The international journal of behavioral nutrition and physical activity, Jan 2, 2017
Low levels of physical activity (PA) are a global concern and increasing PA engagement is becomin... more Low levels of physical activity (PA) are a global concern and increasing PA engagement is becoming a priority in current public health policies. Despite the large number of studies and reviews available, the evidence regarding the behavioral determinants of PA is still inconclusive. Thus, the aim of this umbrella systematic literature review (SLR) was to summarize the evidence on the behavioral determinants of PA across the life course. A systematic online search was conducted on MEDLINE, ISI Web of Science, Scopus, and SPORTDiscus databases. The search was limited to studies published in English from January, 2004 to April, 2016. SLRs and meta-analyses (MAs) of observational studies that investigated the behavioral determinants of PA were considered eligible. The extracted data were assessed based on the importance of the determinants, the strength of evidence, and the methodological quality. The full protocol is available from PROSPERO (PROSPERO 2014:CRD42015010616). Seventeen rev...
Background Raised blood pressure is an important risk factor for cardiovascular diseases and chro... more Background Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defi ned as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher.
Objectives: To examine in the context of a school day whether a pedometer, compared to an acceler... more Objectives: To examine in the context of a school day whether a pedometer, compared to an accelerometer, was an effective tool to identify children with low physical activity levels. Additionally, to characterise within the school day, patterns of variation in level and timing of activity of the most active and least active children. Design: Observational study to compare two methods (accelerometer and pedometer) of identifying less active children and intensity of activity. Method: During school hours, for three consecutive days, children (n = 47, aged 8–11 years) in two classes wore an accelerometer and sealed pedometer. Accelerometers were programmed to record at 15s epochs and the number of pedometer steps taken were recorded at the end of each school day. Patterns of activity by total accelerometer counts, and with cutoffs applied, were examined against time and the number of steps taken. Results: Based on the accelerometer (>1500 counts/min), the majority (68%) of children spent more than 60 min in moderate to vigorous physical activity (MVPA) during the school day. Overall, time spent in MVPA was three times greater during break times compared to classroom time, with no apparent differences by class/age or gender. Total accelerometer counts and pedometer steps were correlated (r = 0.60). One minute of MVPA was equivalent to 45 (95% CI 20 to 70) pedometer steps. Conclusion: The pedometer, a practical, relatively inexpensive tool, is suitable for the identification of less active children and has some utility to assess the relative intensity of activities in the context of a school day.
Background/Objectives: In 2002, the prevalence of overweight and obesity, defined by body mass in... more Background/Objectives: In 2002, the prevalence of overweight and obesity, defined by body mass index (BMI), was higher in New Zealand Maori (40%) and Pacific (60%) than in European (24%) children; however, this does not take into account interethnic differences in body composition. This study compared trajectories of anthropometric indices from 2004 to 2006 among 5- and 10-year-old Maori and European children. Subjects/Methods: In 2004 and then in 2006, 1244 children (639 boys and 605 girls) aged 5 and 10 years had height, weight and fat-free mass (FFM) by bioimpedance measured to derive measures of fat mass (FM), percentage body fat (%BF), FM index (FMI, FM/height2), FFM index (FFMI, FFM/height2), and s.d. scores for BMI and %BF and BMI categories by International Obesity Task Force criteria. Results: Body composition and growth in Maori children is different from European children. Over 2 years, the BMI and %BF s.d. scores in both 5- and 10-year-old cohorts increased more in Maori children than in European children. The prevalence of overweight and obesity also increased within ethnicity and age group. The relative change of FMI and FFMI differed by age group, gender and ethnicity. In Maori girls, the magnitude of the changes between 10 and 12 years of age was most marked—the major contribution was from an increase in FMI. At 12 years, the mean %BF of Maori girls was 31.7% (95% confidence interval (CI): 30.1 and 33.3) compared with that of European girls (28.0%; 95% CI: 27.0 and 29.0). Conclusions: FM and FFM measures provide a more appropriate understanding of growth and body composition change in children than BMI, and vary with gender and ethnicity. Thus, FMI and FFMI should be tracked and compared among populations.
Background
It is widely believed that unhealthy eating patterns in childhood can lead to adverse ... more Background It is widely believed that unhealthy eating patterns in childhood can lead to adverse health conditions, particularly obesity. Yet, debate remains around the precise eating behaviours that lead to these conditions. This study aimed to address this lack of evidence by reporting on the eating frequency, breakfast consumption and body mass of youth.
Methods A total of 315 (162 boys, 153 girls) participants from nine primary and secondary schools in south-west London provided self-report measures of dietary intake, via 3-day food diaries. Anthropometric measures of height and weight were also obtained.
