High sodium intake of children through ‘hidden’ food sources and its association with the Mediterranean diet: the GRECO study

Objectives: Sodium is the mineral that has been, mainly, linked to hypertension and cardiovascular disease. It is found naturally in many foods, but is also used in the food industry and manufacturing. Identification of total sodium intake, as well as ‘hidden’ sodium intake from food sources early in life is necessary. Methods: Four thousand, five hundred and eighty children aged 10–12 years were enrolled, in a cross-sectional, population-based survey. Among other measurements, dietary data were obtained by a semi-quantitative food frequency questionnaire, and sodium intake was calculated. High sodium consumption was considered an intake over 2200 mg/day. Adherence to the Mediterranean dietary pattern was evaluated using the Mediterranean Diet Quality Index for children and adolescent score (KIDMED score). Results: Twenty-three percent of Greek children had sodium intake which exceeded the 2200 mg/day recommendation, excluding salt added at table and during cooking. Sodium intake was found elevated in children with moderate and high adherence to the Mediterranean Diet. Additionally, 1 unit increase in KIDMED score (i.e. higher adherence) was associated with 10% [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.07–1.13] increased likelihood of consuming sodium above the median intake (i.e. >1500 mg/day). Thirty-four percent of sodium intake from ‘hidden’ sources came from bread, processed cereals and white cheese. Conclusions: Greek children have an elevated sodium intake from ‘hidden’ sources and main contributors are foods which are recommended to be consumed on a daily basis according to the Mediterranean Diet Pyramid. These findings should induce manufacturers to reduce the amount of sodium added during processing of ‘healthy’ foods, especially bread and cheese

Socio-economic and demographic determinants of childhood obesity prevalence in Greece: the GRECO (Greek Childhood Obesity) study

Objective: Given the rapid increase in the prevalence of childhood obesity, identifying the sociodemographic influences on obesity status is important for planning and implementing effective prevention initiatives. However, this type of data is limited for Greek children. Therefore the aim of the present study was to identify possible sociodemographic factors associated with childhood obesity at the national level. Design: Cross-sectional, population-based survey, carried out from October to May 2009. Setting: Under the context of the GRECO (Greek Childhood Obesity) study, a nationwide sample of 2315 primary-school children. Subjects: Children aged 10–12 years and their parents were voluntarily enrolled. Direct anthropometric measurements of the children were obtained and information on sociodemographic characteristics of the parents, as well as their self-reported values of body weight and height, were collected. Results: Overweight and obesity prevalence was 29?5 % and 13?1 %, respectively, among boys; 29?5 % and 9?0 %, respectively, among girls. Multiple logistic regression analysis revealed that the most important sociodemographic predictors of childhood obesity were mother’s age, parental BMI classification and father’s type of occupation. More specifically, increased mother’s age and normal BMI status of the parents seemed to have a protective effect on the likelihood of having an overweight/obese child. Additionally, the odds of a female child of being overweight/obese were reduced when the father’s type of occupation tended to be less manual. Conclusions: Anti-obesity health policy interventions have to address to the parents and promote their active involvement, to effectively confront the alarming magnitude of the paediatric obesity problem in Greece

Maternal smoking and risk of obesity in school children: Investigating early life theory from the GRECO study

Based on the Early Life Theory, maternal smoking may be a factor affecting child weight status, adiposity level and blood pressure later in life. The purpose of this study was primarily to examine the risk of maternal smoking during pregnancy with overweight and obesity, central and total adiposity in school children. Secondarily, to assess the effect of maternal smoking, with children's blood pressure (BP).Data from the Greek Childhood Obesity cross sectional study (GRECO), conducted from October 2008 to May 2009, were used. A total of 2400 questionnaires gathered from children and their parents were analysed. Maternal and gestational data were gathered by a self-administered questionnaire. Women were categorized as non-smokers or smokers if they smoked ≥1 cigarettes/day during pregnancy. Children's body weight, height, waist circumference and BP were measured. Multiple logistic and linear regression analysis was conducted, adjusting for covariates. Four models were used in the process.The study found that children of maternal-smokers were more likely to be overweight or obese (OR: 1.6 to 1.82) and to have a larger waist circumference (OR: 1.73 to 1.85), compared to children of non-smokers in all models used. Total fat percentage was not significantly associated with maternal smoking when adjusted. Systolic and diastolic BP was not associated with maternal smoking. Results of this study strengthen the need for smoking cessation during pregnancy in order to possibly reduce the childhood obesity epidemic. Creating public health awareness of the potential risk of maternal-smoking on children's weight status later in life is warranted. Keywords: Maternal smoking, Central adiposity, Childhood obesity, Blood pressure, Public healt

