[The frequency of risk factors for atherosclerosis in youth aged 16 and 18 years--students of upper-secondary schools in Poland]. / Czestosc wystepowania czynników ryzyka miazdzycy u mlodziezy w wieku 16 i 18 lat--uczniów szkól ponadgimnazjalnych w Polsce.

OBJECTIVES: 1. To examine the prevalence of selected risk factors for atherosclerosis: overweight, tobacco smoking, low physical activity, psychological distress and type A personality (characterized by tenseness, impatience, competitiveness, and aggressiveness) in adolescents and to assess the frequency the coexistence of risk factors (≥3) in relation to gender, age and school type. METHODS: A cross-sectional study was carried out in a representative sample of youth aged 16 and 18 years (N=2983) in 8 voivodeships in Poland. The frequency of five atherosclerosis risk factors and their coexistence (≥3) was examined using self-reported questionnaires, in relation to gender, age and school type. Logistic regression analyses were used to assess the influence of the variables (gender, age and school type) on odds ratios of risk factor coexistence. RESULTS: Low physical activity was the most common risk factor, statistically more frequent in students from Basic Vocational Schools than in other school types (p<0.05). In Basic Vocational Schools there was also the highest percentage of cigarette smokers (p<0.001). Psychological distress and type A behaviour were observed most frequently in students from General Upper Secondary Schools. The highest risk factor accumulation (≥3) was observed among students from Basic Vocational Schools (40%), significantly more frequent in girls than boys (47.5% and 37.5% respectively). Multivariable analyses show that students from Basic Vocational Schools had twice the odds (OR=2.25, p<0.001) to have the coexistence of risk factors for atherosclerosis as compared with students from General Upper Secondary Schools, girls had almost twice as many occurrences (OR=1.83, p<0.001) as boys and 18-year-olds 1.5 more than 16-year-olds (OR=1.46, p<0.001). CONCLUSION: 1. A significant difference in the prevalence of risk factors for atherosclerosis in youth from different school types requires precise definition of priority health promotion activities depending on school type. 2. Students from Basic Vocational Schools should be the target group for intervention aimed at reducing atherosclerosis risk factors.

[Changes in structure and socioeconomic position of the family as determinants of overweight in adolescents]. / Zmiany w strukturze i sytuacji ekonomicznej rodziny jako czynniki warunkujace nadmierna mase ciaca nastolatków.

INTRODUCTION: Previous studies on relationships between the current family structure, socioeconomic status and family members' body mass don't give unequivocal results. A life course perspective evaluates the contribution of early life factors jointly with later life factors to identify risk and protective processes. OBJECTIVES: The relationship between economic status, family structure in first and thirteenth year of life, their changes in this period and overweight among 13-year olds in Poland. PARTICIPANTS AND METHODS: A study sample was the prospective cohort of 11 937 children enrolled in the observation in neonatal period, examined in the third year of life (questionnaire survey of 1250 mothers) and at the age of thirteen (561 children and their parents fulfilled questionnaires, children's height and weight were measured). Overweight criteria was BMI >85 percentile using WHO 2007 growth reference. RESULTS: Higher prevalence of overweight was found in adolescents living in single-parent families than in 2-parent families (30.2% vs. 19.5%; p=0.049). The highest prevalence of adolescents' overweight was observed in families, whose structure changed during 13 years (in ""broken"" families - 32.7%, in reconstructed - 36.4%, p=0.033); the risk of overweight in these children increased twice compared to intact families. Adolescents from families whose reported economic status worsened during 13 years, were twice more likely to be overweight than their peers from middle and high economic status families (p=0.057). CONCLUSIONS: The prevalence of overweight among adolescents in 2-parent families is significantly lower than in other family types. Unfavorable changes in family economic status and structure are the strongest redictors of overweight in 13-year-olds.

[Can family meals protect adolescents from obesity?]. / Czy Spozywanie Wspólnych Posilków Z Rodzinamoze Chronic Nastolatki Przed Otyloscia?

