Eimear Keane

Measured Parental Weight Status and Familial Socio-Economic Status Correlates with Childhood Overweight and Obesity at Age 9

Background Parental obesity is a predominant risk factor for childhood obesity. Family factors including socio-economic status (SES) play a role in determining parent weight. It is essential to unpick how shared family factors impact on child weight. This study aims to investigate the association between measured parent weight status, familial socio-economic factors and the risk of childhood obesity at age 9. Methodology/Principal Findings Cross sectional analysis of the first wave (2008) of the Growing Up in Ireland (GUI) study. GUI is a nationally representative study of 9-year-old children (N = 8,568). Schools were selected from the national total (response rate 82%) and age eligible children (response rate 57%) were invited to participate. Children and their parents had height and weight measurements taken using standard methods. Data were reweighted to account for the sampling design. Childhood overweight and obesity prevalence were calculated using International Obesity Taskforce definitions. Multinomial logistic regression examined the association between parent weight status, indicators of SES and child weight. Overall, 25% of children were either overweight (19.3%) or obese (6.6%). Parental obesity was a significant predictor of child obesity. Of children with normal weight parents, 14.4% were overweight or obese whereas 46.2% of children with obese parents were overweight or obese. Maternal education and household class were more consistently associated with a child being in a higher body mass index category than household income. Adjusted regression indicated that female gender, one parent family type, lower maternal education, lower household class and a heavier parent weight status significantly increased the odds of childhood obesity. Conclusions/Significance Parental weight appears to be the most influential factor driving the childhood obesity epidemic in Ireland and is an independent predictor of child obesity across SES groups. Due to the high prevalence of obesity in parents and children, population based interventions are required.

Trends and prevalence of overweight and obesity in primary school aged children in the Republic of Ireland from 2002-2012: a systematic review

BackgroundThe prevalence of childhood overweight and obesity in developed countries appears to be levelling off. As trends in childhood obesity prevalence have not been examined over the past decade in the Republic of Ireland, this systematic review aims to compile and synthesise all available information on the prevalence of overweight and obesity in primary school aged children between 2002 and 2012.MethodsSystematic review of published and grey literature containing data on objectively measured height and weight. Inclusion criteria included studies where data was collected between 2002 and 2012 from at least 200 primary school aged children in the Republic of Ireland. Database searching, Google searching, reference searching and contact with obesity experts was undertaken. Overweight, obesity and morbid obesity were defined using standard International Obesity Taskforce definitions. Study quality was assessed.ResultsFourteen studies (16 prevalence estimates) met the inclusion criteria. The combined prevalence of overweight and obesity within the studies ranged from 20-34%. No significant trend in overweight prevalence over time was observed (p=0.6). However, there was evidence of a slight decrease in obesity prevalence over the period (p=0.01), with a similar though non-significant decline in the prevalence of morbid obesity (p=0.2).ConclusionThe findings of this systematic review require cautious interpretation though the prevalence of childhood overweight and obesity in the Republic of Ireland has reached a plateau and may be falling. These findings provide some ground for optimism though the current plateau is at an unacceptably high level. Thus current population based preventive strategies need to be sustained and intensified.

Diet, Physical Activity, Lifestyle Behaviors, and Prevalence of Childhood Obesity in Irish Children: The Cork Children’s Lifestyle Study Protocol

Background Childhood obesity is complex, and its aetiology is known to be multifaceted. The contribution of lifestyle behaviors, including poor diet and physical inactivity, to obesity remains unclear. Due to the current high prevalence, childhood obesity is an urgent public health priority requiring current and reliable data to further understand its aetiology. Objective The objective of this study is to explore the individual, family, and environmental factors associated with childhood overweight and obesity, with a specific focus on diet and physical activity. A secondary objective of the study is to determine the average salt intake and distribution of blood pressure in Irish children. Methods A cross-sectional survey was conducted of children 8-11 years old in primary schools in Cork, Ireland. Urban schools were selected using a probability proportionate to size sampling strategy, and a complete sample of rural schools from one area in Cork County were invited to participate. Information collected included physical measurement data (anthropometric measurements, blood pressure), early morning spot and 24 hour urine samples, a 3 day estimated food diary, and 7 days of accelerometer data. Principal- (school head) reported, parent/guardian-reported, and child-reported questionnaires collected information on lifestyle behaviors and environmental attributes. The Cork Children’s Lifestyle Study (CCLaS) was designed by the Department of Epidemiology and Public Health in University College Cork, Ireland in 2011 and 2012. Piloting and modification of study methods was undertaken. Data collection took place between April 2012 and June 2013. Results Overall, 27/46 schools and 1075/1641 children, of which 623 were boys, participated. Preliminary data analysis is underway. It is anticipated that the results of the CCLaS study will be available in late 2014. Conclusions The CCLaS study has collected in-depth data on a wide range of individual, family, social, and environmental correlates which will allow us to access multilevel influences on childhood obesity. This study will contribute to the evidence base by highlighting current knowledge and gaps regarding the predominant drivers of childhood obesity.

