Original articleThe relationship between behavioral factors, weight status and a dietary pattern in primary school aged children: The GRECO study
Introduction
Numerous factors have been associated with the increase in childhood overweight and obesity, including environmental, dietary and behavioral [1], [2]. For this reason, these factors have been termed as “obesogenic” and it is unlikely that they exert their effects individually.
Obesogenic factors that have been associated to the increase of child overweight & obesity include sleep [3], [4], sedentary lifestyle and various eating behaviors. The latter encompass frequency of eating during the day (meal frequency), frequency of having family meals, frequency of eating while watching TV, and frequency of eating or ordering from a restaurant [5], [6]. Television-viewing has been used as a proxy measure to sedentary lifestyle and is the behavioral variable most examined, linked to poor health outcomes and unhealthy weight gain [6], [7], [8]. The effect of total screen time (TV and other media types) on weight status, which is also related to sedentary lifestyle and is an increasing trend among children [9], is limited. Total study hours, has recently been suggested [10], [11] as an additional factor adding to total sedentary time in school aged children, but has not been adequately investigated to date.
Diet & unhealthy eating patterns have been associated with childhood weight status [11], [12] and short sleep duration has been found to increase risk of childhood obesity by 58%–89% [3], [4].
The association of these behavioral factors on children's dietary preferences has also been investigated. Sleep duration and TV-viewing and screen time [13], [14], [15], [16], [17] have been associated with unhealthier food intakes, including high fat & sugary foods and low fruit & vegetable intake. An overall assessment of children's food choices based on individual intakes has been found highly heterogenic [18], which makes it difficult to provide an evidence-based association between Body Mass Index (BMI) status, diet and child-behaviors. The use of dietary patterns, has been shown to decrease heterogeneity since all dietary patterns are assessed based on the same standards. The use of a previously validated dietary pattern, such as the child derived Food Index (cdFI), designed to predict child overweight and obesity, can account for diet heterogeneity and help provide stronger associations. Studies examining the relationship between obesogenic behavioral factors on a dietary pattern as a whole are limited.
Therefore, the aim of the present study was firstly, to examine the association of specific childhood obesogenic behavioral factors, with a specific dietary pattern, the child derived Food Index (cdFI) and secondly, to assess how these behavioral factors and total cdFI score are related to children's weight status, in total and by gender, when addressed together in a model.
Section snippets
Procedure
The study was carried out from October 2008 to May 2009, from the whole district of Greece, via stratified sampling scheme weighted by age, sex, and region, according to the population distribution (National Statistical Services, 2001 census). Precise details on the stratification scheme have been previously published [19]. The number of children required to increase the power of the study to 85% (5% type I error) was considered prior to the study with odds ratio (OR) evaluated to equal 1.10,
Results
The basic total and gender specific characteristics of the study population are shown in Table 1. Mean values along with their standard deviation (SD) are depicted for continuous variables, and frequencies with percentages presented for, categorical variables. Statistically significant gender differences in anthropometric measurements were found in the mean values for height, age, waist-circumference and BMI. BMI categories, as per IOTF standards, did not significantly differ (p = 0.091).
Gender
Discussion
The present study investigated the relationship between a child derived food pattern with behaviors linked to the obesity epidemic, including sleep duration, total screen time, and other eating behaviors. Study time, a factor that adds to sedentary time in school aged children and has not been extensively studied, was also examined. The result of each on children's weight status, in univariate and multivariate analysis was examined, accounting for residual confounding by these already known
Future research
The results of this study may form the basis for implementing public health policies but most importantly for designing intervention studies addressing children's dietary habits (either school oriented or specific overweight group targeted), most of which to date have no or very small effect. It must be recognized that in order to prevent or decrease childhood obesity interventions may need to target behavioral factors, specific dietary patterns and eating habits, in a reasonable time span.
Statement of authorship
The GRECO study started and was conducted from the Agricultural University of Athens. Responsibilities of A.Z., D.B.P., G.R. and P.F. included study design and field work supervision. Statistical analysis was performed and overall write up was performed by E.M., and D.B.P., E.M., and A.Z. interpreted the data. Data management and database preparation was performed by all authors, All authors participated in writing the final version of the submitted paper. The authors have no competing
Sources of funding
The study was funded by the General Secretariat of Consumers-Greek Ministry of Development, Hellenic Association of Food and Beverage Companies, FAGE S.A., Coca Cola Hellas, Coca Cola Hellenic Bottling Company, Cereal Partners Hellas, Unilever Hellas, Nestle Hellas, Kraft Foods Hellas. The European Union (European Social Fund – ESF) has co-financed the research as well as the Greek national funds through the Operational Program “Education and Lifelong Learning” of the National Strategic
Conflicts of interest
The authors declare that they have no conflicts of interest.
