Evangelia Grammatikaki

Social, economic and demographic correlates of overweight and obesity in primary-school children: preliminary data from the Healthy Growth Study.

OBJECTIVEnTo record the prevalence of overweight and obesity in urban primary-school children in relation to several socio-economic and demographic factors.nnnDESIGNnCross-sectional.nnnSETTING/SUBJECTSnA representative sample of 729 schoolchildren (379 male and 350 female), aged 9-13 years, stratified by parental educational level, was examined in the urban region of Athens. Weight and height were measured using standard procedures. The International Obesity Task Force thresholds were used for the definition of overweight and obesity. Several socio-economic and demographic data and the childs popularity score were also recorded with specifically designed standardized questionnaires.nnnRESULTSnThe prevalence of overweight and obesity was 29·6 % and 11·1 %, respectively. Annual family income of € 12,000-20,000 (OR = 1·58), residence ownership (OR = 1·63) and the grandmother as the childs primary caregiver (OR = 1·38) were significantly associated with higher odds of childhood overweight and obesity. Non-Greek parental nationality (OR = 0·72) and higher popularity scores of children (OR = 0·42) were significantly associated with lower odds of overweight and obesity. The grandmother as the childs primary caregiver and an annual family income of € 12,000-20,000 remained significantly associated with childhood overweight and obesity after adding all significant correlates of childhood overweight and obesity observed at the bivariate level in a multivariate regression model (OR = 1·51 and 1·61, respectively).nnnCONCLUSIONSnAmong family income, residence ownership, childs primary caregiver, parental nationality and popularity scores that were identified as significant correlates of childhood overweight and obesity at the bivariate level, lower family income and grandmother as the childs primary caregiver were the only factors that remained significantly associated with childhood overweight and obesity at a multivariate level.

Perinatal predictors of overweight at infancy and preschool childhood: the GENESIS study

Objective:To identify those perinatal parameters and characteristics predisposing children to an increased risk of overweight during infancy and preschool years.Design:The analyses were performed using data from the Growth, Exercise and Nutrition Epidemiological Study In preSchoolers.Subjects:A representative sample of 2374 Greek preschoolers 1–5 years old.Measurements:Anthropometric data, such as body weight, recumbent length and standing height, were obtained by using standard procedures and measuring equipment. Structured interviews were conducted with both parents to collect information on anthropometric, demographic, medical and behavioral data. Finally, childrens anthropometric data at birth, 6 and 12 months of age were recorded from their birth certificates and medical records.Results:Children born large for gestational age were 4.59 and 2.19 times more likely for being overweight at 6 and 12 months of age, respectively, than children born appropriate for gestational age. On the other hand, children that were exclusively breastfed were 0.49 and 0.54 times less likely for being overweight at 6 and 12 months of age, respectively, than children that were exclusively formula fed. Furthermore, 3- to 5-year-old children born to mothers who were both active and passive smokers during pregnancy were 1.79 times more likely of being overweight compared to children born to nonsmoking mothers. Finally, having an overweight father significantly increased the likelihood of childhood overweight at 12 months, 1–3 and 3–5 years of age.Conclusion:Our findings showed that some of the perinatal parameters and characteristics examined in the current study predict overweight at infancy, while others at preschool years. Priority should be given to size at birth, breastfeeding, maternal smoking during pregnancy and parental overweight, when developing public health strategies to reduce the prevalence of childhood overweight and related chronic disease later in life.

Maternal perceptions of their child’s weight status: the GENESIS study

OBJECTIVEnThe objective of the present work was to quantify mothers misclassification of pre-school childrens weight status and to determine factors associated with the maternal misperception.nnnDESIGNnA representative sample of 2287 children aged 2-5 years was examined (GENESIS study). Mothers perceptions of their childs weight status and the childrens and mothers anthropometric and other characteristics (sociodemographic and lifestyle) were recorded.nnnRESULTSnAlmost 38 % of mothers underestimated their childs weight status. The frequency of underestimation was much higher among at risk of being overweight and overweight children (88.3 % and 54.5 %, respectively) compared with underweight/normal-weight children (18.0 %, P < 0.001). Multiple logistic regression modelling revealed that the likelihood of mothers underestimation of their childs weight status was significantly higher in boys, in children engaging in physical activity for less than 3 h/week and in children whose mothers had low education status, compared with their counterparts. Moreover, the higher the BMI-for-age Z-score, the greater the odds that the mother would underestimate her childs weight status.nnnCONCLUSIONSnThe current study demonstrated that more than one-third of mothers misclassify their childrens weight status as being lower than the actual. Given that mothers weight perception might be an important determinant of childs body weight development, clinicians and health professionals should help mothers correctly classify their childrens weight status, which could potentially help in the early prevention of overweight and obesity.

Obesity and television watching in preschoolers in Greece: the GENESIS study.

