Childhood obesity has been described as the main health-related problem in developed countries, due to its link with physical, social and psychological consequences with an increased risk for developing metabolic and cardiovascular diseases in adulthood.
All the pupils of both sexes attending the second year of all the primary schools in Pavia, Northern Italy, were recruited (n=470) for this study. Measurements of weight, height and waist circumference (WC) were taken under standard conditions. Body Mass Index (BMI) and waist-to-height-ratio (W/HtR) were computed and sex specific percentile values for BMI, WC and W/HtR were calculated and compared with the same percentiles available for different countries.
The results show that according to Cole’s cut-off point reference standards, 12.5% and 9.0% of boys and girls respectively are overweight, 4.7% and 5.2% respectively are obese. The WC mean value is equal to 60.0 ± 6.0 cm in boys and 59.0 ± 6.7 cm in girls. Using different 90th reference worldwide standard percentiles for WC as a comparison, the prevalence of our children with WC > 90th percentile is very different. The W/HtR mean value of the total sample is 0.46 ± 0.03. Assuming a cutoff of 0.5, 87.6% of the pupils have a W/HtR value ≤ 0.5, while 12.4% of the subjects have a value > 0.5, showing abdominal obesity among 55 children at an early age.
Our results point out the need for specific preventive and treatment interventions by identifying and implementing effective strategies, policies, and nutritional education programs in order to decrease the prevalence rate of obesity as well as the risk of metabolic disorders.
Aene project a medium city public students obesity studyCIRINEU COSTA
Identifying undernutrition and obesity on students and propose public policies of health are urgent issues. This paper presents a study with weight and stature from students collected by physical education teachers (PEF) in schools of a city near São Paulo. The PEF collected the data and they were inserted in a program especially developed for each school Department (AENE Project). The datas were analyzed by software and evaluation done based on a World Health Organization (WHO_2007) table, that develops health programs worldwide. The results evaluations were used to raise the students and family, teachers and responsibles for treatment search (when required).
Aene project a medium city public students obesity studyCIRINEU COSTA
Identifying undernutrition and obesity on students and propose public policies of health are urgent issues. This paper presents a study with weight and stature from students collected by physical education teachers (PEF) in schools of a city near São Paulo. The PEF collected the data and they were inserted in a program especially developed for each school Department (AENE Project). The datas were analyzed by software and evaluation done based on a World Health Organization (WHO_2007) table, that develops health programs worldwide. The results evaluations were used to raise the students and family, teachers and responsibles for treatment search (when required).
Factors contributing to malnutrition among HIV positive children aged between...iosrjce
The objective of the study was to identify factors contributing to malnutrition among HIV positive
children aged between 6 and 60 months. The study utilized a non experimental descriptive design. It was a
hospital based study conducted at Parirenyatwa Group of Hospital pediatric wards. A total of 30 children and
30 caregivers were recruited through convenience sampling. The children had a confirmed diagnosis of
malnutrition, confirmed HIV positive, aged between 6 and 60 months and had to have a present caregiver
during data collection. There were no dropouts. The main outcome measure were anthropometric measurements
of the children namely; height, weight and mid upper arm circumference and the various stressors contributing
to malnutrition. Twenty-two (73.33%) children were males and 8 (26.66%) were females. Contributing factors
to malnutrition identified were presence other illnesses such as diarrhea, pneumonia, tuberculosis and
kwashiorkor, 19 (63.33%), low socioeconomic status (earned less than USD$100 dollars per month), 16
(53.33%), coming from a family with more than 5 dependants 11 (36.67%), not being on ART 15 (50%), and
birth weight below or equal to 2500g 6 (20%). The major contributing factors to malnutrition were
extrapersonal stressors (54.83) interpersonal stressors (30.28%) and intrapersonal stressors (29.76%).
This pilot study describe the malnutrition with its double burden ( overweight and under weight ) among Egyptian population and its effect on public health.
This poster published in Duphat conference in Dubai
Factors Associated with Growth in the First 1,000 Days CHECKLEYCORE Group
CORE Group GHPC15
October 8, 2015
Concurrent Session: Factors Associated with Growth in the First 1,000 Days: Translating Evidence into Programs for Stunting, Wasting, and the Double Burden of Malnutrition
An assessment of adolescent eating habits in public schools of chak shahzad, ...Zubia Qureshi
Abstract: Eating patterns influence the nutritional status, health, learning process and academic performance of the school children. This study was conducted to explore the food availability at school canteens and food intake by adolescents in break period. A cross sectional study was conducted on 290 adolescents (145 were girls and 145 boys) of 6th, 7th and 8th grade from public schools of Chak Shahzad, Islamabad. Pre-structured questionnaire was used for data collection. Chi square / fisher exact test was done by using SPSS to check the association. The mean age of adolescents was 12.6 ± 1.33 years. They were reported normal, underweight, overweight and obese as 176 (60.7%), 79 (27.2%), 27 (9.3%) and 9 (2.8%) respectively. Nutritional status was significantly related with gender, age and grade of adolescents with p-value <0.05. Response showed that 199 (68.6%) adolescents prefer canteen food during break time, and 66 (22.8%) give preference to homemade lunch. Few of them 25 (8.6%) take fruits in school break time. About (24.8%) took drink with lunch which were juices 30 (10.3%), milk/milk shake 14 (5.9%), carbonated drinks 6 (2.1%), and tea/coffee 13 (4.5%). Consumption of carbohydrates, protein, fruits, vegetables, and dairy products was found as 64 (22.1%), 26 (0.9%), 32 (11%), 4 (1.4%) and 1 (0.3%) respectively in adolescents who brought their lunch from home. Around 49% of students were not satisfied with food provided on their school canteens. Availability of food items on school canteens and overall eating pattern of adolescents is not satisfactory. There is a need of school canteen guidelines/policy and nutritional education to canteen staff and pupils.
Keywords: School Canteen, Pakistan, Eating Habits, Adolescents
Nutritional assessment using anthropometric, biochemical, clinical, and dietary methods with a larger understanding of anthropometric methods used in Ethiopia
Stunting and Wasting in Children Under 2 in a Semi-nomadic Pastoralist Popula...CORE Group
CORE Group GHPC15
October 8, 2015
Concurrent Session: Factors Associated with Growth in the First 1,000 Days: Translating Evidence into Programs for Stunting, Wasting, and the Double Burden of Malnutrition
58% of the households are food insecure.
18% of Women aged 15-49 years are under weight.
31% of children are underweight.
Nutrition status of <5 years children has shown no improvement from last 46 years
Anemia has worsened among both pregnant and non-pregnant women and pregnant women in urban areas are having more iron deficiency anemia.
Pakistan may be witnessing the double burden of under nutrition and obesity within rural and urban women of reproductive age.
RESEARCH
Amercian Heart/Stroke Association- Teaching Americas Kids about a Healthy Lif...Nashville Fitness Supply
As a proponant of putting 'movement' in the classrooms to assist retention with children, here is the AHA/ASA Report on teaching our children about a healthy lifestyle.
YSI Activated Sludge - 3 Things You Need to Know to Improve Process ControlXylem Inc.
Join YSI’s wastewater expert, Dr. Rob Smith, as he discusses activated sludge at municipal water resource recovery facilities. Dr. Rob will review the three things you should know about activated sludge in water resource recovery facilities.
Optimization of the activated sludge process requires careful management of three critical parameters: aeration, sludge wasting, and sludge recirculation. Over the years, wastewater professionals have based their decisions on measurements from batch tests applied to grab samples. The batch measurements are representative of the process but are limited in frequency and subject to interpretation.
On the other hand, direct measurement of water chemistry is performed in the laboratory for demonstrating permit compliance on composited influent and effluent samples. The laboratory measurements provide measurements of important variables like oxygen, solids, ammonium and nitrate, but they are also limited in frequency and the samples are not representative of the process.
Online process monitoring provides the best of both strategies by directly measuring the important variables in representative samples continuously. This webinar discusses online process monitoring and control of activated sludge. Topics include:
1. Measurement principle
2. Operation and maintenance
3. Applications for energy conservation and nutrient removal.
Factors contributing to malnutrition among HIV positive children aged between...iosrjce
The objective of the study was to identify factors contributing to malnutrition among HIV positive
children aged between 6 and 60 months. The study utilized a non experimental descriptive design. It was a
hospital based study conducted at Parirenyatwa Group of Hospital pediatric wards. A total of 30 children and
30 caregivers were recruited through convenience sampling. The children had a confirmed diagnosis of
malnutrition, confirmed HIV positive, aged between 6 and 60 months and had to have a present caregiver
during data collection. There were no dropouts. The main outcome measure were anthropometric measurements
of the children namely; height, weight and mid upper arm circumference and the various stressors contributing
to malnutrition. Twenty-two (73.33%) children were males and 8 (26.66%) were females. Contributing factors
to malnutrition identified were presence other illnesses such as diarrhea, pneumonia, tuberculosis and
kwashiorkor, 19 (63.33%), low socioeconomic status (earned less than USD$100 dollars per month), 16
(53.33%), coming from a family with more than 5 dependants 11 (36.67%), not being on ART 15 (50%), and
birth weight below or equal to 2500g 6 (20%). The major contributing factors to malnutrition were
extrapersonal stressors (54.83) interpersonal stressors (30.28%) and intrapersonal stressors (29.76%).
This pilot study describe the malnutrition with its double burden ( overweight and under weight ) among Egyptian population and its effect on public health.