AIM: To analyse the relationship between the frequency of family meals and the body weight of 13-year-olds and its selected determinants. MATERIAL AND METHODS: The study was conducted in 2008 as the last stage in a prospective cohort study of 605 children. Questionnaires containing questions about the frequency of family meals, the general regularity of meals, fruit and vegetable consumption, physical activity and the number of hours spent watching television or at the computer were sent to 13-year-olds by mail. School nurses performed anthropometric measurements of the pupils' weight and height. Statistical analyses were performed, i.e. Pearson's correlations, the two-step cluster analysis and the logistic regression analysis. RESULTS: Most of the young people (80-90%) eat each of the main meals in the company of their parents at least once a week, 21% have breakfast with their parents every day, 41% - dinner, and 45% - supper. The frequency of family meals correlated negatively with the girls' BMI and the number of hours they spent watching television or at the computer, while positively with physical activity, regular meals and vegetable consumption in adolescents of both genders. The lowest mean values of BMI were found in a group of adolescents often eating family meals, the highest - in the group of young people who rarely ate family meals (over 20% of young people in this group were overweight), but the differences were statistically significant only for girls (p=0.025). The probability of less than 2 hours of sedentary behaviour daily, physical activity of at least 60 minutes per day and everyday vegetable and fruit consumption is twice as high in adolescents often consuming meals with their parents, and with the daily consumption of all the meals in this way - more than fourfold higher than in other groups. CONCLUSIONS: Family meals treated as a predictor of a healthy lifestyle can indirectly protect adolescents from overweight and obesity. Promoting family meals should be an important method of preventing obesity, particularly among teenage girls.

[Overweight and obesity among parents and their 13-old children in Poland]. / Nadwaga i otylosc rodziców i ich 13-letnich dzieci w Polsce.

OBJECTIVE OF THE STUDY: To examine the prevalence of overweight and obesity among parents and their 13-year-old children in Poland, and relationships between parental and child obesity. PARTICIPANTS AND METHODS: The study was conducted in 2008 as a part of prospective cohort follow-up study from 1995. The sample included 579 children (289 girls, 290 boys), their parents (549 mothers, 487 fathers). Parental height and weight were self-reported. Height and weight of children were performed by school nurses. IOTF criteria was used to determine overweight and obesity in children. For adults overweight was defined as BMI > or = 25.0 and obesity BMI > or = 30.0. The relation of parental-child overweight was tested by the odds ratio (OR). RESULTS: The prevalence of overweight was 43.4% for mothers and 71% for fathers (p < 0.001), including obesity respectively 12.3% and 20.3%, more often among rural mothers (48.1%) than urban (38.5%) (p = 0.69). Prevalence of childhood overweight was 16.7% for boys and 13.5% for girls, obesity respectively 2.4% and 1.0%. Overweight was observed more often in urban than rural areas, respectively 17.1% and 13.3%. OR for child hood overweight was the highest when both parents were overweight OR = 3.90 (1.57-9.72), when the mother alone was overweight OR = 2.55 (1.56-4.16), when father alone--OR = 2.10 (1.09-4.05). CONCLUSION: Overweight and obesity is a family problem. In the obesity prevention, interventions should be directed towards the entire family.

[Physical development and puberty of Polish 13 year old adolescents in the first decade of 21st century. Current status and secular trend of growth and maturation in the last 30 years]. / Rozwój fizyczny i dojrzewanie polskich 13-latków w pierwszej dekadzie XXI wieku. Stan obecny oraz trend sekularny wzrastania i dojrzewania w ostatnim trzydziestoleciu.

