Breakfast frequency inversely associated with BMI and body fatness in Hong Kong Chinese children aged 9-18 years.

The present study assessed the relationship between breakfast frequency and measures of obesity in Hong Kong Chinese children aged 9-18 years. A total of 11,570 children (50 % boys) underwent anthropometric measurements and completed a simple self-administered dietary behaviour questionnaire. Their parents completed a questionnaire providing demographic information. Breakfast frequency was assessed by a single question, 'How many days over the past week did you have breakfast?' Children were categorised into three groups: skippers (ate breakfast 0-2 times/week); semi-skippers (ate breakfast 3-4 times/week); non-skippers (ate breakfast 5-7 times/week), to assess all associated characteristics. Of the 3644 primary and 7926 secondary school students, 8 % (8·7 % of boys and 6·9 % of girls) and 14 % (14 % of boys and 15 % of girls), respectively, were breakfast skippers. The prevalence of obesity among breakfast skippers, semi-skippers and non-skippers was, respectively, 9·8, 10·6 and 3·8 % (P < 0·001) for primary school students and 3·9, 3·1 and 2·4 % (P < 0·001) for secondary school students. The 12 % of Hong Kong children aged 9-18 years who skipped breakfast had higher BMI, BMI z-scores and percentage of body fat (PBF) than their counterparts. The dose effects of breakfast frequency (unstandardised regression coefficient, P < 0·001) on BMI and PBF were, respectively, -0·125 kg/m2 and -0·219 % for boys and -0·165 kg/m2 and -0·353 % for girls, adjusting for physical activity per additional breakfast meal per week. Further study is recommended to elucidate whether regular breakfast consumption may have a role in the prevention of childhood obesity.

Associations of insulin-like growth factor binding protein-3 gene polymorphisms with IGF-I activity and lipid parameters in adolescents.

OBJECTIVE: Childhood obesity is a growing global epidemic. Recent studies indicate that obesity and related metabolic traits are highly heritable. Increasing evidence suggests that growth hormone (GH) and the insulin-like growth factor-I (IGF-I) axis have important functions in regulating adiposity and insulin sensitivity. Five single-nucleotide polymorphisms (SNPs) at IGF-binding protein-3 (IGFBP3) were genotyped to find their associations with IGF-1 activity level and common clinical metabolic traits. PATIENTS AND METHODS: We examined the associations of five SNPs at IGFBP3 with serum IGF-I and IGFBP-3 levels, as well as with obesity-related metabolic traits in 981 Hong Kong Chinese adolescents. Factor analysis was used to reduce the intercorrelated variables to five factor scores indicating body composition, blood pressure, IGF-I activity, triglyceride (TG)+high-density lipoprotein cholesterol (HDL-C) and total cholesterol (TC)+low-density lipoprotein cholesterol (LDL-C) factor scores. RESULTS: There was a strong association between the -202A/C polymorphism (rs2854744) and IGF-I activity (P=1.2 x 10(-6)) and TC+LDL-C factor scores (P=0.0085), corrected for age and sex. The C allele was associated with decreased IGFBP-3 levels (P=1.21 x 10(-13)), increased IGF-I/IGFBP-3 molar ratio (P=5.22 x 10(-6)) and decreased LDL-C (P=0.020). There was also a significant association between a G/A polymorphism at the 3' flanking sequence (rs13223993) of the IGFBP3 gene and the TG+HDL-C factor score (P=0.0013). The minor A allele carriers of rs13223993 had a lower HDL-C (P=0.0067) level and a tendency toward a high TG level. Haplotype analysis did not increase the significance of associations between single SNPs and phenotypes. CONCLUSION: Our results support the function of IGFBP3 gene polymorphisms in modulating IGF-I activity and lipid levels in adolescents. Given the prognostic significance of IGF-I, IGFBPs and lipids on risk of diabetes, obesity and cancer, long-term studies are required to clarify the clinical meaning of these findings.

Culturally appropriate nutrition education improves infant feeding and growth in rural Sichuan, China.

