Epidemiology of Obesity in Children and Adolescents (eBook)

Luis Moreno Aznar is Professor in the School of Health Sciences at the University of Zaragoza, Spain.Iris Pigeot is Professor in the Division of Biometry and Data Management at the University of Bremen, Germany.Wolfgang Ahrens is Professor in the Division of Epidemiological Methods and Etiologic Research at the University of Bremen.

Epidemiology of Obesity in Children and Adolescents 4
Preface 6
Contents 8
Chapter 1: Introduction 12
References 15
Chapter 2: Ethics and Public Policy 18
Introduction 18
What are Childhood and Adolescence? 18
Obesity and Individual Choice 19
Parental Responsibility 21
Interventions Through Schools and Kindergartens 23
Possible Public Policy Measures 25
Concluding Reflections 28
References 30
Chapter 3: Methodological Aspects for Childhood and Adolescence Obesity Epidemiology 32
Introduction 32
Definition and Diagnosis of Obesity 33
Screening for Excess Body Fat 33
Reference Population Standards 35
Methodological Aspects Depending on the Aims 35
Assessment of Body Composition 36
Body Composition Changes Throughout Childhood and Adolescence 36
Anthropometry 36
Length/Height 37
Weight 37
Weight-for-Stature Indices 37
Body Mass Index (BMI) 37
Skinfold Thickness 38
Circumferences and Diameters 39
Non-Anthropometric Methods 40
Bioimpedance Analysis 40
Hydrodensitometry 40
Air Displacement Plethysmography (ADP) 41
Dual-Energy X-Ray Absorptiometry (DXA) 41
Imaging Methods 42
Epidemiological Aspects 42
Strengths and Limitations of Using BMI in Assessing Childhood Obesity 43
Secular Changes in Growth, Body Composition, and Sexual Maturation and Differences Within and Between Populations 44
Conclusions 47
References 48
Part I: Descriptive Epidemiology 52
Chapter 4: Childhood Obesity in the WHO European Region 53
Introduction 53
Geographic Area 54
Definition 54
Socio-Demographic and Economic Characteristics 54
Methods 56
Prevalence of Overweight and Obesity 65
Time Trends by Country 65
Geographic Distribution by Country 65
Prevalence of Obesity by Ethnicity and Socio-Economic Status 68
Discussion of Key Risk Factors 69
Conclusions 73
References 73
Chapter 5: The Epidemiology of Childhood Obesity in Canada, Mexico and the United States 79
Introduction 79
Geographic and Socio-Economic Characteristics 80
Definitions and Measurement of Overweight and Obesity 80
Prevalence and Trends 81
Distribution of Body Mass Index 83
Socio-Demographic Differences 87
Race/Ethnicity 88
Sex and Age 90
Socio-Economic Status 90
Behavioral Aspects of Obesity 99
Diet 99
Sedentary Behaviors 100
Conclusions 102
References 102
Chapter 6: Epidemiology of Obesity in Children in South America 104
Introduction 104
Geographic Region 105
Methods 105
Socio-Economic and Demographic Indicators 108
Obesity Estimates 108
Obesity Definition 108
Obesity Risk Factors 108
Results 109
Prevalence of Obesity in Pre-School Children 109
Prevalence of Obesity in School Children 109
Prevalence of Obesity in Adolescents 111
What Do We Know About Key Risk Factors? 111
Urbanization and Socio-Economic Conditions 111
Sedentary Behavior 113
Dietary Factors 114
Breastfeeding 114
Maternal Obesity 116
Low Birth Weight and Stunting 116
Conclusions 116
References 117
Chapter 7: Epidemiology of Obesity in Children and Adolescents in Australia, New Zealand and the Pacific Region 120
Introduction 120
Geographic Area 121
Prevalence of Overweight and Obesity 123
Australia 123
Findings from the 2007 to 2008 National Health Survey 124
Findings from the 2007 Australian National Children’s Nutrition and Physical Activity Survey 124
Findings from the Longitudinal Study of Australian Children (2004) 126
Secular Trends 127
New Zealand 128
Secular Trends 130
Pacific Region 130
Findings from the 2005/2006 Obesity Prevention in Communities Study for Fiji 131