Results Frequent breakfast consumers had significantly lower BMI Z-scores than those who did not eat breakfast regularly and overall, those aged 10 and under consumed breakfast more frequently than those aged 11 or over. Mean BMI Z-scores for both genders were within the healthy range ‘normal’ and there was no relationship between BMI Z-score and eating frequency. Older boys (11-13 y) were less likely to eat regularly and had the lowest breakfast consumption intakes.
Conclusions Although this study shows participants eating regularly, older boys were the least likely to eat regularly and to consume breakfast. Educating these boys on the importance of regular eating patterns, particularly breakfast consumption, may be essential to ensure healthier long-term eating patterns. Furthermore, the lower breakfast intakes in older youth and higher BMI Z-scores of those who do not eat breakfast regularly, needs to be monitored.
Through-school nutrition and physical activity interventions are designed to help reduce excess w... more Through-school nutrition and physical activity interventions are designed to help reduce excess weight gain and risk of chronic disease. From 2004 to 2006, Project Energize was delivered in the Waikato Region of New Zealand as a longitudinal randomised controlled study of 124 schools (year 1– 6), stratified by rurality and social deprivation, and randomly assigned to intervention or control. Children (686 boys and 662 girls) aged 5 (1926) and 10 (1426) years (692 interventions and 660 controls) had height, weight, body fat (by bioimpedance) and resting blood pressure (BP) measured at baseline and 2 years later. Each intervention school was assigned an 'Energizer'; a trained physical activity and nutrition change agent, who worked with the school to achieve goals based on healthier eating and quality physical activity. After adjustment for baseline measures, rurality and social deprivation, the intervention was associated with a reduced accumulation of body fat in younger children and a reduced rate of rise in systolic BP in older children. There was some evidence that the pattern of change within an age group varied with rurality, ethnicity and sex. We conclude that the introduction of an 'Energizer led' through-school programme may be associated with health benefits over 2 years, but the trajectory of this change needs to be measured over a longer period. Attention should also be paid to the differing response by ethnicity, sex, age group and the effect of rurality and social deprivation.
Being taller is associated with enhanced longevity, and higher education and earnings. We reanaly... more Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5–22.7) and 16.5 cm (13.3–19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8–144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.
Background: Physical activity (PA) is a key performance indicator for policy documents in both th... more Background: Physical activity (PA) is a key performance indicator for policy documents in both the Republic of Ireland and Northern Ireland. Building on baseline grades set in 2014, Ireland's second Report Card on Physical Activity for Children and Youth allows for continued surveillance of indicators related to PA in children and youth. Methods: Data and information were extracted and collated for 10 indicators and graded using an international standardized grading system. Results: Overall, 7 grades stayed the same, 2 increased, and 1 decreased. Grades were assigned as follows: Overall PA, D (an increase) Community and the Built Environment, B+ (an increase); and Government, INC. Unlike 2014's report card, different grades for the Republic (C-) and Northern Ireland (C+) were assigned for Organized Sport Participation. Conclusions: Although the grade for Overall PA levels increased to a D, this may reflect the increased quality and quantity of data available. The double burden of low PA and high sedentary levels are concerning and underscore the need for advocacy toward, and surveillance of, progress in achieving targets set by the new National Physical Activity Plan in the Republic and obesity and sport plans in the North.
Prevention of childhood obesity is a global priority. The school setting offers access to large n... more Prevention of childhood obesity is a global priority. The school setting offers access to large numbers of children and the ability to provide supportive environments for quality physical activity and nutrition. This article describes Project Energize, a through-school physical activity and nutrition programme that celebrated its 10-year anniversary in 2015 so that it might serve as a model for similar practices, initiatives and policies elsewhere. The programme was envisaged and financed by the Waikato District Health Board of New Zealand in 2004 and delivered by Sport Wai-kato to 124 primary schools as a randomised controlled trial from 2005 to 2006. The programme has since expanded to include all 242 primary schools in the Waikato region and 70 schools in other regions, including 53,000 children. Ongoing evaluation and development of Project Energize has shown it to be sustainable (ongoing for >10 years), both effective (lower obesity, higher physical fitness) and cost effective (one health related cost quality adjusted life year between $18,000 and $30,000) and efficient ($45/child/year) as a childhood 'health' programme. The pro-gramme's unique community-based approach is inclusive of all children, serving a population that is 42 % Māori, the indigenous people of New Zealand. While the original nine healthy eating and seven quality physical activity goals have not changed, the delivery and assessment processes has been refined and the health service adapted over the 10 years of the programme existence, as well as adapted over time to other settings including early childhood education and schools in Cork in Ireland. Evaluation and research associated with the programme delivery and outcomes are ongoing. The dissemination of findings to politicians and collaboration with other service providers are both regarded as priorities.