This poster published in Duphat conference in Dubai
Factors Associated with Growth in the First 1,000 Days CHECKLEYCORE Group
CORE Group GHPC15
October 8, 2015
Concurrent Session: Factors Associated with Growth in the First 1,000 Days: Translating Evidence into Programs for Stunting, Wasting, and the Double Burden of Malnutrition
An assessment of adolescent eating habits in public schools of chak shahzad, ...Zubia Qureshi
Abstract: Eating patterns influence the nutritional status, health, learning process and academic performance of the school children. This study was conducted to explore the food availability at school canteens and food intake by adolescents in break period. A cross sectional study was conducted on 290 adolescents (145 were girls and 145 boys) of 6th, 7th and 8th grade from public schools of Chak Shahzad, Islamabad. Pre-structured questionnaire was used for data collection. Chi square / fisher exact test was done by using SPSS to check the association. The mean age of adolescents was 12.6 ± 1.33 years. They were reported normal, underweight, overweight and obese as 176 (60.7%), 79 (27.2%), 27 (9.3%) and 9 (2.8%) respectively. Nutritional status was significantly related with gender, age and grade of adolescents with p-value <0.05. Response showed that 199 (68.6%) adolescents prefer canteen food during break time, and 66 (22.8%) give preference to homemade lunch. Few of them 25 (8.6%) take fruits in school break time. About (24.8%) took drink with lunch which were juices 30 (10.3%), milk/milk shake 14 (5.9%), carbonated drinks 6 (2.1%), and tea/coffee 13 (4.5%). Consumption of carbohydrates, protein, fruits, vegetables, and dairy products was found as 64 (22.1%), 26 (0.9%), 32 (11%), 4 (1.4%) and 1 (0.3%) respectively in adolescents who brought their lunch from home. Around 49% of students were not satisfied with food provided on their school canteens. Availability of food items on school canteens and overall eating pattern of adolescents is not satisfactory. There is a need of school canteen guidelines/policy and nutritional education to canteen staff and pupils.
Keywords: School Canteen, Pakistan, Eating Habits, Adolescents
Nutritional assessment using anthropometric, biochemical, clinical, and dietary methods with a larger understanding of anthropometric methods used in Ethiopia
Stunting and Wasting in Children Under 2 in a Semi-nomadic Pastoralist Popula...CORE Group
CORE Group GHPC15
October 8, 2015
Concurrent Session: Factors Associated with Growth in the First 1,000 Days: Translating Evidence into Programs for Stunting, Wasting, and the Double Burden of Malnutrition
58% of the households are food insecure.
18% of Women aged 15-49 years are under weight.
31% of children are underweight.
Nutrition status of <5 years children has shown no improvement from last 46 years
Anemia has worsened among both pregnant and non-pregnant women and pregnant women in urban areas are having more iron deficiency anemia.
Pakistan may be witnessing the double burden of under nutrition and obesity within rural and urban women of reproductive age.
RESEARCH
Amercian Heart/Stroke Association- Teaching Americas Kids about a Healthy Lif...Nashville Fitness Supply
As a proponant of putting 'movement' in the classrooms to assist retention with children, here is the AHA/ASA Report on teaching our children about a healthy lifestyle.
YSI Activated Sludge - 3 Things You Need to Know to Improve Process ControlXylem Inc.
Join YSI’s wastewater expert, Dr. Rob Smith, as he discusses activated sludge at municipal water resource recovery facilities. Dr. Rob will review the three things you should know about activated sludge in water resource recovery facilities.
Optimization of the activated sludge process requires careful management of three critical parameters: aeration, sludge wasting, and sludge recirculation. Over the years, wastewater professionals have based their decisions on measurements from batch tests applied to grab samples. The batch measurements are representative of the process but are limited in frequency and subject to interpretation.
On the other hand, direct measurement of water chemistry is performed in the laboratory for demonstrating permit compliance on composited influent and effluent samples. The laboratory measurements provide measurements of important variables like oxygen, solids, ammonium and nitrate, but they are also limited in frequency and the samples are not representative of the process.
Online process monitoring provides the best of both strategies by directly measuring the important variables in representative samples continuously. This webinar discusses online process monitoring and control of activated sludge. Topics include:
1. Measurement principle
2. Operation and maintenance
3. Applications for energy conservation and nutrient removal.
Lecture notes of Industrial Waste Treatment (Elective -III) as per syllabus of Solapur university for BE Civil
Prepared by
Prof S S Jahagirdar,
Associate Professor,
N K ORchid College of Engg and Tech,
Solapur
Effluent Treatment Plant Design, Operation And Analysis Of Waste Water Jaidev Singh
Contents
1. Introduction to Effluent Treatment Plant (ETP)
1.1 Use of water in industries
1.2 Industrial waste water sources
1.3 Effluent Treatment Plant
1.4 National Standards for waste water
1.5 What do these standards means?
1.6 Waste water treatment
1.7 Planning an Effluent Treatment Plant : Factors to Consider
2. Treatment Methods
2.1 Physical Unit Operations
2.2 Chemical Unit Processes
2.3 Biological Unit Processes
3. Operation and control
3.1 Mixed liquor suspended solids
3.2 Sludge Volume Index and Sludge Density Index
3.3 Sludge Age; Mean Cell Residence Time (MCRT)
3.4 Food/Mass Ratio
3.5 Constant MLSS
3.6 Return Activated Sludge Control (RAS)
4. Choosing an Effluent Treatment Plant
4.1 Biological Treatment
4.2 Physico-Chemical Treatment
4.3 Physico-Chemical and Biological Treatment
4.4 Area Requirement Comparison
4.5 Cost Comparison
5. Chemical Analysis of Waste Water
5.1 Commonly used chemicals
5.2 Chemical Tests and procedures
Correlation between Blood group, Hypertension, Obesity, Diabetes, and combina...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A health promoting school (HPS) is a school that constantly seeks to strengthen its capacity to promote healthy living, learning and working conditions (WHO). It aims to provide a multifaceted response to the health needs of students.
Does physical-activity-and-sport-practice-lead-to-a-healthier-lifestyle-and-e...Annex Publishers
The prevalence of childhood obesity has been increasing rapidly and there is general consensus that good nutritional practices and physical activity should be encouraged as early as possible in life. The aim of this study was to describe and to compare the current lifestyle and dietary pattern of normal weight (NW) and overweight + obese (OW+OB) male adolescents who are physically active.
Methods: This observational and retrospective study was based on clinical records analysis of male adolescents aged 11-18 years who had undergone a medical evaluation at a Medical Sport Centre (Pavia, Italy) during 2009, and had filled in a self-administered life style questionnaire.
Results: The results showed that out of 1423 clinical records 23.0% of subjects were OW, 5.4% OB and 71.6% NW. We invited all the overweight and obese subjects to participate in the study, 308 of them (75.8%) agreed. Then we randomly enrolled an equivalent number of NW participants (n=308) in the medical evaluation at the sports center with similar characteristics as for socio-economic status, physical activity and age for a whole sample of 616 subjects. We handled them a validated lifestyle questionnaire. The questionnaire analysis was used to compare OW+OB and NW participants, as far as eating habits, sedentary activities and time spent in sports. All the subjects frequently skipped breakfast, did not consume fruit and vegetables daily and had a high soft drinks intake. Inverse correlations were found between weight and physical activity (p=0.01). Sedentary activities were preferred by about 25% and 66 % of the NW and OW+OB groups respectively. The percentage of smokers was similar within the two groups (14%).
Conclusions: Adolescents eating habits are incorrect, despite BMI and sports practice. Sports practice seems contributing to lower spare time physical inactivity, but does not improve eating habits. Public health interventions should focus on the reinforcement of leisure time physical activity, besides nutrition education and behavioral education programs in order to prevent obesity in the adulthood.
A Pilot Study on Prevalence of Obesity and its Determinants among Adolescents...ijtsrd
Objective To assess prevalence of obesity in adolescents of selected schools of Jalandhar, Punjab, to assess Obesity determinants in adolescents of selected schools of alandhar, Punjab, To find out the association between the findings of the study and the selected demographic variables, and In a view to prepare a pamphlet on prevention of obesity. Methodology A cross sectional pilot study was conducted in corporate school of Jalandhar, Punjab and school children aged between13 years to 15 years of age were recruited by purposive random sampling method. Children with physical limitations, mental disability or children undergoing any form of clinical therapy were not included in this study. Anthropometric assessment was done and data were analyzed models using SPSS P value less than 0.05 was considered as statistically significant. Results The WHO BMI chart was used to calculate BMI of adolescents. Among 47 participants the prevalence of obesity was 4.2 and 17.02 were overweight, 60 were under weight and 19 were healthy. Based on the sex 7.40 males were having prevalence of obesity , 22.22 males and 11.11 females were having over weight.. The demographic variables revealed that, 57 of participants were from 15 yrs age group, 26 were of 14 yrs age group and the lowest 17 of them were 13 yrs old. Determinants which contribute prevalence of obesity reveal that, there is a significant association between selected socio demographic variables with sedentary behavior P value at 0.001 level which shows highly significant. There is a highly significant association between level of obesity with selected demographic variables in areas like obesity, mothers qualification and family history of obesity at P 0.001, P 0.05 levels. Prof. M. Chinna Devi ""A Pilot Study on Prevalence of Obesity and its Determinants among Adolescents in Schools of Jalandhar, Punjab"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-4 , June 2019, URL: https://www.ijtsrd.com/papers/ijtsrd23825.pdf
Paper URL: https://www.ijtsrd.com/medicine/nursing/23825/a-pilot-study-on-prevalence-of-obesity-and-its-determinants-among-adolescents-in-schools-of-jalandhar-punjab/prof-m-chinna-devi
Epidemiological studies are applicable to communicable and non-com.docxSALU18
Epidemiological studies are applicable to communicable and non-communicable diseases. Childhood obesity is an area that is receiving more attention in public health due to the multiple morbidities that emerge as a result of this condition. Below are links to a cross-sectional study and a case-control study. Imagine that you are interested in conducting a case-control or cross-sectional study proposal of childhood obesity vs. birth weight (prenatal and early life influences). Both articles below address prenatal influences on childhood obesity and birth weight using different approaches.