Findings from the 2005/2006 Obesity Prevention in Communities Study for Tonga 131
Secular Trends 132
Conclusions 132
References 133
Chapter 8: Prevalence and Etiology: Middle East and North Africa (MENA) Countries 135
Introduction 135
Risk Profile in Developing Countries 135
Overweight Standards 136
Risk Profile in the MENA Region 136
Geographic Area 137
Near East 137
Gulf Region and Arabian Peninsula 137
North Africa 138
Socio-demographic and Economic Characteristics 138
Methods 139
Prevalence of Overweight and Obesity 139
Near East Sub-region 153
Gulf and Arabian Peninsula Sub-region 153
North Africa Sub-region 154
Cross-regional Studies 154
Risk Factors Studied 155
Conclusions 156
References 157
Chapter 9: Prevalence of Overweight and Obesity in Japan 161
Introduction 161
Geographic Area 162
Definition 162
Socio-demographic and Economic Characteristics 162
Methods 162
Data Source 162
School-Aged Children and Adolescents 162
Pre-school-aged Children 163
National Nutrition Survey 163
Methods of Data Retrieval and Compilation 163
School-Aged Children and Adolescents 163
Pre-school-aged Children 163
Nutrient Intakes in Infants, Children, and Adolescents 163
Prevalence of Overweight and Obesity 164
Definition of Overweight and Obesity 164
Prevalence of Overweight and Obesity of School-Aged Children and Adolescents in 2007 164
Time Trend of Prevalence of Overweight and Obesity of School-Aged Children and Adolescents Between 1977 and 2007 165
Time Trend of Prevalence of Obesity and Severe Obesity of Pre-school-aged Children Between 1998 and 2007 166
Risk Factors for Overweight and Obesity in Children and Adolescents 168
Total Energy Intake and Intake of Each Macronutrient 168
Prevalence of Breastfeeding 168
Prevalence of Overweight in Adults in Japan 169
Conclusions 169
References 170
Chapter 10: Social Epidemiology of Nutritional Burden Among Children and Adolescents in India 171
Introduction 171
Socio-Demographic and Economic Characteristics of India 174
Methods 174
Data 174
Measures 175
Prevalence 176
Overweight and Obesity 176
Underweight, Stunting, and Wasting 177
Dual Burden 179
Summary 182
Social Epidemiology 182
Parental Indicators 182
School Level Indicators 184
State-Level Indicators 184
Summary 185
Lifestyle Risk Factors 185
Conclusions 185
References 186
Chapter 11: Epidemiology of Obesity in Children and Adolescents in China 190
Introduction 190
China’s Socio-demographic and Economic Characteristics 191
Classification of Obesity in Children and Adolescents in China 192
The Prevalence and Trends of Childhood Obesity in China 193
Time Trends in the Prevalence of Childhood Obesity 194
Sex and Age Differences 195
Urban and Rural Differences 195
The Main Factors That Have Contributed to the Increase in Obesity in China 196
Discussion and Conclusions 199
References 200
Chapter 12: Epidemiology and Clinical Profile of Obesity in Children and Adolescents: South-East Asia and Singapore 202
Introduction 202
Geographic, Socio-demographic and Economic Characteristics 203
Hong Kong 203
Singapore 203
Taiwan 205
Malaysia 205
Korea (South) 205
Philippines 205
Thailand 206
Vietnam 206
Summary 206
Prevalence of Overweight and Obesity in Children 206
Taiwan 208
Malaysia 208
Korea (South) 209
Thailand 209
Vietnam 209
Comparison of Prevalence of Overweight and Obesity in Children and Adults 210
Summary 210
Risk Factors for Obesity 210
Dietary Patterns 212
Infant Feeding Practices 212
Physical Activity 213
Summary 213
Clinical Consequences of Childhood Obesity 214
Hypertension 214
Hyperlipidemia 215
Insulin Resistance and Type 2 Diabetes 215
Metabolic Syndrome 217
Non-alcoholic Fatty Liver Disease (NAFLD) 218
Summary 218
Conclusions 219
References 219
Chapter 13: Childhood Obesity: Prevalence Worldwide - Synthesis Part I 225
Introduction 225
