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Epidemiology

Hierarchical analysis of dietary, lifestyle and family environment risk factors for childhood obesity: the GRECO study

European Journal of Clinical Nutrition volume 68, pages 1107–1112 (2014)Cite this article

Subjects

Abstract

Background/objectives:

To facilitate the development of practical public health advice targeted at childhood obesity (OB) prevention and make the intervention programs more effective, one has to promote the most protective habits and limit or modify the risk factors. The objective of the present study was to recognize the most important dietary and physical activity habits, sedentary behaviors, plus parental influences that are associated with childhood overweight (OW) and OB, in a nationwide, cross-sectional sample of Greek school children.

Subjects/methods:

Data from 4552 children (10–12 years old) and 2225 of their parents were included in the analysis. Direct anthropometric measurements and information on dietary and physical activity habits was obtained from the children, as was information on parental self-reported anthropometric values, perceptions and family environment information.

Results:

Multiple logistic regression analysis revealed that the most important predictors of childhood OW/OB were breakfast frequency (odds ratio (OR): 0.95; 95% confidence interval (CI): 0.92–0.97), daily number of meals and snacks (OR: 0.92; 95% CI: 0.87–0.97), the frequency of family meals (OR: 0.86; 95% CI: 0.76–0.99), having both a TV and a PC/video game player in the bedroom (OR: 1.41; 95% CI: 1.18–1.69) and study hours on weekdays (OR: 1.07; 95% CI: 1.02–1.13). In the case of parents, mothers' age (OR: 0.91; 95% CI: 0.86–0.97), maternal (OR: 1.13; 95% CI: 1.06–1.21) and paternal (OR: 1.08; 95% CI: 1.02–1.15) body mass index (BMI) and children's BMI misclassification (OR: 6.22; 95% CI: 3.62–10.71) were significant predictors of children’s OW/OB.

Conclusions:

These findings could guide future investigations or public health initiatives to prevent and confront the childhood OB epidemic more efficiently.

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References

  1. Ogden CL, Caroll MD, Curtin LR, Lamb MM, Flegal KM . Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA 2010; 303: 242–249.

    Article  CAS  PubMed  Google Scholar 

  2. Lobstein T, Frelut ML . Prevalence of overweight among children in Europe. Obes Rev 2003; 4: 195–200.

    Article  CAS  PubMed  Google Scholar 

  3. Binkin N, Fontana G, Lamberti A, Cattaneo C, Baglio G, Perra A, Spinelli A . A national survey of the prevalence of childhood overweight and obesity in Italy. Obes Rev 2010; 11: 2–10.

    Article  CAS  PubMed  Google Scholar 

  4. Farajian P, Risvas G, Karasouli K, Pounis GD, Kastorini CM, Papangiotakos DB et al. Very high childhood obesity prevalence and low adherence rates to the Mediterranean diet in Greek children: The GRECO study. Atherosclerosis 2011; 217: 525–530.

    Article  CAS  PubMed  Google Scholar 

  5. Deshmukh-Taskar P, Nicklas TA, Morales M, Yang SJ, Zakeri I, Berenson GS . Tracking of overweight status from childhood to young adulthood: the Bogalusa Heart Study. Eur J Clin Nutr 2006; 60: 48–57.

    Article  CAS  PubMed  Google Scholar 

  6. Freedman DS, Dietz WH, Srinivasan SR, Berenson GS . The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics 1999; 103: 1175–1182.

    Article  CAS  PubMed  Google Scholar 

  7. Deshmukh-Taskar PR, Nicklas TA, O’Neil CE, Keast DR, Radcliffe JD, Cho S . The relationship of breakfast skipping and type of breakfast consumption with nutrient intake and weight status in children and adolescents: the National Health and Nutrition Examination Survey 1999–2006. J Am Diet Assoc 2010; 110: 869–878.

    Article  CAS  PubMed  Google Scholar 

  8. Kontogianni MD, Farmaki AE, Vidra N, Sofrona S, Magkanari F, Yannakoulia M . Associations between lifestyle patterns and body mass index in a sample of Greek children and adolescents. J Am Diet Assoc 2010; 110: 215–221.

    Article  PubMed  Google Scholar 

  9. Nicklas TA, Baranowski T, Cullen KW, Berenson G . Eating patterns, dietary quality and obesity. J Am Coll Nutr 2001; 20: 599–608.