Background Underweight and severe and morbid obesity are associated with highly elevated risks of... more Background Underweight and severe and morbid obesity are associated with highly elevated risks of adverse health outcomes. We estimated trends in mean body-mass index (BMI), which characterises its population distribution, and in the prevalences of a complete set of BMI categories for adults in all countries.
Objective: To investigate the dietary intake and physical activity of boys and girls aged 9–13 ye... more Objective: To investigate the dietary intake and physical activity of boys and girls aged 9–13 years, and the influence of peers on these behaviours. Design: Cross-sectional study. Setting: Nine primary and secondary schools in southwest London. Subjects: A total of 315 children wore sealed pedometers, provided self-report measures of dietary intake and answered a questionnaire relating to peer influence. Anthropometric measures of height and weight were also obtained. Results: Obese children had the lowest reported energy intakes and the lowest step counts per day. Boys took significantly more steps per day than girls, however girls were closer to achieving their recommended cutoffs for physical activity. Girls had lower energy intakes per day and lower BMI Z-scores than boys, however both genders, across all age groups, had higher than recommended intakes of saturated fat. There were significant associations between peer influence and physical activity levels but not between peer influence and dietary intake. Conclusions: Low energy intake and physical activity levels but high saturated fat intakes among boys and girls across all age groups highlight the importance of promoting both physical activity and healthy food choices. The finding that peers have a significant effect on physical activity levels but not on dietary intake offers an important approach for the design of health promotion interventions and obesity prevention programmes. Such designs may be particularly beneficial for obese youth, since the low physical activity levels found could be a major contributing factor to the maintenance of the condition.
Background: This study investigated physical activity and dietary intake of children aged 9–11 ye... more Background: This study investigated physical activity and dietary intake of children aged 9–11 years, and the influence of peers on these behaviours over a 2-year period. Methods: A total of 106 (64 girls; 42 boys) children were investigated annually, over 2 years. Measures included physical activity (sealed pedometer), self-report measures of dietary intake and physical activity, and a peer influence questionnaire. Anthropometric measures of height and weight were also obtained. Results: The findings reveal insufficient energy intakes, physical activity levels and fruit and vegetable consumption but high intakes of saturated fat and sodium, over time, in both boys and girls. Both male calcium and female iron intakes were also of concern. Throughout the survey, peers were found to influence physical activity behaviour but not dietary intake. Conclusions: The fact that youth consistently failed to meet established nutrition and physical activity recommendations highlights the importance of promoting physical activity and healthy eating to children younger than 9 years of age. The finding that peers significantly influence physical activity behaviour over time should be considered when designing new physical activity interventions aimed at young people.
Objective: Adequate fluid intake has been well documented as important for health but whether it ... more Objective: Adequate fluid intake has been well documented as important for health but whether it has adverse effects on overall energy and sugar intakes remains under debate. Many dietary studies continue to refrain from reporting on beverage consumption, which the present study aimed to address. Design: A cross-sectional survey investigated self-reported measures of dietary intake and anthropometric measurements. Setting: Primary and secondary schools in southwest London, UK. Subjects: Boys and girls (n 248) aged 9–13 years. Results: Boys consumed 10 % and girls consumed 9 % of their daily energy intake from beverages and most children had total sugar intakes greater than recommended. Beverages contributed between a quarter and a third of all sugars consumed, with boys aged 11–13 years consuming 32 % of their total sugar from beverages. There was a strong relationship between consumption of beverages and energy intake; however, there was no relationship between beverage type and either BMI or BMI Z-score. Fruit juices and smoothies were consumed most frequently by all girls and 9–10-year-old boys; boys aged 11–13 years preferred soft drinks and consumed more of their daily energy from soft drinks. Milk and plain water as beverages were less popular. Conclusions: Although current health promotion campaigns in schools merit the attention being given to improving hydration and reducing soft drinks consumption , it may be also important to educate children on the energy and sugar contents of all beverages. These include soft drinks, as well as fruit juices and smoothies, which are both popular and consumed regularly.
Background: Recent evidence predicts that by 2030, Ireland will have the highest rate of obesity ... more Background: Recent evidence predicts that by 2030, Ireland will have the highest rate of obesity in Europe. Consequently, there are concerns that health problems associated with this condition will present in childhood. Studies have shown that interventions based on increasing physical activity (PA) levels, reducing sedentary lifestyles and improving nutritional habits all pose protective mechanisms against obesity and its related disorders in youth. Yet, to date, there are no interventions being delivered in Ireland that concurrently target PA, nutritional habits and sedentary time amongst school children. Purpose: The purpose of this study is to implement and evaluate an intervention that targets PA, nutritional habits and sedentary time in primary school children. Methods: 'Project Spraoi' is a school based health promotion intervention, based on 'Project Energize,' which has been in operation in New Zealand since 2004. Measures of PA, nutritional knowledge/be-haviours and health parameters including body composition, blood pressure (BP) and fitness will be gathered before and after the programme completion (24 months). For comparative purposes, we will compare these scores to a separate group who will not participate in the intervention and to counterparts partaking in Project Energize, NZ. Conclusions: There is strong evidence that quality multi-component school-based programmes can increase PA, improve weight status and promote healthier dietary habits. Due to the increasing obesity levels, the implementation of such a programme that is rigorously evaluated is warranted in Ireland.
