To assess the validity of self-reported height and weight by parents of 4-year-old children and subjective weight perception.

Descriptive cross-sectional study.

Paediatric population living in the Autonomous Community of Madrid.

Children born in 2008–2009 examined at 47–59 months of age. Data were collected by paediatricians of the Madrid Primary Care Physicians Sentinel Network. Parents reported weight and height data. Prevalence of weight status categories was calculated using WHO and International Obesity Task Force (IOTF) reference criteria. Sensitivity, specificity and positive predictive value (PPV) were estimated. The appraisal of their child’s weight perception and parental misperception were assessed.

For 2914 children, reported height was underestimated by −1·38 cm, weight by −0·25 kg and BMI was overestimated by +0·41 kg/m2 on average. The prevalence of obesity estimated with reported data was 2·7 times higher than that calculated with measured data (16·2 v. 6·0 %) according to WHO classification, and 3·6 times higher with IOTF classification. Sensitivity to identify obesity was 70·5 %, specificity was 87·3 % and PPV was 26·2 % (WHO classification). Half of the parents of pre-schoolers with obesity failed to identify their child’s weight status. Parental misperception among children classified as having overweight or obesity reached 93·0 and 58·8 %, respectively.

Parents underestimated children’s height and weight, leading to an overestimation of the prevalence of obesity. Small inaccuracies in reported measures have an important effect for the estimation of population prevalences. Parents’ report of child weight status is unreliable. Parental awareness and acknowledgement of child weight status should be improved.

To describe and quantify the magnitude and distribution of stunting, wasting, anaemia, overweight and obesity by wealth, level of education and ethnicity in Ecuador.

We used nationally representative data from the 2012 Ecuadorian National Health and Nutrition Survey. We used the Multidimensional Poverty Index (MPI) as a proxy of wealth. The MPI identifies deprivations across three dimensions (health, education and standard of living). We defined education by years of schooling and ethnicity as a social construct, based on shared social, cultural and historical experiences, using Ecuadorian census categories.

Urban and rural Ecuador, including the Amazon rainforest and the Galapagos Islands.

Children aged <5 years (n 8580), adolescent women aged 11–19 years (n 4043) and adult women aged 20–49 years (n 15 203).

Among children <5 years, stunting and anaemia disproportionately affected low-wealth, low-education and indigenous groups. Among adolescent and adult women, higher rates of stunting, overweight and obesity were observed in the low-education and low-wealth groups. Stunting and short stature rates were higher in indigenous women, whereas overweight and obesity rates were higher in Afro-Ecuadorian women.

Malnutrition differs significantly across sociodemographic groups, disproportionately affecting those in the low wealth tertile and ethnic minorities. Rates of stunting remain high compared with other countries in the region with similar economic development. The effective implementation of double-duty actions with the potential to impact both sides of the double burden is urgently required.

Bangladesh, like many emerging economies of South-East Asia, has started to experience a double burden of continuing high rates of undernutrition and increasing rates of overweight and obesity. A lack of assessment of the nutritional shift leaves a gap in current policies: the growing overweight and obesity is yet to be addressed. The present paper investigates the change in nutritional status, particularly the shift in BMI, of Bangladeshi women of reproductive age (15–49 years) and characterizes the vulnerable households for both underweight and overweight status during a period of 10 years (2004–2014).

Generalized linear mixed-effect models were fitted for both urban and rural residents to assess underweight and overweight status.

Bangladesh Demographic and Health Surveys.

Women aged 15–49 years (n 53 077).

The proportion of overweight increased during 2004–2014 from 10·7 to 25·1 % and the proportion of underweight decreased from 32·6 to 18·2 %. Prevalence of underweight status remained high in rural areas and prevalence of overweight increased rapidly in both rural and urban areas, creating a double burden. The significant contributors to this double burden were the change in women’s level of education, increased household wealth, divisional location and rapid urbanization.

The findings indicate that specific cohort- or area-based intervention policy studies in line with the UN Decade of Action on Nutrition are required to address the nutritional double burden in Bangladesh.

The ongoing demographic, nutritional and epidemiological transitions in sub-Saharan Africa highlight the importance of monitoring overweight and obesity. We aimed to assess the prevalence of overweight and obesity in Mozambique in 2014/2015 and compare the estimates with those obtained in 2005.

Cross-sectional study conducted in 2014/2015, following the WHO Stepwise Approach to Chronic Disease Risk Factor Surveillance (STEPS). Prevalence estimates with 95 % CI were computed for different categories of BMI and abdominal obesity, along with age-, education- and income-adjusted OR. The age-standardized prevalence in the age group 25–64 years was compared with results from a STEPS survey conducted in 2005.

