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      Understanding weight status and dietary intakes among Australian school children by remoteness: a cross-sectional study

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          Abstract

          Objective:

          To determine whether primary school children’s weight status and dietary behaviours vary by remoteness as defined by the Australian Modified Monash Model (MMM).

          Design:

          A cross-sectional study design was used to conduct secondary analysis of baseline data from primary school students participating in a community-based childhood obesity trial. Logistic mixed models estimated associations between remoteness, measured weight status and self-reported dietary intake.

          Setting:

          Twelve regional and rural Local Government Areas in North-East Victoria, Australia.

          Participants:

          Data were collected from 2456 grade 4 (approximately 9–10 years) and grade 6 (approximately 11–12 years) students.

          Results:

          The final sample included students living in regional centres (17·4 %), large rural towns (25·6 %), medium rural towns (15·1 %) and small rural towns (41·9 %). Weight status did not vary by remoteness. Compared to children in regional centres, those in small rural towns were more likely to meet fruit consumption guidelines (OR: 1·75, 95 % CI (1·24, 2·47)) and had higher odds of consuming fewer takeaway meals (OR: 1·37, 95 % CI (1·08, 1·74)) and unhealthy snacks (OR = 1·58, 95 % CI (1·15, 2·16)).

          Conclusions:

          Living further from regional centres was associated with some healthier self-reported dietary behaviours. This study improves understanding of how dietary behaviours may differ across remoteness levels and highlights that public health initiatives may need to take into account heterogeneity across communities.

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          Most cited references38

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          Development of a WHO growth reference for school-aged children and adolescents

          OBJECTIVE: To construct growth curves for school-aged children and adolescents that accord with the WHO Child Growth Standards for preschool children and the body mass index (BMI) cut-offs for adults. METHODS: Data from the 1977 National Center for Health Statistics (NCHS)/WHO growth reference (1-24 years) were merged with data from the under-fives growth standards' cross-sectional sample (18-71 months) to smooth the transition between the two samples. State-of-the-art statistical methods used to construct the WHO Child Growth Standards (0-5 years), i.e. the Box-Cox power exponential (BCPE) method with appropriate diagnostic tools for the selection of best models, were applied to this combined sample. FINDINGS: The merged data sets resulted in a smooth transition at 5 years for height-for-age, weight-for-age and BMI-for-age. For BMI-for-age across all centiles the magnitude of the difference between the two curves at age 5 years is mostly 0.0 kg/m² to 0.1 kg/m². At 19 years, the new BMI values at +1 standard deviation (SD) are 25.4 kg/m² for boys and 25.0 kg/m² for girls. These values are equivalent to the overweight cut-off for adults (> 25.0 kg/m²). Similarly, the +2 SD value (29.7 kg/m² for both sexes) compares closely with the cut-off for obesity (> 30.0 kg/m²). CONCLUSION: The new curves are closely aligned with the WHO Child Growth Standards at 5 years, and the recommended adult cut-offs for overweight and obesity at 19 years. They fill the gap in growth curves and provide an appropriate reference for the 5 to 19 years age group.
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            Predicting adult obesity from childhood obesity: a systematic review and meta-analysis.

            A systematic review and meta-analysis was performed to investigate the ability of simple measures of childhood obesity such as body mass index (BMI) to predict future obesity in adolescence and adulthood. Large cohort studies, which measured obesity both in childhood and in later adolescence or adulthood, using any recognized measure of obesity were sought. Study quality was assessed. Studies were pooled using diagnostic meta-analysis methods. Fifteen prospective cohort studies were included in the meta-analysis. BMI was the only measure of obesity reported in any study, with 200,777 participants followed up. Obese children and adolescents were around five times more likely to be obese in adulthood than those who were not obese. Around 55% of obese children go on to be obese in adolescence, around 80% of obese adolescents will still be obese in adulthood and around 70% will be obese over age 30. Therefore, action to reduce and prevent obesity in these adolescents is needed. However, 70% of obese adults were not obese in childhood or adolescence, so targeting obesity reduction solely at obese or overweight children needs to be considered carefully as this may not substantially reduce the overall burden of adult obesity.
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              Increased food energy supply as a major driver of the obesity epidemic: a global analysis

              Abstract Objective We investigated associations between changes in national food energy supply and in average population body weight. Methods We collected data from 24 high-, 27 middle- and 18 low-income countries on the average measured body weight from global databases, national health and nutrition survey reports and peer-reviewed papers. Changes in average body weight were derived from study pairs that were at least four years apart (various years, 1971–2010). Selected study pairs were considered to be representative of an adolescent or adult population, at national or subnational scale. Food energy supply data were retrieved from the Food and Agriculture Organization of the United Nations food balance sheets. We estimated the population energy requirements at survey time points using Institute of Medicine equations. Finally, we estimated the change in energy intake that could theoretically account for the observed change in average body weight using an experimentally-validated model. Findings In 56 countries, an increase in food energy supply was associated with an increase in average body weight. In 45 countries, the increase in food energy supply was higher than the model-predicted increase in energy intake. The association between change in food energy supply and change in body weight was statistically significant overall and for high-income countries (P < 0.001). Conclusion The findings suggest that increases in food energy supply are sufficient to explain increases in average population body weight, especially in high-income countries. Policy efforts are needed to improve the healthiness of food systems and environments to reduce global obesity.
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                Author and article information

                Journal
                Public Health Nutr
                Public Health Nutr
                PHN
                Public Health Nutrition
                Cambridge University Press (Cambridge, UK )
                1368-9800
                1475-2727
                June 2023
                30 January 2023
                : 26
                : 6
                : 1185-1193
                Affiliations
                [ 1 ]Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University , Waterfront Campus, 1 Gheringhap St, Geelong, VIC 3220, Australia
                [ 2 ] Deakin University , Biostatistics Unit, Faculty of Health, Geelong, Australia
                [ 3 ] Deakin University , Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Geelong, Australia
                [ 4 ]Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University , Geelong, Australia
                Author notes
                [* ] Corresponding author: Email jane.jacobs@ 123456deakin.edu.au
                Author information
                https://orcid.org/0000-0001-9434-109X
                https://orcid.org/0000-0003-2731-9858
                Article
                S1368980023000198
                10.1017/S1368980023000198
                10346081
                36710638
                1e5413be-44af-4a17-bbf3-5addb41eb775
                © The Authors 2023

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.

                History
                : 30 April 2022
                : 18 October 2022
                : 11 January 2023
                Page count
                Figures: 1, Tables: 2, References: 48, Pages: 9
                Categories
                Research Paper
                Behavioural Nutrition

                Public health
                dietary intake,rural health,childhood obesity,health inequalities
                Public health
                dietary intake, rural health, childhood obesity, health inequalities

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