    Article  CAS  PubMed  Google Scholar 

  10. Wong SL, Leatherdale ST . Association between sedentary behavior, physical activity, and obesity: inactivity among active kids. Prev Chronic Dis 2009; 6: A26.

    PubMed  Google Scholar 

  11. Chaput JP, Lambert M, Gray-Donald K, McGrath JJ, Tremblay MS, O'Loughlin J et al. Short sleep duration is independently associated with overweight and obesity in Quebec children. Can J Public Health 2011; 102: 369–374.

    PubMed  PubMed Central  Google Scholar 

  12. Hense S, Pohlabeln H, De Henauw S, Eiben G, Molnar D, Moreno LA et al. Sleep duration and overweight in European children: is the association modified by geographic region? Sleep 2011; 34: 885–890.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Adamo KB, Brett KE . Parental perceptions and childhood dietary quality. Matern Child Health J 2013; 18: 978–995.

    Article  Google Scholar 

  14. Manios Y, Kondaki K, Kourlaba G, Vasilopoulou E, Grammatikiaki E . Maternal perceptions of their child's weight status: the GENESIS study. Publ Health Nutr 2008; 12: 1099–1105.

    Article  Google Scholar 

  15. Farajian P, Panagiotakos DB, Risvas G, Karasouli K, Bountziouka V, Voutzourakis N et al. Socioeconomic and demographic determinants of childhood obesity prevalence in Greece: the GRECO Study. Publ Health Nutr 2013; 16: 240–247.

    Article  Google Scholar 

  16. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240–1243.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Farajian P, Karasouli K, Risvas G, Panagiotakos DB, Zampelas A . Repeatability and validity of a food frequency and dietary habits questionnaire in children. Circulation 2009; 119: e288.

    Google Scholar 

  18. Kowalski KC, Crocker PR, Faulkner RA . Validation of the Physical Activity Questionnaire for older children. Pediatr Exerc Sci 1997; 9: 174–186.

    Article  Google Scholar 

  19. US Department of Agriculture and US Department of Health and Human Services. Dietary Guidelines for Americans, 7th edn. US Government Printing Office: Washington, DC, USA, 2010.

  20. World Health Organization Obesity: preventing and managing the global epidemic. Report of a WHO Consultation on Obesity; Technical Report Series No. 98.1, Geneva, Switzerland, 1997.

  21. Panagiotakos DB, Pitsavos C, Arvaniti F, Stefanadis C . Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity, among healthy adults; the accuracy of the MedDietScore. Prev Med 2005; 44: 335–340.

    Article  Google Scholar 

  22. Elder JP, Ayala GX, Harris S . Theories and intervention approaches to health-behavior change in primary care. Am J Prev Med 1999; 17: 275–284.

    Article  CAS  PubMed  Google Scholar 

  23. Grydeland M, Bergh IH, Bjelland M, Lien N, Andersen LF, Ommundsen Y et al. Correlates of weight status among Norwegian 11-years-olds: the HEIA study. BMC Public Health 2012; 12: 1053.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Moschonis G, Kalliora AC, Costarelli V, Papandreou C, Koutoukidis D, Lionis C et al. Identification of lifestyle patterns associated with obesity and fat mass in children: the Healthy Growth study. Publ Health Nutr 2013; 26: 1–11.

    Google Scholar 

  25. Toschke AM, Kuchenhoff H, Koletzko B, Von Kries R . Meal frequency and childhood obesity. Obes Res 2005; 13: 1932–1938.

    Article  PubMed  Google Scholar 

  26. Koletzko B, Toschke AM . Meal pattern and frequencies: do they affect body weight in children and adolescents? Crit Rev Food Sci Nutr 2010; 50: 100–105.

    Article  PubMed  Google Scholar 

  27. Hammons AJ, Fiese BH . Is frequency of shared family meals related to the nutritional health of children and adolescents. Pediatrics 2011; 127: e1565–e1574.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Scaglioni S, Salvioni M, Galimberti C . Influence of parental attitudes in the development of children eating behavior. Br J Nutr 2008; 99: S22–S25.

