15 research outputs found
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
Urban and rural differences in frequency of fruit, vegetable, and soft drink consumption among 6–9‐year‐old children from 19 countries from the WHO European region
In order to address the paucity of evidence on the association between childhood eating habits and urbanization, this cross-sectional study describes urban–rural differences in frequency of fruit, vegetable, and soft drink consumption in 123,100 children aged 6–9 years from 19 countries participating in the fourth round (2015-2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children's parents/caregivers completed food-frequency questionnaires. A multivariate multilevel logistic regression analysis was performed and revealed wide variability among countries and within macroregions for all indicators. The percentage of children attending rural schools ranged from 3% in Turkey to 70% in Turkmenistan. The prevalence of less healthy eating habits was high, with between 30–80% and 30–90% children not eating fruit or vegetables daily, respectively, and up to 45% consuming soft drinks on >3 days a week. For less than one third of the countries, children attending rural schools had higher odds (OR-range: 1.1–2.1) for not eating fruit or vegetables daily or consuming soft drinks >3 days a week compared to children attending urban schools. For the remainder of the countries no significant associations were observed. Both population-based interventions and policy strategies are necessary to improve access to healthy foods and increase healthy eating behaviors among children.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; Austria: Federal Ministry of Social Affairs, Health, Care and Consumer Protection, Republic
of Austria; 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; Ministry of Health of the Czech Republic,
grant nr. AZV MZČR 17-31670 A and MZČR–RVO EÚ 00023761;
Denmark: Danish Ministry of Health; Estonia: Ministry of Social
Affairs, Ministry of Education and Research (IUT 42-2), WHO Country
Office, and National Institute for Health Development; 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; North Macedonia: COSI in
North Macedonia is 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 in the
country. WHO country office provides support for training and data
management; 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; Serbia: This study was supported by the World Health
Organization (Ref. File 2015-540940); Slovakia: Biennial Collaborative
Agreement between WHO Regional Office for Europe and Ministry
of Health SR; 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.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
Parental Perceptions of Children’s Weight Status in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative: COSI 2015/2017
Introduction: Parents can act as important agents of change
and support for healthy childhood growth and development. Studies have found that parents may not be able to
accurately perceive their child’s weight status. The purpose
of this study was to measure parental perceptions of their
child’s weight status and to identify predictors of potential
parental misperceptions. Methods: We used data from the
World Health Organization (WHO) European Childhood
Obesity Surveillance Initiative and 22 countries. Parents
were asked to identify their perceptions of their children’s
weight status as “underweight,” “normal weight,” “a little
overweight,” or “extremely overweight.” We categorized
children’s (6–9 years; n = 124,296) body mass index (BMI) as
BMI-for-age Z-scores based on the 2007 WHO-recommended growth references. For each country included in the analysis and pooled estimates (country level), we calculated the
distribution of children according to the WHO weight status
classification, distribution by parental perception of child’s
weight status, percentages of accurate, overestimating, or
underestimating perceptions, misclassification levels, and
predictors of parental misperceptions using a multilevel logistic regression analysis that included only children with
overweight (including obesity). Statistical analyses were performed using Stata version 15 1. Results: Overall, 64.1% of
parents categorized their child’s weight status accurately
relative to the WHO growth charts. However, parents were
more likely to underestimate their child’s weight if the child
had overweight (82.3%) or obesity (93.8%). Parents were
more likely to underestimate their child’s weight if the child
was male (adjusted OR [adjOR]: 1.41; 95% confidence intervals [CI]: 1.28–1.55); the parent had a lower educational level
(adjOR: 1.41; 95% CI: 1.26–1.57); the father was asked rather
than the mother (adjOR: 1.14; 95% CI: 0.98–1.33); and the
family lived in a rural area (adjOR: 1.10; 95% CI: 0.99–1.24).
Overall, parents’ BMI was not strongly associated with the
underestimation of children’s weight status, but there was a
stronger association in some countries. Discussion/Conclusion: Our study supplements the current literature on factors
that influence parental perceptions of their child’s weight
status. Public health interventions aimed at promoting
healthy childhood growth and development should consider parents’ knowledge and perceptions, as well as the sociocultural contexts in which children and families live.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 by: Albania: World
Health Organization 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, World
Health Organization Regional Office for Europe; Croatia: Ministry of Health, Croatian Institute of Public Health and World
Health Organization Regional Office for Europe; Czechia: Grants
AZV MZČR 17-31670 A and MZČR – RVO EÚ 00023761; Denmark: Danish Ministry of Health; France: French Public Health
Agency; Georgia: World Health Organization; Ireland: Health
Service Executive; Italy: Ministry of Health; Istituto Superiore di
sanità (National Institute of Health); Kazakhstan: Ministry of Health of the Republic of Kazakhstan and World Health Organization Country Office; Latvia: n/a; Lithuania: Science Foundation of
Lithuanian University of Health Sciences and Lithuanian Science
Council and World Health Organization; Malta: Ministry of
Health; Montenegro: World Health Organization 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 of Center for Studies and Research on Social Dynamics and
Health (CEIDSS); Romania: Ministry of Health; Russia (Moscow): n/a; San Marino: Health Ministry; Educational Ministry; Social Security Institute; the Health Authority; Spain: Spanish Agency for Food Safety and Nutrition (AESAN); Tajikistan: World
Health Organization Country Office in Tajikistan and Ministry of
Health and Social Protection; and Turkmenistan: World Health
Organization Country Office in Turkmenistan and Ministry of
Health. The authors alone are responsible for the views expressed
in this article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.info:eu-repo/semantics/publishedVersio
Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions
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
Waist circumference and waist-to-height ratio in 7-year-old children—WHO Childhood Obesity Surveillance Initiative
Urban and rural differences in frequency of fruit, vegetable, and soft drink consumption among 6–9-year-old children from 19 countries from the WHO European region
In order to address the paucity of evidence on the association between childhood eating habits and urbanization, this cross-sectional study describes urban–rural differences in frequency of fruit, vegetable, and soft drink consumption in 123,100 children aged 6–9 years from 19 countries participating in the fourth round (2015–2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children's parents/caregivers completed food-frequency questionnaires. A multivariate multilevel logistic regression analysis was performed and revealed wide variability among countries and within macroregions for all indicators. The percentage of children attending rural schools ranged from 3% in Turkey to 70% in Turkmenistan. The prevalence of less healthy eating habits was high, with between 30–80% and 30–90% children not eating fruit or vegetables daily, respectively, and up to 45% consuming soft drinks on >3 days a week. For less than one third of the countries, children attending rural schools had higher odds (OR-range: 1.1–2.1) for not eating fruit or vegetables daily or consuming soft drinks >3 days a week compared to children attending urban schools. For the remainder of the countries no significant associations were observed. Both population-based interventions and policy strategies are necessary to improve access to healthy foods and increase healthy eating behaviors among children.</p
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