School-based interventions to tackle the rise in childhood overweight and obesity remain inconclu... more School-based interventions to tackle the rise in childhood overweight and obesity remain inconclusive and are often limited in their application to diverse populations. To inform and measure the effect of the implementation of a primary school-based longitudinal randomised controlled nutrition and activity intervention, Project Energize, baseline measures of body size and blood pressure were required. This cross-sectional study stratified by age, sex, ethnicity, rurality and school socio-economic-status (school-SES) measured body mass index (BMI), percentage body fat (%BF), waist and resting blood pressure from 2752 5- and 10-year-old children (62% European, 31% Māori) representative of the Waikato region of New Zealand. Waikato children have a high prevalence of overweight and obesity that is linked with hypertension. Cardiovascular risk factors including raised blood pressure and hypertension, waist and arm circumference and percentage body fat (%BF) were more prevalent in 10-year-olds, lower school-SES and to some extent, urban living. In European children, BMI and waist circumference were similarly predictive of %BF, but for Māori children, waist circumference predicted %BF better than BMI. A variety of stratified, baseline measurements is important when designing school-based interventions. In particular, waist circumference measures may be a more accurate predictor of %BF than BMI when determining measurement protocols that consider different ethnic groups and environments among children. The effect of targeted improvements of the school physical activity and nutrition environment on the rate of increase of weight, fatness and blood pressure in children should be examined.
The international journal of behavioral nutrition and physical activity, Jan 2, 2017
Low levels of physical activity (PA) are a global concern and increasing PA engagement is becomin... more Low levels of physical activity (PA) are a global concern and increasing PA engagement is becoming a priority in current public health policies. Despite the large number of studies and reviews available, the evidence regarding the behavioral determinants of PA is still inconclusive. Thus, the aim of this umbrella systematic literature review (SLR) was to summarize the evidence on the behavioral determinants of PA across the life course. A systematic online search was conducted on MEDLINE, ISI Web of Science, Scopus, and SPORTDiscus databases. The search was limited to studies published in English from January, 2004 to April, 2016. SLRs and meta-analyses (MAs) of observational studies that investigated the behavioral determinants of PA were considered eligible. The extracted data were assessed based on the importance of the determinants, the strength of evidence, and the methodological quality. The full protocol is available from PROSPERO (PROSPERO 2014:CRD42015010616). Seventeen rev...
Background Raised blood pressure is an important risk factor for cardiovascular diseases and chro... more Background Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defi ned as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher.
Objectives: To examine in the context of a school day whether a pedometer, compared to an acceler... more Objectives: To examine in the context of a school day whether a pedometer, compared to an accelerometer, was an effective tool to identify children with low physical activity levels. Additionally, to characterise within the school day, patterns of variation in level and timing of activity of the most active and least active children. Design: Observational study to compare two methods (accelerometer and pedometer) of identifying less active children and intensity of activity. Method: During school hours, for three consecutive days, children (n = 47, aged 8–11 years) in two classes wore an accelerometer and sealed pedometer. Accelerometers were programmed to record at 15s epochs and the number of pedometer steps taken were recorded at the end of each school day. Patterns of activity by total accelerometer counts, and with cutoffs applied, were examined against time and the number of steps taken. Results: Based on the accelerometer (>1500 counts/min), the majority (68%) of children spent more than 60 min in moderate to vigorous physical activity (MVPA) during the school day. Overall, time spent in MVPA was three times greater during break times compared to classroom time, with no apparent differences by class/age or gender. Total accelerometer counts and pedometer steps were correlated (r = 0.60). One minute of MVPA was equivalent to 45 (95% CI 20 to 70) pedometer steps. Conclusion: The pedometer, a practical, relatively inexpensive tool, is suitable for the identification of less active children and has some utility to assess the relative intensity of activities in the context of a school day.
