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Methodological limitations in measuring childhood and adolescent obesity and overweight in epidemiological studies: does overweight fare better than obesity?

  • Lluís Serra-Majem (a1) (a2), Lourdes Ribas-Barba (a2), Carmen Pérez-Rodrigo (a3), Joy Ngo (a2) and Javier Aranceta (a3)...

Abstract

Objectives

International definitions of childhood obesity based on body mass index (BMI) are intended to be used for international comparisons of obesity prevalence. In general, they are not appropriate to be used in clinical practice. The objective of this study is to compare international-ecological vs. national-clinical reference data of obesity in Spain, as well as to describe trends.

Design

Cross-sectional study from a representative national random sample of Spanish children and youth conducted between 1998 and 2000. Prevalence estimates of obesity in a national random sample of Spanish children and youth are presented in this paper, defined by age- and sex-specific BMI national reference standards for the 85th percentile (overweight) and 95th percentile (obesity), as well as by Cole et al. criteria. The study protocol included personal data, data on education and socio-economic status for the family and anthropometric measurements.

Setting

Population-based study set in Spain.

Subjects

A random sample of 3534 individuals, aged 2–24 years.

Results

Prevalence of obesity using national reference data was higher (15.3%) than using international data (5.8%), but overweight rates were similar. Agreement observed for both definitions was low for obesity but higher for overweight. Obesity trends among children and adolescents in Spain show increasing patterns in boys but not in girls.

Conclusions

Results indicate the need to standardise the definitions of obesity and overweight in childhood and recommend the use of overweight due to the greater degree of agreement observed among the different methods used. The IOTF reference method underestimates obesity rates in Spanish schoolchildren.

