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Differences in Weight Status and Energy-Balance Related Behaviors among Schoolchildren across Europe: The ENERGY-Project

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      Abstract

      Background

      Current data on the prevalence of overweight and energy-balance behaviors among European children is necessary to inform overweight prevention interventions.

      Methodology/Principal Findings

      A school-based survey among 10–12 year old children was conducted in seven European countries using a standardized protocol. Weight, height, and waist circumference were measured; Engagement in physical activity, sedentary and dietary behaviors, and sleep duration were self-reported. Descriptive analyses were conducted, looking at differences according to country, gender, and parental education. 7234 children (52%girls; 11.6±0.7 years) participated. 25.8% and 5.4% of boys, and 21.8% and 4.1% of girls were overweight (including obese) and obese (according to International Obesity Task Force criteria), respectively. Higher prevalence of overweight/obesity was observed in Greece, Hungary, Slovenia and Spain than in Belgium, Netherlands and Norway. Large differences between countries were found in intakes of sugar-sweetened beverages, breakfast, active transport, TV and computer time. More favorable overweight status and behavior patterns were found in girls than boys and in children of higher educated parents than in children of lower educated parents.

      Conclusions/Significance

      High levels and striking differences in overweight status and potential risk behaviors were found among schoolchildren across Europe.

      Related collections

      Most cited references 38

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        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. 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. 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/m(2) to 0.1 kg/m(2). At 19 years, the new BMI values at +1 standard deviation (SD) are 25.4 kg/m(2) for boys and 25.0 kg/m(2) for girls. These values are equivalent to the overweight cut-off for adults (> or = 25.0 kg/m(2)). Similarly, the +2 SD value (29.7 kg/m(2) for both sexes) compares closely with the cut-off for obesity (> or = 30.0 kg/m(2)). 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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          Overweight and obesity in youth are important public health concerns and are of particular interest because of possible long-term associations with adult weight status and morbidity. The aim of this study was to systematically review the literature and update evidence concerning persistence of childhood overweight. A computerized bibliographical search--restricted to studies with a prospective or retrospective longitudinal design--was conducted. Two authors independently extracted data and assessed the methodological quality of the included studies in four dimensions (i) study population and participation rate; (ii) study attrition; (iii) data collection and (iv) data analysis. Conclusions were based on a rating system of three levels of evidence. A total of 25 publications were selected for inclusion in this review. According to a methodological quality assessment, 13 studies were considered to be of high quality. The majority of these high-quality studies were published after 2001, indicating that recently published data, in particular, provide us with reliable information. All included studies consistently report an increased risk of overweight and obese youth becoming overweight adults, suggesting that the likelihood of persistence of overweight into adulthood is moderate for overweight and obese youth. However, predictive values varied considerably. Limiting aspects with respect to generalizability and methodological issues are discussed.
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            Author and article information

            Affiliations
            [1 ]Department of Epidemiology and Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
            [2 ]Department of Public and Occupational Health and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
            [3 ]Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
            [4 ]Department of Nutrition, University of Oslo, Norway
            [5 ]Department of Public Health, Sport and Nutrition, University of Agder, Kristiansand, Norway
            [6 ]Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
            [7 ]Department of Public Health, Ghent University, Ghent, Belgium
            [8 ]GENUD (Growth, Exercise, Nutrition and Development) Research Group. E.U. Ciencias de la Salud, Universidad de Zaragoza, 50009 Zaragoza, Spain
            [9 ]Slovenian Heart Foundation, Ljubljana, Slovenia
            [10 ]Department of Paediatrics, Pecs University, Pecs, Hungary
            [11 ]IASO, International Association for the Study of Obesity, London, United Kingdom
            University of Sao Paulo, Brazil
            Author notes

            Conceived and designed the experiments: JB STV AS MC EB YM. Performed the experiments: JB MVS STV MC IDB NL EB VM AS L. Maes L. Moreno NJ EK TL YM. Analyzed the data: JB MVS STV. Contributed reagents/materials/analysis tools: JB MVS STV MC IDB NL EB VM AS L. Maes L. Moreno NJ EK TL YM. Wrote the paper: JB. Provided feedback on drafts of the manuscript: MVS STV MC IDB NL EB VM AS L. Maes L. Moreno NJ EK TL YM.

            Contributors
            Role: Editor
            Journal
            PLoS One
            PLoS ONE
            plos
            plosone
            PLoS ONE
            Public Library of Science (San Francisco, USA )
            1932-6203
            2012
            25 April 2012
            : 7
            : 4
            3338827
            22558098
            PONE-D-11-23400
            10.1371/journal.pone.0034742
            (Editor)
            Brug et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
            Counts
            Pages: 13
            Categories
            Research Article
            Medicine
            Global Health
            Nutrition
            Obesity
            Pediatrics
            Public Health
            Behavioral and Social Aspects of Health
            Child Health
            Preventive Medicine
            Socioeconomic Aspects of Health
            Sports and Exercise Medicine

            Uncategorized

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