The effects of individual, family and environmental factors on physical activity levels in children: a cross-sectional study

BackgroundPhysical activity plays an important role in optimising physical and mental health during childhood, adolescence, and throughout adult life. This study aims to identify individual, family and environmental factors that determine physical activity levels in a population sample of children in Ireland.MethodsCross-sectional analysis of the first wave (2008) of the nationally representative Growing Up in Ireland study. A two-stage clustered sampling method was used where national schools served as the primary sampling unit (response rate: 82%) and age eligible children from participating schools were the secondary units (response rate: 57%). Parent reported child physical activity levels and potential covariates (parent and child reported) include favourite hobby, total screen time, sports participation and child body mass index (measured by trained researcher). Univariate and multivariate multinomial logistic regression (forward block entry) examined the association between individual, family and environmental level factors and physical activity levels.ResultsThe children (N = 8,568) were classified as achieving low (25%), moderate (20%) or high (55%) physical activity levels. In the fully adjusted model, male gender (OR 1.64 [95% CI: 1.34-2.01]), having an active favourite hobby (OR 1.65 [95% CI: 1.31-2.08]) and membership of sports or fitness team (OR 1.90 [95% CI: 1.48-2.45]) were significantly associated with being in the high physical activity group. Exceeding two hours total screen time (OR 0.66 [95% CI: 0.52-0.85]), being overweight (OR 0.41 [95%CI: 0.27-0.61]; or obese (OR 0.68 [95%CI: 0.54-0.86]) were significantly associated with decreased odds of being in the high physical activity group.ConclusionsIndividual level factors appear to predict PA levels when considered in the multiple domains. Future research should aim to use more robust objective measures to explore the usefulness of the interconnect that exists across these domains. In particular how the family and environmental settings could be useful facilitators for consistent individual level factors such as sports participation.

levels and sociodemographic correlates of accelerometer-based physical activity in Irish children: a cross-sectional study

Background The aim of this study was to explore levels and sociodemographic correlates of physical activity (PA) over 1 week using accelerometer data. Methods Accelerometer data was collected over 1 week from 1075 8–11-year-old children in the cross-sectional Cork Childrens Lifestyle Study. Threshold values were used to categorise activity intensity as sedentary, light, moderate or vigorous. Questionnaires collected data on demographic factors. Smoothed curves were used to display minute by minute variations. Binomial regression was used to identify factors correlated with the probability of meeting WHO 60 min moderate to vigorous PA guidelines. Results Overall, 830 children (mean (SD) age: 9.9(0.7) years, 56.3% boys) were included. From the binomial multiple regression analysis, boys were found more likely to meet guidelines (probability ratio 1.17, 95% CI 1.06 to 1.28) than girls. Older children were less likely to meet guidelines than younger children (probability ratio 0.91, CI 0.87 to 0.95). Normal weight children were more likely than overweight and obese children to meet guidelines (probability ratio 1.25, CI 1.16 to 1.34). Children in urban areas were more likely to meet guidelines than those in rural areas (probability ratio 1.19, CI 1.07 to 1.33). Longer daylight length days were associated with greater probability of meeting guidelines compared to shorter daylight length days. Conclusions PA levels differed by individual factors including age, gender and weight status as well as by environmental factors including residence and daylight length. Less than one-quarter of children (26.8% boys, 16.2% girls) meet guidelines. Effective intervention policies are urgently needed to increase PA.