Article 1 -attached
Article 2-attached
Using the information in the articles, answer the following questions using AMA format.
1. How would you select cases and controls for this study and how would you define exposure and outcome variables for a case-control study design? What other factors would you control for?
2. How would you design a proposal measuring the effect of birthweight on childhood obesity for a cross-sectional study design? What other factors would you control for?
BioMed CentralBMC Public Health
ss
Open AcceStudy protocol
Cross sectional study of childhood obesity and prevalence of risk
factors for cardiovascular disease and diabetes in children aged 11–
13
Anwen Rees*1, Non Thomas1, Sinead Brophy2, Gareth Knox1 and
Rhys Williams2
Address: 1Cardiff School of Sport, University of Wales Institute Cardiff, Wales, UK and 2School of Medicine, Swansea University, Wales, UK
Email: Anwen Rees* - [email protected]; Non Thomas - [email protected]; Sinead Brophy - [email protected];
Gareth Knox - [email protected]; Rhys Williams - [email protected]
* Corresponding author
Abstract
Background: Childhood obesity levels are rising with estimates suggesting that around one in
three children in Western countries are overweight. People from lower socioeconomic status and
ethnic minority backgrounds are at higher risk of obesity and subsequent CVD and diabetes.
Within this study we examine the prevalence of risk factors for CVD and diabetes (obesity,
hypercholesterolemia, hypertension) and examine factors associated with the presence of these
risk factors in school children aged 11–13.
Methods and design: Participants will be recruited from schools across South Wales. Schools
will be selected based on catchment area, recruiting those with high ethnic minority or deprived
catchment areas. Data collection will take place during the PE lessons and on school premises. Data
will include: anthropometrical variables (height, weight, waist, hip and neck circumferences, skinfold
thickness at 4 sites), physiological variables (blood pressure and aerobic fitness (20 metre multi
stage fitness test (20 MSFT)), diet (self-reported seven-day food diary), physical activity (Physical
Activity Questionnire for Adolescents (PAQ-A), accelerometery) and blood tests (fasting glucose,
insulin, lipids, fibrinogen (Fg), adiponectin (high molecular weight), C-react ...
What are the causes and effects of childhood obesity, and what strategies can health and government bodies use to tackle the issue? Nathalie Farpour-Lambert, President of the European Association for the Study of Obesity (EASO), examines scientific data and presents recommendations. This presentation was delivered as part of a Global Active City and Ciudad Activa Summit in Buenos Aires in October 2018. EASO is a supporting partner of the Active Well-being Initiative, which runs the Global Active City programme. The world’s first Global Active Cities are Buenos Aires, Hamburg, Lillehammer, Liverpool, Ljubljana, and Richmond, British Columbia, Canada. Visit http://www.activewellbeing.org or follow @AWBInitiative on Twitter.
Role of Daily life style and Medication in Prevention and treatment of obesityPriyankaKilaniya
The rising prevalence of overweight and obesity underscores the need for enhanced intervention strategies to tackle this significant public health issue. Increases in energy expenditure through exercise and other physical activity may be a crucial component of effective interventions to enhance initial weight loss and prevent weight regain. achieve these outcomes, it is recommended to engage in appropriate levels of exercise and physical activity, with 60 to 90 minutes per day being the recommended duration. Epidemiological surveys in England reveal that obesity is prevalent, defined as a body mass index (BMI) of greater than 30 kg/m2. This study is the first to report the prevalence of general obesity and abdominal obesity in the adult population of Spain, based on weight, height, and waist circumference measurements. Diet, smoking, and physical activity are significant lifestyle factors that can significantly impact body weight and fat accumulation. The PREDIMED study, a randomized dietary primary prevention trial conducted in Spain, assessed the relationship between lifestyle and obesity risk. A study assessed 7,000 high-cardiovascular risk subjects, determining a healthy lifestyle pattern (HLP) based on Mediterranean diet adherence, moderate alcohol consumption, daily physical activity of 200kcal/day, and non-smoking.
Running head PICOT STATEMENT 1PICOT STATEMENT 5.docxtoltonkendal
Running head: PICOT STATEMENT 1
PICOT STATEMENT 5
PICOT Statement: Childhood Obesity
P-I-C-O-T Statement
P- Patients who suffer from obesity (BMI of more than 30)
I- Undertaking nutritional education, diet, and exercise
C- Comparison to nutritional education, endoscopic bariatric surgical intervention
O- Improved health outcomes in terms of overall weight
T - A year’s time limit
PICOT Statement: Childhood Obesity
Introduction
Childhood obesity poses serious health problems in the US as the number of overweight and obese population increases at a rapid pace every year. The effects of this problem have arrested the attention of policymakers, societal members, and government agencies. This has resulted in ranking childhood obesity as a national health concern. The adverse impacts of this disease go beyond the health realms to include economic burden on both personal and national budgets. While there are numerous risk factors and various evidence-based interventions to address this challenge, no single approach is consistently efficacious in curbing the disease. Consequently, it is imperative that efficacious initiatives and policies be developed to address the never-ending problem of childhood obesity. Multidisciplinary approaches are often broad and cut across all dimensions of personal health problems. Instead of placing emphasis solely on biomedical models, health care professionals should also seek to promote behavior change among obesity patients and their family members. A PICOT statement can be utilized as an effective tool to seek interventions of addressing childhood obesity.
PICOT Statement
Population
In the US, obesity prevalence is highest among children aged from 6 to 11 years (Cheung et al. 2016). The disease has tripled among this age group from 4.2 percent to 15.3 percent from 1963 to 2012. In the last three decades, increased cases of obesity prevalence have been noted among children of all ages, although the differences in obesity prevalence have been recorded in terms of age, race, ethnicity, and gender (Cheung et al. 2016). In this respect, children from socioeconomically disadvantaged families and some racial and ethnic minorities experience the higher median score on obesity than the dominant white population. Higher obesity rates are often recorded among blacks and Hispanics compared to whites. For instance, a survey on girls in the Southwest revealed that the yearly cases of obesity stood at 4.5 percent among Blacks, 2 percent among Hispanics, and 0.7 percent among white girls aged from 13 to 17 years (Cheung et al. 2016). For low-income earners, American Indians rank highest at 6.3 percent, followed closely by Hispanics at 5.5 percent.
Intervention
Evidence-based interventions that seek to reduce childhood obesity incidences in the country should target two major areas: prevention and treatment. High-quality RCT has been proven as one of the most effective preventative ...
ABSTRACT- The rising incidence of overweight and obesity among children and adolescents has become a cause of concern for India. Overweight/Obesity is an independent risk factor of cardiovascular diseases (CVDs) but it needs to be addressed seriously. Research has shown that modifiable and environmental factors along with genetics triggers the risk of cardiovascular diseases quite early in childhood threatening the health prospects of adults. It is crucial to address the causes of overweight/obesity like physical inactivity, unhealthy eating, lack of knowledge and awareness and impact of media and advertising. Clustering of cardiovascular risk factors like high blood pressure, hyperglycemia, abdominal obesity, high triglycerides in children and adolescents is an alarming sign. In order to dodge this serious public health crisis in near future we need to curb the prevailing risk factors of overweight/obesity. A holistic approach to tackle the obesity epidemic with an array of activities from policy making to program implementation, community education to individual knowledge and skill development is required. We need to promote healthy eating and lifestyle modifications in childhood and adolescents to prevent CVD risk in adulthood. Key-words- Adolescents, Obesity, Overweight, Cardiovascular Diseases
ABSTRACT- Background: Malnutrition constitutes a major public health concern worldwide and serves as an indicator
of hospitalized patient’s prognosis. Nutritional support is an essential aspect of the clinical management of children
admitted to hospital. Malnutrition has been long associated with poor quality, poor diet and inadequate access to health
care, and it remains a key global health issue that both stems from and contributes to weakness, with 50% of childhood
deaths due to principal under nutrition.
Methods: The present hospital based cross sectional study was conducted in April to Dec 2015 among 300 rural
adolescents of 9-18 years age (146 boys and 154 girls) attending the outpatient department at Patna Medical College and
Hospital, Bihar, India, belonging to the all caste communities. The nutritional status was assessed in terms of under
nutrition (weight-for-age below 3rd percentile), stunting (Height-for-age below 3rd percentile) and thinness (BMI-for-age
below 5th percentile). Diseases were accepted as such as diagnosed by pediatrician, skin specialist and medical officer.
Results: The prevalence of underweight, stunting and thinness were found to be 31%, 22.3% and 30.7% respectively. The
maximum prevalence of malnutrition was observed among early adolescents (23% - 54%) and the most common
morbidities were diarrhoea (16.7%), carbuncle / furuncle (16.7%) and scabies (12%).
Conclusion: Malnutrition among hospitalized under five children and around suffers moderately high rates of
malnutrition. Present nutrition programs attention on education for at risk children and referral to regional hospitals for
malnourished children. Screening tools to classify children at risk of developing malnutrition might be helpful.