Perinatal and family factors associated with preadolescence overweight/obesity in Greece: The GRECO study

Objective: To explore associations of perinatal and family factors with preadolescence overweight and obesity in a sample of Greek schoolchildren. Methods: A nationwide cross-sectional study among 2093 students (10.9 ± 0.72 years, 44.9% boys) and their parents were conducted. Anthropometric (e.g., height, weight, mother’s body mass index (BMI) at the time of the study and at conception), socio-demographic (e.g., age, education, socio-economic status), diet and other major lifestyle characteristics (e.g., smoking, alcohol intake, physical activity and inactivity) and perinatal factors (e.g., breast- and formula-feeding) were collected with validated questionnaires. Height and weight of students were measured. Overweight/obesity was classified using IOTF cut-offs. Multivariable logistic and linear regression analyses were used to identify major independent factors of overweight/obesity among preadolescents and factors related with the percentage change of mother’s BMI, respectively. Results: Increased age at pregnancy [odds ratios (OR) = 0.95, 95% Confidence Interval (CI): 0.93–0.97], higher BMI at conception (OR = 1.17, 95% CI: 1.12–1.22) and heavy smoking (OR = 2.02, 95% CI: 1.23–3.33) were positively associated with child’s overweight/obesity status. Moreover, mother’s age and TV viewing, indicating inactivity, were the strongest factors of the percentage increase in mother’s BMI (b ± se = 0.23 ± 0.07, p = 0.002; b ± se = 0.32 ± 0.10, p = 0.002, respectively). Conclusions: Preadolescent obesity is associated with mother’s pre-pregnancy weight, age and heavy smoking at conception and mother’s BMI change after gestation

Dietary and lifestyle patterns in relation to high blood pressure in children: the GRECO study

Objective: The objective of the present study was to investigate possible associations of dietary patterns with high blood pressure (BP) in a nationwide cross-sectional sample of 10-12 years old Greek schoolchildren. Methods: Anthropometric measurements and information on dietary (by a semi-quantitative food frequency questionnaire) and physical activity habits were obtained from the children. BPs was measured in a single occasion using a standard protocol. Data from 2024 normal energy reporting children were included in the analysis. Principal component analysis was applied to identify dietary patterns. Results: Seven dietary components (patterns) were extracted explaining 55% of the total variation in intake. Multiple logistic regression analysis revealed that predictors of high BP (75th percentile of SBP and/or DBP) were a pattern mainly characterized by the high consumption of cheese and red processed meat [odds ratio (OR) 1.15; 95% confidence intervals (CI) 1.03-1.30], being overweight (OR 2.10; 95% CI 1.61-2.73) or obese (OR 3.84; 95% CI 2.44-6.06) and breakfast frequency (OR 0.95; 95% CI 0.90-0.99). After controlling for sodium intake levels, the dietary pattern did not remain a significant predictor of high BP, indicating the potential mediating effect of sodium in the association. Conclusion: A dietary pattern that is characterized by high cheese and red processed meat consumption increases the likelihood of having high BP in children, probably through increasing dietary sodium intake. These findings could guide future interventions or public health initiatives to prevent the increasing rates of childhood elevated BP levels

Very high childhood obesity prevalence and low adherence rates to the Mediterranean diet in Greek children: The GRECO study

Objective: In order to provide estimates of overweight and obesity among Greek schoolchildren, and the adherence rates to the Mediterranean diet (MD), a nationwide survey was performed among fifth and sixth grade students aged 10–12 years old. Methods: A stratified sampling in 10 regions of the country was applied to voluntarily enroll a representative sample of 4786 children. Children were weighed and measured and completed a semi-quantitative food frequency questionnaire with a supplementary section for the assessment of dietary aspects and physical activity levels. Additionally, the KIDMED index was used to evaluate the degree of adherence to the MD. Results: According to the IOTF cut-offs, overweight (OW) and obesity (OB) prevalence among boys was 29.9% and 12.9%, while in girls 29.2% and 10.6%, respectively. Only 4.3% of the children had an optimal KIDMED score. KIDMED score did not differ between boys and girls and no differences were detected between normal weight and OW and OB children. However, children from semi-urban or rural regions had higher score. Furthermore, children with higher KIDMED score reported following a healthier diet and having higher physical activity levels. Conclusion: The prevalence of childhood obesity in Greece is the highest ever reported together with low adherence rates to the dietary patterns of the MD. Current findings suggest an increased risk for even higher rates of obesity in adolescence and adulthood in the near future. Taking into account that children are also abandoning the traditional cardio-protective MD, the increased risk for future adverse health consequences seems evident