Background/Objectives: In 2002, the prevalence of overweight and obesity, defined by body mass in... more Background/Objectives: In 2002, the prevalence of overweight and obesity, defined by body mass index (BMI), was higher in New Zealand Maori (40%) and Pacific (60%) than in European (24%) children; however, this does not take into account interethnic differences in body composition. This study compared trajectories of anthropometric indices from 2004 to 2006 among 5- and 10-year-old Maori and European children. Subjects/Methods: In 2004 and then in 2006, 1244 children (639 boys and 605 girls) aged 5 and 10 years had height, weight and fat-free mass (FFM) by bioimpedance measured to derive measures of fat mass (FM), percentage body fat (%BF), FM index (FMI, FM/height2), FFM index (FFMI, FFM/height2), and s.d. scores for BMI and %BF and BMI categories by International Obesity Task Force criteria. Results: Body composition and growth in Maori children is different from European children. Over 2 years, the BMI and %BF s.d. scores in both 5- and 10-year-old cohorts increased more in Maori children than in European children. The prevalence of overweight and obesity also increased within ethnicity and age group. The relative change of FMI and FFMI differed by age group, gender and ethnicity. In Maori girls, the magnitude of the changes between 10 and 12 years of age was most marked—the major contribution was from an increase in FMI. At 12 years, the mean %BF of Maori girls was 31.7% (95% confidence interval (CI): 30.1 and 33.3) compared with that of European girls (28.0%; 95% CI: 27.0 and 29.0). Conclusions: FM and FFM measures provide a more appropriate understanding of growth and body composition change in children than BMI, and vary with gender and ethnicity. Thus, FMI and FFMI should be tracked and compared among populations.
Background
It is widely believed that unhealthy eating patterns in childhood can lead to adverse ... more Background It is widely believed that unhealthy eating patterns in childhood can lead to adverse health conditions, particularly obesity. Yet, debate remains around the precise eating behaviours that lead to these conditions. This study aimed to address this lack of evidence by reporting on the eating frequency, breakfast consumption and body mass of youth.
Methods A total of 315 (162 boys, 153 girls) participants from nine primary and secondary schools in south-west London provided self-report measures of dietary intake, via 3-day food diaries. Anthropometric measures of height and weight were also obtained.
Results Frequent breakfast consumers had significantly lower BMI Z-scores than those who did not eat breakfast regularly and overall, those aged 10 and under consumed breakfast more frequently than those aged 11 or over. Mean BMI Z-scores for both genders were within the healthy range ‘normal’ and there was no relationship between BMI Z-score and eating frequency. Older boys (11-13 y) were less likely to eat regularly and had the lowest breakfast consumption intakes.
Conclusions Although this study shows participants eating regularly, older boys were the least likely to eat regularly and to consume breakfast. Educating these boys on the importance of regular eating patterns, particularly breakfast consumption, may be essential to ensure healthier long-term eating patterns. Furthermore, the lower breakfast intakes in older youth and higher BMI Z-scores of those who do not eat breakfast regularly, needs to be monitored.
Through-school nutrition and physical activity interventions are designed to help reduce excess w... more Through-school nutrition and physical activity interventions are designed to help reduce excess weight gain and risk of chronic disease. From 2004 to 2006, Project Energize was delivered in the Waikato Region of New Zealand as a longitudinal randomised controlled study of 124 schools (year 1– 6), stratified by rurality and social deprivation, and randomly assigned to intervention or control. Children (686 boys and 662 girls) aged 5 (1926) and 10 (1426) years (692 interventions and 660 controls) had height, weight, body fat (by bioimpedance) and resting blood pressure (BP) measured at baseline and 2 years later. Each intervention school was assigned an 'Energizer'; a trained physical activity and nutrition change agent, who worked with the school to achieve goals based on healthier eating and quality physical activity. After adjustment for baseline measures, rurality and social deprivation, the intervention was associated with a reduced accumulation of body fat in younger children and a reduced rate of rise in systolic BP in older children. There was some evidence that the pattern of change within an age group varied with rurality, ethnicity and sex. We conclude that the introduction of an 'Energizer led' through-school programme may be associated with health benefits over 2 years, but the trajectory of this change needs to be measured over a longer period. Attention should also be paid to the differing response by ethnicity, sex, age group and the effect of rurality and social deprivation.
Being taller is associated with enhanced longevity, and higher education and earnings. We reanaly... more Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5–22.7) and 16.5 cm (13.3–19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8–144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.
Background: Physical activity (PA) is a key performance indicator for policy documents in both th... more Background: Physical activity (PA) is a key performance indicator for policy documents in both the Republic of Ireland and Northern Ireland. Building on baseline grades set in 2014, Ireland's second Report Card on Physical Activity for Children and Youth allows for continued surveillance of indicators related to PA in children and youth. Methods: Data and information were extracted and collated for 10 indicators and graded using an international standardized grading system. Results: Overall, 7 grades stayed the same, 2 increased, and 1 decreased. Grades were assigned as follows: Overall PA, D (an increase) Community and the Built Environment, B+ (an increase); and Government, INC. Unlike 2014's report card, different grades for the Republic (C-) and Northern Ireland (C+) were assigned for Organized Sport Participation. Conclusions: Although the grade for Overall PA levels increased to a D, this may reflect the increased quality and quantity of data available. The double burden of low PA and high sedentary levels are concerning and underscore the need for advocacy toward, and surveillance of, progress in achieving targets set by the new National Physical Activity Plan in the Republic and obesity and sport plans in the North.
