Browsing by Author "Kunešová, Marie"
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- Association between Characteristics at Birth, Breastfeeding and Obesity in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative – COSI 2015/2017Publication . Rito, Ana Isabel; Buoncristiano, Marta; Spinelli, Angela; Salanave, Benoit; Kunešová, Marie; Hejgaard, Tatjana; García Solano, Marta; Fijałkowska, Anna; Sturua, Lela; Hyska, Jolanda; Kelleher, Cecily; Duleva, Vesselka; Musić Milanović, Sanja; Farrugia Sant’Angelo, Victoria; Abdrakhmanova, Shynar; Kujundzic, Enisa; Peterkova, Valentina; Gualtieri, Andrea; Pudule, Iveta; Petrauskienė, Aušra; Tanrygulyyeva, Maya; Sherali, Rakhmatulloev; Huidumac-Petrescu, Constanta; Williams, Julianne; Ahrens, Wolfgang; Breda, JoãoBackground: In Europe, although the prevalence of childhood obesity seems to be plateauing in some countries, progress on tackling this important public health issue remains slow and inconsistent. Breastfeeding has been described as a protective factor, and the more exclusively and the longer children are breastfed, the greater their protection from obesity. Birth weight has been shown to have a positive association with later risk for obesity. Objectives: It was the aim of this paper to investigate the association of early-life factors, namely breastfeeding, exclusive breastfeeding and birth weight, with obesity among children. Method: Data from 22 participating countries in the WHO European COSI study (round 4: 2015/2017) were collected using cross-sectional, nationally representative samples of 6- to 9-year-olds (n = 100,583). The children’s standardized weight and height measurements followed a common WHO protocol. Information on the children’s birth weight and breastfeeding practice and duration was collected through a family record form. A multivariate multilevel logistic regression analysis regarding breastfeeding practice (both general and exclusive) and characteristics at birth was performed. Results: The highest prevalence rates of obesity were observed in Spain (17.7%), Malta (17.2%) and Italy (16.8%). A wide between-country disparity in breastfeeding prevalence was found. Tajikistan had the highest percentage of children that were breastfed for ≥6 months (94.4%) and exclusively breastfed for ≥6 months (73.3%). In France, Ireland and Malta, only around 1 in 4 children was breastfed for ≥6 months. Italy and Malta showed the highest prevalence of obesity among children who have never been breastfed (21.2%), followed by Spain (21.0%). The pooled analysis showed that, compared to children who were breastfed for at least 6 months, the odds of being obese were higher among children never breastfed or breastfed for a shorter period, both in case of general (adjusted odds ratio [adjOR] [95% CI] 1.22 [1.16–1.28] and 1.12 [1.07–1.16], respectively) and exclusive breastfeeding (adjOR [95% CI] 1.25 [1.17–1.36] and 1.05 [0.99–1.12], respectively). Higher birth weight was associated with a higher risk of being overweight, which was reported in 11 out of the 22 countries. Bulgaria, Croatia, France, Italy, Poland and Romania showed that children who were preterm at birth had higher odds of being obese, compared to children who were full-term babies. Conclusion: The present work confirms the beneficial effect of breastfeeding against obesity, which was highly increased if children had never been breastfed or had been breastfed for a shorter period. Nevertheless, adoption of exclusive breastfeeding is below global recommendations and far from the target endorsed by the WHO Member States at the World Health Assembly Global Targets for Nutrition of increasing the prevalence of exclusive breastfeeding in the first 6 months up to at least 50% by 2025.