Mozambique.

Representative sample of the population aged 18–64 years (n 2595).

Between 2005 and 2014/2015, the prevalence of overweight and obesity increased from 18·3 to 30·5 % (P < 0·001) in women and from 11·7 to 18·2 % (P < 0·001) in men. Abdominal obesity increased among women (from 9·4 to 20·4 %, P < 0·001), but there was no significant difference among men (1·5 v. 2·1 %, P = 0·395). In 2014/2015, the prevalence of overweight and obesity was more than twofold higher in urban areas and in women; in the age group 18–24 years, it was highest in urban women and lowest in rural men.

In Mozambique, there was a steep increase in the prevalence of overweight and obesity among adults between 2005 and 2014/2015. Overweight and obesity are more prevalent in urban areas and among women, already affecting one in five urban women aged 18–24 years.

Low- and middle-income countries (LMIC) are increasingly experiencing the double burden of malnutrition. Studies to identify ‘double-duty’ actions that address both undernutrition and overweight in sub-Saharan Africa are needed. We aimed to identify acceptable behaviours to achieve more optimal feeding and physical activity practices among both under- and overweight children in Rwanda, a sub-Saharan LMIC with one of the largest recent increases in child overweight.

We used the Trials of Improved Practices (TIPs) method. During three household visits over 1·5 weeks, we used structured interviews and unstructured observations to collect data on infant and young child feeding practices and caregivers’ experiences with testing recommended practices.

An urban district and a rural district in Rwanda.

Caregivers with an under- or overweight child from 6 to 59 months of age (n 136).

We identified twenty-five specific recommended practices that caregivers of both under- and overweight children agreed to try. The most frequently recommended practices were related to dietary diversity, food quantity, and hygiene and food handling. The most commonly cited reason for trying a new practice was its benefits to the child’s health and growth. Financial constraints and limited food availability were common barriers. Nearly all caregivers said they were willing to continue the practices and recommend them to others.

These practices show potential for addressing the double burden as part of a broader intervention. Still, further research is needed to determine whether caregivers can maintain the behaviours and their direct impact on both under- and overweight.

To assess the effect of rural-to-urban migration on nutrition transition and overweight/obesity risk among women in Kenya.

Secondary analysis of data from nationally representative cross-sectional samples. Outcome variables were women’s BMI and nutrition transition. Nutrition transition was based on fifteen different household food groups and was adjusted for socio-economic and demographic characteristics. Stepwise backward multiple ordinal regression analysis was applied.

Kenya Demographic and Health Survey 2014.

Rural non-migrant, rural-to-urban migrant and urban non-migrant women aged 15–49 years (n 6171).

Crude data analysis showed rural-to-urban migration to be associated with overweight/obesity risk and nutrition transition. After adjustment for household wealth, no significant differences between rural non-migrants and rural-to-urban migrants for overweight/obesity risk and household consumption of several food groups characteristic of nutrition transition (animal-source, fats and sweets) were observed. Regardless of wealth, migrants were less likely to consume main staples and legumes, and more likely to consume fruits and vegetables. Identified predictive factors of overweight/obesity among migrant women were age, duration of residence in urban area, marital status and household wealth.

Our analysis showed that nutrition transition and overweight/obesity risk among rural-to-urban migrants is apparent with increasing wealth in urban areas. Several predictive factors were identified characterising migrant women being at risk for overweight/obesity. Future research is needed which investigates in depth the association between rural-to-urban migration and wealth to address inequalities in diet and overweight/obesity in Kenya.

Depression frequently co-occurs with disorders of glucose and insulin homeostasis (DGIH) and obesity. Low-grade systemic inflammation and lifestyle factors in childhood may predispose to DGIH, obesity and depression. We aim to investigate the cross-sectional and longitudinal associations among DGIH, obesity and depression, and to examine the effect of demographics, lifestyle factors and antecedent low-grade inflammation on such associations in young people.

Using the Avon Longitudinal Study of Parents and Children birth cohort, we used regression analyses to examine: (1) cross-sectional and (2) longitudinal associations between measures of DGIH [insulin resistance (IR); impaired glucose tolerance] and body mass index (BMI) at ages 9 and 18 years, and depression (depressive symptoms and depressive episode) at age 18 years and (3) whether sociodemographics, lifestyle factors or inflammation [interleukin-6 (IL-6) at age 9 years] confounded any such associations.