Key-words- Malnutrition, Hospitalized children, Morbidities, Prevalence, Stunting
Management of Excess Weight and Obesity: A Global PerspectiveCrimsonPublishersIOD
Non-communicable diseases (NCDs), especially, hypertension, excess weight, obesity, metabolic syndrome, type-2 diabetes, and vascular diseases,
have increased rapidly in the last two decades and have reached an epidemic status worldwide. Some experts have compared this increase in the
incidence of these diseases as “tsunamis”. Tsunamis’ are seasonal and unpredictable whereas, these diseases are predictable and not seasonal. So, what
are we going to do about this situation? Are we going to sit and wait for some miracle to happen? What are the member nations of the United Nations,
World Health Organization, NCD Task Force going to do about this, besides writing and publishing scary reports of future economic and healthcare
disasters? In this overview, we would like to discuss briefly the salient findings on this topic, initiate a healthy dialogue, request suggestions, positive
comments, and offer few suggestions.
Abstract—Obesity is the major global nutrition concern. Modernisation and urbanisation have led to changes in dietary and lifestyle factors which are contributing to the increased prevalence of overweight and obesity.
Objective: To find out various life style risk factors for obesity among school children of affluent families aged 10-18 years in Jaipur city.
Methods: A cross-sectional study in ten randomly selected schools of Jaipur city with tuition fee > 18000 ₹/year was conducted from July 2012 to April 2013. 1610 students of class V to XII were included and their detailed life style history with anthropometric measurements was recorded after their informed written consent. Indian Academy of Pediatrics' growth Monitoring Guidelines for children from birth to 18 years was followed for defining and classifying obesity.
Result: 364 (22.61%) participants were found obese/overweight. Watching television during meals, frequency of main meals outside home per month, frequency of snacks outside home per week and duration of television/ computer watching per day were found significant predictors of overweight/ obesity on binary multivariate logistic regression method.
Conclusion: The present study highlights childhood overweight/obesity is an emerging health problem (22.61%) and lifestyle factors are important risk for it.
Dyslipidemia:
Among the total sample, 55.3% of patients had dyslipidemia.
11.7% of patients had high cholesterol,
28.6% had high triglyceride,
32.7% had high LDL, and
18.0% had low HDL.
Waist circumference was significantly associated with having dyslipidemia.
With every unit increase (1 cm), the odds of having dyslipidemia significantly increases by 1.020
Similar to Overweight obesity-and-abdominal-obesity-in-primary-school-children-in-pavia-northern-italy (20)
Journal of Nutrition and Health Sciences is an open access journal that publishes peer reviewed research articles and short communications in all aspects of nutrition. This Journal encompasses the full spectrum of nutritional science including nutritional requirements, public health nutrition, epidemiology, dietary surveys, body composition, energetics, appetite, obesity, ageing and metabolic studies.
Journal of Proteomics & Geneomics (JPG) is an instructional journal providing a chance to researchers and scientists to explore the advanced and latest research developments within the field of Proteomics and Geneomics. Journal of Proteomics & Geneomics publishes the best quality scientific articles amalgamating broad vary of fields together with the fields associated with Proteomics & Geneomics.
Journal of Obesity and Overweight (JOO) is a peer reviewed open access journal. It is dedicated to increase knowledge, fostering research, and promoting better treatment for people with obesity. It includes subjects like nutrition medicine, clinical nutrition medicine, genetics and nutrition, biophysics and lipid metabolism, etc. It aims to publish advanced research works related to public health and medical developments.
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Journal of Biometrics and Its Applications (JBIA) is peer reviewed open access journal which addresses the fundamental areas in computer science that deal with biological measurements. It covers both the theoretical and practical aspects of human identification and verification. Biometrics based authentication, an integral component of identity science, is now being utilized in several applications playing a central role in personal, national and global security. Biometric refers to the field of development of statistical and mathematical methods applicable to data analysis problems in the biological sciences.
Journal of Gynecology Research (JGR) publishes original articles and research studies on, scientific advances, new medical and surgical techniques, obstetric management, and clinical evaluation of drugs and instruments and all aspects of gynecology including gynecological endoscopy, infertility, oncology contraception, urogynecology, fertility, and clinical practice and ultrasonography. It aims to publish the highest quality medical research in women's health, worldwide.
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Journal of Clinical and Experimental Research in Cardiology (JCERC) is an international open access, scholarly peer-reviewed journal publishing high quality articles in all areas of cardiology related fields, especially current research, new concepts, novel methods, new therapeutic agents, and approaches for early detection and prevention of cardiac disorders and reporting new methods on basic and advanced clinical aspects of cardiology research.
Journal of Genetic Mutations and Disorders (JGMD) is an open access, peer reviewed journal which provides advanced researches including Genetics of Infectious Diseases, Genealogical Tracing, Stem Cell Research, Gene mapping with three-point crosses, Genetic linkage and genetic maps. JGMD publishes original research, review articles in all aspects of genetic mutations and disorders
CLINICAL AND EXPERIMENTAL RESEARCH IN CARDIOLOGYAnnex Publishers
Journal of Clinical and Experimental Research in Cardiology (JCERC) is an international open access, scholarly peer-reviewed journal publishing high quality articles in all areas of cardiology related fields, especially current research, new concepts, novel methods, new therapeutic agents, and approaches for early detection and prevention of cardiac disorders and reporting new methods on basic and advanced clinical aspects of cardiology research.
Journal of Bioequivalence Studies (JBS) is an open access, peer reviewed journal that publishes the most relevant and reliable researches with respect to the subject of Bioequivalence studies which includes pharmacokinetic and pharmcodynamic properties of a drug. JBS publishes original articles, review articles, case reports, short communications, etc.
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JOURNAL OF VETERINARY SCIENCE & ANIMAL HUSBANDRYAnnex Publishers
Journal of Veterinary Science and Animal Husbandry (JVSAH) is a scientific journal which has topics associated with fundamental and aspects of veterinary science and animal husbandry. JVSAH has a special feature of publishing special issues in experimental clinical research, veterinary medicine and current research. At Annex Publishers, we tend to publish quality articles and try our best to provide the most effective analysis journal to the scientific community.
Anti arthritic-efficacy-and-safety-of-crominex-3+(trivalent-chromium-phyllant...Annex Publishers
Abstract
The present investigation was undertaken to evaluate the therapeutic efficacy and safety of Crominex® 3+ (a complex of trivalent chromium, Phyllanthus emblica (Amla) extract and purified Shilajit) in moderately arthritic dogs. Eleven client-owned moderately arthritic dogs in a randomized double-blinded study received placebo or Crominex® 3+ twice daily for a period of 150 days. On a monthly basis, each dog was evaluated for arthritis associated pain (overall pain, pain upon limb manipulation and pain after physical exertion) and a full physical exam (body weight, body temperature and heart rate). At the same time intervals, dogs serum samples were examined for biomarkers of kidney (BUN and creatinine), liver (bilirubin, ALT and AST) and heart and skeletal muscle (CK) functions. Findings of this investigation revealed that dogs receiving Crominex® 3+ (1000 μg chromium, 15 mg Amla extract and 15 mg purified Shilajit per day in two divided doses) exhibited a significant (P< 0.05) reduction in arthritic pain noted as early as after 90 days with a maximum reduction after 150 days of treatment. Pain level remained the same or slightly increased in the dogs receiving placebo. No significant change occurred in physical parameters or serum biomarkers in dogs on placebo or Crominex® 3+, which suggested that Crominex® 3+ was well tolerated by arthritic dogs. In conclusion, Crominex® 3+ significantly (P< 0.05) ameliorated arthritic pain and improved quality of life without causing any untoward effects in moderately arthritic dogs.
Abstract
The objectives of this retrospective study were 1. To determine the effect of three surgical techniques (right flank omentopexy, right flank omentoabomasopexy, and left flank abomasopexy), and 2. To determine the effect of concurrent disease on return to normal milk production. Return to normal milk production occurred in 86.3% of cows diagnosed with LDA. Results suggested that cattle diagnosed with LDA corrected via right flank omentopexy or left flank abomasopexy were significantly more likely to return to normal milk production as compared to those corrected via right flank omentoabomasopexy (p< 0.02). No significant difference in return to normal milk production was noted between surgical techniques for correction of RDA (p=1.000) and right abomasal volvulus (p=0.596). Concurrent disease diagnoses did not affect return to milk production. Reported complications were infrequent (n=11).
List of abbreviations: LDA- Left displaced abomasum; RDA- Right displaced abomasum; RAV- Right abomasal volvulus; RAOV- Right abomasal-omasal volvulus; RFO- Right flank omentopexy; RFOA- Right flank omentoabomasopexy; LFA- Left flank abomasopexy; DA – Displaced Abomasum
Abstract
Three surgical case reports are presented to demonstrate the clinical efficacy of using an improved aqueous solution of chlorine dioxide complex (160 ppm) as a topical antiseptic in the post operative management of serious wounds in dogs. In vitro studies are included to demonstrate the antiseptic properties of this new chlorine dioxide complex.