The aim of the current work was to evaluate the effect of preschoolers television (TV) watching time on the prevalence of obesity even after controlling for their total energy intake and their physical activity status. A representative sample of 2,374 Greek children aged 1–5 years was examined (“Growth, Exercise and Nutrition Epidemiological Study in preSchoolers”, GENESIS study). Childrens TV watching time on a usual weekday and at a usual weekend was recorded. The overall mean of childrens TV viewing time was 1.32 h/day. The majority of participants (74.0%) spent <2 h/day watching TV whereas only 3.1% spent >4 h/day in front of a TV set. Overall, 65.2% of participants were normal weight, 17.2% were overweight, and the rest 17.6% were obese. The prevalence of obesity was significantly higher among those with TV viewing time ≥2 h/day (21.7%) compared to those watching TV <2 h/day (16.1%, P = 0.003). TV viewing time remained significantly associated with the likelihood of being obese even after controlling for potential confounders (i.e., socio demographic and other characteristics and physical activity status) only among children aged 3–5 years. However, further adjusting for childrens total energy intake revealed that the association between the TV viewing time and the probability of being obese was no longer statistically significant. On the other hand, physical activity status continued to be an independent factor of being obese. The current findings support the hypothesis that the effect of TV viewing time on childhood obesity is independent of physical activity status and may be attributed to the increased total energy intake during TV watching.

Television viewing and food habits in toddlers and preschoolers in Greece: the GENESIS study

The aim of the current study was to evaluate the association between television (TV) viewing time and dietary habits of preschoolers. A representative sample of 2,374 Greek children aged 1–5xa0years was examined (GENESIS study). The majority of participants (74.0%) spent less than 2xa0h/day watching TV. Children spending ≥2xa0h/day watching TV seem to have higher energy intake compared to children watching TV less than 2xa0h/day, even after adjustment for potential confounders (pu2009<u20090.001). Furthermore, it was detected that the former were more likely to consume more than 5, 2, and 1.5 exchanges of fat, meat, and other carbohydrates per day, respectively, compared to the latter. In conclusion, the current findings indicate that prolonged TV viewing time may be associated with increased consumption of high-fat and high-sugar foods resulting in increased daily energy intake. Therefore, interventions aiming to modify children’s TV viewing behaviour might need to be implemented.

Impact of peroxisome proliferator–activated receptors γ and δ on adiposity in toddlers and preschoolers in the GENESIS study

Peroxisome proliferator–activated receptor γ (PPAR γ) and peroxisome proliferator–activated receptor δ (PPAR δ) are promising candidate genes for obesity. Associations between adiposity‐related phenotypes and genetic variation in PPAR γ (Pro12Ala and C1431T), as well as PPAR δ (T+294C) were assessed in 2,102 Greek children aged 1–6 years, as part of a large‐scale epidemiological study (Growth, Exercise and Nutrition Epidemiological Study In preSchoolers). In girls aged 3–4 years, the Ala12 allele was associated with higher mid‐upper arm (P = 0.010) and hip (P = 0.005) circumferences, as well as subscapular (P = 0.008) and total skinfolds (P = 0.011) that explained 2.0, 3.7, 2.1, and 1.9% of the phenotypic variance, respectively, while the T1431 allele was associated with higher mean values for waist circumference (P = 0.018) and suprailiac skinfold (P = 0.017), genotype accounting for 1.6% of the variance in both phenotypes. No significant effects of PPAR δ T+294C polymorphism or the interaction of the PPAR δ and PPAR γ variants on adiposity‐related phenotypes were observed in any age group or gender. Haplotype‐based analysis including both PPAR γ polymorphisms revealed that in girls aged 3–4 years, the Ala‐T haplotype was associated with higher waist (P = 0.014) and hip (P = 0.007) circumferences compared to the common Pro‐C haplotype. The PPAR γ Pro12Ala and C1431T polymorphisms are associated with increased adiposity during early childhood in a gender‐ and age‐specific manner and independently of the PPAR δ T+294C polymorphism.

Diet quality of preschool children and maternal perceptions/misperceptions: The GENESIS study

OBJECTIVESnTo quantify maternal perceptions regarding the quality of their childs diet, and to identify factors associated with misperceptions.nnnSTUDY DESIGNnA representative sample of 2287 children aged 2-5 years from a cross-sectional study (GENESIS study) was used.nnnMETHODSnMaternal perceptions of the quality of their childs diet, childs and mothers anthropometric characteristics, and other characteristics (i.e. socio-demographic and lifestyle) were recorded. The actual quality of each childs diet was estimated using the Healthy Eating Index (HEI) score.nnnRESULTSnBased on the HEI score, 18.3% of participants had a poor diet, 81.5% had a diet which needs improvement and only 0.2% had a good diet. Almost 83% of mothers overestimated the quality of their childs diet. The overestimation rate was 86% among mothers who declared that they choose their childs food based on what they consider to be healthy, and 72% among those who reported that other factors play the predominant role in food choices for their child (P<0.001). Moreover, total energy intake as well as the intake of fruits, grains, vegetables, meat and milk was significantly higher among children whose mothers overestimated the quality of their diet.nnnCONCLUSIONnThe vast majority of mothers overestimate the quality of their childs diet. Given that maternal perceptions regarding the quality of their childs diet are likely to be one of the predominant factors determining the childs food intake, health professionals should make mothers aware of the existence of particular dietary recommendations that their children should meet in order to eat a healthy diet.