Prevention of childhood obesity is a global priority. The school setting offers access to large n... more Prevention of childhood obesity is a global priority. The school setting offers access to large numbers of children and the ability to provide supportive environments for quality physical activity and nutrition. This article describes Project Energize, a through-school physical activity and nutrition programme that celebrated its 10-year anniversary in 2015 so that it might serve as a model for similar practices, initiatives and policies elsewhere. The programme was envisaged and financed by the Waikato District Health Board of New Zealand in 2004 and delivered by Sport Wai-kato to 124 primary schools as a randomised controlled trial from 2005 to 2006. The programme has since expanded to include all 242 primary schools in the Waikato region and 70 schools in other regions, including 53,000 children. Ongoing evaluation and development of Project Energize has shown it to be sustainable (ongoing for >10 years), both effective (lower obesity, higher physical fitness) and cost effective (one health related cost quality adjusted life year between $18,000 and $30,000) and efficient ($45/child/year) as a childhood 'health' programme. The pro-gramme's unique community-based approach is inclusive of all children, serving a population that is 42 % Māori, the indigenous people of New Zealand. While the original nine healthy eating and seven quality physical activity goals have not changed, the delivery and assessment processes has been refined and the health service adapted over the 10 years of the programme existence, as well as adapted over time to other settings including early childhood education and schools in Cork in Ireland. Evaluation and research associated with the programme delivery and outcomes are ongoing. The dissemination of findings to politicians and collaboration with other service providers are both regarded as priorities.
Background Underweight and severe and morbid obesity are associated with highly elevated risks of... more Background Underweight and severe and morbid obesity are associated with highly elevated risks of adverse health outcomes. We estimated trends in mean body-mass index (BMI), which characterises its population distribution, and in the prevalences of a complete set of BMI categories for adults in all countries.
Objective: To investigate the dietary intake and physical activity of boys and girls aged 9–13 ye... more Objective: To investigate the dietary intake and physical activity of boys and girls aged 9–13 years, and the influence of peers on these behaviours. Design: Cross-sectional study. Setting: Nine primary and secondary schools in southwest London. Subjects: A total of 315 children wore sealed pedometers, provided self-report measures of dietary intake and answered a questionnaire relating to peer influence. Anthropometric measures of height and weight were also obtained. Results: Obese children had the lowest reported energy intakes and the lowest step counts per day. Boys took significantly more steps per day than girls, however girls were closer to achieving their recommended cutoffs for physical activity. Girls had lower energy intakes per day and lower BMI Z-scores than boys, however both genders, across all age groups, had higher than recommended intakes of saturated fat. There were significant associations between peer influence and physical activity levels but not between peer influence and dietary intake. Conclusions: Low energy intake and physical activity levels but high saturated fat intakes among boys and girls across all age groups highlight the importance of promoting both physical activity and healthy food choices. The finding that peers have a significant effect on physical activity levels but not on dietary intake offers an important approach for the design of health promotion interventions and obesity prevention programmes. Such designs may be particularly beneficial for obese youth, since the low physical activity levels found could be a major contributing factor to the maintenance of the condition.
Background: This study investigated physical activity and dietary intake of children aged 9–11 ye... more Background: This study investigated physical activity and dietary intake of children aged 9–11 years, and the influence of peers on these behaviours over a 2-year period. Methods: A total of 106 (64 girls; 42 boys) children were investigated annually, over 2 years. Measures included physical activity (sealed pedometer), self-report measures of dietary intake and physical activity, and a peer influence questionnaire. Anthropometric measures of height and weight were also obtained. Results: The findings reveal insufficient energy intakes, physical activity levels and fruit and vegetable consumption but high intakes of saturated fat and sodium, over time, in both boys and girls. Both male calcium and female iron intakes were also of concern. Throughout the survey, peers were found to influence physical activity behaviour but not dietary intake. Conclusions: The fact that youth consistently failed to meet established nutrition and physical activity recommendations highlights the importance of promoting physical activity and healthy eating to children younger than 9 years of age. The finding that peers significantly influence physical activity behaviour over time should be considered when designing new physical activity interventions aimed at young people.
