Health; Italian National Institute of Health (Istituto Superiore di Sanità). Kazakhstan: the Ministry of Health of the Republic of Kazakhstan within the scientific and technical program. Kyrgyzstan: World Health Organization. Latvia: Centre for Disease Prevention and Control, Ministry of Health, Latvia. Lithuania: Science Foundation of Lithuanian University of Health Sciences and Lithuanian Science Council and WHO. Malta: Ministry of Health. Montenegro: WHO and Institute of Public Health of Montenegro. Poland: National Health Programme, Ministry of Health. Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of Health, Regional Health Directorates and the kind technical support from the Center for Studies and Research on Social Dynamics and Health (CEIDSS). Romania: Ministry of Health. Russian Federation: WHO. San Marino: Health Ministry. Spain: the Spanish Agency for Food Safety & Nutrition. Tajikistan: WHO Country Office in Tajikistan and Ministry of Health and Social Protection; Turkmenistan: WHO Country Office in Turkmenistan and Ministry of Health. Turkey: Turkish Ministry of Health and World Bank. Austria: Federal Ministry of Labor, Social Affairs, Health and Consumer Protection of Austria.info:eu-repo/semantics/publishedVersio

Clustering of Multiple Energy Balance-Related Behaviors in School Children and Its Association with Overweight and Obesity—WHO European Childhood Obesity Surveillance Initiative (COSI 2015–2017)

It is unclear how dietary, physical activity and sedentary behaviors co-occur in school-aged children. We investigated the clustering of energy balance-related behaviors and whether the identified clusters were associated with weight status. Participants were 6- to 9-year-old children (n = 63,215, 49.9% girls) from 19 countries participating in the fourth round (2015/2017) of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative. Energy balance-related behaviors were parentally reported. Weight and height were objectively measured. We performed cluster analysis separately per group of countries (North Europe, East Europe, South Europe/Mediterranean countries and West-Central Asia). Seven clusters were identified in each group. Healthier clusters were common across groups. The pattern of distribution of healthy and unhealthy behaviors within each cluster was group specific. Associations between the clustering of energy balance-related behaviors and weight status varied per group. In South Europe/Mediterranean countries and East Europe, all or most of the cluster solutions were associated with higher risk of overweight/obesity when compared with the cluster 'Physically active and healthy diet'. Few or no associations were observed in North Europe and West-Central Asia, respectively. These findings support the hypothesis that unfavorable weight status is associated with a particular combination of energy balance-related behavior patterns, but only in some groups of countries