THE AIM OF THE STUDY: 1. Current physical status and selected pubertal features were assessed in Polish 13-year old adolescents, in urban and rural areas. 2. Dynamics and secular trends of body height, mass and body mass index in 1980-2008 were analyzed. MATERIAL AND METHODS: The study was conducted in 2008 in prospective cohort of 605 children (305 girls and 300 boys), who had been observed in the neonatal period, later at age of 3 years and now at age of 13 years. 49% adolescents were from urban and 51% from rural area. For secular trend analyses comparisons of the age and sex-specific means of body height, mass and BMI from 2008 with previous data from 1980, 1999 and 2005 in 13-year old were carried out. Similar comparison was made concerning average age at menarche by using previous probit analysis to determine average age at menarche during the last 3 decades. RESULTS: Mean values of anthropometric features in adolescents were a little higher in 13-yrs old living in urban than rural area, but were statistically insignificant. Two thirds of examined 13-year-old girls already had their first period (menarche), statistically more often urban living girls (p = 0,017). The median age at menarche for entire group of 13-year-old girls estimated by means of Kaplan-Meier analysis was 12.77 years. The girls from urban areas had their first menses earlier than their rural living peers (12.65 and 12.88 years, p = 0.01). There were no statistically significant differences in urban and rural boys concerning age of appearance of facial hair. There are increases of mean height and weight values during the period of 30 years in 13-year-olds (2.51 cm and 2.2 kg for girls and 5.51 cm and 5.08 kg for boys) and BMI 0.21 kg/m3 and 0.75 kg/m2 for girls and boys. The average age of menarche was almost the same as in Warsaw girls in 1986 and 1996. CONCLUSIONS: 1. The study confirmed a reduction of differences in somatic development between 13-years olds in rural and urban areas. 2. Difference in mean age at menarche is still observed, they show earlier maturation in urban girls (about 2 months earlier than in rural girls). 3. Positive secular trend in height in Polish 13-year-olds is observed during the last 3 decades. 4. The mean age at menarche in Polish girls stabilized at 12.77 years in the last decade.

[Meals consumption among thirteen years olds and selected family socio-economic correlates]. / Regularnosc spozywania posilków przez 13-latków a wybrane cechy spoleczno-ekonomiczne rodziny.

AIM: To analyse the influence of selected family socioeconomic factors on the regularity of meals consumption among 13-years aged adolescents. MATERIAL AND METHOD: Group of 605 13-years olds identified in the prospective cohort study in 2008 was analysed. Data was gathered with use of posted questionnaires. On the basis of information given by children the regularity (4-5 times a week) of meals consumption on school days and eating meals with parents were correlated with parents' educational level, occupational status and perceived family wealth. The study also recognised the distinction between urban and rural residents. RESULTS: Most questionnaires were filled out by mothers (95%), only 5% by fathers. In urban area, the mother's occupation and the perceived family wealth, correlate with children meals consumption and eating meals with parents. Children whose mothers have a job eat breakfast 1.5 times and supper 3 times less regularly, than children whose mothers don't work. Children from poor families eat breakfast 14 times less regularly than children from rich families as well as eat supper 3 times less regularly than children from average wealthy families. In the rural area, the regularity of meals consumption significantly influence the mother's education. Children whose mothers have a secondary education, compared with children of mothers with basic education, are 4 times more likely to eat dinner and supper regularly. CONCLUSION: The family socioeconomic factors significantly correlate with regularity of 13-years olds meals consumption and regularity of family meals. The place of residence involve the different factors influencing meals consumption habits. It was shown that children and fathers were too little engaged in family life, including family meals preparation and consumption.

[Determinants of adolescents' physical activity]. / Determinanty aktywnosci fizycznej mlodziezy.