Keywords: Chlorine dioxide; Antiseptic; Antimicrobial; Wound management
Abbreviations: ClO2-Chlorine dioxide; Cl2-Chlorine; PPM-Parts Per Million; SPP-Species; TEM-Transmission Electron Micrograph
Abstract
Salmonella is a causative agent for a wide variety of pathological diseases in humans, cattle, poultry and other farm animals and hence Salmonella infections are a major cause of concern to humans, veterinary animals and to food industry. With characterization of over 2500 Salmonella serovars, the pathogen nearly infects all vertebrates but the severity of infection varies from one serovar to another depending upon their host specificity. Some Salmonella serovars are restricted to one or few hosts while others have a broad host spectrum. Thus the understanding of the mechanisms involving host preference by one serovar over another is very important. As our knowledge about host adaptability will then be instrumental in designing better vaccines. Furthermore, methods involving identification of genetic markers for host specificity will prove to be instrumental in determining virulence factors for other pathogenic bacteria that cause systemic infections.
Keywords: Host adaption; Evolution; Salmonella serovar; Horizontal gene transfer
Anti inflammatory-and-anti-arthritic-efficacy-and-safety-of-purified-shilajit...Annex Publishers
Abstract
The objective of this investigation was to evaluate the efficacy and safety of purified Shilajit in moderately arthritic dogs. Ten client-owned dogs in a randomized double-blinded study received either a placebo or Shilajit (500 mg) twice daily for a period of five months. Dogs were evaluated each month for physical condition (body weight, body temperature, heart rate, and respiration rate) and pain associated with arthritis (overall pain, pain from limb manipulation, and pain after physical exertion). Serum samples collected from these dogs were examined each month for biomarkers of liver (bilirubin, ALT, and AST), kidney (BUN and creatinine) heart and muscle (creatine kinase) functions. The findings of this study revealed that dogs receiving Shilajit (Group-II) showed a significant (P< 0.05) reduction in pain from limb manipulation by day 60, and overall pain and pain after physical exertion by day 120. Maximum pain reduction, using all three criteria, was observed on day 150. Pain level remained significantly unchanged in dogs receiving the placebo. Dogs in either group showed no significant change (P>0.05) in physical parameters or serum markers, suggesting that Shilajit was well tolerated by moderately arthritic dogs. It was concluded that Shilajit significantly (P< 0.05) reduced pain in osteoarthritic dogs and markedly improved their daily life without any side effects.
Keywords: Purified Shilajit; Osteoarthritis in canine; Shilajit safety; Anti-arthritic nutraceutical
The updated-international-veterinary-anatomical-and-embryological-nomenclaturesAnnex Publishers
The international nomenclature of the anatomical, histological and embryological terms is known as Nomina Anatomica Veterinaria (N.A.V.), Nomina Histologica Veterinaria (N.H.V.) and Nomina Embryologica Veterinaria (N.E.V.).
This is the tripod of terms for the morphological sciences in our profession, a dictionary of terms used by all specialists in the basic and in the clinical sciences.
Observation of Io’s Resurfacing via Plume Deposition Using Ground-based Adapt...Sérgio Sacani
Since volcanic activity was first discovered on Io from Voyager images in 1979, changes
on Io’s surface have been monitored from both spacecraft and ground-based telescopes.
Here, we present the highest spatial resolution images of Io ever obtained from a groundbased telescope. These images, acquired by the SHARK-VIS instrument on the Large
Binocular Telescope, show evidence of a major resurfacing event on Io’s trailing hemisphere. When compared to the most recent spacecraft images, the SHARK-VIS images
show that a plume deposit from a powerful eruption at Pillan Patera has covered part
of the long-lived Pele plume deposit. Although this type of resurfacing event may be common on Io, few have been detected due to the rarity of spacecraft visits and the previously low spatial resolution available from Earth-based telescopes. The SHARK-VIS instrument ushers in a new era of high resolution imaging of Io’s surface using adaptive
optics at visible wavelengths.
This presentation explores a brief idea about the structural and functional attributes of nucleotides, the structure and function of genetic materials along with the impact of UV rays and pH upon them.
Deep Behavioral Phenotyping in Systems Neuroscience for Functional Atlasing a...Ana Luísa Pinho
Functional Magnetic Resonance Imaging (fMRI) provides means to characterize brain activations in response to behavior. However, cognitive neuroscience has been limited to group-level effects referring to the performance of specific tasks. To obtain the functional profile of elementary cognitive mechanisms, the combination of brain responses to many tasks is required. Yet, to date, both structural atlases and parcellation-based activations do not fully account for cognitive function and still present several limitations. Further, they do not adapt overall to individual characteristics. In this talk, I will give an account of deep-behavioral phenotyping strategies, namely data-driven methods in large task-fMRI datasets, to optimize functional brain-data collection and improve inference of effects-of-interest related to mental processes. Key to this approach is the employment of fast multi-functional paradigms rich on features that can be well parametrized and, consequently, facilitate the creation of psycho-physiological constructs to be modelled with imaging data. Particular emphasis will be given to music stimuli when studying high-order cognitive mechanisms, due to their ecological nature and quality to enable complex behavior compounded by discrete entities. I will also discuss how deep-behavioral phenotyping and individualized models applied to neuroimaging data can better account for the subject-specific organization of domain-general cognitive systems in the human brain. Finally, the accumulation of functional brain signatures brings the possibility to clarify relationships among tasks and create a univocal link between brain systems and mental functions through: (1) the development of ontologies proposing an organization of cognitive processes; and (2) brain-network taxonomies describing functional specialization. To this end, tools to improve commensurability in cognitive science are necessary, such as public repositories, ontology-based platforms and automated meta-analysis tools. I will thus discuss some brain-atlasing resources currently under development, and their applicability in cognitive as well as clinical neuroscience.
Cancer cell metabolism: special Reference to Lactate PathwayAADYARAJPANDEY1
Normal Cell Metabolism:
Cellular respiration describes the series of steps that cells use to break down sugar and other chemicals to get the energy we need to function.
Energy is stored in the bonds of glucose and when glucose is broken down, much of that energy is released.
Cell utilize energy in the form of ATP.
The first step of respiration is called glycolysis. In a series of steps, glycolysis breaks glucose into two smaller molecules - a chemical called pyruvate. A small amount of ATP is formed during this process.
Most healthy cells continue the breakdown in a second process, called the Kreb's cycle. The Kreb's cycle allows cells to “burn” the pyruvates made in glycolysis to get more ATP.
The last step in the breakdown of glucose is called oxidative phosphorylation (Ox-Phos).
It takes place in specialized cell structures called mitochondria. This process produces a large amount of ATP. Importantly, cells need oxygen to complete oxidative phosphorylation.
If a cell completes only glycolysis, only 2 molecules of ATP are made per glucose. However, if the cell completes the entire respiration process (glycolysis - Kreb's - oxidative phosphorylation), about 36 molecules of ATP are created, giving it much more energy to use.
IN CANCER CELL:
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
introduction to WARBERG PHENOMENA:
WARBURG EFFECT Usually, cancer cells are highly glycolytic (glucose addiction) and take up more glucose than do normal cells from outside.
Otto Heinrich Warburg (; 8 October 1883 – 1 August 1970) In 1931 was awarded the Nobel Prize in Physiology for his "discovery of the nature and mode of action of the respiratory enzyme.
WARNBURG EFFECT : cancer cells under aerobic (well-oxygenated) conditions to metabolize glucose to lactate (aerobic glycolysis) is known as the Warburg effect. Warburg made the observation that tumor slices consume glucose and secrete lactate at a higher rate than normal tissues.
(May 29th, 2024) Advancements in Intravital Microscopy- Insights for Preclini...Scintica Instrumentation
Intravital microscopy (IVM) is a powerful tool utilized to study cellular behavior over time and space in vivo. Much of our understanding of cell biology has been accomplished using various in vitro and ex vivo methods; however, these studies do not necessarily reflect the natural dynamics of biological processes. Unlike traditional cell culture or fixed tissue imaging, IVM allows for the ultra-fast high-resolution imaging of cellular processes over time and space and were studied in its natural environment. Real-time visualization of biological processes in the context of an intact organism helps maintain physiological relevance and provide insights into the progression of disease, response to treatments or developmental processes.
In this webinar we give an overview of advanced applications of the IVM system in preclinical research. IVIM technology is a provider of all-in-one intravital microscopy systems and solutions optimized for in vivo imaging of live animal models at sub-micron resolution. The system’s unique features and user-friendly software enables researchers to probe fast dynamic biological processes such as immune cell tracking, cell-cell interaction as well as vascularization and tumor metastasis with exceptional detail. This webinar will also give an overview of IVM being utilized in drug development, offering a view into the intricate interaction between drugs/nanoparticles and tissues in vivo and allows for the evaluation of therapeutic intervention in a variety of tissues and organs. This interdisciplinary collaboration continues to drive the advancements of novel therapeutic strategies.
THE IMPORTANCE OF MARTIAN ATMOSPHERE SAMPLE RETURN.Sérgio Sacani
The return of a sample of near-surface atmosphere from Mars would facilitate answers to several first-order science questions surrounding the formation and evolution of the planet. One of the important aspects of terrestrial planet formation in general is the role that primary atmospheres played in influencing the chemistry and structure of the planets and their antecedents. Studies of the martian atmosphere can be used to investigate the role of a primary atmosphere in its history. Atmosphere samples would also inform our understanding of the near-surface chemistry of the planet, and ultimately the prospects for life. High-precision isotopic analyses of constituent gases are needed to address these questions, requiring that the analyses are made on returned samples rather than in situ.