Objective: Adequate fluid intake has been well documented as important for health but whether it ... more Objective: Adequate fluid intake has been well documented as important for health but whether it has adverse effects on overall energy and sugar intakes remains under debate. Many dietary studies continue to refrain from reporting on beverage consumption, which the present study aimed to address. Design: A cross-sectional survey investigated self-reported measures of dietary intake and anthropometric measurements. Setting: Primary and secondary schools in southwest London, UK. Subjects: Boys and girls (n 248) aged 9–13 years. Results: Boys consumed 10 % and girls consumed 9 % of their daily energy intake from beverages and most children had total sugar intakes greater than recommended. Beverages contributed between a quarter and a third of all sugars consumed, with boys aged 11–13 years consuming 32 % of their total sugar from beverages. There was a strong relationship between consumption of beverages and energy intake; however, there was no relationship between beverage type and either BMI or BMI Z-score. Fruit juices and smoothies were consumed most frequently by all girls and 9–10-year-old boys; boys aged 11–13 years preferred soft drinks and consumed more of their daily energy from soft drinks. Milk and plain water as beverages were less popular. Conclusions: Although current health promotion campaigns in schools merit the attention being given to improving hydration and reducing soft drinks consumption , it may be also important to educate children on the energy and sugar contents of all beverages. These include soft drinks, as well as fruit juices and smoothies, which are both popular and consumed regularly.
Background: Recent evidence predicts that by 2030, Ireland will have the highest rate of obesity ... more Background: Recent evidence predicts that by 2030, Ireland will have the highest rate of obesity in Europe. Consequently, there are concerns that health problems associated with this condition will present in childhood. Studies have shown that interventions based on increasing physical activity (PA) levels, reducing sedentary lifestyles and improving nutritional habits all pose protective mechanisms against obesity and its related disorders in youth. Yet, to date, there are no interventions being delivered in Ireland that concurrently target PA, nutritional habits and sedentary time amongst school children. Purpose: The purpose of this study is to implement and evaluate an intervention that targets PA, nutritional habits and sedentary time in primary school children. Methods: 'Project Spraoi' is a school based health promotion intervention, based on 'Project Energize,' which has been in operation in New Zealand since 2004. Measures of PA, nutritional knowledge/be-haviours and health parameters including body composition, blood pressure (BP) and fitness will be gathered before and after the programme completion (24 months). For comparative purposes, we will compare these scores to a separate group who will not participate in the intervention and to counterparts partaking in Project Energize, NZ. Conclusions: There is strong evidence that quality multi-component school-based programmes can increase PA, improve weight status and promote healthier dietary habits. Due to the increasing obesity levels, the implementation of such a programme that is rigorously evaluated is warranted in Ireland.
School-based interventions to tackle the rise in childhood overweight and obesity remain inconclu... more School-based interventions to tackle the rise in childhood overweight and obesity remain inconclusive and are often limited in their application to diverse populations. To inform and measure the effect of the implementation of a primary school-based longitudinal randomised controlled nutrition and activity intervention, Project Energize, baseline measures of body size and blood pressure were required. This cross-sectional study stratified by age, sex, ethnicity, rurality and school socio-economic-status (school-SES) measured body mass index (BMI), percentage body fat (%BF), waist and resting blood pressure from 2752 5- and 10-year-old children (62% European, 31% Māori) representative of the Waikato region of New Zealand. Waikato children have a high prevalence of overweight and obesity that is linked with hypertension. Cardiovascular risk factors including raised blood pressure and hypertension, waist and arm circumference and percentage body fat (%BF) were more prevalent in 10-year-olds, lower school-SES and to some extent, urban living. In European children, BMI and waist circumference were similarly predictive of %BF, but for Māori children, waist circumference predicted %BF better than BMI. A variety of stratified, baseline measurements is important when designing school-based interventions. In particular, waist circumference measures may be a more accurate predictor of %BF than BMI when determining measurement protocols that consider different ethnic groups and environments among children. The effect of targeted improvements of the school physical activity and nutrition environment on the rate of increase of weight, fatness and blood pressure in children should be examined.
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Papers by Tara Coppinger
New Zealand Maori (40%) and Pacific (60%) than in European (24%) children; however, this does not take into account
interethnic differences in body composition. This study compared trajectories of anthropometric indices from 2004 to 2006
among 5- and 10-year-old Maori and European children.
Subjects/Methods: In 2004 and then in 2006, 1244 children (639 boys and 605 girls) aged 5 and 10 years had height, weight
and fat-free mass (FFM) by bioimpedance measured to derive measures of fat mass (FM), percentage body fat (%BF), FM index
(FMI, FM/height2), FFM index (FFMI, FFM/height2), and s.d. scores for BMI and %BF and BMI categories by International
Obesity Task Force criteria.