Compliance with ethical standards
Ethical Standards The Agricultural University of Athens research committee approved procedures as well as the Hellenic Ministry of Education (Department of Primary Education) as the law provides in Greece for any studies conducted at school during formal working hours. Data protection regulations were observed in the survey. Signed informed consent was obtained from main caregiver prior to enrolling the children in the study.
References (33)
- et al.
Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight
Pediatr Clin North Am
(2001) - et al.
Television watching and frequency of family meals are predictive of overweight onset and persistence in a national sample of school-aged children
J Am Diet Assoc
(2007) - et al.
Sleep curtailment is accompanied by increased intake of calories from snacks
Am J Clin Nutr
(2009) - et al.
The associations between TV viewing, food intake, and BMI A prospective analysis of data from the Longitudinal Study of Australian Children
Appetite
(2012) - et al.
Development of eating behaviors among children and adolescents
Pediatrics
(1998) - et al.
Meta-analysis of short sleep duration and obesity in children and adults
Sleep-New York then Westchester
(2008) - et al.
Is sleep duration associated with childhood obesity? A systematic review and meta-analysis
Obesity
(2008) - et al.
Social factors and television use during meals and snacks is associated with higher BMI among pre-school children
Public Health Nutr
(2008) - et al.
Associations between sedentary behavior and blood pressure in young children
Arch Pediatr Adolesc Med
(2009) - et al.
Youth screen-time behaviour is associated with cardiovascular risk in young adulthood: the European Youth Heart Study
Eur J Prev Cardiol
(2014)
Adiposity and different types of screen time
Pediatrics
Hierarchical analysis of dietary, lifestyle and family environment risk factors for childhood obesity: the GRECO study
Eur J Clin Nutr
Newly derived children-based food index. An index that may detect childhood overweight and obesity
Int J Food Sci Nutr
HuSKY: a healthy nutrition score based on food intake of children and adolescents in Germany
Br J Nutr
Children's physical activity, TV watching and obesity in Cyprus: the CYKIDS study
Eur J Public Health
Sleep duration or bedtime? Exploring the association between sleep timing behaviour, diet and BMI in children and adolescents
Int J Obes
Cited by (29)
The association between dietary patterns and quality and duration of sleep in children and adolescents: A systematic review
2021, Clinical Nutrition ESPENCitation Excerpt :Overall, 12 cross-sectional studies with 29,333 participants were considered eligible for this review [17,22–32]. Identified studies were from New Zealand [24,29], Portugal [28], Greece [27], USA [25], Italy [23], Turkey [17], China [26,30], Norway [31], Finland [32], and one study was international, gathering the data from 12 different countries [22]. Various methods were used to measure sleep and diet in the included studies.
CoCu: A new short questionnaire to evaluate diet composition and culture of eating in children and adolescents
2019, Clinical NutritionCitation Excerpt :Another feature that is related to what children eat is how they eat (i.e., eating culture). For example, the composition of children's diets has been shown to be affected by a tendency to watch television while eating [14–16], by skipping meals [17], and by the frequency of shared family dinners [16,18,19]. In addition, the way children eat, i.e., their eating culture, has been related to more general health outcomes, especially weight [15,20,21].
Screen time, dietary patterns and intake of potentially cariogenic food in children: A systematic review
2019, Journal of DentistryCitation Excerpt :In particular, diet quality seems to be affected by the amount of television viewing time among children [13–15]. However, it is not clear whether young people who watch more television simply eat a poorer diet overall [16], or if they eat foods during television viewing that contribute to an overall diet that is lower in quality [17]. Dental caries, considered by the World Health Organization as a major public health problem globally, and the most widespread non-communicable disease [18], share common risk factors, such as diet, with other conditions, such as obesity [19].
Factors associated with consuming unhealthy food in school children: A population-based study from Hong Kong
2024, Health Science ReportsSchool-related sedentary behaviours and indicators of health and well-being among children and youth: a systematic review
2022, International Journal of Behavioral Nutrition and Physical Activity