- Childhood overweight and obesity in Europe: Changes from 2007 to 2017Publication . Buoncristiano, Marta; Spinelli, Angela; Williams, Julianne; Nardone, Paola; Rito, Ana Isabel; García‐Solano, Marta; Grøholt, Else Karin; Gutiérrez‐González, Enrique; Klepp, Knut Inge; Starc, Gregor; Petrauskienė, Aušra; Kunešová, Marie; Hassapidou, Maria; Pérez‐Farinós, Napoleón; Pudule, Iveta; Kelleher, Cecily C.; Duleva, Vesselka; Rakovac, Ivo; Chatterjee, Saion; Breda, JoãoThe Childhood Obesity Surveillance Initiative (COSI) routinely measures height andweight of primary school children aged 6–9 years and calculates overweight andobesity prevalence within the World Health Organization (WHO) European Regionusing a standard methodology. This study examines the trends in the prevalence ofoverweight and obesity from the first round of COSI carried out in 2007/2008 to thelatest of 2015/2017 in 11 European countries in which data were collected for atleast three rounds. In total 303,155 children were measured. In general, the preva-lence of overweight and obesity among boys and girls decreased in countries withhigh prevalence (Southern Europe) and remained stable or slightly increased in North-ern European and Eastern European countries included in the analysis. Among boys, the highest decrease in overweight (including obesity) was observed in Portugal (from40.5% in 2007/2008 to 28.4 in 2015/2017) and in Greece for obesity (from 30.5% in2009/2010 to 21.7% in 2015/2017). Lithuania recorded the strongest increase in theproportion of boys with overweight (from 24.8% to 28.5%) and obesity (from 9.4% to12.2%). The trends were similar for boys and girls in most countries. Several countriesin Europe have successfully implemented policies and interventions to counteract theincrease of overweight and obesity, but there is still much to be done.
- Prevalence of Severe Obesity among Primary School Children in 21 European CountriesPublication . Spinelli, Angela; Buoncristiano, Marta; Kovacs, Viktoria Anna; Yngve, Agneta; Spiroski, Igor; Obreja, Galina; Starc, Gregor; Pérez, Napoleón; Rito, Ana Isabel; Kunešová, Marie; Sant'Angelo, Victoria Farrugia; Meisfjord, Jørgen; Bergh, Ingunn Holden; Kelleher, Cecily; Yardim, Nazan; Pudule, Iveta; Petrauskiene, Ausra; Duleva, Vesselka; Sjöberg, Agneta; Gualtieri, Andrea; Hassapidou, Maria; Hyska, Jolanda; Burazeri, Genc; Petrescu, Constanta Huidumac; Heinen, Mirjam; Takacs, Hajnalka; Zamrazilová, Hana; Bosi, Tulay Bagci; Sacchini, Elena; Pagkalos, Ioannis; Cucu, Alexandra; Nardone, Paola; Gately, Paul; Williams, Julianne; Breda, JoãoThe World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was established more than 10 years ago to estimate prevalence and monitor changes in overweight and obesity in children aged 6-9 years. Since then, there have been five rounds of data collection in more than 40 countries involving more than half a million children. To date, no comparative studies with data on severe childhood obesity from European countries have been published.
