Patterns of lifestyle-related behaviors and parents'overweight are associated with increased body adiposity in schoolchildren: a cross-sectional study in Portugal

BACKGROUND: This study evaluated the association between lifestyle-related behavior patterns and weight status indicators in schoolchildren. METHODS: Cross-sectional study includes nationally representative sample of Portuguese school children (6­9yearsold;n= 10,258). Weight status was assessed using the body mass index (BMI) and waist circumference (WC). Principal component analysis was used to identify lifestyle-related behavior patterns. Multiple linear regression models were used to estimate the association between behavior patterns, BMI, and WC.RESULTS: Six lifestyle-related behavior patterns were identified: pattern 1: consuming iced tea and soft drinks≥2 times/week, having a television (TV) in the bedroom, watching TV≥2 h/day, and consuming <2 portions of fruits/day; pattern 2: parents and children remaining physically inactive during leisure time; pattern 3: consuming≤1 portion of vegetables and milk/day; pattern 4: having parents with excess weight; pattern 5: consuming≤3daily meals and skipping breakfast; and pattern 6: not participating in physical education classes. After the adjustment, all of the patterns were associated with increased BMIz-score (P≤0.02) and WC (P≤0.03).CONCLUSIONS: Lifestyle-related behavior patterns were associated with an increased risk of excess weight and the central distribution of body fat. Taking a public health perspective toward preventing childhood obesity, special attention should be given to identify subgroups with simultaneous occurrence of multiple risk behaviors, which is useful for planning prevention programs.

Irregular breakfast habits are associated with children's increased adiposity and children's and parents' lifestyle-related behaviors: a population-based cross-sectional study

BACKGROUND: Skipping meals, especially breakfast, is related to an increase in adiposity indicators, and this behavior is related to metabolic changes that predispose to the development of chronic diseases, recognized as major causes of death worldwide. The objective of the present paper was estimated the association between irregular breakfast habits with adiposity indices in schoolchildren and other lifestyle factors. METHODS: A population-based cross-sectional study was conducted in 2009­2010, including schoolchildren (n=10,243) between 6 and 9 years old (51.3 % girls) from 18 districts of mainland Portugal. Breakfast habits were as certained by asking a yes/no question ("Does your child eat breakfast regularly?"). An index estimated by performing principal component analysis was used to assess body adiposity from three different adiposity indicators (body mass index (BMI), waist circumference (WC), and the triceps, subscapular, and supra iliac skinfolds (used to estimate body fat percentage (BFP))). Multivariate logistic regression and multiple linear regression models were used to estimate the association of irregular breakfast habits with anthropometric indicators (BMI, BMI z score, WC, BFP, and adiposity index) and with children's and parents' lifestyle and socioeconomic characteristics. RESULTS: A total of 3.5 % of the children did not have breakfast regularly (girls 3.9 %; boys 3.1 %; P= 0.02). Among boys, irregular breakfast habits were associated with lower fathers' education level, television time≥2 h/day, and soft drink consumption≥2 times/week. For girls, irregular breakfast habits were associated with lower mothers' education level and physical inactivity, soft drink consumption≥2 times/week, and <1 portion of milk/day. Multivariate linear models revealed a positive association between irregular breakfast habits with increased adiposity indicators among boys (BMI (kg/m2):ß= 1.33; BMI z score:ß= 0.48; WC (cm):ß= 2.00; BFP (%):ß= 2.20; adiposity index:ß= 0.37;P< 0.01 for all). No significant association was found for girls. CONCLUSIONS: Irregular breakfast habits were positively associated with boys' increased global adiposity and were significantly affected by children's and parents' lifestyle-related behaviors.