Development of a diet–lifestyle quality index for young children and its relation to obesity: the Preschoolers Diet–Lifestyle Index

OBJECTIVEnTo develop an index that assesses the degree of adherence to existing diet-lifestyle recommendations for preschoolers (Preschoolers Diet-Lifestyle Index (PDL-Index)) and to investigate its association with obesity.nnnDESIGNnThe PDL-Index was constructed using eleven components (i.e. questions regarding the frequency of consumption of selected foods/food groups, time spent on television watching and on moderate-to-vigorous physical activities).nnnSETTINGnScores from 0 to 4 were assigned to all components of the index. The PDL-Index total score ranged from 0 to 44. Higher values of the PDL-Index indicate greater adherence to dietary and lifestyle recommendations for preschoolers or otherwise greater adherence to healthier dietary-lifestyle patterns.nnnSUBJECTSnAs a validation procedure, a sample of 2287 preschoolers from Greece (GENESIS study) was used.nnnRESULTSnThe participants following healthier diet-lifestyle patterns (third tertile of PDL-Index) were less likely to be obese or overweight/obese compared to those following unhealthy diet-lifestyle patterns (first tertile of PDL-Index). It was observed that a 1/44 unit increase in the score of the PDL-Index was associated with approximately 5 % and 3 % lower odds of being obese and overweight/obese, respectively. Statistically significant results were observed after adjusting for potential confounders.nnnCONCLUSIONSnThe suggested PDL-Index could help public health policy makers in identifying vulnerable population subgroups and developing cost-effective, targeted intervention actions both in family and preschool settings. In addition, health-care professionals can use the PDL-Index to evaluate diet quality, lifestyle and risk for overweight/obesity at an individual level and counsel parents accordingly.

Comparison of two methods for identifying dietary patterns associated with obesity in preschool children: the GENESIS study

Background/Objectives:The aim of this work was to identify dietary patterns based on reduced rank regression (RRR) and principal component analysis (PCA) and to evaluate the association of these patterns with the prevalence of childhood obesity.Subjects/Methods:A sample of 2317 toddlers and preschoolers from Greece (Growth, Exercise and Nutrition Epidemiological Study In preSchoolers) was used. In total, 12 food groups were used as predictors of RRR and PCA. Nutrients such as total fat, simple carbohydrate and fiber intake were used as response variables to apply RRR.Results:One factor/pattern was retained from RRR and PCA in order to ensure the comparability of the methods. The pattern derived from PCA was mainly characterized by consumption of fruits, vegetables, legumes, fish and seafood, grains and oils. This pattern explained 12.5% of the total variation in food groups. On the other hand, the pattern extracted from RRR was mainly characterized by reduced consumption of fruits, vegetables and legumes, and by increased consumption of sweets and red meat. The pattern derived from RRR explained 8.2% of the total variation in food groups. Simple and multiple logistic regression revealed that the pattern extracted from RRR is significantly associated with the prevalence of childhood obesity (OR=1.11, 95% CI: 1.00–1.28 for each unit increase of dietary pattern) as opposed to the pattern derived from PCA.Conclusions:The preferable technique to derive dietary patterns related to childhood obesity seems to be RRR compared with PCA.

Development of a lifestyle-diet quality index for primary schoolchildren and its relation to insulin resistance: the Healthy Lifestyle-Diet Index

Objective:The aim of this work was to develop an index that evaluates the degree of adherence to existing dietary and lifestyle guidelines for primary school-aged children (Healthy Lifestyle–Diet Index (HLD-Index)) and examine its relationship with selected nutrient intake and insulin resistance (IR).Methods:Ten components were used to develop the HLD-Index. Scores from 0 to 4 were assigned to all components. The HLD-Index total score ranged between 0 and 40. A sample of 729 schoolchildren from Greece aged 10–12 years (The Healthy Growth Study) was used to evaluate the validation of the proposed index.Results:The overall mean±standard deviation of the HLD-Index score was 20±4.4. Higher HLD-Index scores were associated with lower proportion of children having intakes lower than Estimated Average Requirements by Institute of Medicine. On the basis of the cutoff point of 3.16 for homeostasis model assessment of IR, 20.9% of participants were found to be insulin resistant. After adjusting for potential confounders, logistic regression showed that a 1 unit increase in the score is associated with almost 8% lower odds for being insulin resistant. The cutoff point analysis revealed that score equal to or lower than 21 best discriminates children with IR from those without IR. On the basis of this cutoff point, the sensitivity of the HLD-Index was 70% and the corresponding specificity was 47%.Conclusions:The proposed HLD-Index could be used by public health policy makers and other health-care professionals to identify subgroups in the population with poor diet–lifestyle habits who are at increased probability for IR.