- A Snapshot of European Children’s Eating Habits: Results from the Fourth Round of the WHO European Childhood Obesity Surveillance Initiative (COSI)Publication . Williams, Julianne; Buoncristiano, Marta; Nardone, Paola; Rito, Ana Isabel; Spinelli, Angela; Hejgaard, Tatjana; Kierkegaard, Lene; Nurk, Eha; Kunešová, Marie; Musić Milanović, Sanja; García-Solano, Marta; Gutiérrez-González, Enrique; Brinduse, Lacramioara Aurelia; Cucu, Alexandra; Fijałkowska, Anna; Farrugia Sant’Angelo, Victoria; Abdrakhmanova, Shynar; Pudule, Iveta; Duleva, Vesselka; Yardim, Nazan; Gualtieri, Andrea; Heinen, Mirjam; Bel-Serrat, Silvia; Usupova, Zhamyla; Peterkova, Valentina; Shengelia, Lela; Hyska, Jolanda; Tanrygulyyeva, Maya; Petrauskiene, Ausra; Rakhmatullaeva, Sanavbar; Kujundzic, Enisa; Ostojic, Sergej M.; Weghuber, Daniel; Melkumova, Marina; Spiroski, Igor; Starc, Gregor; Rutter, Harry; Rathmes, Giulia; Bunge, Anne Charlotte; Rakovac, Ivo; Boymatova, Khadichamo; Weber, Martin; Breda, JoãoConsuming a healthy diet in childhood helps to protect against malnutrition and noncommunicable diseases (NCDs). This cross-sectional study described the diets of 132,489 children aged six to nine years from 23 countries participating in round four (2015-2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children's parents or caregivers were asked to complete a questionnaire that contained indicators of energy-balance-related behaviors (including diet). For each country, we calculated the percentage of children who consumed breakfast, fruit, vegetables, sweet snacks or soft drinks "every day", "most days (four to six days per week)", "some days (one to three days per week)", or "never or less than once a week". We reported these results stratified by country, sex, and region. On a daily basis, most children (78.5%) consumed breakfast, fewer than half (42.5%) consumed fruit, fewer than a quarter (22.6%) consumed fresh vegetables, and around one in ten consumed sweet snacks or soft drinks (10.3% and 9.4%, respectively); however, there were large between-country differences. This paper highlights an urgent need to create healthier food and drink environments, reinforce health systems to promote healthy diets, and continue to support child nutrition and obesity surveillance.
- Socioeconomic differences in food habits among 6- to 9-year-old children from 23 countries-WHO European Childhood Obesity Surveillance Initiative (COSI 2015/2017)Publication . Fismen, Anne‐Siri; Buoncristiano, Marta; Williams, Julianne; Helleve, Arnfinn; Abdrakhmanova, Shynar; Bakacs, Márta; Bergh, Ingunn Holden; Boymatova, Khadichamo; Duleva, Vesselka; Fijałkowska, Anna; García‐Solano, Marta; Gualtieri, Andrea; Gutiérrez‐González, Enrique; Hejgaard, Tatjana; Huidumac‐Petrescu, Constanta; Hyska, Jolanda; Kelleher, Cecily C.; Kierkegaard, Lene; Kujundžić, Enisa; Kunešová, Marie; Milanović, Sanja Musić; Nardone, Paola; Nurk, Eha; Ostojic, Sergej M.; Ozcebe, Lütfiye Hilal; Peterkova, Valentina; Petrauskiene, Ausra; Pudule, Iveta; Rakhmatulleoeva, Sanavbar; Rakovac, Ivo; Rito, Ana Isabel; Rutter, Harry; Sacchini, Elena; Stojisavljević, Dragana; Farrugia Sant'Angelo, Victoria; Shengelia, Lela; Spinelli, Angela; Spiroski, Igor; Tanrygulyyeva, Maya; Usupova, Zhamilya; Weghuber, Daniel; Breda, JoãoBackground: Socioeconomic differences in children's food habits are a key public health concern. In order to inform policy makers, cross-country surveillance studies of dietary patterns across socioeconomic groups are required. The purpose of this study was to examine associations between socioeconomic status (SES) and children's food habits. Methods: The study was based on nationally representative data from children aged 6-9 years (n = 129,164) in 23 countries in the World Health Organization (WHO) European Region. Multivariate multilevel analyses were used to explore associations between children's food habits (consumption of fruit, vegetables, and sugar-containing soft drinks) and parental education, perceived family wealth and parental employment status. Results: Overall, the present study suggests that unhealthy food habits are associated with lower SES, particularly as assessed by parental education and family perceived wealth, but not parental employment status. We found cross-national and regional variation in associations between SES and food habits and differences in the extent to which the respective indicators of SES were related to children's diet. Conclusion: Socioeconomic differences in children's food habits exist in the majority of European and Asian countries examined in this study. The results are of relevance when addressing strategies, policy actions, and interventions targeting social inequalities in children's diets.