Effects of social and environmental determinants on overweight and obesity among Brazilian schoolchildren from a developing region / Efectos de los determinantes sociales y ambientales sobre la obesidad y el sobrepeso en escolares de una región en desarrollo del Brasil

OBJECTIVE: To identify the social and environmental determinants most strongly associated with overweight and obesity in Brazilian schoolchildren from a developing region. METHODS: Data were collected from a community-based survey of schoolchildren from the Valley of Jequitinhonha, Minas Gerais, Brazil. The sample was composed of 5 100 school children aged 6-18 years. Overweight and obesity were defined by body mass index based on the current method recommended by the World Health Organization in 2007. Social and environmental determinants were collected by using a structured questionnaire. RESULTS: The prevalence of overweight and obesity was 11.1 percent and 2.7 percent in girls and 8.2 percent and 1.5 percent in boys, respectively. The chance of overweight was higher in schoolchildren who engaged in remunerated work (odds ratio [OR] = 2.19, 95 percent confidence interval [CI] 1.30- 3.26), whose parents had higher education levels (OR = 1.52, 95 percent CI 1.12-2.07), who had two or fewer siblings (OR = 1.74, 95 percent CI 1.21-2.49), and who were in a high economic class (OR = 1.93, 95 percent CI 1.32-2.85). Schoolchildren who traveled by car to school (OR = 1.50, 95 percent CI 1.14-1.91), lived < 5 km from school (OR = 1.64, 95 percent CI 1.06-2.39), and consumed foods sold in the school cafeteria (OR = 1.56, 95 percent CI 1.19-2.16) presented high odds of being overweight. CONCLUSIONS: The background from a particular region of a country should be considered when implementing preventive measures regarding overweight and obesity, especially for very poor, developing regions like the Valley of Jequitinhonha. Measures taken should consider a multilevel intervention that includes the family, school, and physical environment.

OBJETIVO: Identificar los determinantes sociales y ambientales más firmemente asociados con el sobrepeso y la obesidad en niños que asisten a la escuela en una región en desarrollo del Brasil. MÉTODOS: Se recopilaron los datos de una encuesta comunitaria llevada a cabo en niños inscritos en escuelas del valle de Jequitinhonha, Minas Gerais (Brasil). La muestra estuvo integrada por 5 100 escolares de 6 a 18 años de edad. El sobrepeso y la obesidad se definieron según el índice de masa corporal, con base en el método actualmente recomendado por la Organización Mundial de la Salud (2007). Los determinantes sociales y ambientales se recopilaron mediante un cuestionario estructurado. RESULTADOS: La prevalencia del sobrepeso y de la obesidad fue de 11,1 por ciento y 2,7 por ciento en niñas y de 8,2 por ciento y 1,5 por ciento en niños, respectivamente. Las probabilidades de tener sobrepeso fueron mayores en los escolares que desempeñaban un trabajo remunerado (razón de probabilidades [RP] = 2,19; intervalo de confianza [IC] de 95 por ciento, 1,30-3,26); en aquellos cuyos padres tenían niveles superiores de educación (RP = 1,52; IC de 95 por ciento, 1,12-2,07); en quienes tenían dos o menos hermanos (RP = 1,74; IC de 95 por ciento, 1,21-2,49); y en los de clase económica alta (RP = 1,93; IC de 95 por ciento, 1,32-2,85). Presentaron altas probabilidades de tener sobrepeso los niños que viajaban en automóvil a la escuela (RP = 1,50; IC de 95 por ciento, 1,14-1,91), los que vivían a < 5 km de la escuela (RP = 1,64; IC de 95 por ciento, 1,06-2,39) y los que consumían los alimentos que se venden en la cafetería de la escuela (RP = 1,56; IC de 95 por ciento, 1,19-2,16). CONCLUSIONES: Deben tenerse en cuenta las características de cada región particular de un país cuando se ejecutan medidas preventivas del sobrepeso y la obesidad, especialmente en las regiones muy pobres y en desarrollo, como el valle de Jequitinhonha en Brasil. Las medidas que se adopten deben considerar una intervención en varios niveles que incluya a la familia, la escuela y el entorno físico.