Methods 226
Database 226
Comparability of Different Reference Systems 226
Selection and Compilation of Data 232
Worldwide Prevalence of Overweight and Obesity 233
Geographic Distribution 233
Association with SES by Geographic Region 237
Conclusions and Outlook 239
References 240
Part II: Etiological Factors 242
Chapter 14: Genetic Factors 243
Introduction 243
Heritability of Body Weight 244
Methodological Approaches to the Study of Polygenic Obesity 245
Lessons from GWA Studies: The Case of MC4R and FTO 247
The Melanocortin-4 Receptor Gene (MC4R) 247
The Fat Mass and Obesity Associated Gene (FTO) 248
Gene?–Environment Interaction and Obesity 250
Epigenetic Mechanisms in Obesity 251
Conclusions 252
References 252
Chapter 15: Genetics and Nutrigenomics of Obesity 257
Introduction 257
Genetic Influences in Human Obesity: A Physiology-Based Overview 258
Genes Related to the Central Regulation of Energy Balance 258
Genes Related to Adipogenesis 261
Genes Related to Lipid Turnover 263
Genes Related to Lipogenesis 264
Genes Related to Lipolysis 265
Genes Related to Adaptive Thermogenesis and Oxidative Metabolism 266
Genes Related to Insulin Signaling 268
Genes Related to Other Extracellular Signals Impinging on Energy Metabolism 269
Summary 270
Gene-Nutrient Interactions: Selected Examples in Connection with Obesity and Related Disorders 271
Nutrigenomic Effects 272
Nutrigenetic Interactions 272
Nutrient Status Effects on Intracellular Signaling Pathways 273
Summary 276
Early Life Nutrition and Later Obesity 276
Developmental Programming of Adulthood Obesity 277
Effects of Undernutrition in the Fetal Life on the Incidence of Obesity in Adulthood 278
Effects of Overnutrition in the Fetal Life on the Incidence of Obesity in Adulthood. The Case of Gestational Diabetes 278
Protective Effects of Breastfeeding Against Obesity 279
Leptin in the Regulation of Energy Balance. The Role of Breast Milk Leptin 280
Previously Known Functions of Leptin 280
The New Function of Leptin in Breast Milk in the Prevention of Later Obesity 281
Summary 282
Conclusions 282
References 283
Chapter 16: Neuroendocrine Regulation 295
Introduction 295
Central Neuroendocrine System 296
The Hypothalamus 296
Brain Circuitry Involved in Appetite, Metabolism and Satiety 299
Peripheral Hormone Feedback at the Hypothalamus 300
Adipose Tissue Signals 300
Digestive System Signals 301
Signals from GI tract 301
Signals from the pancreas 302
Nutrient Effects on Hypothalamic Signaling 303
Free Fatty Acids 303
Glucose 303
Intracellular Signaling in Hypothalamic Neurons 303
Insulin Signaling 303
Leptin Signaling 304
Ghrelin Signaling 305
Hypothalamic-Pituitary-Adipose Axis: “Adipotropins” 305
Hypothalamic Changes in Obesity 306
Neuropeptide Changes 306
In-Put Signals 306
Leptin Signaling Down-Regulation 306
Insulin Signaling Down-Regulation 307
Conclusions 307
References 307
Chapter 17: Perinatal and Infant Determinants of Obesity 314
Introduction 314
Prenatal Risk Factors for Obesity 315
Gestational Diabetes or Hyperglycemia and Offspring Obesity Risk 315
The Diabetic and Hyperglycemic Intrauterine Environment and Infant Adiposity 315
The Diabetic and Hyperglycemic Intrauterine Environment and Later Obesity Risk 315
Developmental Overnutrition 317
Maternal Adiposity During Pregnancy and Future Offspring Obesity Risk 318
Maternal Weight Gain During Pregnancy 319
Maternal Diet During Pregnancy 320
Maternal Smoking During Pregnancy 320
Intrauterine Growth and Later Risk of Obesity 322
Infant Risk Factors of Obesity 323
Accelerated Infant Growth 323
Infant Nutrition 324
Conclusions 326
References 326
Chapter 18: Food Patterns and Nutrient Intake in Relation to Childhood Obesity 332
Introduction 332
Methodological Challenges in Studying Children’s Diets 334
Instrumentation Issues in Measuring Children’s Diets 334