- Thinness, overweight, and obesity in 6‐ to 9‐year‐old children from 36 countries: The World Health Organization European Childhood Obesity Surveillance Initiative - COSI 2015-2017Publication . Spinelli, Angela; Buoncristiano, Marta; Nardone, Paola; Starc, Gregor; Hejgaard, Tatjana; Júlíusson, Petur Benedikt; Fismen, Anne‐Siri; Weghuber, Daniel; Musić Milanović, Sanja; García‐Solano, Marta; Rutter, Harry; Rakovac, Ivo; Cucu, Alexandra; Brinduse, Lacramioara Aurelia; Rito, Ana Isabel; Kovacs, Viktoria Anna; Heinen, Mirjam M.; Nurk, Eha; Mäki, Päivi; Abdrakhmanova, Shynar; Rakhmatulleoeva, Sanavbar; Duleva, Vesselka; Farrugia Sant'Angelo, Victoria; Fijałkowska, Anna; Gualtieri, Andrea; Sacchini, Elena; Hassapidou, Maria; Hyska, Jolanda; Kelleher, Cecily C.; Kujundžić, Enisa; Kunešová, Marie; Markidou Ioannidou, Eliza; Ostojic, Sergej M.; Peterkova, Valentina; Petrauskienė, Aušra; Popović, Stevo; Pudule, Iveta; Russell Jonsson, Kenisha; Dal‐Re Saavedra, Maria Ángeles; Salanave, Benoît; Shengelia, Lela; Spiroski, Igor; Tanrygulyyeva, Maya; Tichá, Ľubica; Usupova, Zhamilya; Ozcebe, Lütfiye Hilal; Abildina, Akbota; Schindler, Karin; Weber, Martin W.; Filipović Hadžiomeragić, Aida; Melkumova, Marina; Stojisavljević, Dragana; Boymatova, Khadichamo; Williams, Julianne; Breda, JoãoIn 2015-2017, the fourth round of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was conducted in 36 countries. National representative samples of children aged 6–9 (203,323) were measured by trained staff, with similar equipment and using a standardized protocol. This paper assesses the children's body weight status and compares the burden of childhood overweight, obesity, and thinness in Northern, Eastern, and Southern Europe and Central Asia. The results show great geographic variability in height, weight, and body mass index. On average, the children of Northern Europe were the tallest, those of Southern Europe the heaviest, and the children living in Central Asia the lightest and the shortest. Overall, 28.7% of boys and 26.5% of girls were overweight (including obesity) and 2.5% and 1.9%, respectively, were thin according to the WHO definitions. The prevalence of obesity varied from 1.8% of boys and 1.1% of girls in Tajikistan to 21.5% and 19.2%, respectively, in Cyprus, and tended to be higher for boys than for girls. Levels of thinness, stunting, and underweight were relatively low, except in Eastern Europe (for thinness) and in Central Asia. Despite the efforts to halt it, unhealthy weight status is still an important problem in the WHO European Region.
