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Obesity, non-communicable disease (NCD) risk factors and dietary factors among Chinese school-aged children.

ABSTRACT: BACKGROUND AND OBJECTIVES:China's nutrition transition is characterized by dramatic increases in overweight and cardiometabolic (CM) risk. The burden of obesity, CM risk factors and dietary intake among Chinese children were explored. METHODS AND STUDY DESIGN:Children 7-12 y old from the 2009 China Health and Nutrition Survey with available dietary intake data, anthropometry, blood pressure, and fasting blood samples were included (n=663). CM risk prevalence was calculated; logistic regression was used to investigate the association of nutrient intakes with CM risk, adjusting for age, gender, physical activity, area of residence and income. RESULTS:14% of Chinese school-aged children and ~20% of those from urban areas and higher income households had overweight/obesity (p<0.05). The prevalence of prehypertension was ~20% while hypertension was 14%. Around 20% of all children and >=30% of those from urban areas and higher income households had impaired glucose/ HbA1c (p<0.05). More than half of the studied children had pre-dyslipidemia (i.e. at least one lipid measurement above borderline levels) and 21% of children had dyslipidemia. Approximately 30% of all children had energy intakes above requirements and 38% of them had excessive proportions of dietary fat and saturated fat. Children with higher intakes of total daily energy and total and added sugars had a greater likelihood of having impaired blood pressure and glucose/HbA1c. CONCLUSIONS:Childhood overweight and CM risk is prevalent in urban and rural areas of China and across different socioeconomic groups although disparities between classes still pervade. Several dietary factors such as sugars were significant correlates of CM risk.

SUBMITTER: Piernas C

PROVIDER: S-EPMC5094276 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

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Obesity, non-communicable disease (NCD) risk factors and dietary factors among Chinese school-aged children.

Piernas Carmen C Wang Dantong D Du Shufa S Zhang Bing B Wang Zhihong Z Su Chang C Popkin Barry M BM

Asia Pacific journal of clinical nutrition 20161201 4

<h4>Background and objectives</h4>China's nutrition transition is characterized by dramatic increases in overweight and cardiometabolic (CM) risk. The burden of obesity, CM risk factors and dietary intake among Chinese children were explored.<h4>Methods and study design</h4>Children 7-12 y old from the 2009 China Health and Nutrition Survey with available dietary intake data, anthropometry, blood pressure, and fasting blood samples were included (n=663). CM risk prevalence was calculated; logist ...[more]

PMID: 27702726

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Project description:BACKGROUND:In countries undergoing rapid economic transition such as China, rates of increase in childhood obesity exceed that in the West. However, prevention trials in these countries are inadequate in both quantity and methodological quality. In high-income countries, recent reviews have demonstrated that school-based prevention interventions are moderately effective but have some methodological limitations. To address these issues, this study evaluated clinical- and cost- effectiveness of the Chinese Primary School Children Physical Activity and Dietary Behaviour Changes Intervention (CHIRPY DRAGON) developed using the United Kingdom Medical Research Council complex intervention framework to prevent obesity in Chinese primary-school-aged children. METHODS AND FINDINGS:In this cluster-randomised controlled trial, we recruited 40 state-funded primary schools from urban districts of Guangzhou, China. A total of 1,641 year-one children with parent/guardian consent took part in baseline assessments prior to stratified randomisation of schools (intervention arm, 20 schools, n = 832, mean age = 6.15 years, 55.6% boys; control arm n = 809, mean age = 6.14 years, 53.3% boys). The 12-month intervention programme included 4 school- and family-based components delivered by 5 dedicated project staff. We promoted physical activity and healthy eating behaviours through educational and practical workshops, family activities, and supporting the school to improve physical activity and food provision. The primary outcome, assessed blind to allocation, was between-arm difference in body mass index (BMI) z score at completion of the intervention. A range of prespecified, secondary anthropometric, behavioural, and psychosocial outcomes were also measured. We estimated cost effectiveness based on quality-adjusted life years (QALYs), taking a public sector perspective. Attrition was low with 55 children lost to follow up (3.4%) and no school dropout. Implementation adherence was high. Using intention to treat analysis, the mean difference (MD) in BMI z scores (intervention - control) was -0.13 (-0.26 to 0.00, p = 0.048), with the effect being greater in girls (MD = -0.18, -0.32 to -0.05, p = 0.007, p for interaction = 0.015) and in children with overweight or obesity at baseline (MD = -0.49, -0.73 to -0.25, p < 0.001, p for interaction < 0.001). Significant beneficial intervention effects were also observed on consumption of fruit and vegetables, sugar-sweetened beverages and unhealthy snacks, screen-based sedentary behaviour, and physical activity in the intervention group. Cost effectiveness was estimated at £1,760 per QALY, with the probability of the intervention being cost effective compared with usual care being at least 95% at a willingness to pay threshold of £20,000 to 30,000 per QALY. There was no evidence of adverse effects or harms. The main limitations of this study were the use of dietary assessment tools not yet validated for Chinese children and the use of the UK value set to estimate QALYS. CONCLUSIONS:This school- and family-based obesity prevention programme was effective and highly cost effective in reducing BMI z scores in primary-school-aged children in China. Future research should identify strategies to enhance beneficial effects among boys and investigate the transferability of the intervention to other provinces in China and countries that share the same language and cultures. TRIAL REGISTRATION:ISRCTN Identifier ISRCTN11867516.

Project description:BackgroundGlobally, non-communicable diseases (NCDs) are identified as one of the leading causes of mortality. NCDs have several modifiable risk factors including unhealthy diet, physical inactivity, tobacco use and alcohol abuse. Schools provide ideal settings for health promotion, but the effectiveness of school policies in the reduction of risk factors for NCD is not clear. This study reviewed the literature on the impact of school policies on major NCD risk factors.MethodsA systematic review was conducted to identify, collate and synthesize evidence on the effectiveness of school policies on reduction of NCD risk factors. A search strategy was developed to identify the relevant studies on effectiveness of NCD policies in schools for children between the age of 6 to 18 years in Ovid Medline, EMBASE, and Web of Science. Data extraction was conducted using pre-piloted forms. Studies included in the review were assessed for methodological quality using the Effective Public Health Practice Project (EPHPP) quality assessment tool. A narrative synthesis according to the types of outcomes was conducted to present the evidence on the effectiveness of school policies.ResultsOverall, 27 out of 2633 identified studies were included in the review. School policies were comparatively more effective in reducing unhealthy diet, tobacco use, physical inactivity and inflammatory biomarkers as opposed to anthropometric measures, overweight/obesity, and alcohol use. In total, for 103 outcomes independently evaluated within these studies, 48 outcomes (46%) had significant desirable changes when exposed to the school policies. Based on the quality assessment, 18 studies were categorized as weak, six as moderate and three as having strong methodological quality.ConclusionMixed findings were observed concerning effectiveness of school policies in reducing NCD risk factors. The findings demonstrate that schools can be a good setting for initiating positive changes in reducing NCD risk factors, but more research is required with long-term follow up to study the sustainability of such changes.

Dataset Information

Obesity, non-communicable disease (NCD) risk factors and dietary factors among Chinese school-aged children.

Publications

Obesity, non-communicable disease (NCD) risk factors and dietary factors among Chinese school-aged children.

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