Richard's aventures in two entangled wonderlandsRichard Gill
Since the loophole-free Bell experiments of 2020 and the Nobel prizes in physics of 2022, critics of Bell's work have retreated to the fortress of super-determinism. Now, super-determinism is a derogatory word - it just means "determinism". Palmer, Hance and Hossenfelder argue that quantum mechanics and determinism are not incompatible, using a sophisticated mathematical construction based on a subtle thinning of allowed states and measurements in quantum mechanics, such that what is left appears to make Bell's argument fail, without altering the empirical predictions of quantum mechanics. I think however that it is a smoke screen, and the slogan "lost in math" comes to my mind. I will discuss some other recent disproofs of Bell's theorem using the language of causality based on causal graphs. Causal thinking is also central to law and justice. I will mention surprising connections to my work on serial killer nurse cases, in particular the Dutch case of Lucia de Berk and the current UK case of Lucy Letby.
Comparing Evolved Extractive Text Summary Scores of Bidirectional Encoder Rep...University of Maribor
Slides from:
11th International Conference on Electrical, Electronics and Computer Engineering (IcETRAN), Niš, 3-6 June 2024
Track: Artificial Intelligence
https://www.etran.rs/2024/en/home-english/
1. Annex Publishers | www.annexpublishers.com
Volume 1 | Issue 1Abstract
Childhood obesity has been described as the main health-related problem in developed countries, due to its link with physical, social and psychological consequences with an increased risk for developing metabolic and cardiovascular diseases in adulthood. Introduction
Overweight, Obesity and Abdominal Obesity in Primary School Children in Pavia, Northern Italy
Turconi G*1, Rossi M2, Testa L1, Moro S2, Roggi C1 and Maccarini L2
1 Department of Public Health, Experimental and Forensic Medicine, Unit of Human Nutrition and Dietetics, University of Pavia, Italy
2 Department of Public Health, Experimental and Forensic Medicine, Unit of Hygiene and Preventive Medicine, University of Pavia, Italy
*Corresponding author: Turconi G, Department of Public Health, Experimental and Forensic Medicine, Unit of Human Nutrition and Dietetics, Faculty of Medicine, University of Pavia, Via Bassi-21, Pavia, 27100, Italy, Fax: 0039 0382 987191, Tel: 0039 0382 987544, E-mail: gturconi@unipv.it
Citation: Turconi G, Rossi M, Testa L, Moro S, Roggi C, et al. (2014) Overweight, Obesity and Abdominal Obesity in Primary School Children in Pavia, Northern Italy. J Nutr Health Sci 1(1): 101. doi: 10.15744/2393- 9060.1.101
Research Article
Open Access
Volume 1 | Issue 1
Journal of Nutrition and Health SciencesKeywords: Overweight/obesity; Abdominal obesity; BMI; Waist circumference; Waist-to-height-ratioList of abbreviations: BMI-Body Mass Index; WC-Waist Circumference; W/HtR-Waist-to-Height-Ratio; IASO-International Association for the Study of Obesity; IOTF-International Obesity Task Force; WHO- World Health Organization
All the pupils of both sexes attending the second year of all the primary schools in Pavia, Northern Italy, were recruited (n=470) for this study. Measurements of weight, height and waist circumference (WC) were taken under standard conditions. Body Mass Index (BMI) and waist-to-height-ratio (W/HtR) were computed and sex specific percentile values for BMI, WC and W/HtR were calculated and compared with the same percentiles available for different countries.
The results show that according to Cole’s cut-off point reference standards, 12.5% and 9.0% of boys and girls respectively are overweight, 4.7% and 5.2% respectively are obese. The WC mean value is equal to 60.0 ± 6.0 cm in boys and 59.0 ± 6.7 cm in girls. Using different 90th reference worldwide standard percentiles for WC as a comparison, the prevalence of our children with WC > 90th percentile is very different. The W/HtR mean value of the total sample is 0.46 ± 0.03. Assuming a cutoff of 0.5, 87.6% of the pupils have a W/HtR value ≤ 0.5, while 12.4% of the subjects have a value > 0.5, showing abdominal obesity among 55 children at an early age.
Our results point out the need for specific preventive and treatment interventions by identifying and implementing effective strategies, policies, and nutritional education programs in order to decrease the prevalence rate of obesity as well as the risk of metabolic disorders.
Children’s obesity has been described as the primary health-related problem worldwide, due to its link with physical, social and psychological consequences. Its prevalence rate is rising almost universally [1-4] with an increased risk for developing chronic diseases such as type 2 diabetes, cardiovascular diseases and a variety of other co-morbidities before or during early adulthood.
Overweight children enter adulthood with an increased risk of adult obesity of up to 17-fold, while adult obesity in turn carries an increased likelihood of metabolic and cardiovascular diseases, certain cancers and a range of other disorders. Even if subsequent weight loss is achieved and maintained, there is evidence that mortality rates are higher among those adults who had been obese as adolescents [5].
The prevalence of overweight and obese children is dramatically higher in economically developed regions, but is rising significantly in most parts of the world [2,4]. Once considered a problem only in high income countries, the prevalence rate is now dramatically on the rise in low- and middle-income countries, particularly in urban settings.
The most recent data from the International Association for the Study of Obesity (IASO) [4] show that in the WHO Regions prevalence of overweight and obesity, respectively in boys and girls, is 1.9% and 2.6% in African Regions, 27.3 % and 26.3% in American Regions, 15.2% and 16.6% in the Eastern Mediterranean Regions, 22.1% and 20.3% in European Regions, 14.2% and 7.0% in South East Asian Regions, 17.7% and 12.7% in Western Pacific Regions.
Received Date: January 22, 2014 Accepted Date: May 16, 2014 Published Date: May 20, 2014
ISSN: 2393-9060
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Volume 1 | Issue 1
2
Waist circumference (WC) is recommended as a means of identifying people at risk of morbidity associated with central adiposity, especially with the risk of cardiovascular and metabolic disease, and it has been shown to be a highly sensitive and specific marker of upper body fat accumulation also in children [6]. The associated lipid abnormalities and insulin concentrations also correlate with WC [7,8]. WC represents the intra-abdominal fat that is thought to be more metabolically active, and it helps to predict cardio-metabolic risk even in patients with a normal BMI (‘‘metabolically obese individuals’’). However, stature influences the magnitude of WC throughout growth in childhood. Thus WC measurement, either alone or in combination with stature, might offer a more sensitive mean than BMI for identifying overweight and obese children who might be at an increased risk of developing metabolic complications.
To identify children at risk for the metabolic syndrome, different WC cut-off percentiles have been proposed. According to Maffeis et al. [9] children with a waist circumference > 90th percentile are considered to have abdominal obesity. The 90th percentile is also recommended in the International Diabetes Federation (IDF) definition for metabolic syndrome [10]: increased WC > 90th percentile is used as the “sine qua non” factor for diagnosing the syndrome.
Recently, many authors [9,11-14] suggested the weight-to-height-ratio (W/HtR) as a measure of excess central adiposity, correcting the WC for the height of the individuals, since it has been shown to more readily identify youth with adverse cardiovascular risk factors compared to WC and body mass index (BMI) [9,11]. The rationale underlying this index is that, for a given height, there is an acceptable degree of fat stored on the upper body. Since the W/HtR takes into account children’s height, a single cut-off point can likely be set for the ratio, without age and gender difference bias [14]. In addition, it has been shown to be a simple, non-invasive and practical tool that correlates well with visceral fat and it is easier to use [11-14]. In the small number of studies that have examined this index in children, W/HtR has been shown to be superior in its ability to predict cardiovascular disease risk factors compared to either BMI or percentage of body fat [13]. The correction of WC for height offers the advantage that a single W/HtR boundary value may be useful in different ethnic, age and sex groups [15,16], while WC requires population-specific boundary values [1]. A W/HtR cut-off-point of 0.5 has been proposed as a simple means of indicating whether the amount of central adiposity is excessive and represents a health risk in children [9,11-15]. The weighted mean boundary value of 0.5 supports the simple public health message “keep your waist circumference to less than half your height” [11,15]. Methods
Sample
All children of both sexes attending the second year of all the primary schools (n=13) in Pavia, Northern Italy, were recruited (n=470) in 2012. Four hundred and forty eight healthy subjects (95.3% of the entire sample) participated in the study, 52.5% males and 47.5% females, among whom 71 were from non-European countries, recently immigrated or born in Italy. Twenty two children, 16 Italians and 6 foreigners, refused to undergo anthropometric measurement assessment, since their parents were not interested in the project. None of the eligible children was mobility impaired nor disabled nor with medical condition that might affect their anthropometric measurements.
The mean age of the sample is 7.7 ± 0.4 years (range 7-8.5), with a prevalent distribution between 7.5 (51.8% of subjects) and 8 years (37.1 %). Six Italian children and ten foreigners were aged above eight years. We decided to select only the second year primary school pupils, as we intend to follow up the children until the last year of primary school after a nutritional education intervention provided by the school teachers. This study was carried out as part of a wider nutritional surveillance project conducted with the cooperation of the Education Department of Pavia City Hall, which also included investigation into the meals consumed in school canteens, dietary habits of children and their families, children’s physical activity level as well as the family’s educational level and SES and parents’ BMI. All students were surveyed over the course of three months, from April to the end of May 2012.
The survey was conducted with the cooperation of both the school teachers and the Education Department of Pavia City Hall. Before starting the study, the research team organized many meetings together with teachers to explain the aim of the research and to request their participation. After then, students and their parents were informed of the study by means of assemblies in each school as well as they were provided with a written document in which the research relevance in the context of a nutrition surveillance program was outlined. Finally they were invited to participate in the study. Informed written consent was obtained from them by means of a signed letter that the pupils gave back to their teacher. Only 22 remainder calls were needed just once to return consent form.