Chinese studies indicate that the growth of rural infants and children lags behind that of their urban counterparts after 4 mo of age and that the gap is widening. However, the rural areas are home to >85% of China's 300 million children. Clearly, culturally appropriate rural complementary feeding interventions are needed to close the growth and health gaps. After a 1990 survey of infants in rural Sichuan confirmed that poor infant feeding practices rather than inadequate household food resources were responsible for the growth faltering, a year-long community-based pilot nutrition education intervention (n congruent with 250 infants each in Education and Control groups) was undertaken in four townships. The goal was to improve infant growth by improving infant feeding practices. Features of the intervention included the training and mobilizing of village nutrition educators who made monthly growth monitoring and complementary feeding counseling visits to all pregnant women and families with infants born during the intervention in the study villages. After 1 y, the Education group mothers showed significantly higher nutrition knowledge and better reported infant feeding practices than their Control group counterparts. Also, the Education group infants were significantly heavier and longer, but only at 12 mo (weight-for-age -1.17 vs. -1.93; P = 0.004; height-for-age -1.32 vs. -1.96; P = 0.022), had higher breast-feeding rates overall (83% vs. 75%; P = 0.034) and lower anemia rates (22% vs. 32%; P = 0.008) than the Control group infants. We conclude that these methods have potential for adaptation and development to other rural areas in the county, province and nation.

Obstacles to community health promotion.

The health transition ushered into the world in this century calls for a reorientation of traditional health services to manage the new causes of morbidity and mortality, renewing interest in disease prevention and health promotion. Community-based health promotion emphasizes prevention and community participation with people's empowerment to overturn current inequities and increase control over their health. Encouraged worldwide by the World Health Organization for the last two decades, some community health promotion programs have been implemented and lessons learned. However, the shift in focus required means nothing less than a paradigm change demanding not only a reorientation of professional training, but also a reorganization of social structures in communities. This article discusses nine of the interrelated obstacles that must be overcome to further develop community health promotion.

Developmental, behavioural, and environmental risk factors for diarrhoea among rural Bangladeshi children of less than two years.

One hundred and eighty-five rural Bangladeshi children (80 boys and 105 girls) aged 4-27 months were observed to investigate developmental, behavioural, and environmental risk factors for diarrhoea during a 6-month period. Incidence of diarrhoea was found to be the highest among children aged 10-12 months. Children of this age group had the greatest exposure to environmental contaminants in the neighbourhood. Incidence of diarrhoea was the highest in hot, dry months. Risk factors for diarrhoea included: faecal contamination and garbage disposal in infant's outdoor play compound, crawling, contact of hand and mouth with contaminated materials, greater distance of household from water source, inadequate cleaning after defecation; dirt of child's face, presence of flies, feeding rotten food; insufficient washing of infant's and caretaker's hands before feeding rice meals or soft, wet foods; and lack of mothers' willingness to visit a modern (allopathic) health practitioner.

Breastfeeding practices in Chengdu, Sichuan, China.

Barriers to increased breastfeeding rates in Chengdu, Sichuan were investigated in 1992 and 1993. Responses of focus groups showed that ignorance about breastfeeding and belief that the mother's milk was inadequate, and lack of support from their families, places of employment, and the health system acted as barriers to the women's breastfeeding their infants up to the age of four to six months. Subsequently, 363 mothers of 4- to 12-month-old Chengdu infants were surveyed. Although most mothers in both studies said breastmilk was the best food for their infant up to age of four to six months, only about half of the mothers breastfed for longer than one month. Both studies showed that infants who roomed with their mothers after birth were more likely to have been put to their mother's breast earlier, fed colostrum, breastfed somewhat longer, and exclusively breastfed for a somewhat longer period, although their mothers' infant feeding knowledge did not differ. The researchers conclude that Chengdu health workers should teach parents and parents-to-be more about breastfeeding, and that rooming-in be expanded in Chengdu hospitals.