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Copyright

Corresponding author

Corresponding author: Email lserra@dcc.ulpgc.es

References

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1Ballabriga, A, Carrascosa, A. Obesidad en la infancia y adolescencia. In: Ballabriga, A, Carrascosa, A, eds. Nutrición en la Infancia y Adolescencia, 2nd ed. Madrid: Ergon S.A., 2001; 559582.
2Valtueña Martínez, S, Arija Val, V, Salas-Salvadó, J. Estado actual de los métodos de evaluación de la composición corporal: descripción, reproductibilidad, precisión, ámbitos de aplicación, seguridad, coste y perspectivas de futuro. Medicina Clínica (Barcelona) 1996; 106: 624635.
3Caballero, B. Obesidad. In: Rojo, R, ed. Tratado de Nutrición Pediátrica. Barcelona: Ediciones Doyma S.L., 2001; 547557.
4Gibson, RS. Principles of Nutritional Assessment. New York: Oxford University Press, 1990.
5Reilly, JJ. Descriptive epidemiology and health consequences of childhood obesity. Best Practice and Research Clinical Endocrinology and Metabolism 2005; 19 (3): 327341.
6Chinn, S. Definitions of childhood obesity: current practice. European Journal of Clinical Nutrition 2006; 60 (10): 11891194.
7Serra Majem, L, Aranceta Bartrina, J, Ribas Barba, L, Pérez Rodrigo, C, García Closas, R. Estudio enKid: objetivos y metodología. In: Serra Majem, L, Aranceta, J, eds. Desayuno y equilibrio alimentario. Estudio enKid. Barcelona: Masson S.A., 2000; 18.
8Serra Majem, L, García Closas, R, Ribas, L, Pérez Rodrigo, C, Aranceta, J. Food patterns of Spanish schoolchildren and adolescents: the enKid study. Public Health Nutrition 2001; 4 (6A): 14331438.
9Serra-Majem, L, Ribas, L, Perez-Rodrigo, C, Garcia-Closas, R, Pena-Quintana, L, Aranceta, J. Determinants of nutrient intake among children and adolescents: results from the enKid Study. Annals of Nutrition and Metabolism 2002; 46 (Suppl. 1): 3138.
10Serra Majem, L, Manno, S, Ribas, L, Gonzalvo, B, Pérez Rodrigo, C, Aranceta, J. Desayuno y obesidad. In: Serra Majem, L, Aranceta, J, eds. Desayuno y equilibrio alimentario. Estudio enKid. Barcelona: Masson S.A., 2000; 3144.
11Serra-Majem, L, Aranceta Bartrina, J, Perez-Rodrigo, C, Ribas-Barba, L, Delgado-Rubio, A. Prevalence and determinants of obesity in Spanish children and young people. British Journal of Nutrition 2006; 96 (Suppl. 1): S67S72.
12 US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey. CDC Growth Charts. United States: BMIAGE. Available at http://www.cdc.gov/nchs/data/nhanes/growthcharts/zscore/bmiagerev.xls. Accessed July 2001.
13Cole, TJ, Bellizzi, MC, Flegal, KM, Dietz, WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. British Medical Journal 2000; 320: 12401243.
14Hernández, M, Castellet, J, Narvaiza, JL, Rincón, JM, Ruiz, I, Sánchez, E, et al. . Curvas y tablas de crecimiento. Instituto sobre crecimiento y desarrollo fundación F. Orbegozo. Madrid: Editorial Garsi, 1988.
15Cole, TJ. The LMS method for constructing normalized growth standards. European Journal of Clinical Nutrition 1990; 44: 4560.
16Serra Majem, L, Ribas Barba, L, Aranceta Bartrina, J, Perez Rodrigo, C, Saavedra Santana, P, Pena Quintana, L. Obesidad infantil y juvenil en España. Resultados del estudio enKid (1998–2000). Medicina Clínica (Barcelona) 2003; 121 (19): 725732.
17Flegal, KM. Curve smoothing and transformations in the development of growth curves. The American Journal of Clinical Nutrition 1990; 70 (Suppl.): 163S165S.
18Cole, TJ. The use and construction of anthropometric growth reference standards. Nutrition Research Reviews 1993; 6: 1950.
19Frisancho, AR. Anthropometric Standards for the Assessment of Growth and Nutritional Status. Ann Arbor: The University of Michigan Press, 1990.
20Must, A, Dallal, GE, Dietz, WH. Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2) and triceps skinfold thickness. The American Journal of Clinical Nutrition 1991; 53: 839846 (Erratum: The American Journal of Clinical Nutrition 1991; 54: 773).
21Grupo colaborativo español para el estudio de los Factores de riesgo Cardiovascular en la Infancia y adolescencia. Factores de riesgo cardiovascular en la infancia y adolescencia en España. Estudio Ricardin II: valores de referencia. Anales Españoles de Pediatría 1995; 43: 1117.
22Manila, RM, Katzmarzyk, PT. Validity of the body mass index as an indicator of the risk and presence of overweight in adolescents. The American Journal of Clinical Nutrition 1999; 79 (Suppl.): 131S136S.
23Lehingue, Y. The European Childhood Obesity Group (ECOG) project: the European collaborative study on the prevalence of obesity in children. The American Journal of Clinical Nutrition 1999; 70 (Suppl.): 166S168S.
24Poskitt, EME. Body mass index and child obesity: are we nearing a definition? Acta Paediatrica 2000; 89: 507509.
25Bellizzi, MC, Dietz, WH. Workshop on childhood obesity: summary of the discussion. The American Journal of Clinical Nutrition 1999; 70 (Suppl.): 173S175S.