- Urban and rural differences in frequency of fruit, vegetable, and soft drink consumption among 6–9‐year‐old children from 19 countries from the WHO European regionPublication . Heinen, Mirjam M.; Bel‐Serrat, Silvia; Kelleher, Cecily C.; Buoncristiano, Marta; Spinelli, Angela; Nardone, Paola; Milanović, Sanja Musić; Rito, Ana Isabel; Bosi, A. Tülay Bağci; Gutiérrrez‐González, Enrique; Pudule, Iveta; Abdrakhmanova, Shynar; Abdurrahmonova, Zulfiya; Brinduse, Lacramioara Aurelia; Cucu, Alexandra; Duleva, Vesselka; Fijałkowska, Anna; Gualtieri, Andrea; Hejgaard, Tatjana; Hyska, Jolanda; Kujundžić, Enisa; Petrauskiene, Ausra; Sacchini, Elena; Shengelia, Lela; Tanrygulyyeva, Maya; Usupova, Zhamilya; Bergh, Ingunn Holden; Weghuber, Daniel; Taxová Braunerová, Radka; Kunešová, Marie; Sant'Angelo, Victoria Farrugia; Nurk, Eha; Ostojic, Sergej M.; Spiroski, Igor; Tichá, Ľubica; Rutter, Harry; Williams, Julianne; Boymatova, Khadichamo; Rakovac, Ivo; Weber, Martin W.; Breda, JoãoIn order to address the paucity of evidence on the association between childhood eating habits and urbanization, this cross-sectional study describes urban–rural differences in frequency of fruit, vegetable, and soft drink consumption in 123,100 children aged 6–9 years from 19 countries participating in the fourth round (2015-2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children's parents/caregivers completed food-frequency questionnaires. A multivariate multilevel logistic regression analysis was performed and revealed wide variability among countries and within macroregions for all indicators. The percentage of children attending rural schools ranged from 3% in Turkey to 70% in Turkmenistan. The prevalence of less healthy eating habits was high, with between 30–80% and 30–90% children not eating fruit or vegetables daily, respectively, and up to 45% consuming soft drinks on >3 days a week. For less than one third of the countries, children attending rural schools had higher odds (OR-range: 1.1–2.1) for not eating fruit or vegetables daily or consuming soft drinks >3 days a week compared to children attending urban schools. For the remainder of the countries no significant associations were observed. Both population-based interventions and policy strategies are necessary to improve access to healthy foods and increase healthy eating behaviors among children.
- WHO European Childhood Obesity Surveillance Initiative: associations between sleep duration, screen time and food consumption frequenciesPublication . Börnhorst, Claudia; Wijnhoven, Trudy M.A.; Kunešová, Marie; Yngve, Agneta; Rito, Ana I.; Lissner, Lauren; Duleva, Vesselka; Petrauskiene, Ausra; Breda, JoãoBACKGROUND: Both sleep duration and screen time have been suggested to affect children's diet, although in different directions and presumably through different pathways. The present cross-sectional study aimed to simultaneously investigate the associations between sleep duration, screen time and food consumption frequencies in children. METHODS: The analysis was based on 10 453 children aged 6-9 years from five European countries that participated in the World Health Organization European Childhood Obesity Surveillance Initiative. Logistic multilevel models were used to assess associations of parent-reported screen time as well as sleep duration (exposure variables) with consumption frequencies of 16 food items (outcome variables). All models were adjusted for age, sex, outdoor play time, maximum educational level of parents and sleep duration or screen time, depending on the exposure under investigation. RESULTS: One additional hour of screen time was associated with increased consumption frequencies of 'soft drinks containing sugar' (1.28 [1.19;1.39]; odds ratio and 99% confidence interval), 'diet/light soft drinks' (1.21 [1.14;1.29]), 'flavoured milk' (1.18 [1.08;1.28]), 'candy bars or chocolate' (1.31 [1.22;1.40]), 'biscuits, cakes, doughnuts or pies' (1.22 [1.14;1.30]), 'potato chips (crisps), corn chips, popcorn or peanuts' (1.32 [1.20;1.45]), 'pizza, French fries (chips), hamburgers'(1.30 [1.18;1.43]) and with a reduced consumption frequency of 'vegetables (excluding potatoes)' (0.89 [0.83;0.95]) and 'fresh fruits' (0.91 [0.86;0.97]). Conversely, one additional hour of sleep duration was found to be associated with increased consumption frequencies of 'fresh fruits' (1.11 [1.04;1.18]) and 'vegetables (excluding potatoes)' (1.14 [1.07;1.23]). CONCLUSION: The results suggest a potential relation between high screen time exposure and increased consumption frequencies of foods high in fat, free sugar or salt whereas long sleep duration may favourably be related to children's food choices. Both screen time and sleep duration are modifiable behaviours that may be tackled in childhood obesity prevention efforts.