We included 3208 participants. At age 18 years, IR and BMI were positively associated with depression. These associations may be explained by sociodemographic and lifestyle factors. There were no longitudinal associations between DGIH/BMI and depression, and adjustment for IL-6 and C-reactive protein did not attenuate associations between IR/BMI and depression; however, the longitudinal analyses may have been underpowered.

Young people with depression show evidence of DGIH and raised BMI, which may be related to sociodemographic and lifestyle effects such as deprivation, smoking, ethnicity and gender. In future, studies with larger samples are required to confirm this. Preventative strategies for the poorer physical health outcomes associated with depression should focus on malleable lifestyle factors.

We describe diet quality by demographic factors and weight status among Barbadian children and examine associations with excess energy intake (EI). A screening tool for the identification of children at risk of excess EI was developed.

In a cross-sectional survey, the Diet Quality Index–International (DQI-I) was used to assess dietary intakes from repeat 24h recalls among 362 children aged 9–10 years. Participants were selected by probability proportional to size. A model to identify excess energy intake from easily measured components of the DQI-I was developed.

Barbados.

Primary-school children in Barbados.

Over one-third of children were overweight/obese, and mean EI for boys (8644 (se 174·5) kJ/d (2066 (se 41·7) kcal/d)) and girls (8912 (se 169·9) kJ/d (2130 (se 40·6) kcal/d)) exceeded the RDA. Children consuming a variety of food groups, more vegetables and fruits, and lower percentage energy contribution from empty-calorie foods showed reduced likelihood of excess EI. Intake of more than 2400 mg Na/d and higher macronutrient and fatty acid ratios were positively related to the consumption of excess energy. A model using five DQI-I components (overall food group variety, variety for protein source, vegetables, fruits and empty calorie intake) had high sensitivity for identification of children at risk of excess EI.

Children’s diet quality, despite low intakes of fruit and vegetables, was within acceptable ranges as assessed by the DQI-I and RDA; however, portion size was large and EI high. A practical model for identification of children at risk of excess EI has been developed.

As part of a national initiative to reduce child obesity, a comprehensive school-based nutrition education intervention to change eating behaviours among grade 4 primary-school students was developed, implemented and evaluated.

The intervention was developed by school staff, with technical assistance from outside health education specialists. The programme included school facility upgrades, school teacher/staff training, curriculum changes and activities for parents. Student scores on nine key eating behaviours were assessed prior to and after the programme. The quality of programme implementation in the schools was monitored by technical assistance teams.

Shandong Province (high household income) and Qinghai Province (low household income), China. Three programme schools and three control schools in each province.

Students in grade 4 (age 8–9 years).

There were significant positive changes in self-reported eating behaviour scores from pre- to post-assessment in programme schools. At post-test students in programme schools had significantly higher scores than students in control schools after controlling for other variables. The programme was more effective in the high-income province. Observations by the technical assistance teams suggested the programme was implemented more completely in Shandong. The teams noted the challenges for implementing and evaluating programmes like these.

This intervention increased healthy eating behaviours among 4th graders in both provinces and had more effect in the more affluent province. Results suggest that a scaled-up initiative using existing school and public health resources could change eating practices in a large population over time. The intervention also provided lessons for implementing and evaluating similar nutrition programmes.

To examine score validity and reliability of a child version of the twenty-one-item Three-Factor Eating Questionnaire (CTFEQ-R21) in a sample of Canadian children and adolescents and its relationship with BMI Z-score and food/taste preferences.

Cross-sectional study.

School-based.

Children (n 158), sixty-three boys (mean age 11·5 (sd 1·6) years) and ninety-five girls (11·9 (sd 1·9) years).

Exploratory factor analysis revealed that the CTFEQ-R21 was best represented by four factors with item 17 removed (CFFEQ-R20), representing Cognitive Restraint (CR), Cognitive Uncontrolled Eating (UE 1), External Uncontrolled Eating (UE 2) and Emotional Eating (EE), accounting for 41·2 % of the total common variance with good scale reliability. ANOVA revealed that younger children reported higher UE 1 and CR scores than older children, and boys who reported high UE 1 scores had significantly higher BMI Z-scores. Children with high UE 1 scores reported a greater preference for high-protein and -fat foods, and high-fat savoury (HFSA) and high-fat sweet (HFSW) foods. Higher preference for high-protein, -fat and -carbohydrate foods, and HFSA, HFSW and low-fat savoury foods was found in children with high UE 2 scores.

The study suggests that the CFFEQ-R20 can be used to measure eating behaviour traits and associations with BMI Z-score and food/taste preferences in Canadian children and adolescents. Future research is needed to examine the validity of the questionnaire in larger samples and other geographical locations, as well as the inclusion of extraneous variables such as parental eating or socio-economic status.