Summary 335
Other Methodological Challenges 335
Energy and Nutrient Intake in Obese vs. Non-Obese Children 338
Energy and Energy Intake 338
Fat and Fat Type 339
Protein 340
Sucrose 340
Other Aspects of Nutrient Composition 341
Summary Regarding Nutrient Composition and Childhood Obesity 341
Food Consumption Patterns as Obesity Risk Factors 342
Meal Frequency and Daily Distribution of Meal 342
Food Portion Size 342
Family Control of Children’s Eating 343
Fast Food Restaurant Consumption 343
Snack Consumption 343
Beverage Consumption 344
To Eat High-Quality Foods and Food Variety 344
Summary Regarding Food Patterns and Childhood Obesity 345
Conclusions 345
References 345
Chapter 19: Physical Activity, Fitness and Fatness in Children and Adolescents 350
Introduction 350
Physical Activity and Body Fat in Children and Adolescents: Does the Intensity Matter? 351
Physical Activity and Total Body Fat 351
Physical Activity and Central Body Fat 353
Physical Activity and Obesity-Related Cardiovascular Disease Risk Factors 354
Physical Fitness and Body Fat in Children and Adolescents 356
Physical Fitness and Total Body Fat 356
Physical Fitness and Central Body Fat 356
Physical Fitness and Obesity-Related Cardiovascular Disease Risk Factors 357
Cardiorespiratory Fitness and Obesity-Related Cardiovascular Disease Risk Factors 357
Cardiorespiratory Fitness and Later Obesity-Related Cardiovascular Disease Risk Factors 359
Musculoskeletal Fitness and Obesity-Related Cardiovascular Disease Risk Factors 359
Musculoskeletal Fitness and Later Obesity-Related Cardiovascular Disease Risk Factors 360
Cardiovascular Consequences of Being Fat but Fit 361
Conclusions 362
References 363
Chapter 20: Sedentary Behaviors and Obesity in Children and Adolescents 370
Introduction 370
Assessment of Sedentary Behaviors in Children and Adolescents 371
Prevalence of Sedentary Behaviors in Children and Adolescents 371
Sedentary Behaviors and Obesity 373
Are Sedentary Behaviors Displacing Physical Activity? 373
Are All the Sedentary Behaviors Equally Obesogenic? 374
Television Watching and Obesity 374
Video Games and Obesity 375
Computers and Obesity 376
Food Habits Associated with Sedentary Behaviors 376
Conclusions 377
References 377
Chapter 21: Socio-Economic Status and Obesity in Childhood 380
Introduction 380
Epidemiological Evidence Linking Childhood Obesity with SES 380
Developing Countries 381
Developed Countries 381
Demographic Moderators of the SES-Obesity Association 382
Ethnicity 382
Age 383
Sex 383
Time Trends in the Socio-Economic Gradient in Child Obesity 383
Measurement of SES 384
Area-Level Indicators 384
Family-Level Indicators 385
Putative Causal Mechanisms in the Association Between SES and Obesity 385
Built Environment/Neighborhood Factors 386
Parental Overweight 386
Lifestyle Factors: Eating Behavior, and Physical Activity 387
Attitudes, Beliefs and Perceptions 387
Parental Feeding and the Home Food Environment 388
Conclusions 388
References 389
Chapter 22: Environmental Factors: Opportunities and Barriers for Physical Activity, and Healthy Eating 394
Introduction 394
Environmental Factors Related to Obesity 396
What Is Meant with “The Environment”? 396
Which Environmental Factors Will Be Discussed in this Chapter? 397
Environmental Factors Influencing Physical Activity and Sedentarism 397
Environmental Factors Influencing Eating Habits, Dietary Preferences and Food Supplies 398
Methods Used to Determine Environmental Factors Influencing Childhood Obesity 399
Study Designs Used to Investigate Environmental Factors Related to Obesity 400
Modern Technologies Used to Investigate Environmental Factors Related to Childhood Obesity 400
Evidences for Environmental Changes Influencing the Obesity Epidemic 401
Environmental Barriers for a Physically Active Lifestyle 401