- WHO European Childhood Obesity Surveillance Initiative: health-risk behaviours on nutrition and physical activity in 6-9-year-old schoolchildrenPublication . Wijnhoven, Trudy M.A.; van Raaij, Joop M.A.; Yngve, Agneta; Sjöberg, Agneta; Kunešová, Marie; Duleva, Vesselka; Petrauskiene, Ausra; Rito, Ana I.; Breda, JoãoObjective: To assess to what extent eight behavioural health risks related to breakfast and food consumption and five behavioural health risks related to physical activity, screen time and sleep duration are present among schoolchildren, and to examine whether health-risk behaviours are associated with obesity. Design: Cross-sectional design as part of the WHO European Childhood Obesity Surveillance Initiative (school year 2007/2008). Children’s behavioural data were reported by their parents and children’s weight and height measured by trained fieldworkers. Descriptive statistics and logistic regression analyses were performed. Setting: Primary schools in Bulgaria, Lithuania, Portugal and Sweden; paediatric clinics in the Czech Republic. Subjects: Nationally representative samples of 6–9-year-olds (n 15 643). Results: All thirteen risk behaviours differed statistically significantly across countries. Highest prevalence estimates of risk behaviours were observed in Bulgaria and lowest in Sweden. Not having breakfast daily and spending screen time ≥2 h/d were clearly positively associated with obesity. The same was true for eating ‘foods like pizza, French fries, hamburgers, sausages or meat pies’ >3 d/week and playing outside <1 h/d. Surprisingly, other individual unhealthy eating or less favourable physical activity behaviours showed either no or significant negative associations with obesity. A combination of multiple less favourable physical activity behaviours showed positive associations with obesity, whereas multiple unhealthy eating behaviours combined did not lead to higher odds of obesity. Conclusions: Despite a categorization based on international health recommendations, individual associations of the thirteen health-risk behaviours with obesity were not consistent, whereas presence of multiple physical activity-related risk behaviours was clearly associated with higher odds of obesity.
- WHO European Childhood Obesity Surveillance Initiative: Impact of Type of Clothing Worn during Anthropometric Measurements and Timing of the Survey on Weight and Body Mass Index Outcome Measures in 6–9-Year-Old ChildrenPublication . Wijnhoven, Trudy M.A.; van Raaij, Joop M.A.; Spinelli, Angela; Yngve, Agneta; Lissner, Lauren; Spiroski, Igor; Farrugia Sant'Angelo, Victoria; Pérez-Farinós, Napoleón; Martos, Éva; Heinen, Mirjam; Kunešová, Marie; Rito, Ana I.; Hovengen, Ragnhild; Starc, Gregor; Duleva, Vesselka; Pudule, Iveta; Petrauskiene, Ausra; Braeckevelt, Lien; Hassapidou, Maria; Breda, João; van 't Veer, PieterBackground. The World Health Organization European Childhood Obesity Surveillance Initiative (COSI) conducted examinations in 6–9-year-old children from 16 countries in the first two rounds of data collection. Allowing participating countries to adhere to their local legal requirements or adapt to other circumstances required developing a flexible protocol for anthropometric procedures. Objectives. (1) Review intercountry variation in types of clothing worn by children during weight and height measurements, clothes weight adjustments applied, timing of the survey, and duration of data collection; (2) assess the impact of the observed variation in these practices on the children’s weight or body mass index (BMI) outcome measures. Results. The relative difference between countries’ unadjusted and clothes-adjusted prevalence estimates for overweight was 0.3–11.5%; this figure was 1.4–33.3% for BMI-for-age Z-score values. Monthly fluctuations in mean BMI-for-age Z-score values did not show a systematic seasonal effect. The majority of the monthly BMI-for-age Z-score values did not differ statistically within a country; only 1–3 monthly values were statistically different within some countries. Conclusions. The findings of the present study suggest that the built-in flexibility in the COSI protocol concerning the data collection practices addressed in the paper can be kept and thus do not necessitate a revision of the COSI protocol.