AIM: To compare the study results concerning the correct level of 13- and 15-year-old adolescents physical activity and impact of selected physical activity determinants (self-efficacy, BMI, gender, domicile) obtained from two nationwide studies out in Poland, using a similar questionnaire in 2006 and 2008. MATERIAL AND METHODS: The material comes from two studies. The first, the 2006 HBSC survey included 2287 15-year-old students (1092 boys and 1195 girls); the second, the 2008 third phase of a prospective, three-phase survey, included 605 13-year-olds (300 boys and 305 girls) born in Poland in January 1995. Questions on physical activity were analysed (MVPA), along with the following determinants: self-efficacy, domicile, gender, body weight and height. Cross-tabulation with chi2 analysis and multilevel modelling were applied. RESULTS: Physical activity deficiency was found in both examined populations. In study I--84.8%, in study II--80.3%. Self-efficacy (p < 0.01), gender (p < 0.001) and BMI (p < 0.04) had an impact on the 15-year-olds physical activity. In 13-year-olds, only self-efficacy was close to significant relation with physical activity. The results of multilevel logistic regression in study I identified protective factors: male gender [OR = 0.41; CI (OR): 0.32-0.53] and strong self-efficacy [OR = 0.66; CI (OR): 0.51-0.85]; while being underweight was identified as a risk factor [OR = 2.77; CI (OR): 1.11-6.95]. In study II only strong self-efficacy was found as a protective factor [OR = 0.51; CI (OR): 0.30-0.89] against lack of physical activity. CONCLUSIONS: Most of the examined adolescents from study I as well as study II suffered from physical activity deficiency. The share of biological determinants (gender, BMI) in maintaining correct level of physical activity increased with age. A link between physical activity and self-efficacy was demonstrated in the 15-year-olds, while this tendency was identified in the 13-year-olds. The results point to a need for implementing programmes supporting self-efficacy in children under the age of 13 and to carry out assessment of self satisfaction concerning own bodyweight. In preparing these programmes sex differences should be taken into consideration.

[Assessment of physical development of children and adolescents. Part I. Infants and children up to 5 years--national reference values or WHO standards?]. / Ocena rozwoju fizycznego dzieci i mlodziezy. cz. i. niemowlita i dzieci do 5 lat--normy krajowe czy standardy who?

INTRODUCTION: Growth and development assessment of infants and young children is a very important component of early prophylaxis in paediatric health care. In 2006 the World Health Organization published the new Child Growth Standards for children up to 5 years of age. They describe the optimal pattern of young children development. AIM OF THE STUDY: 1. To compare the cut-off points for selected anthropometric parameters in children up to 5 years between reference values for Polish children and WHO Child Growth Standards. 2. To attempt to answer the question whether the WHO Child Growth Standards can be implemented to assess health and development in children up to 5 years in Poland. METHODS: The differences for mean (50th percentile) and extreme values (3rd and 97th percentile) for length/height for age and weight for age were calculated for boys and girls. The differences in BMI units for overweight (mean + 1 SD) and obesity (mean + 2 SD) were compared using the z-score method. RESULTS: Comparisons of the WHO and Polish length/height and weight for age showed no differences in children aged 1-60 months. Small differences were seen in the 3rd percentile (less than 2%) in children aged 3 and 6 years. BMI values for overweight and obesity were slightly lower for Polish children in the first 6 months of life than in WHO standards. These differences have positive values for boys and girls starting at 9th month and increasing in toddlers. CONCLUSIONS: WHO standards reflect the optimal growth pattern for children from birth up to 5 years. Therefore these instruments should be adopted for Polish children to assessing their growth.

[Assessment of physical development of children and adolescents. Part II. Children and adolescents aged 6-19 years--national references or WHO recommendations?]. / Ocena rozwoju fizycznego dzieci i mtodziezy. cz. ii. dzieci i mtodziez w wieku 6-18 lat- normy krajowe czy rekomendowane przez who?