PIP: In China in 1992, a focus group was conducted of 4-9 mothers at eight different places of employment in Chengdu, Sichuan (total mothers, 55), to learn their attitudes, beliefs, concerns, knowledge, and preferred channels of receiving infant feeding information. During April 1993, interviews were conducted with 363 infant-caretaker pairs from each of Chengdu's five districts to examine infant feeding practices. 88% of infants were ever breast fed. Even though almost 73% of the caregivers thought that breast milk was the best food for the first six months, only 32% of infants 4-6 months old were currently being breast fed. The targeted breast feeding rate of the National Action Programme for Child Development in China is 80%. Only one 7-month-old infant was currently exclusively breast fed. The findings of the survey corroborated those of the focus groups. Mothers tended to have little knowledge about breast feeding, to believe their breast milk was inadequate, and to have no support from their families, employers, and the health system. Knowledge on infant feeding of mothers whose infants roomed with them after delivery and that of mothers whose infants did not room with them after delivery was similar. Infants who roomed with their mothers after delivery tended to have first been breast fed earlier (p 0.0001), to have been given breast milk as their first food (; 0.0001), to continue to have been breast fed when the mothers thought that their breast milk was inadequate (p = 0.0003), to have received colostrum (p = 0.003), to have been breast fed longer (p = 0..0002), and to have been exclusively breast fed longer (p 0.0001). These findings led to three recommendations to encourage breast feeding in Chengdu: health workers should consider breast feeding important and should educate parents about infant feeding and nutrition; more hospitals in Chengdu need to practice rooming-in; and a study should be conducted to determine whether health workers have adequate knowledge about breast feeding.

Weaning practices and growth in rural Sichuan infants: a positive deviance study.

To understand some of the factors involved in weaning and growth faltering in rural China, a cross-sectional positive deviance study was undertaken among 389 rural 4-12-month-old infants from two townships of a county in Sichuan. The infants' mothers were interviewed about their child-feeding practices and other sociodemographic information, and anthropometric measurements were made on their infants. Positive deviant infants (those growing adequately in environments in which the majority of the children suffer from growth retardation and malnutrition) were identified from the Chinese WAZ-scores calculated from the anthropometric measurements. Feeding practices found to be associated with the better growth of the positive deviant infants included breastfeeding through age 12 months, feeding soybean milk, liver and pork blood products on a more than weekly basis during the ages of 7-9 months, not feeding rice flour (mifen) before age 7 months, and not giving supplements or tonics. Mothers' nutrition knowledge was also associated with positive deviance status. The relevance of the findings is discussed with respect to designing nutrition education interventions for rural Sichuan.

Maternal education and child feeding practices in rural Bangladesh.

This study in rural lowland Bangladesh used spot and event observations from 185 children aged 4-27 months in order to examine whether child feeding practices differed with mother's education and with household education. Each child and his/her caretakers were observed for a mean of 20 hr over 6 months from February to July 1986. Only 25% of mothers and 51% of fathers had had any formal education. Exploratory partial correlations and stepwise multiple regression analyses revealed significant behavioral differences with both maternal and household measures of education while controlling for wealth. Caretakers in families with education were found to feed the children more frequently, with fresher food, and in cleaner, more protected places. They did not allow their children to eat food intended for someone else as often, and were more observant when their children's food dropped during the feeding. These caretakers also used more cups and bottles for feedings, breastfed their children less frequently, and their mothers terminated the breastfeedings more often. These behaviors suggested a shift from less attentive feeding practices and less frequent feedings to more frequent feedings in which the caretaker took more control of the child's feeding sessions. They also suggest a commitment to more labor-intensive child care. These associations between education and child feeding practices are mechanisms through which maternal education may improve child health and growth. They suggest the need for promoting more formal and nonformal education.

[A survey of nutrition knowledge-attitudes-practices of Sichuan urban and rural adults].