The aim of this study was to assess in a sample of Italian children the prevalence rate of overweight, obesity and abdominal obesity by means of weight, height and waist circumference (WC) measurements under standard conditions, then to compute Body Mass Index (BMI), waist-to-height-ratio (W/HtR) and sex specific percentile values for BMI, WC, W/HtR and finally to compare them with the same percentiles available for different countries.
The study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects were approved by the Ethics Committees of Pavia University Medical School.
Journal of Nutrition and Health Sciences
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Volume 1 | Issue 1
3
Journal of Nutrition and Health Sciences
Anthropometric measurements assessment
All the subjects were examined by two trained dietitians after setting up a classroom as a clinic in each school. The dietitians had received 8 hours of instruction and had been standardized in the measurement assessments. A subset of children (20 males and 20 females) was measured by the two dietitians to determine intra- and inter-operator variability, which was < 3% for all the measurements (Kappa reliability test).
The assessment was carried out during school hours in the late morning, about an hour before lunch, subject to an appointment with the school teachers.
Measurements of weight, height and waist circumference were taken under standard conditions [17]:
• Body weight, measured to the nearest 0.5 kg on subjects wearing only underwear and without shoes by means of a steelyard scale (precision ± 100 g) ;
• Body height measured to the nearest 0.5 cm on subjects without shoes by means of a stadiometer (precision ± 1 mm);
• Waist circumference (WC) measured to the nearest 0.5 cm in duplicate according to standard conditions, by placing a flexible tape midway between the lowest rib and the iliac crest. The tape was snug, but did not squeeze or compress the skin, and was parallel to the floor. The measurement was taken on unclothed, relaxed subjects, after gently exhaling.
BMI was calculated as the ratio between weight (in kilograms) and the square of height (in meters). W/HtR was calculated as the ratio between waist and height both measured in centimeters.
Cut off values
In accordance with the International Obesity Task Force (IOTF) [18], Cole et al.’s cut-off point reference standards for BMI [19] were used to identify overweight and obesity at a young age. Cole’s percentile curves were drawn so that at age 18 years they passed through the widely used cut-off points of 25 and 30 kg/m2 for overweight and obese adults. The resulting curves were averaged to provide age- and sex-specific cut-off points from 2 to 18 years. The IOTF [18,20,21] suggests that Cole’s cut-off points are less arbitrary and more internationally based than current alternatives (they were developed by measuring 97,876 males and 94,851 females from birth to 18 years of age living in Brazil, Great Britain, Hong Kong, The Netherlands, Singapore and the USA [19]) and will help to provide internationally comparable prevalence rates of overweight and obesity in children and adolescents.
Children with a waist circumference > 90th percentile were considered to have abdominal obesity [9,10]. The ratio between waist and height (W/HtR) was calculated and a cutoff of 0.5 used to differentiate low W/HtR from high W/HtR was chosen [9,11,15,16].
Data analysis
Data were processed using the Statistical Package for the Social Sciences version 18 for PC (SPSS Inc., Chicago, IL, USA). Descriptive statistics (means and standard deviations) and frequency distribution were calculated. Percentile regression was used to model the regression lines of the 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th and 97th percentiles of the distribution of BMI, WC and W/HtR. Results
Out of 448 subjects who agreed to participate in the study, 442 children underwent anthropometric assessment measurements, since during the days of investigation 6 subjects were at home due to illness. As reported above, the mean age of the sample is 7.7 ± 0.4 years (range 7-8.5), with a prevalent distribution between 7.5 (51.8% of subjects) and 8 years (37.1 %).
Age and anthropometric measurements of the sample are presented in Table 1. Mean BMI value is equal to 16.4 ± 2.4 kg/m2 for boys and 16.2 ± 2.6 kg/m2 for girls. According to Cole’s cut-off point reference standards, 12.5% and 9.0% of boys and girls respectively are overweight, while 4.7% and 5.2% respectively are obese. Overall, 15.9% of the all sample are overweight and obese. Weight, height and WC are slightly higher in boys than in girls, while the other anthropometric measurements are similar in both groups. The prevalence rate of underweight and obese subjects is higher in girls; overweight prevalence is higher in boys and normal weight children are similar in the two groups. Sex specific percentile values for BMI are shown in Table 2.
Referring to Cole’s reference standard percentiles, Figure 1 shows pupils’ BMI values illustrating normal distribution, without any difference between boys and girls. By analyzing the sample subdivided between Italian and foreign children, the prevalence rate of underweight children is higher in Italian when compared to foreign subjects (15.1% vs 4.2%; p<0.05); normal weight rate is similar in the two groups (70.9% vs 70.4%) while overweight and obesity rate is higher in foreign pupils (25.4% vs 14.0%; p<0.01). We point out that the foreigners come from various (n=23) non-European countries (Northern, Central and South America, Northern and Central Africa, East Asia and the Middle East) with different ethnic and cultural lifestyles.
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Girls
(n = 210)
Mean (SD)
Boys
(n = 232)
Mean (SD)
Total
(n = 442)
Mean (SD)
7.6 (0.3)
7.7 (0.5)
7.7 (0.4)
Age (years)
26.9 (6.0)
27.8 (5.5)
27.3 (5.8)
Weight (kg)
128.2 (5.8)
129.8 (5.2)
129.0 (5.6)
Height (cm)
16.2 (2.6)
16.4 (2.4)
16.3 (2.5)
BMI (kg/m²)
59.0 (6.7)
60.0 (6.0)
59.5 (6.3)
Waist Circumference (WC) (cm)
0.46 (0.03)
0.46 (0.04)
0.46 (0.03)
Waist-to-height ratio (W/HtR)
13.2 (0.5)
(15.2 %)*
13.5 (0.5)
(11.6 %)*
13.3 (0.5)
(13.3 %)*
Under weight subjects’ BMI (kg/m²)
15.9 (1.4)
(70.6 %)*
15.9 (1.2)
(71.2 %)*
15.9 (1.0)
(70.8 %)*
Normal weight subjects’ BMI (kg/m²)
20.0 (1.1)
(9.0 %)*
19.6 (0.9)
(12.5 %)*
19.7 (1.0)
(10.9 %)*
Overweight subjects’ BMI (kg/m²)
23.5 (1.9)
(5.2 %)*
23.4 (1.5)
(4.7 %)*
23.5 (1.7)
(5.0 %)*
Obese subjects’ BMI (kg/m²)
*percentage of subjects in brackets
Table 1: Age and anthropometric measurements of the sample (n=442)
W/HtR
WC (cm)
BMI (kg/m2)
Percentiles
girls
boys
girls
boys
girls
boys
0.40
0.41
50.2
53.0
12.8
13.1
3rd
0.40
0.42
51.0
54.0
13.0
13.4
5th
0.41
0.42
52.0
54.0
13.6
13.9
10th
0.43
0.44
54.0
56.0
14.6
14.7
25th
0.45
0.46
57.0
59.0
15.7
16.1
50th
0.48
0.47
63.0
62.0
17.1
17.5
75th
0.52
0.51
68.0
68.0
19.6
19.8
90th
0.55
0.55
75.5
73.0
22.3
21.8
95th
0.56
0.57
78.0
76.0
22.7
22.8
97th
Table 2: Sex specific percentile values for BMI (kg/m2), WC (cm) and W/HtR in our sample (n=442)
Figure: 1: BMI distribution according to Cole’s reference standard percentiles
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The WC mean value is equal to 60.0 ± 6.0 cm in boys and 59.0 ± 6.7 cm in girls. Sex specific percentile values of our sample for WC are shown in Table 2. Our WC 50th percentile is then compared with the same percentile in different populations at 8 years of age in Table 3.
Authors
WC values (cm)
at 50th percentile
Countries
girls
boys
Turconi et al., 2014
57.0
59.0
Pavia, Northern Italy
Zannolli et al., 1996 [35]
69.0
67.0
Pescara, Central Italy
Aeberli et al., 2011 [24]
58.4
59.2
Switzerland
Schwandt et al., 2008 [37]
57.2
58.6
Germany
McCarthy et al., 2001 [32]
54.1
54.7
United Kingdom
Ostrowska Nawarycz et al., 2010 [30]
55.5
57.1
Poland
Hatipoglu et al., 2008 [31]
54.7
56.4
Turkey
Sung et al., 2008 [23]
53.2
55.3
Hong Kong
Zhang et al., 2013 [22]
53.7
55.8
Shandong, China
Fernandez et al., 2004 [33]
58.8
59.6
United States
(European American Children)
Gomez-Diaz et al., 2005 [34]
60.0
62.5
Mexico City
Avalos et al., 2012 [36]
63.7
63.2
Santiago, Chile
Table 3: WC value at the 50th percentile for both gender in various populations at 8 years of age
Using different 90th reference worldwide standard percentiles for WC as a comparison, the percentage of our children with WC > 90th percentile is very different, ranging from 1.3% (Mexico City) to 28.4% (UK) for boys and from 0.8% (Central Italy) to 29.8% (UK) for girls, as shown in Table 4. Assuming a cutoff of 0.5 (≤ 0.5 and >0.5) used to differentiate low W/HtR from high W/HtR, the W/HtR mean value of the total sample is 0.46 ± 0.03 showing a value under 0.5. Sex specific percentile values for W/HtR are provided in Table 2. Eighty-seven point six percent of the children have a W/HtR value ≤ 0.5, while 12.4% of the subjects (n=55; 11.6% of boys and 13.3% of girls) have a value >0.5, of whom 9.7% are overweight and obese subjects.