AIMS: 1. Comparison of cut-off points for selected anthropometric parameters in children and adolescents between reference values for Polish Institute of Mother and Child (IMD) and WHO growth METHODS: The accepted reference system were IMD reference values and the differences for mean (50th) and 3rd and 97th percentile for height and weight were calculated for boys and girls. The differences between BMI units for overweight (85th) and obesity (95th) percentile were compared. Warsaw 1980 reference values were used to estimate secular trend influence on differences between IMD and WHO cut-off points in stunting adolescents. RESULTS: Comparison of height-for-age showed the largest differences with positive values relative to 3rd percentile in the Polish population. Boys aged 16 years attain 4% (6.2 cm) of 3rd percentile height value and girls aged 14 years 2.3% (2.8 cm). Secular trend of the Polish population did not influence the differences between IMD and WHO values in stunting adolescents. The differences for 85th and 95th percentile of BMI were most pronounced in prepubescence and the largest values were for boys and girls aged 10 years. CONCLUSIONS: 1. National height-for-age references should be used for growth assessment in Polish school-aged children and adolescents especially in stunting adolescents identified in puberty. 2. WHO norms for BMI, can be used as a tool for identifying overweight and obesity in epidemiological studies in Poland and for international comparisons. 3. The usefulness of WHO norms for clinical evaluation of overweight and obesity should be discussed among experts.

[Screening for developmental disorders of infants and young children in the primary care clinics--is there a need for standardized tools implementation?]. / Metody przesiewowe do wykrywania zaburzen w rozwoju psychoruchowym niemowlat i malych dzieci--czy istnieje potrzeba wprowadzenia wystandaryzowanych narziedzi do stosowania w podstawowej opiece zdrowotnej w polsce?*.

Early identification of children with developmental delay is an important task for the primary care physicians. Different screening tests are used to detect developmental disorders in infants and young children. The authors describe screening tools currently available in Poland in the primary care setting. The review of the standardized developmental screening tests available in other countries is given: parent report instruments, such as Ages and Stages Questionnaires (ASQ), Parent's Evaluation of Developmental Status (PEDS) and instruments that require direct examination as the Denver-ll Developmental Screening Test (DDST) and Bayley Infant Neurodevelopmental Screener (BINS). The authors describe a proposed standardized developmental screening instrument of infants and young children for primary care pediatricians and family doctors in Poland.

Protection, promotion and support of breast-feeding in Europe: progress from 2002 to 2007.

OBJECTIVE: To assess progress in the protection, promotion and support of breast-feeding in Europe. DESIGN: Data for 2002 and 2007 were gathered with the same questionnaire. Of thirty countries, twenty-nine returned data for 2002, twenty-four for 2007. RESULTS: The number of countries with national policies complying with WHO recommendations increased. In 2007, six countries lacked a national policy, three a national plan, four a national breast-feeding coordinator and committee. Little improvement was reported in pre-service training; however, the number of countries with good coverage in the provision of WHO/UNICEF courses for in-service training increased substantially, as reflected in a parallel increase in the number of Baby Friendly Hospitals and the proportion of births taking place in them. Little improvement was reported as far as implementation of the International Code on Marketing of Breastmilk Substitutes is concerned. Except for Ireland and the UK, where some improvement occurred, no changes were reported on maternity protection. Due to lack of standard methods, it was difficult to compare rates of breast-feeding among countries. With this in mind, slight improvements in the rates of initiation, exclusivity and duration were reported by countries where data at two points in time were available. CONCLUSIONS: Breast-feeding rates continue to fall short of global recommendations. National policies are improving slowly but are hampered by the lack of action on maternity protection and the International Code. Pre-service training and standard monitoring of breast-feeding rates are the areas where more efforts are needed to accelerate progress.

[Prevalence of growth and nutritional status disorders among Polish 13-year-olds in the first decade of 21st century]. / Wystepowanie zaburzen wzrastania i stanu odzywienia u polskich 13-latków w pierwszej dekadzie XXI wieku.