Environmental Opportunities to Increase Our Physical Activity Level 404
Environmental Barriers for Healthy Dietary Habits 408
Environmental Opportunities to Stimulate Healthy Dietary Habits 410
Institutionalization of Systems Required 411
Conceptual and Methodological Considerations 411
Methodological Considerations with Regard to the Studies Reported in this Chapter 411
Recommendations for Future Study Designs and Analytical Strategies for Environmental Research on Obesity, Physical Activity an 412
Mediators and Moderators to Explain Causality 413
Conclusions 415
References 417
Chapter 23: Psychosocial Aspects of Childhood Obesity 422
Introduction 422
Psychosocial Risk Factors for the Development of Obesity 422
Childhood Depression 423
Summary 423
Chronic Stress (Sexual Abuse, Neglect) 423
Summary 425
Childhood Behavioral Problems 425
Summary 426
Psychosocial Sequelae of Childhood Obesity 426
Stigmatization 426
Self-Esteem 427
Suicidal Behavior 427
Quality of Life 428
Peer Relationships 428
Disordered Eating Behaviors 429
Conclusions 429
References 429
Chapter 24: Consumer Behavior in Childhood Obesity Research and Policy 433
Sec30_24 433
The Background 433
Overview of Factors of Consumer Behavior Influencing Childhood Obesity 434
Children’s Impact as Consumers 436
Roles of Socialization Agents as Regards Food and Physical Activity 437
Models of Children’s Behavior and Development 438
Roles of Parents and the Family 439
Roles of Caretakers 440
Roles of Media 442
Empirical Evidence of Influencing Factors 443
Pester Power 443
The Role of Social Class 444
Food Industry 445
Media Use 446
Advertising 447
Policy Implications 448
Implications for Parents and Caretakers 449
Implications for Consumer Organizations 449
Implications for Regulators 449
Implications for Industry and Advertising 450
References 451
Chapter 25: Eating Behavior and Weight in Children 457
Introduction 457
Methods and Measures Used in Eating Behavior Research 458
Behavioral Measures of Eating Behaviors in Children 458
Energy Compensation 458
Microstructural Analysis of Ingestive Patterns 458
Sensory Activation of Eating 459
Eating in the Absence of Hunger 459
Behavioral Economic Analysis of Food Choice 459
Food Preference Studies 459
Limitations of Behavioral Studies of Eating in Children 460
Quantitative Psychometric Measurement of Eating Behaviors in Children 460
Assessing the Relationship Between Eating Behaviorand Weight in Children 461
Current Evidence Relating Eating Behaviors to Weight in Children 461
Responsiveness to Food Cues 461
Sensitivity to Internal Cues of Satiety 463
Speed of Eating 463
Preload Compensation 464
Food Preferences and Food Fussiness 464
Food Preferences 464
Food Fussiness 465
Emotional Eating 465
Future Research into Eating Behaviors and Child Weight 466
Etiology of Eating Behaviors 466
Physiological Correlates of Eating Behaviors 466
Genetic Influences on Eating Behaviors 467
Heritability of Eating Behaviors 467
Molecular Genetic Basis of Eating Behaviors 470
Summary of Research into the Genetic Influence on Eating Behaviors 471
Environmental Influences on Eating Behaviors 472
Perinatal Nutritional Influences on Eating Behaviors 472
Parental Influences on Eating Behaviors During Infancy and Childhood 473
Summary of Research into the Environmental Influences on Eating Behaviors 475
Implications for Treatment and Prevention 475
References 476
Chapter 26: Childhood Obesity: Etiology - Synthesis Part II 485
Introduction 485
Genetics, Epigenetics and Nutrigenomics 486
Early Nutrition Programming 487
Neuroendocrine Regulation 488
Food Patterns and Eating Behavior 488
Consumer Behavior 489
Physical (In-)Activity and Physical Fitness 490
Environmental Factors 491
Social and Psychological Factors 492
Conclusions 493
References 493
Index 495