Authors
% of children with
WC > 90th percentile
WC values (cm)
at 90th percentile
Countries
girls
boys
girls
boys
Turconi et al., 2014
68.0
68.0
Pavia, Northern Italy
Zannolli et al., 1996[35]
0.8
1.8
79.7
77.0
Pescara, Central Italy
Aeberli et al., 2011[24]
11.0
10.3
66.4
67.0
Switzerland
Schwandt et al., 2008[37]
11.4
9.5
65.8
67.5
Germany
McCarthy et al., 2001[32]
29.8
28.4
60.4
60.9
United Kingdom
Ostrowska Nawarycz et al., 2010[30]
15.2
10.8
64.2
66.7
Poland
Hatipoglu et al., 2008[31]
25.2
16.4
61.9
64.4
Turkey
Sung et al., 2008[23]
26.6
10.1
61.6
66.6
Hong Kong
Zhang et al., 2013[22]
15.2
6.7
64.0
70.0
Shandong, China
Fernandez et al., 2004[33]
7.6
6.5
69.7
71.0
United States (European American Children)
Gomez-Diaz et al., 2005[34]
5.2
1.3
73.8
79.9
Mexico City
Avalos et al., 2012[36]
1.4
1.7
77.9
77.8
Santiago (Chile)
Table 4: Percentage of children of Pavia exceeding the WC 90th percentile obtained from various populations at 8 years of age
When the value of the W/HtR that corresponds to the 50th percentile in this study is compared with the same available reference standard percentiles, our value for both genders lies between the 50th and 75th percentiles of Shandong children [22], between the 50th and 75th percentiles of Hong Kong children [23] for boys and between the 75th and 90th percentiles for girls, and at the 50thpercentile of Swiss children [24] for boys and between the 5th and 50th percentiles for girls.
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6Discussion
This study, carried out as part of a wider nutritional surveillance project, was aimed at assessing in a sample of Italian children the prevalence rate of overweight, obesity and abdominal obesity as indicative risk of cardiovascular and metabolic diseases, and comparing our population with similar studies.
In the current study, the prevalence rate of overweight and obese subjects is higher in males (17.2%) than in females (14.2%). The value in the total sample is equal to 15.9% and is lower than the most recent Italian national data collected in 2012. A cross-sectional survey carried out by the Italian Ministry of Health and coordinated by the National Institute of Health on 46,483 students aged 8-9 years (OKkio alla Salute Surveillance Project, 2012 [25]) shows that out of the children weighed and measured using the international standardized methodology, 32.8% were overweight or obese, with the highest percentage in central (>35%) and southern (>40%) Italy. Indeed, the national data subdivided according to geographical areas show in Lombardy Region a prevalence rate of overweight and obesity decreasing from 25-33% in 2008 to ≤ 25% in 2012 [25,26].
Our data are encouraging and are in line with those of a study carried out by Brambilla et al. in 2012 in Milan [27], northern Italy, reporting a decrease in the prevalence rate of overweight and obesity in 2,117 children aged 5-6 years from 23.1% in 2001 to 16.6% in 2011. In addition, they are in line with international epidemiological data [28] referring to nine European and non-European countries (Australia, China, England, France, Netherland, New Zealand, Sweden, Switzerland and USA) collected on 467,294 children aged 2-19 years, reporting that the increase in prevalence of overweight and obesity has slowed appreciably, or has even plateaued.
Therefore, it might be supposed that the childhood obesity epidemic is decreasing, but it should also be pointed out that our data and those collected in Milan and in Lombardy Region refer to selected age groups of children (7-8 years in Pavia, 5-6 years in Milan and 8-9 years in Lombardia) and to a specific area in Italy, then they need further in-depth studies to exclude a shift in the onset of overweight and obesity in adolescence.
From 1995, WC by itself was proposed as an alternative measurement for central or abdominal obesity [29], since BMI gives no indication about body fat distribution. WC is strongly correlated with abdominal fat measurements from advanced imaging techniques, and is thought to represent fat stored in visceral deposits [15].
To date, there are no international reference standard percentile values for WC. Thus, considering the influence of age, gender and ethnicity on this anthropometric index, different countries worldwide provided WC percentile curves for children by age and gender, aimed at defining the mean and distribution of WC at each age, so that WC requires population specific boundary values [1].
Therefore, our 50th percentile value for boys and girls, compared with those listed in Table 3, are higher than those in Poland [30], Turkey [31], UK [32], Hong Kong [23] and China [22] and lower than those in United States [33], Mexico City [34], Pescara [35] and Chile [36]. Germany [37] shows 50th percentile values closer to ours. We compared our percentile curves also to those provided for Central Italy (Pescara) as a reference standard [35] although these values refer to a small town in a specific Italian region and were moreover collected a long time ago (1996), nevertheless they are the only available for Italian children.
Since children with a WC >90th percentile are considered to have abdominal obesity and to be at risk of metabolic syndrome [9,10], when we refer to the 90th percentile value of those standards, the percentage of our children with WC >90th are extremely different (Table 4), ranging from 1.3% (Mexico City [34]) to 28.4% (UK [32]) for boys and from 0.8% (Pescara [35]) to 29.8% (UK [32]) for girls.
This may be due to the influence of ethnicity, genetics, different dietary habits and body shape in various countries, although comparison of WC data between different studies needs to be undertaken with caution since WC may be measured at four different anatomical sites as reported by Browning et al. [15] in a systematic recent review: the minimum WC, WC at or 1cm from the umbilicus, WC at the midpoint between the xiphisternum and the umbilicus or using the WHO definition of halfway between the lower rib and the iliac crest.
Moreover, WC may over and under evaluate risk for tall and short subjects with similar WC. In addition, the time that the data were collected in the various countries could reflect different phases of the global obesity epidemic. Therefore, it is very difficult to correctly identify those children at risk of central obesity and cardiovascular and metabolic disorders.
These observations suggest the need to undertake further studies in various countries worldwide in order to obtain WC percentiles curves which could be used at international level as Cole’s BMI curves.
Another useful anthropometric measurement to better define abdominal obesity is W/HtR, which is increasingly used to assess the risk for diseases related to visceral fatness in adults [38-41] as well as in children [9,11-14]. Since the W/HtR takes children’s height into account, a single cut-off point (>0.5) can likely be set for the ratio, without age and gender difference bias [14].
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Ashwell and Hsieh [16] suggested a few reasons why the W/HtR is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Among these, the most important are the following: a boundary value of WHtR of 0.5 indicates increased risk for men and women; it may indicate increased risk for individuals in different ethnic groups; it may allow the same boundary values for children and adults. However, it is recognized that WC can be measured at a variety of different sites and therefore only one standard site should be used for the measurement.
According to this cut-off point, 12.4% of our subjects (n=55) have a value >0.5, among them 9.7% are overweight and obese subjects according to BMI. Our results are in line with those found for children aged eight years in Hong Kong [23] and Shandong (China) [22], are slightly lower than those found in Switzerland [24] and higher than those in UK [11], with the latter showing lower values both for children’s BMI and WC. These results are worrying and need to be taken into consideration, since metabolic syndrome is becoming a very significant health problem in children too [42]. Childhood obesity is a problem of epidemic proportions. Furthermore, the accumulation of fat in the upper segment of the body plays an important role in the pathogenesis of metabolic and cardiovascular diseases also in pediatric age. Our results point out the need for specific preventive interventions by continuing on effective strategies, policies, and nutritional education programs in order to contain the prevalence rate of obesity as well as to decrease the risk of metabolic disorders. In our Lombardy Region health preventive targeting programs aimed at improving a healthy diet, weight status and increasing physical activity are carrying out by the local health institution in each primary school at an early age, involving not only children but also their family and environment.
Our study has a few limitations that must be considered. First, no in-depth analysis was performed when comparing the two groups of Italian and foreign children because of the different number of subjects in each group as well as the various countries of origin of the immigrants (23 non-European countries) with different ethnic and cultural lifestyles. Second, we assessed only second year primary school children since we intend to follow up the children during subsequent years until the last year of primary school and after a nutritional education intervention provided by the school teachers.
The strength of our study is that we compared our results of WC and W/HtR with other data available for various European and non-European countries. Conclusions
Overweight and obese children are an important public health concern, not only in the developed worlds but also in emerging countries, and abdominal obesity is an established factor for the development of metabolic syndrome also at an early age. Therefore, children with excessive visceral adipose tissue should be observed carefully.
The use of WC measurement cannot correctly identify those children at risk of central obesity and cardiovascular and metabolic disorders, since WC may over and under evaluate risk for tall and short subjects with similar WC and, in addition, it is recognized that WC can be measured at a variety of different sites. As suggested by Ashwell and Hsieh [16] the W/HtR is a rapid and effective global indicator for health risks of obesity since it takes children’s height into account and a single cut-off point can likely be set for the ratio, without age and gender difference bias. Other studies should be carried out in order to provide W/HtR percentiles for children in many countries. Acknowledgements
The authors would like to express their acknowledgement to the staff of the Education Department of Pavia City Hall: Dr. R. Faldini, Dr. M. Adduci, Dr. P. Mangiarotti, Dr. F. Gallone, Dr. F. Biffi, Dr. L. La Carbonara. They are very grateful to all the teachers, the pupils and their parents for their continuous cooperation and to the dietitians for the anthropometric measurement assessment.
The research was supported by grants from Pavia City Hall Education Department. References
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