    Article  CAS  PubMed  Google Scholar 

  29. Dupuy M, Godeau E, Vignes C, Ahluwalia N . Socio-demographic and lifestyle factors associated with overweight in a representative sample of 11-15 year olds in France: results from the WHO-Collaborative Health Behaviour in School-aged Children (HBSC) cross-sectional study. BMC Public Health 2011; 11: 442.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Janssen I, Katzmarzyk PT, Boyce WF, Vereecken C, Mulvihill C, Roberts C et al. Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationships with physical activity and dietary patterns. Obes Rev 2005; 6: 123–132.

    Article  CAS  PubMed  Google Scholar 

  31. Wareham NJ, Van Sluijs EM, Ekelund U . Physical activity and obesity prevention: a review of the current evidence. Proc Nutr Soc 2005; 64: 229–247.

    Article  PubMed  Google Scholar 

  32. Van Der Horst K, Paw MJ, Twisk JW, Van Mechelen W . A brief review on correlates of physical activity and sedentariness in youth. Med Sci Sports Exerc 2007; 39: 1241–1250.

    Article  PubMed  Google Scholar 

  33. Cameron AJ, van Stralen MM, Brug J, Salmon J, Bere E, Chinapaw MJ et al. Television in the bedroom and increased body weight: potential explanations for their relationship among European schoolchildren. Pediatr Obes 2013; 8: 130–141.

    Article  CAS  PubMed  Google Scholar 

  34. Manios Y, Angelopoulos PD, Kourlaba G, Kolotourou M, Grammatikaki E, Cook TL et al. Prevalence of obesity and body mass index correlates in a representative sample of Cretan school children. Int J Ped Obesity 2010; 6: 135–141.

    Article  Google Scholar 

  35. Seagle HM, Strain GW, Makris A, Reeves RS . Position of the American Dietetic Association: weight management. J Am Diet Assoc 2009; 109: 330–346.

    Article  PubMed  Google Scholar 

  36. Maynard LM, Galuska DA, Blanck HM, Serdula MK . Mothers’ perceptions of weight status of children. Pediatrics 2003; 111: 1226–1231.

    PubMed  Google Scholar 

  37. Rietmeijer-Mentink M, Paulis WD, van Middelkoop M, Bindels PJE, van der Wouden JC . Difference between parental perception and actual weight status of children: a systematic review. Matern Child Nutr 2013; 9: 3–22.

    Article  PubMed  Google Scholar 

  38. Supreme Scientific Health Council, Ministry of Health and Welfare of Greece. Dietary guidelines for adults in Greece. Arch Hellenic Med 1999; 16: 516–524.

    Google Scholar 

  39. Spencer EA, Appleby PN, Davey GK, Key TJ . Validity of self-reported height and weight in 4808 EPIC-Oxford participants. Public Health Nutr 2002; 5: 561–565.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Funding for the study was provided by the General Secretariat of Consumers-Greek Ministry of Development, Hellenic Association of Food and Beverage Companies, Coca Cola Hellas, Coca Cola Hellenic Bottling Company, Cereal Partners Hellas, FAGE SA, Unilever Hellas, Nestle Hellas and Kraft Foods Hellas. This research has also been cofinanced by the European Union (European Social Fund—ESF) and Greek national funds through the Operational Program ‘Education and Lifelong Learning’ of the National Strategic Reference Framework (NSRF)—Research Funding Program: Heraclitus II. Investing in knowledge society through the European Social Fund.

AUTHOR CONTRIBUTIONS

PF, DBP, GR and AZ were responsible for the study design and the supervision of the field study. DBP and PF were responsible for the statistical analysis. PF, DBP, OM, GR and AZ were responsible for the interpretation of the data. All authors carried out data management, contributed to database preparation and participated in writing the submitted manuscript.

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Authors and Affiliations

  1. Department of Food Science and Human Nutrition, Unit of Human Nutrition, Agricultural University of Athens, Athens, Greece

    P Farajian, G Risvas, O Malisova & A Zampelas

  2. Department of Nutrition-Dietetics, Harokopio University, Athens, Greece

    D B Panagiotakos

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  1. P Farajian
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  2. D B Panagiotakos
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  3. G Risvas
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  4. O Malisova
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  5. A Zampelas
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Correspondence to A Zampelas.

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Cite this article

Farajian, P., Panagiotakos, D., Risvas, G. et al. Hierarchical analysis of dietary, lifestyle and family environment risk factors for childhood obesity: the GRECO study. Eur J Clin Nutr 68, 1107–1112 (2014). https://doi.org/10.1038/ejcn.2014.89

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