Physical activity, sedentary behavior and the risk of overweight and obesity in school-aged children

PURPOSE Globally, public health policies are targeting modifiable lifestyle behaviors. We explore the independent association of moderate-to-vigorous physical activity (MVPA) and sedentary behavior on the risk of childhood overweight/obesity. METHOD A cross-sectional survey of children aged 8-11 years (N = 826). Objective body mass index was used to classify children as normal weight or overweight/obese. Children wore wrist-worn Geneactiv accelerometers for 7-days and thresholds were applied to categorize MVPA and sedentary time. Screen time (ST) was parent reported. Poisson regression examined the independent association of (1) MVPA (2), objective sedentary time and (3) ST on the risk of overweight/obesity. RESULTS Overall, 23.7% (95% CI, 20.8-26.6%) of children were overweight/obese. On average, children spent 10.8% of waking time at MVPA and 61.3% sedentary. One-fifth (22.1%, 95% CI, 19.3-25.0%) of children achieved MVPA recommendations (≥ 60 min each day) and 17.5% (95% CI, 14.9-20.1%) met ST recommendations (<2 hr per day). Time spent at MVPA was inversely associated with the risk of overweight/obese independent of total sedentary time. Total time spent sedentary was not associated with overweight/obese independent of MVPA. ST was associated with an increased risk of overweight/obese independent of physical activity. CONCLUSION Few schoolchildren met physical activity and screen time recommendations suggesting population based measures are needed.

Dietary quality in children and the role of the local food environment

Diet is a modifiable contributor to many chronic diseases including childhood obesity. The local food environment may influence childrens diet but this area of research is understudied. This study explores if distance to and the number of supermarkets and convenience stores in the local area around households are associated with dietary quality in nine year olds whilst controlling for household level socio-economic factors. This is a secondary analysis of Wave 1 (2007/2008) of the Growing Up in Ireland (GUI) Child Cohort Study, a sample of 8568 nine year olds from the Republic of Ireland. Dietary intake was assessed using a short, 20-item parent reported food frequency questionnaire and was used to create a dietary quality score (DQS) whereby a higher score indicated a higher diet quality. Socio-economic status was measured using household class, household income, and maternal education. Food availability was measured as road network distance to and the number of supermarkets and convenience stores around households. Separate fixed effects regression models assessed the association between local area food availability and dietary quality, stratified by sex. The DQS ranged from −5 to 25 (mean 9.4, SD 4.2). Mean DQS was higher in those who lived furthest (distance in quintiles) from their nearest supermarket (p<0.001), and in those who lived furthest from their nearest convenience store (p<0.001). After controlling for socio-economic characteristics of the household, there was insufficient evidence to suggest that distance to the nearest supermarket or convenience store was associated with dietary quality in girls or boys. The number of supermarkets or convenience stores within 1000 m of the household was not associated with dietary quality. Food availability had a limited effect on dietary quality in this study. Issues associated with conceptualising and measuring the food environment may explain the findings of the current study.

Physical activity, screen time and the risk of subjective health complaints in school-aged children

Internationally, subjective health complaints have become increasingly prevalent in children. Thus, a comprehensive understanding of the determinants of health complaints is needed to inform effective policies and strategies. This study explores if meeting physical activity and total screen time (TST) recommendations are associated with the risk of reporting health complaints weekly or more. The 2014 Irish Health Behaviour in School-aged Children study collected questionnaire data from 10,474 10-17year olds. Children reported how often they experienced eight health complaints as less than weekly or weekly or more. Children who met moderate-to-vigorous physical activity recommendations were active for 60min/day in the past seven days. Three types of screen based activity were categorised to reflect if children met TST recommendations of ≤2h/day. Poisson regression examined the association between meeting recommendations and the risk of health complaints. The prevalence of individual health complaints ranged from 20.4-44.3% in girls and from 10.1-35.4% in boys. Overall, 5.1% (4.5-5.6%) of girls and 8.7% (7.8-9.5%) of boys met both (physical activity and TST) recommendations, while two thirds of girls (67.3%, 66.1-68.5%) and over half of boys (55.0%, 53.5-56.6%) met neither recommendation. Not meeting TST recommendations was significantly associated with the risk of reporting health complaints while associations with physical activity were less apparent. Children who did not meet either recommendation had a significantly increased risk for six of the health complaints when compared to those who met both recommendations. As health complaints and poor lifestyle behaviours were common in children, population level measures are warranted.