Results: Body composition and growth in Maori children is different from European children. Over 2 years, the BMI and %BF s.d.
scores in both 5- and 10-year-old cohorts increased more in Maori children than in European children. The prevalence of
overweight and obesity also increased within ethnicity and age group. The relative change of FMI and FFMI differed by
age group, gender and ethnicity. In Maori girls, the magnitude of the changes between 10 and 12 years of age was most
marked—the major contribution was from an increase in FMI. At 12 years, the mean %BF of Maori girls was 31.7%
(95% confidence interval (CI): 30.1 and 33.3) compared with that of European girls (28.0%; 95% CI: 27.0 and 29.0).
Conclusions: FM and FFM measures provide a more appropriate understanding of growth and body composition change in
children than BMI, and vary with gender and ethnicity. Thus, FMI and FFMI should be tracked and compared among
populations.
It is widely believed that unhealthy eating patterns in childhood can lead to adverse health conditions, particularly obesity. Yet, debate remains around the precise eating behaviours that lead to these conditions. This study aimed to address this lack of evidence by reporting on the eating frequency, breakfast consumption and body mass of youth.
Methods
A total of 315 (162 boys, 153 girls) participants from nine primary and secondary schools in south-west London provided self-report measures of dietary intake, via 3-day food diaries. Anthropometric measures of height and weight were also obtained.
Results
Frequent breakfast consumers had significantly lower BMI Z-scores than those who did not eat breakfast regularly and overall, those aged 10 and under consumed breakfast more frequently than those aged 11 or over. Mean BMI Z-scores for both genders were within the healthy range ‘normal’ and there was no relationship between BMI Z-score and eating frequency. Older boys (11-13 y) were less likely to eat regularly and had the lowest breakfast consumption intakes.
Conclusions
Although this study shows participants eating regularly, older boys were the least likely to eat regularly and to consume breakfast. Educating these boys on the importance of regular eating patterns, particularly breakfast consumption, may be essential to ensure healthier long-term eating patterns. Furthermore, the lower breakfast intakes in older youth and higher BMI Z-scores of those who do not eat breakfast regularly, needs to be monitored.
New Zealand Maori (40%) and Pacific (60%) than in European (24%) children; however, this does not take into account
interethnic differences in body composition. This study compared trajectories of anthropometric indices from 2004 to 2006
among 5- and 10-year-old Maori and European children.
Subjects/Methods: In 2004 and then in 2006, 1244 children (639 boys and 605 girls) aged 5 and 10 years had height, weight
and fat-free mass (FFM) by bioimpedance measured to derive measures of fat mass (FM), percentage body fat (%BF), FM index
(FMI, FM/height2), FFM index (FFMI, FFM/height2), and s.d. scores for BMI and %BF and BMI categories by International
Obesity Task Force criteria.
Results: Body composition and growth in Maori children is different from European children. Over 2 years, the BMI and %BF s.d.
scores in both 5- and 10-year-old cohorts increased more in Maori children than in European children. The prevalence of
overweight and obesity also increased within ethnicity and age group. The relative change of FMI and FFMI differed by
age group, gender and ethnicity. In Maori girls, the magnitude of the changes between 10 and 12 years of age was most
marked—the major contribution was from an increase in FMI. At 12 years, the mean %BF of Maori girls was 31.7%
(95% confidence interval (CI): 30.1 and 33.3) compared with that of European girls (28.0%; 95% CI: 27.0 and 29.0).
Conclusions: FM and FFM measures provide a more appropriate understanding of growth and body composition change in
children than BMI, and vary with gender and ethnicity. Thus, FMI and FFMI should be tracked and compared among
populations.
It is widely believed that unhealthy eating patterns in childhood can lead to adverse health conditions, particularly obesity. Yet, debate remains around the precise eating behaviours that lead to these conditions. This study aimed to address this lack of evidence by reporting on the eating frequency, breakfast consumption and body mass of youth.
Methods
A total of 315 (162 boys, 153 girls) participants from nine primary and secondary schools in south-west London provided self-report measures of dietary intake, via 3-day food diaries. Anthropometric measures of height and weight were also obtained.
Results
Frequent breakfast consumers had significantly lower BMI Z-scores than those who did not eat breakfast regularly and overall, those aged 10 and under consumed breakfast more frequently than those aged 11 or over. Mean BMI Z-scores for both genders were within the healthy range ‘normal’ and there was no relationship between BMI Z-score and eating frequency. Older boys (11-13 y) were less likely to eat regularly and had the lowest breakfast consumption intakes.
Conclusions
Although this study shows participants eating regularly, older boys were the least likely to eat regularly and to consume breakfast. Educating these boys on the importance of regular eating patterns, particularly breakfast consumption, may be essential to ensure healthier long-term eating patterns. Furthermore, the lower breakfast intakes in older youth and higher BMI Z-scores of those who do not eat breakfast regularly, needs to be monitored.