AIM OF THE STUDY: to examine the prevalence of nutritional status and growth disorders in 13-year-olds in Poland by sex and place of residence and changes during the period 2005 to 2008. PARTICIPANTS AND METHODS: The study was conducted in 2008 as a part of prospective cohort follow-up study of 605 children (305 girls and 300 boys), from birth to 13 years. Analyses of anthropometric measurements: height and weight were performed. Institute of Mother and Child growth references for height-for-age and BMI-for-age (1999) were used to assess physical disorders. RESULTS: The prevalence of overweight (BMI > or = 85th percentile) was 14% and underweight (BMI < 5 percentile) was 4,1%. Short stature (< 10th percentile of height) was found in 6%, and 6,2% were above 97th percentile of height. We found no statistically significant difference in nutritional and growth status disorders by sex and place of residence. The overall prevalence of overweight (including obesity) did not change from 2005 to 2008. Prevalence of underweight decreased especially among boys (9% to 3,1%, p=0,010) and among adolescents from rural area (8,2% to 4%, p=0,058). We found some evidence for equalization of the percentages of short stature in boys and girls, rural and urban adolescents. The tall stature rate rose only among girls (3,8% to 8,3%, p=0,050). CONCLUSIONS: Disappearance of the prevalence of physical disorders by sex and place of residence has been observed in the last few years in Poland. Overweight among 13-year-olds is not growing and acceleration of height is still observed.

[Effect of feeding pattern on the body mass of infants in the first six months of life]. / Sposób zywienia a masa ciala niemowlat w pierwszym pólroczu zycia.

AIMS: To compare the body mass patterns of breastfed and formula fed Polish infants in the first 6 months of life and to compare the results with the current Polish data. METHODS: Data was taken from the last country-wide survey conducted in 1997. The group of 14116 infants under 6 months were in the original cohort. The final sample consisted of: 4546 exclusively breastfed (2228 male, 2318 female) and 391 formula fed (214 male, 177 female) healthy infants, weighing > 2500 g at birth. The infants were weighed at birth and again on the day of the interview. The 24-hours recall period data for feeding practices was collected. RESULTS: Mean body mass of exclusively breastfed boys was greater in the period from 2 to 5 months (in month 3 the difference was statistically significant) in comparison with formula fed boys. Mean body mass of exclusively breastfed girls was greater for each month from birth to 6 months (in month 3 and 6 the difference was statistically significant) in comparison with formula fed girls. Compared with current Warsaw data, the infants of the analysed groups grew less rapidly. CONCLUSION: Our analysis shows that exclusively breastfed Polish infants in the first 6 months of life gained weight better than formula fed infants. Independently of feeding mode, gender and age, the mean body mass was lower in the examined infants as compared with the current Warsaw data. A reference body mass data based on breastfed infants is needed in Poland.

[Effect of parental smoking on feeding pattern and weight of infants]. / Wplyw palenia papierosów przez rodziców na sposób zywienia i zachowania sie masy ciala niemowlat.

The effect of parental smoking on feeding pattern, birth weight and weight gain were studied in 13503 randomly selected infants aged 11-180 days. Among them 53% were exposed to parental smoking. The infants of smoking mothers tend to have lower birth weight and higher frequency of birth weight below 2500 g. When mothers smoke the infants born with weight below 2500 g who were exclusively breastfed gained daily significantly less. Smoking mothers less frequently initiated breastfeeding. Maternal smoking was associated with shortened exclusive and total breastfeeding duration. When the father smoked also, the effect of maternal smoking on birth weight, daily weight gain and risk of earlier weaning was significantly increased.

[Long-term health effects of infant feeding practices]. / Odlegle skutki zdrowotne sposobu zywienia niemowlat.

A growing body of research suggest that infant feeding can influence the prevalence of several chronic diseases of childhood, adolescence and adult life. Artificial infant feeding and too early supplementation of breastfeeding have been identified as a risk factors for different multifactorial diseases. Breast milk feeding promotes better intellectual development from early childhood trough the later life. As a genetic predisposition and environmental factors are understood more completely, the evidences for the role of breastfeeding in health and development is becoming more important for programming health care and standards. Recommendations of the necessary changes in the infants and young children feeding practices in Poland are presented.