P53 Epidemiological evidence to support a tax on Sugar Sweetened Drinks as a measure to address childhood obesity

Background The obesity epidemic represents a public health crisis with the potential to reverse recent favourable trends in life expectancy and undermine the financial viability of health systems. Though multifactorial in origin, links between the consumption of sugar-sweetened drinks (SSD) and excessive weight gain in children have been observed. Aim: To investigate the association between SSD consumption and overweight and obesity in 8–11 year old children. Methods Cross sectional data from 1075 8–11 year old school children. Consumption of SSD was assessed from 3-day food diaries. Height (m) and weight (kg) were measured using standard methods. BMI was used to define obesity (IOTF definitions). Plausible energy reporters (PER) were classified using Scholfield equation. Results are reported for PER only Results Eighteen percent of children with PER were overweight (16%) or obese (2%) compared with 25% of the total sample. Of those with PER, 82% were SSD consumers. Consumers had increased odds of being overweight or obese compared to normal weight children. Mean calories from SSDs increased incrementally between weight categories: SSD contributed 86 kcal, 117 kcal and 274 kcal for normal weight, overweight and obese children respectively, equating to 4.7%; 6.1% and 10.7% of total calories respectively. Mean intake volumes were significantly higher in children who were overweight or obese compared to normal weight children. Average consumption volume was 487 ml/d; 368 ml/d and 315 ml/d for obese, overweight and normal weight children respectively. Adjusting for gender and parental education, an increase of one can per day (330 ml) is associated with a 0.51 kg/m2 (95% CI [0.21–0, 81]) increase in BMI. Conclusion While no single measure will reverse current trends in obesity, given the high level of consumption of SSD and the lack of nutritional value of these products, action needs to be taken to reduce consumption, particularly in children. There is a compelling case for the introduction of public policy to reduce SSD consumption in the population. The introduction of a tax on SSDs in combination with other public health interventions has the potential to have a measurable effect on the scale of the epidemic of childhood obesity.

P51 The association between markers of diet quality and wellbeing in adolescents aged 12–18: A cross-sectional study

Background Positive wellbeing, including high life-satisfaction can buffer against negative outcomes such as psychological disorders. Modifiable lifestyle factors including diet may be associated with maintaining positive wellbeing however; this association is not extensively researched in adolescents. Fruit and vegetables are markers of healthy diet quality whereas sugar sweetened beverages are markers of poor diet quality. This study investigates whether markers of diet quality are associated with wellbeing in adolescents aged 12–18. Methods A cross-sectional, nationally representative sample of adolescents aged 12–18 from the Irish, 2014, Health Behaviour in School-aged Children (HBSC) study (n = 8,995). A two-staged sampling strategy was employed, the sampling frame was post-primary schools across Ireland and schools were randomly selected from 8 geographical regions as the primary sampling units. Classes within schools were the secondary sampling units. School and pupil level response rates were 59% and 84.5% respectively. Adolescents self-completed a health and lifestyle questionnaire. Diet was assessed by consumption frequency of fruit, vegetables and soft drinks that contain sugar. Response options were on a 7 point scale ranging from never to everyday more than once (dichotomised as daily vs. less than daily consumption). Adolescents reported general health as good (excellent/good) or poor (fair/poor). Life-satisfaction was assessed on a scale of 0–10 using the Cantril ladder and defined as high (≤7) or low (<7). Separate binary logistic regression models explored associations between dietary variables and general health and life-satisfaction, whilst adjusting for important socio-demographic, lifestyle behaviours and perceived social-support. Stata v.12 was used for analyses. Results Just over one-quarter of adolescents rated their life-satisfaction as low (26.9% (95% CI: 26.0% to 27.8%) and 13.4% (12.6% to 14.1%) rated their general health as poor. Overall, 39.0% (95% CI: 38.0% to 40.0%) of adolescents reported daily consumption of fruit, 44.7 (43.7% to 45.7%) consumed vegetables and 12.8% (12.1% to 13.5%) consumed soft drinks daily. In fully adjusted models, adolescents who did not eat fruit (OR (95% CI:) 1.35 (1.18 1.54)) or vegetables (1.34 (1.18 1.53)) daily and those who consumed soft drinks daily (1.45 (1.20 1.76)) had a significantly higher odds of reporting low life-satisfaction. Similar associations were observed for poor general health. Conclusion Consuming a good quality diet is protective of wellbeing. Though this study is cross-sectional, prior longitudinal research found that diet precedes wellbeing. Daily consumption of fruit/veg is worryingly low. Thus creating supportive environments may increase healthy dietary choices which are important for good general health and wellbeing.