26Troiano, RP, Flegal, KM. Overweight children and adolescents: description, epidemiology, and demographics. Pediatrics 1998; 101 (Suppl.): 497504.
27Livingstone, MB. Childhood obesity in Europe: a growing concern. Public Health Nutrition 2001; 4 (1A): 109116.
28Reilly, JJ. Assessment of childhood obesity: national reference data or international approach? Obesity Research 2002; 10 (8): 838840.
29Guillaume, M. Defining obesity in childhood: current practice. The American Journal of Clinical Nutrition 1999; 70 (Suppl.): 126S130S.
30Poskitt, EME. and the European Childhood Obesity Group. Committee report. Defining childhood obesity: the relative body mass index (BMI). Acta Paediatrica 1996; 84: 961963.
31Reilly, JJ, Wilson, ML, Summerbell, CD, Wilson, DC. Obesity: diagnosis, prevention, and treatment; evidence based answers to common questions. Archives of Disease in Childhood 2002; 86 (6): 392394.
32World Health Education. An evaluation of infant growth. Geneva: WHO NUT/94:8, 1994.
33Garza, C, De Onis, M. A new international growth reference for young children. The American Journal of Clinical Nutrition 1999; 70 (Suppl.): 169S172S.
34Hammer, LD, Kraemer, HC, Wilson, DM, Ritter, PL, Dornbusch, SM. Standardized percentile curves of body-mass index for children and adolescents. American Journal of Diseases of Children 1991; 145: 259263.
35Sarría, A, Moreno, LA, García Llop, LA, Fleta, J, Morellón, MP, Bueno, M. Body mass index, triceps skinfold and waist circumference in screening for adiposity in male children and adolescents. Acta Paediatrica 2001; 90: 387392.
36Flegal, KM, Ogden, CL, Wei, R, Kuczmarski, RL, Johnson, CL. Prevalence of overweight in US children: comparison of US growth charts from the Centers for Disease Control and Prevention with other values for body mass index. The American Journal of Clinical Nutrition 2001; 73: 10861093.
37Paidos’84. Estudio epidemiológico sobre nutrición y obesidad infantil. Paidos’84. Madrid: Gráficas Jomagar, 1985.
38Rodriguez, G, Moreno, LA, Sarría, A, Fleta, J, Bueno, M. Assessment of nutritional status and body composition in children using physical anthropometry and bioelectrical impedance: influence of diurnal variations. Journal of Pediatric Gastroenterology and Nutrition 2000; 30: 305309.
39Moreno, LA, Fleta, J, Mur, L, Rodriguez, G, Sarría, A, Bueno, M. Waist circumference values in Spanish children – gender related differences. European Journal of Clinical Nutrition 1999; 53: 429433.
40Gutierrez-Fisac, JL. La obesidad infantil: un problema de salud y de medición. Nutrición y obesidad 1999; 2: 103106.
41Serra Majem, L, Aranceta Bartrina, J, Pérez Rodrigo, C, Moreno Esteban, B, Tojo Sierra, R, Delgado Rubio, A, Grupo colaborativo AEP-SENC-SEEDO. Dossier de Consenso. Curvas de Referencia para la Tipificación Ponderal. Población Infantil y Juvenil. Madrid: IM&C, 2002: 1–83.
42Marco Hernández, M, Méndez Fernández, MJ, Marco Méndez, RR. Evolución secular de la talla en España. Pediátrica 1999; 19: 337344.
43 Serra-Majem L, García-Álvarez, Ribas-Barba L, Castell C, Foz M, Uauy R, et al. Obesity and overweight trends in Catalonia, Spain (1992–2003). Gender and socioeconomic determinants, in press.
44Livingstone, B. Epidemiology of childhood obesity in Europe. European Journal of Paediatrics 2000; 159 (Suppl. 1): S14S34.
45Moreno, LA, Sarría, A, Fleta, J, Rodriguez, M, Bueno, M. Trends in obesity among children in Aragon (Spain) 1985–1995. International Journal of Obesity and Related Metabolic Disorders 1998; 19 (Suppl. 4): S7.
46Power, C, Lake, JK, Cole, TJ. Body mass index and height from childhood to adulthood in the 1958 British birth cohort. The American Journal of Clinical Nutrition 1997; 66: 10941101.
47Zoppi, G, Bressan, F. Obesity in paediatrics: analysis of some definitions and determination of their limits on Italian standards. Rivista Italiana di Pediatria 1990; 16: 139143.
48Reilly, JJ, Dorosty, AR, Emmett, PM, Avon Longitudinal Study of Pregnancy and Childhood Study Team. Identification of the obese child: adequacy of the body mass index for clinical practice and epidemiology. International Journal of Obesity and Related Metabolic Disorders 2000; 24 (12): 16231627.
49Zimmermann, MB, Gubeli, C, Puntener, C, Molinari, L. Detection of overweight and obesity in a national sample of 6–12-y-old Swiss children: accuracy and validity of reference values for body mass index from the US Centers for Disease Control and Prevention and the International Obesity Task Force. The American Journal of Clinical Nutrition 2004; 79 (5): 838843.
50Neovius, MG, Linne, YM, Barkeling, BS, Rossner, SO. Sensitivity and specificity of classification systems for fatness in adolescents. The American Journal of Clinical Nutrition 2004; 80 (3): 597603.

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