To provide a basis for designing nutrition education, two nutrition knowledge--attitudes--practices (KAP) surveys of adults aged 18 to 55 were conducted in 1989 in an urban (N = 1004) and a rural (N = 506) area of Sichuan. The results indicated that the nutrition levels in both sites were low, and an awareness of the relationship between nutrition and certain common diseases was lacking. However, both urban and rural adults possessed good attitudes toward nutrition and nutrition education. Large differences existed between urban and rural adults' food patterns, with the rural diet more monotonous than the urban one. The rural women will be a hard-to-reach audience requiring more intensive efforts. The findings suggest that nutrition education efforts for Sichuan urban and rural area adults will require different contents and emphases, different methods of delivery, and language suitable for each group, in order to obtain good results.

Evaluation of a nutrition education activity for medical students in China.

In China, where cancers and cardiovascular disease are the major causes of morbidity and mortality, an important role for preventive medicine has emerged. Therefore, preparing China's medical students to tackle contemporary health problems requires attention to nutrition and health promotion in the medical curriculum. To evaluate the effectiveness of a nutrition education activity for medical students, a two-group pre-test/post-test nutrition education program was conducted in a medical university in south-western China (n=300 per group). Students in another south-western Chinese medical university served as controls (n= 150 per group). Special features of the intervention were: (1) nutrition education materials developed from (a) the results of a pre-test survey of medical students and (b) discussions with medical students, faculty, and physicians; and (2) a multi-channel delivery, which included a classroom lecture-discussion; a nutrition knowledge competition; a handout providing a day's dietary allotment; campus radio and movie theatre announcements, and posters. Analysis of variance, chi-square, and t-tests showed a significant increase (P<0.05) in nutrition knowledge, but not in nutrition attitude score. The final nutrition knowledge and attitude scores were also found to be related to the students' increased exposure to the various channels (P<0.001). Also observed was an increase in the consumption of soybean and dairy products (P<0.05). It is concluded that the method is a useful and practical model for designing and developing student nutrition education activities in China, as well as demonstrating nutrition and health education methods among the medical university community.

Effectiveness of a worksite nutrition education activity in a factory in China.

To evaluate the effectiveness of a worksite nutrition education activity in China, a two-group pretest-posttest nutrition education lesson was designed and carried out in two divisions (N = 240 in each division) of a steel tube factory in Chengdu, Sichuan. Special features of the program were nutrition education materials developed from both (a) the results of a pretest survey of the employees, and (b) focus group discussions conducted with factory hospital and workteam staff; a colloquial style; a slogan; and an illustrated handout depicting the new Chinese Dietary Guidelines and a proposed Food Guide. Analysis of variance, chi-square, and t-tests showed both significant increases (p < 0.05) in nutrition knowledge and attitude scores and significant improvements in dietary practices in the group receiving the education. It is concluded that the method is a useful and practical model for designing and developing worksite nutrition education in China.

Designing appropriate nutrition education for the Chinese: the urban and rural nutrition situation in Sichuan.

In the People's Republic of China, as in the West, diet has emerged as an important determinant of morbidity and mortality. In order to provide one of the bases for designing nutrition education, two nutrition knowledge-attitudes-practices surveys of adults aged 18-55 were conducted in 1989 in an urban (N = 1004) and a rural (N = 506) area of Sichuan. Nutrition knowledge levels were low in both sites, but lower in the rural site. Certain general nutrition concepts, such as the value of a varied diet, were reported correctly by over 50 per cent of the population in both areas. However, less than 10 per cent of the urban residents and only 3 per cent of the rural residents reported taking correct measures to prevent or delay cancer or heart disease. Dietary practices, elicited by a food frequency questionnaire, revealed large differences in consumption habits in the two areas. More than half of the urban respondents reported eating rice, vegetable oil, green vegetables, lean meat, and wheat on a daily basis, and other vegetables, pickles, fruit, eggs, soybean products, and meat fat on at least a weekly basis. However, the rural respondents reported eating only rice, vegetable oil, green vegetables, and other vegetables on a daily basis, and no additional foods on a weekly basis.(ABSTRACT TRUNCATED AT 250 WORDS)